M3

Question 1

concerns dictate that a child patient, including older children, should be accompanied by a parent or guardian while they are in the consulting room with you

Answer 1

Child protection

Question 2

should always be obtained

Answer 2

Parent’s/Guardian’s consent

Question 3

TYPES OF VISION EXAM

Answer 3

• Screening
• Comprehensive
• Refraction
• Contact lens

Question 4

Brief examination with limited elements of testing

Answer 4

Screening

Question 5

assess risk factors and determine presence or absence of potential risk factors

Answer 5

Screening

Question 6

recommend appropriate treatment pathway and timing

Answer 6

Screening

Question 7

patient reports with medically related diagnosis

Answer 7

Comprehensive

Question 8

examine all basic areas of vision including refractive, oculomotor and eye and systemic health

Answer 8

Comprehensive

Question 9

brief examination devoted only to refractive status

Answer 9

Refraction

Question 10

medical diagnosis unnecessary , often routine care

Answer 10

Refraction

Question 11

examine only refractive status, new or re- evaluate

Answer 11

Refraction

Question 12

⚬medical diagnosis unnecessary, often routine are for fitting, re-fitting or other assessment of contact lens status
⚬examinerefractiveandeyesystemichealthstatusas applied to contact lens wear, new or re-evaluate

Answer 12

Contact lens * Basic or complex evaluation and fitting

Question 13

⚬medical diagnosis uncessarry, often routine care to check CL status
⚬examine refractive and eye and systemic health status as applied to contact lens wear, new or re-evaluatE

Answer 13

Contact lens * Check

Question 14

Limited Testing - VA only

Answer 14

Vision Screening

Question 15

Untrained personnel

Answer 15

Vision Screening

Question 16

Inadequate testing equipment

Answer 16

Vision Screening

Question 17

Complete and detailed test

Answer 17

Comprehensive

Question 18

Optometrists/ Ophthalmologists

Answer 18

Comprehensive

Question 19

Specialized equipment and procedures

Answer 19

Comprehensive

Question 20

• evaluate the functional status of the eyes and visual system, taking into account each child’s level of development and special vision demand and needs
• assess ocular health and related systemic health conditions
• establish a diagnosis (or diagnoses)
• formulate a treatment and management plan
• counsel and educate parents/caregivers regarding their child’s visual, ocular and releated health care status, including recommendations for prevention, treatment, management, and future care

Answer 20

Objectives of a compre pedia test (AOA)

Question 21

newborn - 2 y/o

Answer 21

Infants and Toddlers

Question 22

3-5y/o

Answer 22

Preschool Children

Question 23

6-18 y/o

Answer 23

School-age Children

Question 24

• Patient History
• Visual Acuity
• Refraction
• Accommodation
• Binocular Vision
  ⚬ OcularMotility
  ⚬ Stereopis
  ⚬ ColorVision
• Ocular Health Assessment

Answer 24

Examination Procedures

Question 25

an initial and ongoing component of the examination

Answer 25

Patient History

Question 26

objective is to obtain specific information about the px, and/or parent's or caregiver's perception of the child's eye and vision status, important background information and related medical issues

Answer 26

Patient History

Question 27

helps identify and assess problems

Answer 27

Patient History

Question 28

provides an opportunity to become acquainted with the px, parents, caregivers establishing confidence and trust

Answer 28

Patient History

Question 29

* Electronic health record or paper charting system * Chair/stool to enable sitting at child’s height or enough space to squat at child’s level for initial conversation * Toys to maintain child’s attention as appropriate * Before beginning, the clinician should be positioned in a way that eye contact can be made and is able to begin observation of the child * if child can contribute to case hx, clinician should stay at child’s eye level and avoid towering over the child when speaking ---> helps establish rapport * when initial questioning is focused on the caregiver, three strategies can be used depending on the disposition of the child at the time:

Answer 29

Case hx intake (Equipment)

Question 30

* All questions are directed to the caregiver if the child is very young (usually 4 y/o and under)

Answer 30

Child is calm/cooperative and does not need the caregiver’s full attention

Question 31

* An assistant can begin objective and noninvasive testing of the child with the parent near the child and answering question

Answer 31

Child is calm/cooperative and does not need the caregiver’s full attention

Question 32

* The child can be held or positioned behind the caregiver during the hx. The exchange should be friendly and warm so that trust is built as the child observes the interaction.

