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Pediatric Eye Conditions In Wisconsins Preschool Population
 

Pediatric Eye Conditions In Wisconsins Preschool Population

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    Pediatric Eye Conditions In Wisconsins Preschool Population Pediatric Eye Conditions In Wisconsins Preschool Population Presentation Transcript

    • Pediatric Eye Conditions in Wisconsin’s Preschool Population Lori J. Lindsly, CLVT
      • Please note: the following are intended to be general guidelines to certain eye conditions. By no means do all these characteristics apply to every child with a specific diagnosis. Each child is a unique individual and should have a functional vision assessment to identify any vision related needs.
      • Many eye conditions are associated with syndromes. Only a few of these syndromes will be covered in this presentation
    • Achromatopsia:
      • cone/rod defect or absence (sometimes referred to as monochromacy)
      • Congenital
      • Non-progressive
      • Defective color vision
      • Reduced acuity
      • Nystagmus
      • Extreme light sensitivity
      • Reduced contrast sensitivity; require bold print
      • May require large print/low vision aids; may benefit from the use of braille
      • May have associated field defects
      • Benefit from ability to adjust lighting
      • Retinal Disorder
    • Amblyopia related to Anisometropia
      • Lazy Eye
      • Decreased vision in one or both eyes without detectable anatomic damage to the retina or the visual pathways
      • Has many types… in this child’s case caused by unequal refractive status in the two eyes
      • May lead to double vision
      • Glasses, contact lenses and refractive surgery are used to treat condition
      • Will likely have issues with eye teaming
      • Functional defect
    • Aniridia
      • absence of a fully formed iris
      • Congenital
      • Usually bilateral, occasionally unilateral
      • Extreme light sensitivity
      • May be cosmetically and functionally improved by the use of special contact lenses that simulate an iris and create artificial pupil
      • May have associated defects including, glaucoma, cataracts, displaced lens and
      • underdeveloped retina, also may be associated with a type of malignant tumor (Wilm’s tumor)
      • Reduced acuity
      • Often degenerative, due to associated conditions (glaucoma)
      • Benefit from ability to control light
      • Sunlenses useful
      • May need large print/optical aids/braille
      • Developmental Disorder
      • Missing iris
      • Can be familial or sporadic
    • Anophthalmia (Microphalmia)
      • congenital absence of the eyeball, abnormally small eyeball
      • Blind (may have some level of vision if any rudimentary eye structure is present)
      • May have facial/skull malformation
      • Prostheses generally used…involves implants and spacers
      • Developmental Disorder
      • May have other midline issues
      • These students typically have needs in all areas of the expanded core curriculum
    • Cataracts
      • Opacity or cloudiness of the crystalline lens
      • Prevents a clear image from falling on the retina, may be removed, (aphakic) power replaced by man-made lens
      • May be present at birth (congenital)
      • Can be unilateral or bilateral
      • If implants are not used, may require high powered lenses in glasses
      • Light sensitivity is a problem
      • Usually fairly good acuity (20/40) if no other pathologies
      • May benefit from large print/magnification
      • Lens disorder
    • Cortical Visual Impairment Cortical Blindness Cerebral Visual Impairment
      • loss of visual function due to injuries to specific regions of the brain
      • Acquired at birth or following brain injury
      • Eye structure appears normal
      • No nystagmus (usually)
      • Associated with other neurological or cognitive deficits
      • May experience some degree of recovery, early on; lots of work does not happen on its own
      • Acuity varies from near normal to NLP
      • Poor contrast sensitivity
      • Color vision is generally intact; may attend well to bright colors
      • Movement enhances vision; mobility may be a relative strength
      • Light cueing may help to direct visual attention
      • Brain Damage
    • Glaucoma
      • increased intraocular pressure causing optic nerve damage
      • Congenital or acquired
      • Progressive (rarely non-progressive)
      • Peripheral field defect
      • Reduced night vision
      • Decreased visual acuity
      • Varied lighting needs, often problems with glare and photophobia
      • Constant medication, recurrent surgery
      • May be associated with myopia
      • Vision may fluctuate
      • Difficulties with reading are common, especially if vision fluctuates
      • Sunlenses may be useful
      • May need large print/optical aids/braille
      • Optic Nerve Disorder
      • There is a form that has normal innerocular pressure but optic nerve still becomes damaged; associated with migraine. Theory that problem is related to blood flow issues
    • Delayed Visual Maturation
      • poor visual attentiveness in early infancy with subsequent improvement
      • Eye exam is generally normal however child does not appear to be fixing and following visual targets
      • May or may not have nystagmus present
      • Usually begins to resolve by about 6 months of age
      • Some speculation problem is caused by a delay in brain development or myelination in vision center of brain.
      • Usually achieve normal visual acuity over time
      • Visual evoked potential test may be conducted to determine ongoing status of vision system
      • Developmental disorder
    • Leber’s Congenital Amaurosis
      • retinal degeneration in young children, a form of RP
      • Congenital, genetic
      • Progressive, sometimes stable
      • Associated with corneal problems and cataracts
      • Reduced visual acuity 20/80 to NLP, generally children are blind
      • Often associated with eye rubbing, poking
