Pediatric Eye Conditions In Wisconsins Preschool Population

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  • 1. Pediatric Eye Conditions in Wisconsin’s Preschool Population Lori J. Lindsly, CLVT
  • 2.
    • 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
  • 3. 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
  • 4. 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
  • 5. 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
  • 6. 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
  • 7. 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
  • 8. 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
  • 9. 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
  • 10. 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
  • 11. 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
  • 12. 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
  • 13. 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
  • 14. 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
  • 15. 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
  • 16. 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
  • 17. 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)
  • 18. 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
  • 19. 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
  • 20. 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