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Lecture fakulti pendidikan 2011
 

Lecture fakulti pendidikan 2011

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  • 60 Nasal /100 degrees temporal / 60 degrees above / 75 below the horizontal meridian
  • Resnikoff et al. (2004),
  • (Stiles & Knox, 1996):
  • Affected pt – 40% children affected, 10 % carriers, 50 % normal
  • (Hughes 1995).

Lecture fakulti pendidikan 2011 Lecture fakulti pendidikan 2011 Presentation Transcript

  • Penaksiran dan Diagnosis Kanak-kanak Bermasalah Penglihatan Dr Safinaz Mohd Khialdin Pensyarah & Pakar Oftalmologi Jabatan Oftalmologi PPUKM
  •  
    • Visual impairment or low vision
      • reduction in vision that cannot be corrected with standard glasses or contact lenses
      • reduces a person's ability to function at certain or all tasks
    Visual Impairment
    • Functional limitation of the eye(s) or visual system
    • Can manifest as
      • Reduced visual acuity
      • Reduced contrast sensitivity
      • Visual field loss
      • Photophobia
      • Diplopia
      • Visual distortion
    Visual Impairment
    • Clearness of vision
      • dependent on the sharpness of the retinal focus within the eye
      • the sensitivity of the interpretative parts of the brain.
    Visual acuity
  • VISION TESTING IN CHILDREN
  • Contrast sensitivity
    • How well your eyes function in dim light
    • How well you can distinguish objects from similarly colored or shaded backgrounds.
    • The total area in which objects can be seen in the peripheral vision while you focus your eyes on a central point.
    Visual field
      • PHOTOPHOBIA – glaring
      • DIPLOPIA – double vision
      • VISUAL DISTORTION
    • Definition:
      • Visual impairment :
        • visual acuity of less than 6/18, but equal or better than 3/60 in the better eye
        • Visual field less than 20 degree from fixation
      • Blindness:
        • visual acuity is less than 3/60 in the better eye
        • Visual field less than 10 degree from fixation
    Visual Impairment
  • 6/60 6/18
    • HISTORY TAKING – SYMPTOMS
    • EXAMINATIONS – SIGNS
    • INVESTIGATIONS – CONFIRM DIAGNOSIS
    EVALUATION & DIAGNOSIS OF VISUAL IMPAIRMENT
    • Ocular History
      • Diagnosis and onset of symptoms
      • Past, current, or planned surgeries or treatments
      • Stability of vision
      • Family history of eye disease
      • Previous history of eye disease or vision problems
      • Current or previous use of spectacles, contact lenses, or low vision aids
    EVALUATION & DIAGNOSIS: HISTORY
    • Visual Functioning
      • Ability to read print and specific reading needs (schooling)
      • Intermediate visual ability and needs (e.g., use of computer, reading music)
      • Distance visual ability and needs
      • Photophobia, glare sensitivity, and lighting requirements
    EVALUATION & DIAGNOSIS: HISTORY
    • Medical History
      • General health review
      • Current medications
      • Hearing impairment or other disability
      • Developmental delay
    EVALUATION & DIAGNOSIS: HISTORY
    • EXAMINATION
      • Visual acuity
      • Visual field
      • Refraction
      • Eye movement
      • Detailed examination of the eye structures
    EVALUATION & DIAGNOSIS: EXAMINATION
    • To confirm eye problem
      • Ultrasound
      • CT scan
    • To assess visual impairment
      • Contrast sensitivity testing
      • Colour vision testing
      • Visual evoked potential
    EVALUATION & DIAGNOSIS: INVESTIGATIONS
  • Eye problems in children
    • Importance
      • Early detection & treatment of peadiatric ocular disease is critical
      • Delay in diagnosis results in irreversible vision loss
      • Assessment should begin at birth
    • Eye pathology : Structural impairment or damage to one or more parts of the eye
    • Refractive errors : or an inability of the eye to sharply focus images on the back of retina
    • Cortical visual impairments : damage to the part of the brain that interprets visual information
    CAUSES OF VISUAL IMPAIRMENT IN CHILDREN
