Visual field testing in pediatrics

Visual field testing in pediatrics Confrontation Arc perimetry Hemispheric perimetry Goldmann perimetry 1 – DL Mayer, 3-14-05

The Count “eats” the white ball when the infant orients to it (looks at it) Confrontation with the Count and the white ball 2 – DL Mayer, 3-14-05

Arc perimetry Orienting to a flashing light on 4 oblique meridia, at 20 and 30 deg Child with CP – Detects lights in superior left 3 – DL Mayer, 3-14-05

Orienting to a flashing light at a fixed extent on one of 24 half meridia Hemispheric perimetry 4 – DL Mayer, 3-14-05

Goldmann perimetry Light moved from periphery to center of hemisphere Child signals detection of light with tap on buzzer Visual fields of a normal 4 year old Left eye Right eye 5 – DL Mayer, 3-14-05

6 – DL Mayer, 3-14-05

Right and left visual field projection on visual pathway 7 – DL Mayer, 3-14-05

Child with markedly enlarged left ventricle 2a congenital hydrocephalus Right hemifield defect Confrontation 8– DL Mayer, 3-14-05

Right or left hemifield defects
Consequences -
Poor scanning into non-seeing field
Reading affected, especially in right field defects
Missing objects in non-seeing field
Seeing only part of (large) objects
Delayed motor skills
Compensations -
Head turn toward non-seeing field
Head thrusting toward non-seeing field
Complications –
Hemiparesis on side of field defect
Hemispatial neglect in addition to field defect
9– DL Mayer, 3-14-05

Child born at 35 wks gestation Bilateral PVL (white matter injury) Inferior field defect in each eye – dense, complete 10– DL Mayer, 3-14-05

Inferior field defects
Consequences –
Poor scanning downward
Missing objects in lower fields (e.g. food on table, pictures at bottom of communication board, bumping into things below when walking)
Seeing only part of (large) objects
Compensations –
Head tilts to right and left
Head down posture (when walking, reading)
Complications –
Spastic diplegia (legs)
11– DL Mayer, 3-14-05

Child later shown to have complete inferior field defect w/ Goldmann Missed w/ hemispheric perimetry (b/o head down & poor fixation) 12– DL Mayer, 3-14-05

Recommendations for children with major field defects - 1
Services -
Teacher of visually impaired
Orientation and mobility
Further evaluations -
Low vision, as appropriate
Neuropsychology, for difficulties associated with cerebral damage
13– DL Mayer, 3-14-05

Recommendations for children with major field defects - 2
Compensations -
Increasing child’s awareness of space
Scanning to increase search field
Adaptations –
Positioning child & objects to optimize field & minimize effort
Environmental modifications – stairs, furniture, play spaces
14– DL Mayer, 3-14-05

Preterm infant – bilateral cerebral white matter damage MRI – 21 months 26 wks GA, 1 lb 15 oz, twin Spastic diplegia, seizures Mild ROP, X(T), VA sc OU 10/20 Complete, dense inferior field defect VFs-7 Goldmann perimetry, Age 5;8

Missing objects on floor or stumbling over objects while walking; extreme caution going downstairs
Common concerns in children with inferior field defects
Missing food items in lower field at table or on high chair tray –
“ Where is my milk?” -“Eat your peas!” “Where are they?”
Missing pieces in the lower part of a puzzle
Missing icons on the bottom of a communication board
Leaning down to get close to paper when writing or drawing
Crowding a drawing on the upper part of page
Frequent head tilt down, when head is free in wheelchair, or when walking
Missing objects on floor or stumbling over objects while walking
Extreme caution going downstairs, at door thresholds
Sideways head tilt for certain activities (e.g. TV viewing), sometimes nearly always when doing fine motor tasks and reading

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Visual field testing in pediatrics

by eadvisor on Jan 31, 2007

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Visual field testing in pediatrics — Presentation Transcript