Vision Screening - Dr. Wagner.ppt

8/12/2019 Vision Screening - Dr. Wagner.ppt

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Vision Screening

Rudolph S. Wagner, MDDirector of Pediatric Ophthalmology andStrabismusUMDNJ New Jersey Medical School

August 2010 - Vietnam


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Visual Acuity TestingIn what age groups should it be done ?How should it be done ?

What diseases and conditions are we looking for ? What constitutes a failed test ? What do we do once a problem is identified ?


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Birth to Three YearsOcular History Vision assessmentExternal InspectionOcular Motility AssessmentPupil examinationRed reflex

Examination


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Visual Acuity Measurement

3 Years of AgePicture Charts (LEA, LH, Allen,)5 years of age (Snellen letters, E game, HOTV

Charts on wall at 3m (10ft) Note: Distance Acuity !!Measure Binocularly FirstRecord Acuity in Each Eye Independently Attempt Ophthalmoscopy


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Failed Visual Acuity Screening

Fewer than 4 of 6 correct in either eye on the 10/20(20/40) or 3/6 (6/12) Any two line difference between eyes Avoid Crowding Phenomenon


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LEA Symbols Blur to OOOO

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interest !
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Refraction: Pin Hole ?


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Astigmatism


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Hyperopia


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Myopia


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Sure Sight Autorefractor


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Slit Lamp and Ophthalmoscope


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Cataract Screening


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Screening Pre-Verbal Children

Screening for a Red ReflexReduce Room Lights and Focus at meter with 0 lens and

largest diameter of lighthttp://aappolicy.aappublications.org (AAP) Policystatement on Red Reflex Exam
http://aappolicy.aapublications.org/http://aappolicy.aapublications.org/


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Leukocoria or White Pupil


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Blurred Vision


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Cataracts: Not All Visually

Significant


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Not Always Cataracts !


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Poor Vision Following Cataract

Surgery


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YAG Laser Capsulotomy


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Vision screening for pre-verbal and beyond

86% of children entering 1 st grade have had no eye exam

20-25% of children enter school with vision problems that can affecttheir development and progress

70% of school-age children who have learning disability have someform of visual impairment

95% of visions disorders can be corrected if detected early

The best defense is early detection


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Vision AssessmentEvaluate ability to fix and follow objectsTry cover/uncover test

Observe for NystagmusDevelopmental milestones: Smile to face (6 - 8 weeks), follow objects (3months)


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Get the Child Happy and

Interested


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Cover Each Eye and Observe Fixation and

Reaction to Occlusion

Left Eye Covered Right Eye Covered


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Teller Acuity Cards Assess visual acuity ininfantsLabor intensiveprocedure!Mostly used inresearch studies


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Photo ScreeningPolaroid InstantPhotographRefractive Errors

Strabismus or SquintCheck aap.org American Academy ofPediatrics

Use of Photoscreening for Childrens Vision Screening


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Use of Photoscreening for Children s Vision Screening PEDIATRICS Vol. 109 No. 3 March 2002, pp. 524-52

Use of Photoscreening for Childrens Vision ScreeningThis statement asserts that all children should be screened for risk factors associated with amblyopia. Guidelines aresuggested for the use of photoscreening as a technique forthe detection of amblyopia and strabismus in children of various age groups. The American Academy of Pediatricsfavors additional research of the efficacy and cost-effectiveness of photoscreening as a vision screening tool.


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PediaVision PlusOptix S04 The PediaVision solution assists in the detection of :

Refractive errors AmblyopiaStrabismus

AnisocoriaCentral Media Opacities


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Confidential 30


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http://www.pediavision.com/


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Pediavision Instant Screening Results

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Pass / Refe r results are user definedand based on the following:

Near-sightedness (myopia) Far-sightedness (hyperopia) Unequal refractive power

(anisometropia) Blurred vision, eye structure

problem (astigmatism) Pupil size deviations (anisocoria)


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The PediaVision SolutionThe measuring principle is based on eccentric photo-retinoscopy.Infrared light is projected through the pupil onto the retina.

Depending on the refractive error the reflected light forms a specificbrightness pattern within the pupil. The spherical refraction iscalculated based on this crescent pattern. To determine cylinderand axis, the same measurement is repeated in three meridians.

Please refer to the Technical Information module for more specificinformation on screening results.


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PediaVision PlusOptix S04The fully automated solution conducts:

a comprehensive refractive assessmentanalyzes the pupil sizecreates a gaze deviation chart

uses advanced digital imaging for quick referenceof more advanced issues


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Field Testing of the PlusOPtixS04Arthur et al. AAPOS abstract 2008

94% agreement camera and examSensitivity 83% Specificity 96%Positive predictive value 74%Only 1% untestable rate


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Vision Screening: Anyone can

do it !

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Vision Screening - Dr. Wagner.ppt