  • Eye problems in children causing visual impairment
  • Anatomy of the eye
  • Congenital glaucoma
    • Rare (1:10000), 65% males
    • Diagnosed shortly after birth or during 1 st year of life
    • Improper development of the eye drainage channel
    • Leads high pressure in the eye
    • Causing damage to optic nerve and results in vision loss
    • Symptoms:
      • Tearing
      • Photophobia (glaring)
      • Excessive squeezing of the eye
      • Buphthalmos (ox eye)
  • Leucocoria
    • White eye reflex
    • Differential diagnosis
      • R etinoblastoma
      • C ongenital c ataract
      • Retinopathy of P rematurity
      • C oat’s disease
      • P ersistent Hyperplastic Primary Vitreous (PHPV)
  • 1.Leucocoria: Retinoblastoma
    • Most common intraocular malignancy of childhood
    • Rare (1 in 14000-20000)
    • 3% of all childhood cancers
    • Bilateral in 30-35%
    • Age at diagnosis : 18 months (90% less than 3 years old)
    • May be inherited
  • 1.Leucocoria: Retinoblastoma
    • Present with:
      • Leucocoria (white reflex)
      • Squint
      • Poor vision
      • Eye redness, pain
      • Proptosis : forward bulging of the eye
      • Systemic metastases
      • Incidental ocular exam
  •  
  • Retinoblastoma
    • Sight threatening
    • Life threatening
    • Treatment option
      • Radiotherapy
      • Chemotherapy
      • Surgical removal of the eye
      • Genetic counselling
  • 2. Leucocoria: Cataract Definition of cataract : Opacity involving the lens
  • Leucocoria: Cataract
    • Leading cause of blindness
    • Interferes with normal visual develoment
    • Inherited –1/3
    • Associated with other diseases – 1/3
    • Idiopathic – 1/3
  • Nuclear cataract Lamellar cataract Cortical cataract CONGENITAL CATARACT
  • SECONDARY Ocular - Anterior subcapsular – Atopic dermatitis Systemic – oil droplet cataract – Galactossaemia Vossius ring in traumatic cataract
  • Presentations of childhood cataract
    • Lack of visual interest
    • Strabismus/squint
    • Nystagmus : abnormal movement of the eye
    • Developmental delay
    • Associated with systemic/ ocular abnormalities
  • Action
    • Prompt detection & dedicated screening
    • Referral to Ophthalmologist (urgent)
    • Why?
      • Monocular/ binocular cataract in infants results in significant visual deprivation
      • Early visual rehabilitation can prevent amblyopia (lazy eye)
    • Eye disease that affects prematurely born babies
    • Caused by disorganized growth of retinal blood vessels
    • May be mild and resolves spontaneously
    • Severe cases can lead to scarring and retinal detachment.
    3. Leucocoria: Retinopathy of prematurity
  • Leucocoria: Retinopathy of prematurity
    • Risk factor for ROP
      • Pre-term babies – screening
      • Low birth weight
      • Exposure to oxygen
    • Screening of premature babies has to continue till school-going age
      • Risk of myopia, even with no ROP
    Leucocoria: Retinopathy of prematurity
  • Strabismus/squint
    • Definition: Deviation of the eyes so that their visual axes are no longer parallel
  • Causes of squint
    • Muscle imbalance
    • Refractive errors
    • Ocular abnormalities – cataract, macular scar, optic disc pathology
    • Special syndromes – Duanes, Brown
    • Associated disease – hydrocephalus, cerebral palsy, meningitis
  • Other presenting features
    • Symptoms
      • None
      • Noted by parents
      • Poor vision
      • Funny eye movements
    • Signs
      • Poor vision
      • Abnormal head posture
  • Management for squint
    • Refer to ophthalmologist (urgent)
      • Treatment of refractive errors
      • Treatment of amblyopia (lazy eye)
      • Ocular exercise
      • Surgery – mucsle imbalance
    • Why?
      • Amblyopia (Lazy eye)
      • Loss of binocular single vision
      • Cosmetic blemish
  • REFRACTIVE ERROR
    • Physiological condition whereby the refracting system of the eye does not focus objects on the retina
    • A corrective lens has to be placed in front of the eye to enable a sharp image to be seen.
