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Visual field testing in pediatrics Confrontation  Arc perimetry  Hemispheric perimetry   Goldmann perimetry  1 – DL Mayer,...
The Count “eats” the white ball when the infant orients to it (looks at it)   Confrontation with the Count and the white b...
Arc perimetry Orienting to a flashing light on 4  oblique meridia, at 20 and 30 deg Child with CP – Detects lights in supe...
Orienting to a flashing light at a fixed extent on one of 24 half meridia   Hemispheric perimetry   4 – DL Mayer, 3-14-05
Goldmann perimetry Light moved from periphery  to center of hemisphere  Child signals detection of  light with tap on buzz...
6 – DL Mayer, 3-14-05
Right and left  visual field projection on visual pathway 7 – DL Mayer, 3-14-05
Child with markedly enlarged left ventricle 2a congenital hydrocephalus   Right hemifield defect Confrontation 8– DL Mayer...
Right or left hemifield defects <ul><li>Consequences -  </li></ul><ul><li>Poor scanning into non-seeing field </li></ul><u...
Child born at 35 wks gestation Bilateral PVL (white matter injury) Inferior field defect in each eye – dense, complete 10–...
Inferior field defects <ul><li>Consequences – </li></ul><ul><li>Poor scanning downward </li></ul><ul><li>Missing objects i...
Child later shown to have complete inferior field defect w/ Goldmann  Missed w/ hemispheric perimetry (b/o head down & poo...
Recommendations for children with major field defects - 1 <ul><li>Services - </li></ul><ul><li>Teacher of visually impaire...
Recommendations for children with major field defects - 2 <ul><li>Compensations - </li></ul><ul><li>Increasing child’s awa...
Preterm infant –  bilateral cerebral white matter damage   MRI – 21 months   26 wks GA, 1 lb 15 oz, twin Spastic diplegia,...
<ul><li>Missing objects on floor or stumbling over objects while walking;  extreme caution going downstairs </li></ul>Comm...
 
 
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Visual field testing in pediatrics

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This powerpoint presentation by Dr. Luisa Mayer was given at the 2005 ADVISOR workshop.

Published in: Health & Medicine, Technology
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Visual field testing in pediatrics

  1. 1. Visual field testing in pediatrics Confrontation Arc perimetry Hemispheric perimetry Goldmann perimetry 1 – DL Mayer, 3-14-05
  2. 2. The Count “eats” the white ball when the infant orients to it (looks at it) Confrontation with the Count and the white ball 2 – DL Mayer, 3-14-05
  3. 3. Arc perimetry Orienting to a flashing light on 4 oblique meridia, at 20 and 30 deg Child with CP – Detects lights in superior left 3 – DL Mayer, 3-14-05
  4. 4. Orienting to a flashing light at a fixed extent on one of 24 half meridia Hemispheric perimetry 4 – DL Mayer, 3-14-05
  5. 5. Goldmann perimetry Light moved from periphery to center of hemisphere Child signals detection of light with tap on buzzer Visual fields of a normal 4 year old Left eye Right eye 5 – DL Mayer, 3-14-05
  6. 6. 6 – DL Mayer, 3-14-05
  7. 7. Right and left visual field projection on visual pathway 7 – DL Mayer, 3-14-05
  8. 8. Child with markedly enlarged left ventricle 2a congenital hydrocephalus Right hemifield defect Confrontation 8– DL Mayer, 3-14-05
  9. 9. Right or left hemifield defects <ul><li>Consequences - </li></ul><ul><li>Poor scanning into non-seeing field </li></ul><ul><ul><li>Reading affected, especially in right field defects </li></ul></ul><ul><li>Missing objects in non-seeing field </li></ul><ul><li>Seeing only part of (large) objects </li></ul><ul><li>Delayed motor skills </li></ul><ul><li>Compensations - </li></ul><ul><li>Head turn toward non-seeing field </li></ul><ul><li>Head thrusting toward non-seeing field </li></ul><ul><li>Complications – </li></ul><ul><li>Hemiparesis on side of field defect </li></ul><ul><li>Hemispatial neglect in addition to field defect </li></ul>9– DL Mayer, 3-14-05
  10. 10. Child born at 35 wks gestation Bilateral PVL (white matter injury) Inferior field defect in each eye – dense, complete 10– DL Mayer, 3-14-05
  11. 11. Inferior field defects <ul><li>Consequences – </li></ul><ul><li>Poor scanning downward </li></ul><ul><li>Missing objects in lower fields (e.g. food on table, pictures at bottom of communication board, bumping into things below when walking) </li></ul><ul><li>Seeing only part of (large) objects </li></ul><ul><li>Compensations – </li></ul><ul><li>Head tilts to right and left </li></ul><ul><li>Head down posture (when walking, reading) </li></ul><ul><li>Complications – </li></ul><ul><li>Spastic diplegia (legs) </li></ul>11– DL Mayer, 3-14-05
  12. 12. Child later shown to have complete inferior field defect w/ Goldmann Missed w/ hemispheric perimetry (b/o head down & poor fixation) 12– DL Mayer, 3-14-05
  13. 13. Recommendations for children with major field defects - 1 <ul><li>Services - </li></ul><ul><li>Teacher of visually impaired </li></ul><ul><li>Orientation and mobility </li></ul><ul><li>Further evaluations - </li></ul><ul><li>Low vision, as appropriate </li></ul><ul><li>Neuropsychology, for difficulties associated with cerebral damage </li></ul>13– DL Mayer, 3-14-05
  14. 14. Recommendations for children with major field defects - 2 <ul><li>Compensations - </li></ul><ul><li>Increasing child’s awareness of space </li></ul><ul><li>Scanning to increase search field </li></ul><ul><li>Adaptations – </li></ul><ul><li>Positioning child & objects to optimize field & minimize effort </li></ul><ul><li>Environmental modifications – stairs, furniture, play spaces </li></ul>14– DL Mayer, 3-14-05
  15. 15. Preterm infant – bilateral cerebral white matter damage MRI – 21 months 26 wks GA, 1 lb 15 oz, twin Spastic diplegia, seizures Mild ROP, X(T), VA sc OU 10/20 Complete, dense inferior field defect VFs-7 Goldmann perimetry, Age 5;8
  16. 16. <ul><li>Missing objects on floor or stumbling over objects while walking; extreme caution going downstairs </li></ul>Common concerns in children with inferior field defects <ul><li>Missing food items in lower field at table or on high chair tray – </li></ul><ul><li>“ Where is my milk?” -“Eat your peas!” “Where are they?” </li></ul><ul><li>Missing pieces in the lower part of a puzzle </li></ul><ul><li>Missing icons on the bottom of a communication board </li></ul><ul><li>Leaning down to get close to paper when writing or drawing </li></ul><ul><li>Crowding a drawing on the upper part of page </li></ul><ul><li>Frequent head tilt down, when head is free in wheelchair, or when walking </li></ul><ul><li>Missing objects on floor or stumbling over objects while walking </li></ul><ul><li>Extreme caution going downstairs, at door thresholds </li></ul><ul><li>Sideways head tilt for certain activities (e.g. TV viewing), sometimes nearly always when doing fine motor tasks and reading </li></ul>

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