7.2.3 Assesses children’s visual function using appropriate techniques.

Why is stereopsis always performed first?

Depends on intact fusion (cover testing disrupts fusion and thus can affect stereopsis)

Titmus fly test

• Child should see wings elevated above the page

• Hand should be above the page when asked to

• If possible, finer depth perception can be assessed using circles and animals

Lang I & II test

• Alternative not requiring child to wear glasses

• Child should see images on card - car, star, moon etc touch the fly.

Assesses children’s visual function

Extraocular mobility

Check motility by having child look in 6 cardinal directions of gaze. Keep head still if possible. Make sure to check extremes of gaze.

Assesses children’s visual function

Confrontational Visual Fields

• Cover one eye

• Move interesting object out of visual field.

• Observe saccade movement the brining object into peripheral visual field.

Cycloplegic refraction

Indications:

• Suspected latent hyperopia

• Accommodative esotropia

• High hyperopia (prevent amblyopia/strabismus)

• Variable or inconsistent refraction results

• Amblyopia evaluation

• Unexplained decrease in VA

• Pseudomyopia (accommodative spasm) • Children with poor cooperation

Cycloplegic refraction

Advantages vs disadvantages

Advantages

• Reveals latent hyperopia

• Accurate fixation for ret is less crucial

• Aids fundus exam

Disadvantages

• Child distress

• Photophobia

• Decreased ability for near work

• Risk of adverse reactions

Cycloplegic refraction

Procedure

1. Perform at end of exam

2. Obtain consent from parent and child

3. Instil appropriate cycloplegic drug

4. Ask patient to sit in waiting room until drug is in max effect

5. Perform ret

Cycloplegic refraction

Choice of concentration and number of drops instilled is influenced by…

Age of the child and degree of pigmentation or iris.

• 0.5% - under 3 months

• 1% - under 12 years

• 0.5% - over 12 years

Cycloplegic refraction

Adverse reactions

• Systemic effects - incoherent speech, disorientation, restlessness, visual hallucinations, drowsiness (1-5 hours)

• No permanent consequences have been found

• Allergic reactions very rare (local skin rash

Prescribing Guidance

Normal RX by age

Birth +3.00D

1 year +2.00D

2 year +3.00D

3 year +2.00D

4-6 years +0.50D

Children

Always prescribe for:

Any high refractive error

Hypermetropia >3.00D

Myopia >0.75

Astigmatism >2.50D

Strabismus / amblyopia

Anisometropia >1.00D

Age/Snellen chart