      • Myopia
      • Hyperopia
      • Astigmatism
    Refractive errors
  • Refractive errors
    • Various presentations:
      • Squeezing eyes
      • Squint
      • Headache – ocular/ frontal/ diffuse
      • Tearing
      • Complains of tired eyes
      • Child is slow at school
      • Has problems with attentiveness
      • Strong family history of myopia or other refractive error
    • Importance: Untreated or undertreated will cause AMBLYOPIA
    • Visual acuity screening in schools
      • Performed in Standard 1
      • Referral to Ophthalmologist/Optometrist
    Refractive errors
  • Amblyopia
    • ‘ Lazy eye’
    • Definition:
      • Unilateral/ bilateral decrease of best corrected visual acuity
      • Is potentially reversible during the critical period (before 7-9 years old)
  • Critical period: Why is visual development important?
    • Sensory function continues to develop after birth
    • Requires proper visual stimulation
      • Normal vision – receptive cells, clear media and normal retina
      • Normal alignment
      • Normal brain development
  • How does amblyopia develop?
    • Brain receives stimuli from both eyes
    • Child’s maturing brain will select the better image and ignore the blurry image
        • Vision not properly developed in the bad eye (AMBLYOPE)
  • Causes of amblyopia
    • Ammetropia (bilateral high refractive error)
    • Anisometropia (large/ asymmetrical refractive error difference between eyes)
    • Strabismic (squint)
    • Occlusional / form deprivation (media problem)
  • Treatment
    • Can be treated or reversed if detected earlier (critical period)
    • Treat underlying condition – cataract, squint
    • Prescribe spectacles correction – refractive error
    • Force to use the amblyopic eye
      • Patching the good eye
      • Putting atropine eye drops to blur image in the good eye
  • Visual pathway
    • As a result of the damage to the brain.
      • Cerebral palsy
      • Seizure disorder
      • Hydrocephalus, Microcephaly
    • Infants and children with cortical vision impairment
      • Delayed in reaching developmental milestones
      • Sensory motor & activities and social development.
      • Intellectual disability
    Cortical visual impairments
    • The process of treatment and education that helps individuals who are visually disable
    • attain maximum function,
    • a sense of well being,
    • a personally satisfying level of independence,
    • optimum quality of life.
    Visual Rehabilitation
    • OPTICAL DEVICES
    • NON OPTICAL DEVICES
    • HOLISTIC APPROACH
      • Clinicians – ophthalmologist, peadiatrician, optometrist
      • Teachers, Education ministry
      • Occupational therapist
      • Counsellors : psychologist, psychiatrist, social worker
      • Vocational Rehabilitation centers
    Visual Rehabilitation
    • OPTICAL DEVICES
    • Reduced Visual Acuity
      • Magnification for near
      • Magnification for distance
    • Central visual field defect
    • Peripheral visual field defect
    • Reduced contrast sensitivity
    • Glare sensitivity
    Visual Rehabilitation
  • HAND HELD MAGNIFIERS MAGNIFICATION FOR NEAR STAND MAGNIFIERS SPECTACLE-MOUNTED MAGNIFIER CLOSE-CIRCUIT TELEVISION SYSTEM
  • TELESCOPE MAGNIFICATION FOR FAR
  • TREATMENT OF CENTRAL VISUAL FIELD LOSS MODIFIED TEXT
    • Training for eccentric viewing- avoid fixating using the fovea
    • Using large print material
    • Using prism relocation
  • TREATMENT OF PERIPHERAL VISUAL FIELD LOSS MIRROR PRISMS
    • Acts like a side mirror of a car
    • Able to view objects at the non-seeing area of the eye when glancing into the mirror or prism
  • TREATMENT FOR REDUCED CONTRAST SENSITIVITY AND GLARE TINTED LENSES COLOUR CONTRAST TYPOSCOPE : reduce reflected glare from printed pages
    • NON-OPTICAL METHODS
    • Move CLOSER : use an angled reading desk
    • Use COLOUR to show objects more clearly
    • Use CONTRAST : eat white rice off a coloured plate
    • Pay attention to LIGHTING : sit near a window in class
    • Make objects LARGER: write with larger letters
    • Use a LINE-GUIDE such as a ruler when reading and writing.
    Visual Rehabilitation
    • Prognosis for success depends on:
      • Ocular condition
      • Vision loss – nature & extent
      • Patient – physical & mental abilities, attitude, expectation, motivation
      • Clinician – attitude & motivation
    Visual rehabilitation
    • THANK YOU