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Peds > Infants > Flashcards

Infants Flashcards

1
Q

Purpose of infant exam

A
  • early intervention
  • ensure there are no gross irregularities/abnormalities (pathology: life/vision-threatening, RE outside of norms: amblyogenic factors)
  • ensure/encourage appropriate visual development for maximum fxn
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2
Q

Which type of testing should we do first on infants?

A

Binocular testing - VAs

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3
Q

Resistance to occlusion is a red flag for

A

Asymmetry

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4
Q

Case history

A 
Ocular hx (infant and fam)
Medical hx (infant and fam)
Meds/Allergies
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5
Q

APGAR

A

Measured at 1 and 5 min after birth:
1 min - how well baby tolerated birthing process
5 min - how well baby is adapting to the environment

Max score of 2 in each category = overall max score of 10
Score <7 = difficulty adapting; may need immediate medical intervention

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6
Q

VA

A 
F&F
Resistance to occlusion
ITT
Teller/Face Dot/Lea paddles
OKN
VEP
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7
Q

Expected VAs

A

Newborn: 20/400-20/1200 binocularly
6 months: 20/50-20/200 binocularly; 20/80-20/300 monocularly
*same up until 12 months
30 months: 20/20-20/50 bino; 20/20-20/50 mono

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8
Q

F&F

A

Measure of GROSS ACUITY only
Monocular
No sound
Only recommended when baby is unable to participate in more accurate testing

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9
Q

Resistance to occlusion behaviors

A

Crying, pushing hand away
Problem w/ unoccluded eye

*NOT A TRUE MEASURE OF VA

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10
Q

ITT/Vertical Prism test

A

Used w/ pts that have no apparent strabismus

*NOT A TRUE MEASURE OF VA - info on suppression/not a measure of alignment

Fixate on near target
Occlude if possible
10-15 PD BD - upward shift in unoccluded eye
Uncover occluded eye - observe response
- diplopia (ideal response) - eyes will move up and down to try and fixate
- no movement - prefers fixation w/ initially unoccluded eye (hypotropia in unoccluded eye or hypertrophic in occluded eye?)
- single movement to fixate w/ uncovered eye - prefers fixation w/ initially occluded eye

Perform w/ other eye occluded initially and compare symmetry response.
Ex: No movement OS when unoccluded = preferred fixation w/ OD
Occlude OD - single movement to fixate when unoccluded = preferred fixation w/ OD (confirms first test)

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11
Q

Forced choice preferential looking:
Teller cards - cycles/cm, cycles/deg, Snellen Equivalent
Lea paddles - same
FDT/Richman - variable test distance; approximate Snellen equivalent

A

Stripes vs gray field of equal size/luminance

Movement of eyes/head toward pattern if detectable

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12
Q

Lea paddles equation

A

Cycles/deg = test dist/55cm x cycle/cm
Snellen denom = 20 x 30/(cycles/deg)

Ex: 8 cycles/cm @100cm
100/55 x 8 = 14.55 cycles/deg
Snellen denom = 20 x (30/14.55) = 41.2
8 cycles/cm = 20/41

*Note: 20/20 ~16 cycles/cm ~30 cycles/deg

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13
Q

OKN

A

Responses not impacted by significant uncorrected RE

  • Not an accurate measurement of VA
  • Partially facilitated by motion processing

Persistent asymmetry of OKN = strab, ambylopia, unilateral cataract

Infants normally develop temporally to nasal first.

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14
Q

VEP

A

Capacity for ADULT LEVEL of VEP acuity develops in EARLY INFANCY

VEP = higher level of visual potential

Expected VEP acuity:
- 20/20 6-9mo
Vs
Preferential looking:
- 20/100 @6mo, 20/50 @1yr
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15
Q

EOMs

A

Sound CAN be use (contrary to F&F)

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16
Q

CVF

A 
Central target (bell, light)
Bring SILENT target fr periphery until child notices
17
Q

NPC

A

Corneal light reflex w/ light-up toy

TTN or eye drifts out

18
Q

CT (alignment):

A

ITT/Vertical prism test - info on suppression, not alignment
Hirshberg
Krimsky
Bruckner

19
Q

Hirschberg

A

Eval corneal light reflexes (binocular)
Transillumination at 50cm
Look for symmetrical reflexes (Normal = light reflex slightly nasal d/t angle kappa, +0.5mm = eyes slightly exo)

