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Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Practical Vision Screening in the Pediatric Office,Jerry E.Berland,MD,FAAP,Pediatric EyeCare of Atlanta,Pediatric EyeCare of Atlanta,Stephen B.Levine,MD,FACS,FAAP,Jeri S.Salit,MD,FAAO,Jerry E.Berland,MD,FAAP,FAAO,Stephen N.Lipsky,MD,FAAO,I 75,I 75,I 85,I 85,GA,400,I 285,Lilburn,Fayetteville,Woodstock,I 575,Atlanta,Vision Screening,Detect abnormal visual functioning or conditions that may lead to abnormal visual functioning.,Amblyopia-“Lazy Eye,A reduction in visual acuity that is due to abnormal visual experience in early life.,Affects 4%of the population,Causes of Amblyopia,Strabismus,Anisometropia,Visual obstructions such as cataracts and eyelid conditions,Strabismus,Eye misalignment,Greek:“to squint or look obliquely at,Esotropia,Crossed eyes,Exotropia,Out-turned eyes,Hypertropia,An eye turned upward,Hypotropia,An eye turned downward,Glasses in Children,Farsightedness(Hyperopia),Nearsightedness(Myopia),Astigmatism,Reading glasses(bifocals),Rationale for Vision Screening,Very early treatment of congenital abnormalities can prevent severe vision loss.,2%of American children ages 1 to 3 years old have a manifest strabismus.(An additional 3%have latent strabismus.),Rationale for Vision Screening,1 of 4 school-age children has a vision problem that requires professional care,Refractive errors(82%),Amblyopia(10%),Strabismus(5%),Cataracts and other conditions(3%),Rationale for Vision Screening,Early identification and treatment of children with strabismus could have prevented amblyopia in approximately 5 million Americans.,Prevent Blindness“Crossed Eyes,A Needless Handicap 1981,Vision Screening-Ages,Birth,4-6 months,Toddler,Pre-school,School age,Vision Screening Equipment,10 ft.visual acuity cards,Direct ophthalmoscope,Transilluminator light,Finger puppet,Cover paddle,Color test plates,Vision Screening Sequence,Observation,Corneal light reflex testing,Bruchner red reflex test,Cover test for alignment,Cover test for amblyopia or organic vision loss,Distance visual acuity,Other optional tests,Observation and Inspection,Use light with toy,Judge visual interest,Is fixation steady?(Nystagmus),Pupil reactivity,Examine external eye,Simultaneous with corneal reflection test,Corneal Light Reflection Testing,Use light with toy,Blink light for increased interest,Look for asymmetry,Nasal displacement=exotropia,Temporal displacement=esotropia,Bruchner Red Reflex Test,Use ophthalmoscope at arms length,Compare light reflection from each pupil,Detects,strabismus,asymmetric refractive error,cataracts,Underutilized but valuable,Cover Test for Alignment,Use detailed target,Look for shift in either eye,Can detect manifest(cover test)and latent(alternate cover test)strabismus,Cover Test for Amblyopia or Organic Vision Loss,“Objects to covering,Is visual interest and tracking,reaching,etc.,equal with each eye?,Distance Visual Acuity,Screening for distance visual acuity is the single most important test of visual ability,Standardized Technique,Standard charts,Adequate lighting,Standard distance 10 feet or 20 feet,Re-screen children who fail within 2 weeks,Recommended Tests and Methods,Snellen ABCs,“E game,HOTV matching,Allen Pictures,Linear vs.isolated,Criteria for Referral,Age 3 to 5:20/50 or poorer,Age 5 to 8:20/40 or poorer,Age 8 and older:20/30 or poorer,Two lines difference,Symptoms or observable conditions,Other Tests,Stereopsis,Color vision,Photo screening,Color Vision Testing,Ishihara color plates,Males 8%deficient,Females 0.5%deficient,Test in 3rd to 7th grade,Vision Screening,Birth,Observation and inspection,Red reflex testing,Vision Screening,4-6 months of age,Observation and inspection,Corneal light reflex testing,Bruchner red reflex testing,Vision Screening,Toddler,Observation and inspection,Corneal light reflex testing,Bruchner red reflex testing,Cover test for alignment,Cover test for amblyopia or organic vision loss,Vision Screening,Pre-school,Observation and inspection,Corneal light reflex testing,Bruchner red reflex testing,Cover test for alignment,Cover test for amblyopia or organic vision loss,Distance visual acuity,Vision Screening,School-age,Observation and inspection,Corneal light reflex testing,Bruchner red reflex testing,Cover test for alignment,Cover test for amblyopia or organic vision loss,Distance visual acuity,Other optional tests,Vision Screening Pearls,Infants and Toddlers,Toy over light allows easier and more accurate corneal light reflex testing,Bruchner red reflex testing underutilized but valuable,“Objects to cover may equal Amblyopia,Vision Screening Pearls,Pre-school and School-age,Make testing fun,Beware of the professional peeker,Testing at 10 feet may be better,
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