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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).
  • Transcript

    • 1. Penaksiran dan Diagnosis Kanak-kanak Bermasalah Penglihatan Dr Safinaz Mohd Khialdin Pensyarah & Pakar Oftalmologi Jabatan Oftalmologi PPUKM
    • 2.  
    • 3.
      • 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
    • 4.
      • 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
    • 5.
      • 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
    • 6. VISION TESTING IN CHILDREN
    • 7. Contrast sensitivity
      • How well your eyes function in dim light
      • How well you can distinguish objects from similarly colored or shaded backgrounds.
    • 8.
      • The total area in which objects can be seen in the peripheral vision while you focus your eyes on a central point.
      Visual field
    • 9.
        • PHOTOPHOBIA – glaring
        • DIPLOPIA – double vision
        • VISUAL DISTORTION
    • 10.
      • 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
    • 11. 6/60 6/18
    • 12.
      • HISTORY TAKING – SYMPTOMS
      • EXAMINATIONS – SIGNS
      • INVESTIGATIONS – CONFIRM DIAGNOSIS
      EVALUATION & DIAGNOSIS OF VISUAL IMPAIRMENT
    • 13.
      • 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
    • 14.
      • 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
    • 15.
      • Medical History
        • General health review
        • Current medications
        • Hearing impairment or other disability
        • Developmental delay
      EVALUATION & DIAGNOSIS: HISTORY
    • 16.
      • EXAMINATION
        • Visual acuity
        • Visual field
        • Refraction
        • Eye movement
        • Detailed examination of the eye structures
      EVALUATION & DIAGNOSIS: EXAMINATION
    • 17.
      • To confirm eye problem
        • Ultrasound
        • CT scan
      • To assess visual impairment
        • Contrast sensitivity testing
        • Colour vision testing
        • Visual evoked potential
      EVALUATION & DIAGNOSIS: INVESTIGATIONS
    • 18. 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
    • 19.
      • 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
    • 20. Eye problems in children causing visual impairment
    • 21. Anatomy of the eye
    • 22. 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)
    • 23. 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)
    • 24. 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
    • 25. 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
    • 26.  
    • 27. Retinoblastoma
      • Sight threatening
      • Life threatening
      • Treatment option
        • Radiotherapy
        • Chemotherapy
        • Surgical removal of the eye
        • Genetic counselling
    • 28. 2. Leucocoria: Cataract Definition of cataract : Opacity involving the lens
    • 29. Leucocoria: Cataract
      • Leading cause of blindness
      • Interferes with normal visual develoment
      • Inherited –1/3
      • Associated with other diseases – 1/3
      • Idiopathic – 1/3
    • 30. Nuclear cataract Lamellar cataract Cortical cataract CONGENITAL CATARACT
    • 31. SECONDARY Ocular - Anterior subcapsular – Atopic dermatitis Systemic – oil droplet cataract – Galactossaemia Vossius ring in traumatic cataract
    • 32. Presentations of childhood cataract
      • Lack of visual interest
      • Strabismus/squint
      • Nystagmus : abnormal movement of the eye
      • Developmental delay
      • Associated with systemic/ ocular abnormalities
    • 33. 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)
    • 34.
      • 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
    • 35. Leucocoria: Retinopathy of prematurity
    • 36.
      • 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
    • 37. Strabismus/squint
      • Definition: Deviation of the eyes so that their visual axes are no longer parallel
    • 38. 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
    • 39. Other presenting features
      • Symptoms
        • None
        • Noted by parents
        • Poor vision
        • Funny eye movements
      • Signs
        • Poor vision
        • Abnormal head posture
    • 40. 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
    • 41. 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.
    • 42.
        • Myopia
        • Hyperopia
        • Astigmatism
      Refractive errors
    • 43. 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
    • 44.
      • Visual acuity screening in schools
        • Performed in Standard 1
        • Referral to Ophthalmologist/Optometrist
      Refractive errors
    • 45. Amblyopia
      • ‘ Lazy eye’
      • Definition:
        • Unilateral/ bilateral decrease of best corrected visual acuity
        • Is potentially reversible during the critical period (before 7-9 years old)
    • 46. 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
    • 47. 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)
    • 48. Causes of amblyopia
      • Ammetropia (bilateral high refractive error)
      • Anisometropia (large/ asymmetrical refractive error difference between eyes)
      • Strabismic (squint)
      • Occlusional / form deprivation (media problem)
    • 49. 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
    • 50. Visual pathway
    • 51.
      • 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
    • 52.
      • 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
    • 53.
      • 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
    • 54.
      • 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
    • 55. HAND HELD MAGNIFIERS MAGNIFICATION FOR NEAR STAND MAGNIFIERS SPECTACLE-MOUNTED MAGNIFIER CLOSE-CIRCUIT TELEVISION SYSTEM
    • 56. TELESCOPE MAGNIFICATION FOR FAR
    • 57. TREATMENT OF CENTRAL VISUAL FIELD LOSS MODIFIED TEXT
      • Training for eccentric viewing- avoid fixating using the fovea
      • Using large print material
      • Using prism relocation
    • 58. 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
    • 59. TREATMENT FOR REDUCED CONTRAST SENSITIVITY AND GLARE TINTED LENSES COLOUR CONTRAST TYPOSCOPE : reduce reflected glare from printed pages
    • 60.
      • 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
    • 61.
      • Prognosis for success depends on:
        • Ocular condition
        • Vision loss – nature & extent
        • Patient – physical & mental abilities, attitude, expectation, motivation
        • Clinician – attitude & motivation
      Visual rehabilitation
    • 62.
      • THANK YOU