Visual Loss in Childhood and Adolescence
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Questions and Answers

What is the predominant cause of visual loss in childhood and early teens?

  • Infectious diseases
  • Acquired diseases
  • Environmental factors
  • Congenital or hereditary conditions (correct)
  • Which feature is often characteristic of a baby with tyrosinase-negative albinism?

  • Hypermetropic state is stable
  • Greater refractive error (correct)
  • Near-normal visual acuity
  • Presence of visual acuity by age 6 months
  • At what age does the foveal region of the retina reach adult maturity?

  • 4 months (correct)
  • 6 months
  • 2 months
  • 1 year
  • What is the impact of early onset visual impairment on refractive error variability?

    <p>Increased variability with earlier onset (C)</p> Signup and view all the answers

    What recommendatory assessment is crucial when determining visual function in neonates?

    <p>Patience and modified techniques (B)</p> Signup and view all the answers

    Leber's hereditary optic neuropathy primarily affects which aspect of vision?

    <p>Central vision (D)</p> Signup and view all the answers

    What strategy is recommended for a baby who is emmetropic or myopic at birth?

    <p>They may become progressively myopic (D)</p> Signup and view all the answers

    What important consideration should be taken into account regarding the education of visually impaired youth?

    <p>Specialized resources and support are crucial (C)</p> Signup and view all the answers

    What is the inheritance pattern of abetalipoproteinaemia?

    <p>Autosomal dominant (D)</p> Signup and view all the answers

    Which of the following symptoms is NOT commonly associated with abetalipoproteinaemia?

    <p>Retinal detachment (D)</p> Signup and view all the answers

    What is a key aspect of treatment for individuals with abetalipoproteinaemia?

    <p>Oral vitamin E supplementation (A)</p> Signup and view all the answers

    What condition is associated with retinopathy and progressive spinocerebellar ataxia due to vitamin E deficiency?

    <p>Abetalipoproteinaemia (D)</p> Signup and view all the answers

    Which statement about low vision aids is accurate?

    <p>Early introduction can aid educational progress. (B)</p> Signup and view all the answers

    In what manner should visual aids be introduced to young children?

    <p>In a non-threatening manner (A)</p> Signup and view all the answers

    What is a common outcome for children with visual impairments if no family history is present?

    <p>Compensation through adjustment of working distances (C)</p> Signup and view all the answers

    What is a critical decision for parents of children with visual impairments regarding education?

    <p>Availability of low vision aids and educational support (D)</p> Signup and view all the answers

    Which statement about children with retinitis pigmentosa is correct?

    <p>They benefit from closed circuit televisions (CCTVs) for visual tasks. (A)</p> Signup and view all the answers

    What is one possible impact of visual loss on a young person's career choices?

    <p>They might need to modify their career plans due to visual limitations. (C)</p> Signup and view all the answers

    Which of the following aids is most suitable for children with congenital nystagmus?

    <p>Dome magnifiers (A)</p> Signup and view all the answers

    What is a common psychological adjustment for an older child diagnosed with severe visual impairment?

    <p>Adopting a modified lifestyle and altering career choices. (A)</p> Signup and view all the answers

    What level of magnification do aphakic children require for effective vision aids?

    <p>×3 to ×12 (C)</p> Signup and view all the answers

    Which of the following is a recommendation for using low vision aids in public?

    <p>Children should be encouraged to view the device as a leisure and educational tool. (D)</p> Signup and view all the answers

    What is a practical suggestion for patients with good visual fields but who do not meet driving criteria?

    <p>Using a pushbike could be a practical consideration. (D)</p> Signup and view all the answers

    What support is generally necessary for children with mild to moderate visual impairment to cope in normal schools?

    <p>Good parental understanding and teaching support. (A)</p> Signup and view all the answers

    Flashcards

    Low Vision Aids for Children

    Devices to help children with visual impairments see better, such as magnifiers, CCTV, and special software.

    Phakic Children's Low Vision Aid Preference

    Children with a certain level of vision (better than 6/60) often benefit from adjusting their viewing distance and using accommodation.

    Aphakic Children's Low Vision Aid Needs

    Children without a lens in the eye usually need stronger magnification, such as stand magnifiers or spectacle magnifiers.

    Retinitis Pigmentosa & Central Vision Loss

    Children with these conditions benefit from closed-circuit televisions (CCTVs) and on-screen enlargement capabilities.

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    Distance Low Vision Aids Usage

    Almost all school-aged children with visual impairments can use distance aids.

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    Psychological Adjustment in Children with Serious Visual Problems

    Adjusting lifestyle and career choices may be necessary for older children and teenagers.

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    Driving Restrictions & Visual Impairment

    Visual impairment could potentially lead to reduced or no driving rights and impact career prospects.

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    Alternative Transportation for Children with Visual Impairment

    Although not legally required, pushbikes may be a practical alternative for those with visual impairments (no driving rights) requiring consideration and safety.

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    Visual impairment in childhood

    Visual loss during childhood and early teens, often congenital or hereditary.

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    Neonatal visual impairment

    Visual impairment observed in newborns.

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    Normal newborn refractive error

    Newborn infants typically have hypermetropia (farsightedness) of 2-3 diopters, often with astigmatism.