      • Varied lighting needs, frequently benefit from task lighting with no glare
      • Large print/optical aids/braille are beneficial
      • May be associated with cognitive deficiency and other neurological problems including deafness and seizure disorder, in WI and MN many are VI only in disabilities
      • Retinal Disorder
      • May have lens or cornea component
    • Norrie’s Disease (Anderson-Warburg Syndrome)
      • Retinal Dysplasia
      • An x-linked disorder
      • Mental delays in 2/3 of cases
      • Microphthalmia and blindness at birth
      • Can have scrambling of intraocular contents
      • White reflex from masses of immature cells accumulating in the retina
      • May have associated deafness
      • Retinal disorder
    • Nystagmus
      • involuntary eye movements
      • Congenital or acquired; congenital form: student does not see movement; acquired form: student does see movement
      • Nonprogressive
      • Stress may impact on acuity and speed of eye movement
      • Associated with fatigue; especially when reading
      • When found in conjunction with other vision problems may be indicative of poor vision being present from birth
      • Limit amount of information presented at one time, simple pages work best
      • Provide place-holders, line markers and typoscopes
      • Student may frequently skip words when reading
      • Avoid copying whenever possible, shorten assignments
      • May need large print/auditory materials
      • Some students will discover a null point; this is a head or eye position that slows down the movement and allows for improved visual functioning
      • oculomotor disorder
    • Optic atrophy
      • degeneration of the optic nerve tissue
      • Congenital or acquired; acquired from the result of another disorder such as brain tumor
      • Progressive or nonprogressive
      • May be associated with central or peripheral field losses
      • Reduced contrast sensitivity
      • Widely ranging visual acuity: 20/20 to NLP
      • Often reduced color perception
      • May need bold print, contrast enhancement
      • Often benefit from non-glare task lighting
      • May need large print/optical aids/braille
      • Optic Nerve Disorder
    • Ocular Herpes
      • Virus of the skin and mucus membranes
      • Most people have been exposed to herpes simplex virus, for some virus remains dormant in their bodies
      • Several forms ranging from simple infection to potentially blinding disorder
      • Treatment depends on structures involved…eyelid, conjunctiva, cornea, retina
      • Usually, swelling occurs with infection, can be quite painful when cornea is involved
      • May be recurring but can sometimes be controlled…once you have the virus, there is no cure
      • Stress, fever, injury and sunlight may trigger episode
      • Viral infection
    • Optic nerve hypoplasia
      • underdeveloped optic disc
      • Congenital
      • Widely ranging visual acuity: 20/20 to <20/200, depends on how much nerve fiber is intact
      • Associated with field defects, nystagmus, strabismus
      • Suspected link to drug/alcohol use during pregnancy or very young maternal age
      • May be unilateral or bilateral
      • High refractive errors, especially astigmatism
      • Nystagmus is common
      • Septo-optic hypoplasia may be associated with hypoglycemia, diabetes insipidus and
      • difficulty regulating body temperature, may cause sudden death; especially in infancy
      • Glare free task lighting may be useful
      • May need large print/optical aids/braille
      • Septo-optic hypoplasia/dysplasia (DeMorsier Syndrome)
      • optic nerve hypoplasia in addition to CNS and midline anomalies including thinning or absence of septum pellucidum and corpus callosum in the brain,
      • may also involve pituitary disturbances, we have seen high incidence of autism associated with disorder
      • optic nerve disorder
    • Ptosis
      • Drooping upper eyelid
      • May affect one or both eyelids
      • If drooping is severe, it may cause deprivation amblyopia, may also impact on social development if problem is obvious
      • Some forms also have nerve involvement
      • Usually treated with surgery, may use ptosis crutch
      • Developmental muscle disorder (most frequent cause in children)
    • Retinopathy of Prematurity
      • series of destructive changes in retina after life sustaining oxygen is administered to premature infants
      • Acquired
      • Widely ranging visual acuity levels from 20/20 to < 20/200
      • Rarely occurs in infants who were full term and not exposed to oxygen: some speculation that retinal vascular changes may be associated with exposure to light during neonatal period of life
      • May also be associated with myopia, glaucoma, strabismus and nystagmus
      • May lead to retinal detachments later in life resulting in further loss of vision
      • Stereotypically, have poor motor skills, spatial confusion
      • Increased incidences with saving of lower birth weight babies; these babies are also at greater risk for additional disabilities including cortical visual impairment
      • Retinal Disorder
      • May have refractive, corneal, muscle, lacrimal components
    • References
      • Cassin, B.; Solomon, S; (1984) “Dictionary of Eye Terminology”; Gainsville, FL: Triad
      • Gallin, P.F. (2000). “Pediatric Ophthalmology: A Clinical Guide”; New York: Stuttgart.
      • Wright, K.W.; Buckley, E.G.; DelMonte M.A.; et al; (1995) “Pediatric Ophthalmology and Strabismus”; St. Louis, MO: Mosby
      • Wright, K.W.; Spiegel, P.H. (1999). “Pediatric Ophthalmology and Strabismus”.; St. Louis, MO: Mosby
    • Sclerocornea
      • cornea appears opaque cannot be easily distinguished from sclera
      • May be partial or totally cover the cornea, usually both eyes are involved
      • Visual function depends to what extent central area of cornea is involved
      • Condition is considered stable, corneal transplantation has been used as a treatment
      • Congenital abnormality