Dot blot hemes out in the ora serrata any other disease process
Retinal hemes without any other disease process
A head injury, with a subdural hematoma and cortical blindness
The higher the amplitude and frequency of the nystagmus the less time the image spends on the fovea. The less time the image spends on the fovea, the further reduced the acuity.
A the null point the patient has their most reduced VA because this is where the the frequency and amplitude are the highest/fastest.
A nystagmus that is not symmetrical between the eyes it is considered perhaps more pathological
Pendular nystagmus has the same frequency or velocity in both directions
O A patient that has nystagmus and then all of a sudden is also nauseous and also reports that the world is constantly moving, that tells you it’s recent onset and also that tells you that you probably need to be concerned and that they need a referral because they should be treated.
Increases with fixation
Presence of a Null point
Increases with convergence
A classic sign is head bobbing and sometimes a head tilt
Has a very slow large symmetric nystagmus
Is characterized by transillumination defects like ocular albinism
The age of onset is 5-6 years
In a patient with a nystagmus if their null point isn’t in primary gaze, they’re probably going to adopt a unusual head posture which can lead to torticollis if they have adopted that head position at a young age.
The Anderson – Kestenbaum approach was the most classic form of nystagmus management.
Lasik can be used to correct the nystagmus
If the NPC shows that nystagmus is dampens a BO prism can be used to force the child to converge. Assuming that the child is non-strabismic and has good BO ranges.
If the child is a CI you could over minus the child so they will accommodate to dampen the nystagmus - assuming the child had good amps.
Cerebral palsy is multiply handicapping, it’s a condition that is caused by brain maldevelopment and usually caused by damage during the birth process or shortly after birth. Motor dysfunction is the hallmark of cerebral palsy
Mental retardation is a hallmark of cerebral palsy and 100% penetrant while only 70% of the population has visual problems.
There are several categories of cerebral palsy with spasticity being the largest category. It is also marked by hypertonicity
These patients tend to have a high refractive error and an esostropia. Optic atrophy and nystagmus are also found n roughly 7% of the population
Teller Acuity cards
Lea Grating paddles
Their refractive error is typically very low and accommodative dysfunction is found in only 29% of the population.
Strabismus is rare in this population, in the rare event it happens it is typically an exotropia.
As the age of the mother increases incidence of her or the likelihood of her having a child with down syndrome decreases
Common features include: Short stature, large foreheads, flat occipital lobe, low set ears, flat bridge or oral cavity is small, extra digits, webbed fingers
Double ring sign
Early bifurcations of vessels
There are no reported trends in refractive error for autistic children, however they tend to have poor fixations and pursuits
Visual behaviors such as extreme lateral gaze, light gazing, and eye pressing are common
Autistic children enjoy excessive amounts of visual stimulation and auditory stimulation. This is often used in therapy.
Autism is a behavioral syndrome often characterized by abnormalities in understanding and using languages, and social interactions.
Fixation preference was the idea that if a child comes in strabismic, we’re going to see if they can maintain fixation with the eye that’s not fixating.
Even if a child has equal VAs, they may still have a fixation preference.
With the Bruckner test if a child is strabismic, it may appear that the eye may appear whiter and brighter since the light hitting the fundus is no longer hitting the pigmented region of the macula so that more reflectance is coming back, giving a whiter and brighter reflex.
If we can do a good cover test, then that’s the preferred method for evaluating ocular alignment.
When we talk about reliability and being able to assess reliability of stereopsis Lang stereo I is better because we have the star that can be seen monocularly.
Small angle deviation you can't see with cover test
Uncorrected refractive error
The difference with ICare and Tonopen is really that the ICare does not require drops. But you still need child to cooperate to keep eyes open to be able to fixate for you.
Juvenile onset myopia occurs typically when the child is 6-8yrs old, average progression is about 0.5D per year
Recent studies have shown that a higher level of total time spent outdoors is associated with less myopia in 12yr old kids.
As we compare using a Tonopen to Goldman, what we see is that in kids, most of the pressures that we find will be like adult patients, it should be in low teens or less than that
Recent studies have also shown that an increase in near work will increase the amount of myopia in a child.
The ATOM study showed atropine is effective in preventing axial myopia progression
Atropine has many side effect including allergic reactions, discomfort, sensitivity to light, glare, blurry near vision
Spectacles Lenses designed to reduce peripheral hyperopia
Bifocal Contact Lenses