Lecture 5 Flashcards by Emme Gilchrist

What saccade test is good for baseline in sports/concussions

How well did you know this?

Not at all

Perfectly

Describe KD test

First pt looks at numbers connected by solid lines. Horizontal

Then pt looks at numbers with no connected lines. A little harder. Horizontal.

Then pt looks at numbers with no connected lines and squished together.

How well did you know this?

Not at all

Perfectly

How to grade KD tests

Check average time and average errors by age for test 1, 2, and 3. Then find the Z score and compare to percentile rank table.

How well did you know this?

Not at all

Perfectly

How to calculate Z score

Actual-mean
__________
Standard deviation

How well did you know this?

Not at all

Perfectly

What happens if the child’s time on the KD test is greater than the mean?

Then use the negative Z score when looking at the percentile rank table

How well did you know this?

Not at all

Perfectly

What happens if the child’s time on the KD test is less than the mean?

Use positive Z score when looking at the percentile rank table

How well did you know this?

Not at all

Perfectly

DEM test what does it look like

A and B are vertical

C is horizontal and squished.

How well did you know this?

Not at all

Perfectly

How to score DEM

Convert these to Z scores:
total vertical time. Add A and B together
Horizontal time (adjusted for omissions and additions)
Errors
Ratio of horizontal adjusted time/vertical

Compare time to the age based table.

How well did you know this?

Not at all

Perfectly

Ages that can do DEM

6-14

How well did you know this?

Not at all

Perfectly

How to calculate horizontal time adjusted

Adjusted time= time x 80/80 - omissions + add

80 is the amount of numbers in test
time is how long it took child to read.

How well did you know this?

Not at all

Perfectly

How to calculate ratio for DEM

Adjusted horizontal/vertical

How well did you know this?

Not at all

Perfectly

Type 1 DEM
Vertical:
Horizontal:
Ratio:

Normal
Normal
Normal

Results: Normal

How well did you know this?

Not at all

Perfectly

Type II DEM
Vertical:
Horizontal:
Ratio:

Normal
High- slower than avg
Abnormal- high

Result: Ocular motor disfunction.

How well did you know this?

Not at all

Perfectly

Type III DEM
Vertical:
Horizontal:
Ratio:

High
High
Normal

Result: RAN problem. Rapid automatic naming.

How well did you know this?

Not at all

Perfectly

Type IV DEM
Vertical:
Horizontal:
Ratio:

High
High
Abnormal

OMD/RAN problem

How well did you know this?

Not at all

Perfectly

How to treat OMD

How well did you know this?

Not at all

Perfectly

How to treat RAN

Speech language therapy

How well did you know this?

Not at all

Perfectly

What is the readalyzer

Computer program that records eye movements while pt reads passage. Comprehension is tested. Compares variables to grade level norms.

How well did you know this?

Not at all

Perfectly

What does the reanalyzer show

Fixation
Regressions
Fixation duration
Reading rate 
Grade level 
Correct comprehensive answers

How well did you know this?

Not at all

Perfectly

Right eye test

Eye tracking without goggles. Readout of saccades and pursuits. Diagnostic and therapeutic.

How well did you know this?

Not at all

Perfectly

3 big picture methods for saccadic testing

Paper: DEM, KD
Computer: reanalyzer, right eye
Chairside: NSUCO/maples

Static ret

Control accommodation by cyclo, fog, distance fixation to determine distance ret

Dynamic ret

Dose not control accommodation. Purpose is to determine near rx

What percentage of cyclo to use on infants and then kids 12 months plus

Infants: 0.5%
12 moths +: 1%

Use loose lenses or skiascopy bars

Mohindra near ret

A near ret technique for assessment of distance refractive error. Static even tho not fixating in distance.

Mohindra near ret technique

Dark room without ambient light so pt will only look at ret light Infant fixates at ret 50cm Use skiascopy bars subtract -1.25D from result

Toddler/preschool ret and phoropter

Use interesting fixation target- movie maybe Pt will be too small for phoropter- do trial frame. Do not do JCC

At what age can you use phoropter and JCC

school age. 8+

Normal refractive error for full term newborns

On average, +2.00 88% between plano and +4.00 Standard dev of 2.75

Emmetropization

Tendency for the refractive state of the eye to change close to plano. Converges to low hyperopia (+0.50 to -1.00 with S.D of +/- 1.00)

Refractive error trend

Skewed towards hyperopia

Active emmetropization

Regulated by regnal image- eye interprets retinal blur and adjusts by changing axial length. Lets longer for myopes, shorter for hyperopes.

passive emmetropization

Occurs as a result of physical/genetic changes. ``` physical: refractive errors move to emmetropia initially. Genetics: -Both parents myopia 42% -1 parent myopia 23% -Neither myopia 8% ``` Other: Changes in corneal/lenticular power. NO active growth changes.

Emmetropization structural changes

Cyrsalline lens: Thins in infancy and early school years Corneal power decreases Axial growth

Berkely infant biometry study (BIBS) | What was their finding?

Emmetropization (plano to +2.00D) within 3-9 months. Bidirectional. Myopes will become more plus Hyperopes will become more minus Best predictor: Cyclo refraction

1.00D or more of cyl in __% of newborns

30% Highest in first 2 years, adult levels by 4-5 years. Will decrease!

If little astigmatisms in 1st year of life you can predict

That they will likely not develop any

Trend of ATR and WTR astigmatisms in infants

ATR has steady decline | WTR has uptick around 1 year and then steady decline

After age 5, what kind of astigmatism is most common?

WTR

Multi ethnic pediatric eye disease study (MEPEDS)

Looks at astigmatism in children ages 6-72 months Greater than 1.50 DC= 16.8% hispanic Greater than 3.00 DC= 2.9% hispanic Most WTF, decreases with age

Lowest prevalence of myopia is in ___ year olds

5-7 year olds.

5-6 year olds with plano to +0.25 D likely to become

Myopic by teenage years. Females earlier than males.

Refractive error changes faster in children with ___ than ___

Myopia than hyperopia

Accommodation. How does it work

Ciliary muscles contract (stand up) and zonules relax. The lens becomes rounder/more convex

Development of accommodation

Occurs between ages 1-3 months, then adult like.

Infants under 3 months old, they tend to over accommodate. | Due to?

Target proximity Large depth of field- very small pupils Poor sympathetic innervation to ciliary muscle- to relax accommodation. q

How to test accommodation in infants/toddlers/preschoolers

Near ret

How to test accom in school age and beyond

Amp of accommodation (monocular) - Push up - Pull away - Minus lens test FCC testing Near Ret NRA/PRA Done wearing correction!!

Minus lens procedure to measure accom

Done in phoropter use 1 line above best VA at 40cm. Add minus lenses until pt reports first slight sustained blur- not blur out. With young children, start with -3.00D over Rx since they have a large amount of accommodation. Take diff from Rx until blur then subtract working distance.

Hofstetter's norms

Average amp calculation: 18.5- (1/3)(age) | Minimum amp calculation: 15 -(1/4)(age) ** Sweedish study says subtract 2 from this and that it is an over estimation.