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    Visual acuity improvement

    Visual sharpness typically improves as the visual system matures, and refractive error reduces.

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    Foveal immaturity

    The central part of the retina, crucial for sharp vision, is not fully developed at birth and takes several months to mature.

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    Assessing infant visual acuity

    Evaluating a newborn or young infant's vision requires patience and specialized techniques.

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    Myopia in childhood

    Nearsightedness (myopia) often develops progressively throughout childhood and adolescence.

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    Visual development in babies

    The visual system of an infant matures gradually, impacting visual acuity and refractive error.

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    What is Abetalipoproteinaemia (Bassen–Kornzweig syndrome)?

    A rare inherited disorder where the body can't transport fats properly due to a deficiency in a specific protein.

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    What are the symptoms of Abetalipoproteinaemia?

    Nyctalopia (night blindness), neuromuscular weakness, dietary fat intolerance, progressive spinocerebellar ataxia, and retinopathy.

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    How is Abetalipoproteinaemia treated?

    High doses of oral vitamin E, a low-fat diet, and supplements of other fat-soluble vitamins.

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    What are Best's disease, Stargardt's disease, and cone dystrophy?

    These are conditions affecting the retina, often causing mild vision problems in early childhood that worsen later.

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    Why are early interventions crucial for children with visual impairments?

    Because early interventions can help them adapt, use low vision aids, and achieve as much independence as possible.

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    Why are low vision aids important for children with visual impairments?

    They provide tools to improve visual function, making it easier to learn, participate in activities, and live a more fulfilling life.

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    What is the role of ophthalmologists and optometrists for visually impaired children?

    They assess vision, prescribe low vision aids, and guide families on managing the condition and accessing educational support.

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    What is the significance of early detection and surgery for bilateral congenital cataracts?

    It can lead to relatively normal distance vision through contact or intraocular lenses.

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    Study Notes

    Visual Loss in Childhood and Adolescence

    • Visual loss in childhood and early teens is often congenital or hereditary.
    • Diagnosing conditions causing visual impairment in this age group is discussed.
    • Common scenarios presented to ophthalmologists are:
      • Neonates/babies with visual impairment.
      • Babies with visual impairment without obvious abnormalities.
      • Children with visual difficulties.
    • Recent genetic discoveries in the molecular genetics of these conditions are reviewed.
    • Refractive state in a normal newborn is typically 2-3 dioptres of hypermetropia with high astigmatism.
    • Globe diameter at birth is 16.5mm, rapidly increasing to an adult diameter of 24.5mm within the first year.
    • Full-term newborns have spherical equivalent refractive error normally distributed around +2 dioptres with a standard deviation of 2 dioptres.
    • The foveal region of the retina develops fully at 4 months of age.
    • Neural pathways mature until 2 years (lateral geniculate ganglion) and 7 months (optic nerve myelination).
    • Visual acuity improves as hypermetropia reduces (estimated 6/6 [LogMAR] by 20-30 months).

    Practical Advice

    • A baby's ability to track a face is more reliable than a white light at 6 weeks.
    • Visually directed reaching is not a reliable test until ~6 months old.
    • Visual signs of impairment may include abnormal eye movements, poor pupillary reflexes, eye rubbing, lack of facial expression, and absence of optokinetic nystagmus.

    Assessment of Visual Function

    • Assessment of visual acuity in babies requires patience and attention to detail.
    • Attention to fixation as the most reliable test of visual function is critical.
    • 83% of neonates track a face better than a white light
    • Correct examination techniques and follow-up are essential in cases of doubt.

    Ophthalmic Disorders in Childhood

    • Retinopathy of prematurity (ROP): Unlikely in full-term babies, but a risk for low birth weight or premature newborns. Screening is critical.
    • Congenital glaucoma: Occurs 1 in 10,000 births; characterized by raised intraocular pressure, potential for optic nerve damage.
    • Congenital cataracts: Potentially more common in communities with consanguinity. Can be isolated or part of a larger syndrome (e.g., microphthalmia, glaucoma).
    • Leber's hereditary optic neuropathy: X-linked, associated with subtle visual defects.
    • Usher's syndrome: Rare; associated with retinal degeneration and deafness. Several subtypes exist.

    Visual Loss in the Working Age

    • Visual impairments in working-age adults might be caused by conditions not exclusively affecting this age group.
    • These conditions might present with increased difficulties with work and daily tasks.
    • Diabetic retinopathy:
      • Early symptoms might be subtle.
      • Microaneurysms are commonly found in the temporal area of the macula.
      • Progression can vary significantly; some cases don't change for years, while others progress rapidly.
      • Visual loss often involves peripheral vision first.

    Electrophysiological and Other Testing

    • Electrophysiological testing is important in assessing visual function in infants and children.
    • Techniques like VEPs, ERGs, and EOGs are essential tools.

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    Description

    Explore the causes and diagnosis of visual loss in children and adolescents, focusing on congenital and hereditary conditions. This quiz covers common scenarios faced by ophthalmologists, genetic advances, and developmental milestones in vision. Test your knowledge on the factors influencing visual impairment in early life.

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