Answer 32

Child is apprehensive / uncooperative

Question 33

* An assistant can give toys to the child to decrease any apprehension. * A mildly cooperative (not just apprehensive) may need some toys or other distractions to help focus attention * Significantly uncooperative child may require a “time out” conversation with caregiver to discuss if some goals for the exam can be achieved or whether it would be best to find another time when child is lessy sleepy, less stressed etc.

Answer 33

Child is apprehensive / uncooperative

Question 34

* Caregiver may not be able to answer lengthy set of questions because child need the caregiver’s attention.

Answer 34

Child is young/immature such that parent must hold the child

Question 35

* clinician should conduct an abbreviated case hx to obtain most vital details and immediately begin the exam to maximize time

Answer 35

Child is young/immature such that parent must hold the child

Question 36

Observation during Case Hx

Answer 36

⚬ eye turn ⚬ squinting ⚬ head tilt ⚬ type and quality of communication between caregiver and child ⚬ behavior of the child ⚬ general wellness of the child

Question 37

* Name * Age * Gender * Address * Contact nos * Occupation/Course/Grade Level * Hobbies/Avocation

Answer 37

Demographic Data

Question 38

* Open-ended question: “What brings you in today?” * What are the associated factors affecting the chief complaint?

Answer 38

Chief complaint/Hx of Present Illness

Question 39

* When was the last full eye exam for the child, or is this the first? * Has the child ever worn glasses? How old are the current glasses? How often does the child wear the glasses? * Has the child ever worn CLs? If yes, how does she/he care for the CLs? (e.g. disposal, hygiene, etc) * Any observations of lazy eye or eye turns?

Answer 39

Visual and Ocular Hx

Question 40

* Prenatal, perinatal and postnatal hx * Date of most recent medical examination * major medical illnesses (review of systems) * Hx of surgeries or inpatient admissions * Head or ocular trauma hx * vision or ocular tx

Answer 40

General Health hx

Question 41

* medication list (Rx and non-Rx drugs, eye drops or ointments) * drug, food and environmental allergies

Answer 41

Medication

Question 42

* Family medical hx usually screens for cardiovascular disease or other hereditary conditions affecting the visual system * Family ocular hx: ⚬ EOR (onset early in life) ⚬ Strabismus ⚬ Amblyopia ⚬ Glaucoma ⚬ CV deficiency ⚬ Blindess

Answer 42

Family Medical and Ocular Hx

Question 43

*Remember that each child develops at different rate. *Developmental milestone charts give approximate ages at which skills occur but children may not necessarily follow these timelines to the exact age

Answer 43

Developmental Hx

Question 44

* Does the infant recognizes the caregiver’s faces? * Does she follow you or preferred toy with their eyes? * Are they reaching for objects yet? * Any observation of lazy eye or eye turn?

Answer 44

Infants and Toddlers ask specific questions like

Question 45

*questions that focus on typical milestones (motor skills, hand-eye coordination, verbal and social skills) * this allows the clinician to make connections to visual development and coordinate with other providers as appropriate

Answer 45

Preschoolers ask specific questions like

Question 46

* school performance is primary point of discussion and learning difficulties * questions regarding visual habits

Answer 46

Elementary-aged children ask specific questions like

Question 47

* may be less responsive to questioning * ask questions first about themselves and their preferences may help to establish a safe space * may also be interested in CLs, and clinician will assess the readiness of the child and parent

Answer 47

Teenagers/ Adolescents ask specific questions like

Question 48

* Are there any learning-related visual symptoms? * How is the child doing in school? * Is the child in the age-approrpiate grade? Has she/he ever repeated a grade level? If yes, why? * Is the child in a special education setting (individualized education plan or adjusted learning plan)?

Answer 48

Educational Hx

Question 49

* What does the child do in her/his spare time? Include time spent outdoors and near work * How much total screen time in a 24-hr period (including cell phones, video games, computers, tablets, tv, etc? * Environmental hx: ask about pets at home and type of housing (important with cc of itching, watering, eye rubbing, etc)

Answer 49

Time outdoors & screen time

Question 50

* for proper referral and coordination

Answer 50

Names and contact information for the pxs other health care providers