Pediatric Eye Exam

6mo, 3y, 5y

what is the current timeline recommendation for children’s eye exams from the AOA?

1st grade

in IN, children must receive a VA test + the modified clinical technique by the end of the 1st grade

hyperpia

what is the most common RE in pts under 6yo?

myopia

_______ increases in prevalence after 6y

strabismus (kids don’t complain of diplopia, HA, or asthenopia)

what is the most common BV issue in children under 6? why?

does the pt have typical binocular vision, acuity, refraction, & ocular health?

what 4 things are you trying to assess in a peds exam?

12deg, 22pd

1mm of deviation on Hirschberg = __deg = __pd

versions, Hirschberg (<3yo), CT, occlusion preference, NPC, base up/down prism test, pupils, confrontations, MEM, stereopsis

what BV/prelim tests should be done in a peds exam?

1. occlusion preference

2. fix & follow

3. base up prism before 1 eye

4. teller cards

5. cardiff cards

6. lea symbol matching

7. lea symbol naming

8. HOTV

9. ETDRS or Snellen

what are ways to test acuity in a peds exam?

1. acuity

2. test used

3. distance performed

4. confidence in the data

what should be noted when recording VAs?

birth-12mo

what ages are Teller cards recommended for?

12mo-3y

what age are Cardiff cards recommended for?

2.5-3.5yrs

what age is Lea Symbols Matching recommended for?

3.5+yrs

what age is Lea Symbols Naming recommended for?

when the pt can read H, O, T, V

what age is HOTV recommended for?

7+yrs

what age are ETDRS/Snellen recommended for?

1. lighter & easier to carry around

2. cheaper

3. good for kids starting to talk

what are some advantages of Cardiff cards over Teller cards?

50cm, 100cm

what test distances are cardiff cards calibrated for?

circle

all Lea symbols blur to a _____

F

T/F: it is acceptable to use Allen figures for VA testing

0.5% cyclo

what drop is recommended for kids <6mo w/ light irises?

1% cyclo

what drop is recommended for kids >6mo w/ light irises?

0.5% cyclo (if not dilating in 10min, then 0.5% tropicamide also)

what drop is recommended for kids <6mo w/ dark irises?

1% cyclo & 1% tropicamide

what drop is recommended for kids >6mo w/ dark irises?

can be used with little training

what is the advantage of photorefraction?

1. if there is large angle strab, it cannot detect both pupils simultaneously & will produce an error

2. relies on fixation so highly variable in those w/ IDD or poor attention

3. there is generally a cutoff for the level of high hyperopia it can detect

4. generally produces poor data in highly pigmented eyes

what are the disadvantages of photorefraction?

iCare

what IOP assessment is used for children 5 or older?

digital

what IOP assessment is used for children under 5?

BIO

what is the gold standard for post seg exam on a kid?