Hirschberg = bino
Angle kappa = mono
*measure both

1mm displacement ~22PD deviation

20
Q

Hirschberg recording

A

Hirschberg: symmetrical, ortho, or +0.5mm OD/OS

Temporal displacement of light reflex = eso
Hirschberg: (-)

21
Q

Krimsky

A

Used to neutralize deviation found w/ Hirschberg
Rough estimate of deviation (CT MORE ACCURATE)

Prism in front of non-deviating eye
Adjust prism until reflex of deviating eye matches previous position in non-deviating eye

Ex: light reflex temporal = eso
BO to neutralize
Hering’s law - other eye moves the same amt

22
Q

Bruckner

A

DO set to +1.00
50cm to 1m
Observe both eye simultaneously and compare brightness of fundus reflexes

Normal: equal brightness
Different brightness: brighter eye = strab, more anisometropic, pathology (white pupil)

Recording:
Bruckner: OD=OS
OD brighter than OS

23
Q

Accomodation

A

Unlikely able to perform

MEM may help

24
Q

Color testing

A

Unlikely able to perform

25
Q

Stereo (develops at 7 months)

A 
Smile Stereo Pass test:
Forced choice preferential looking
Random dot pattern w/ face on one side
*VA of at least 20/80 and no constant strab required
Polarized glasses
Random E:
FCPL
Control plate w/ 3D image d
Test plates: blank vs E
Polarized glasses

Lang:
Recognition (must know shape); gross measurement
No polarized glasses

26
Q

Determining RE

A

Must be able to rely on OBJECTIVE measurement

  • Mohindra
  • Static retinoscopy (ret bars)
  • Cycloplegic ret
27
Q

Mohindra

A

Non-cycloplegic
Monocular
Dark room

Fixates dim ret at 50cm
- Dim light viewed mono = poor stimulus for accom

Correction factor is subtracted from neutralizing lens

  • corrects for tonic accom
  • estimation - looking for agreement w/ cycloplegic values
  • NOT the same as WD
  • 0.75 to -1.25 (usually -1.25)

Good screening for high RE
- If RE is high — CYCLOPLEGIC EXAM

If prescribing, CHECK CYCLOPLEGIC RET to determine final Rx

  • infants have A LOT of accom - poor control
  • variability in dry ret expected
28
Q

Static ret

A

Fixation on dist target

Difficult for infant; more successful w/ toddler

29
Q

Cycloplegic ret

A

Cyclopentolate = DOC
0.5% <1 yo
1% >1 yo

Complete - pt should fixate ret light (on-axis measurement)
Incomplete - fixate on distant target

30
Q

Cycloplegia infants

A

Greater accom power
Reduced action of cycloplegic action at receptor site
Difficulty admin drop

Reduced reliability, high deg of astig, high prevalence of anisometropia reported

31
Q

Why not atropine?

A

Most potent cycloplegic and mydriatic agent

  • higher incidence of systemic side effects
  • blind as a bat, red as a beet, hot as a hare, mad as a hatter

Cyclo reveals 0.50 less hyperopia
Atropine onset of action: 1-3 hours
Cyclo: 45 mins

*** You will NOT always prescribe what you find. NORMAL for infants to have small to moderate amts of RE and/or astig.

32
Q

Refraction

A

No

33
Q

Vergences

A

Unlikely

34
Q

Near ret

A

Consider MEM

35
Q

Ocular health: ant seg (angles), IOPs, post seg

A

Ant seg:
penlight/Bluminator
20D and transillumination - magnification
SLE for older child

IOP:
Finger touch (usually)
Tono-pen
Icare

Angle eval — Shadow test
Bigger shadow = bad

Post seg:
BIO, DO, PanOptic (MIO)
EUA - ophthalmology

36
Q

Dilation drops

A

Tropicamide (0.5% or 1%) or Cyclo (0.5%)

Phenyl NOT recommended for children under 3 or kids w/ cardiovascular abnormalities (incr side effects)

37
Q

If recommending glasses for infant, you should

A

Discuss frame styles: Miraflex
Measure PD
Set f/u
May need to communicate w/ professionals/referring doctor
- PT/OT req parental consent/record release

Peds (3 decks)

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