Pediatric Eye  Conditions in Wisconsin’s Preschool Population  Lori J. Lindsly, CLVT
<ul><li>Please note:  the following are intended to be general guidelines to certain eye conditions.  By no means do all t...
Achromatopsia: <ul><li>cone/rod defect or absence (sometimes referred to as monochromacy) </li></ul><ul><li>Congenital </l...
Amblyopia related to Anisometropia  <ul><li>Lazy Eye </li></ul><ul><li>Decreased vision in one or both eyes without detect...
Aniridia <ul><li>absence of a fully formed iris  </li></ul><ul><li>Congenital </li></ul><ul><li>Usually bilateral, occasio...
Anophthalmia (Microphalmia)  <ul><li>congenital absence of the eyeball, abnormally small eyeball   </li></ul><ul><li>Blind...
Cataracts <ul><li>Opacity or cloudiness of the crystalline lens </li></ul><ul><li>Prevents a clear image from falling on t...
Cortical Visual Impairment  Cortical Blindness Cerebral Visual Impairment  <ul><li>loss of visual function due to injuries...
Glaucoma  <ul><li>increased intraocular pressure causing optic nerve damage </li></ul><ul><li>Congenital or acquired </li>...
Delayed Visual Maturation  <ul><li>poor visual attentiveness in early infancy with subsequent improvement  </li></ul><ul><...
Leber’s Congenital Amaurosis  <ul><li>retinal degeneration in young children, a form of RP   </li></ul><ul><li>Congenital,...
Norrie’s Disease (Anderson-Warburg Syndrome) <ul><li>Retinal Dysplasia   </li></ul><ul><li>An x-linked disorder  </li></ul...
Nystagmus <ul><li>involuntary eye movements   </li></ul><ul><li>Congenital or acquired; congenital form: student does not ...
Optic atrophy  <ul><li>degeneration of the optic nerve tissue   </li></ul><ul><li>Congenital or acquired; acquired from th...
Ocular Herpes  <ul><li>Virus of the skin and mucus membranes   </li></ul><ul><li>Most people have been exposed to herpes s...
Optic nerve hypoplasia  <ul><li>underdeveloped optic disc   </li></ul><ul><li>Congenital </li></ul><ul><li>Widely ranging ...
Ptosis  <ul><li>Drooping upper eyelid </li></ul><ul><li>May affect one or both eyelids </li></ul><ul><li>If drooping is se...
Retinopathy of Prematurity  <ul><li>series of destructive changes in retina after life sustaining oxygen is administered t...
References <ul><li>Cassin, B.; Solomon, S; (1984) “Dictionary of Eye Terminology”; Gainsville, FL: Triad </li></ul><ul><li...
Sclerocornea <ul><li>cornea appears opaque cannot be easily distinguished from sclera  </li></ul><ul><li>May be partial or...
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Pediatric Eye Conditions In Wisconsins Preschool Population

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Pediatric Eye Conditions In Wisconsins Preschool Population

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

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