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ASSESMENT OF VISUAL ACUITY IN CHILDREN

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ASSESMENT OF VISUAL ACUITY IN CHILDREN

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ASSESMENT OF VISUAL ACUITY IN CHILDREN

  1. 1. ASSESMENT OF VISUAL ACUITY IN CHILDREN Intern:- Kavita Choudhary Moderator :- Kunal Kishor
  2. 2. Definition It is defined as the resolving power of the eye or ability to see two separate objects. It is determined by the smallest retinal image which can be appreciated at a certain distance. The VA test measures the smallest letters that patient can read on a standardized chart at a distance of 6m / 20 feets
  3. 3. Principal The two distinct points can only be recognizable as separate when they subtend an angle of 1minute of an arc at the nodal point of the eye
  4. 4. Normal visual Developments AGE At birth 6/120 4 months 6/60 6 months 6/36 1 year 6/18 2 years 6/6
  5. 5. Expected visual acuity levels Age (months) OKN FPL VEP 1 20/300 20/400 20/300 6 20/60 20/150 20/20 12 20/40 20/100 20/20 36 20/20 20/20 20/20
  6. 6. Vision Tests in InfantsVision Tests in Infants
  7. 7. CSM method C : Central S : Steady M : Maintenance
  8. 8. 2.Preferential Looking Test Most Commonly used Test Based upon turning of the head or eyes towards the pattern rather than a uniform [homogenous] field. Alternating Black and White Stripes are present Stripe width progressively narrows which is then randomly shown next to plain test object Children with better vision are able to see finer grating and turn towards it
  9. 9. Drawbacks of Preferential Looking Tests Test near vision not distance vision
  10. 10. 3.Teller Acuity Cards Modified form of Preferential Looking Test - Simpler & rapid testing - Contains 17 cards - 12.5 x 12.5 cm patches of square wave grating - Gratings contrast: 82% - 84% - Proper illumination: 10 candelas/m²
  11. 11. Drawbacks Measures near visual acuity and not distance Measures resolution acuity
  12. 12. 4.Visual Evoked Potential VEP is the measure of change of electrical activity of the visual cortex in response to patterned stimulus Checkered board or square wave grating Abnormal VEP may indicate a problem with the visual information reaching the cortex VEP is very sensitive to optical blurring, can thus be used as a method of refraction in very young patient
  13. 13. VEP VEP is useful in the determination of problems such as amblyopia, cortical blindness, and visual impairment
  14. 14. 5.Opto kinetic nystagmus Commonly used Test in Neonates Test object moves in one direction Based on observation of Pendular Eye movements Slow following phase & rapid recovery phase. Good correlation with subjective acuity.
  15. 15. Drawbacks of Optokinetic Nystagmus Overestimates the visual acuity as the target is moving
  16. 16. 6.Catford Drum test Based on observation of Pendular Eye movements Testing distance is 60 cm It comprises of white cylinder marked with black dots of increasing size corresponding to visual acuities The drum is masked by a screen except for a rectangular aperture which exposes a single spot Spot is made to oscillate horizontally and stimulates eye movement
  17. 17. Draw backs Overestimate vision as target is moving and test is conducted at short working distance Unreliable for Amblyopia Screening
  18. 18. Testing Of Uniocular Amblyopia In Infants Occluding Amblyopic eye child does not resist. while occluding the normal eye, child resists the occlusion.
  19. 19. Vision test in 1-2 years
  20. 20. 1.Worth's ivory ball test: Commonly Used Based on Quality of Fixation Ivory balls ranging from 0.5" to 1.5" , rolled on floor at a distance of about 3 metres. Child is asked to retrieve each ball Rough estimate of visual acuity is made from the size of smallest ball which the child can see
  21. 21. 2.Boeck Candy Test Child picks up only those candy beads which he can see easily Beads of different sizes are shown to child and is expected to pick them up This gives approximate estimation of visual acuity
  22. 22. 3.Screening Test for Young Children and Retards [STYCAR] Based on Pursuit Eye movements Ten Balls rolled across a well illuminating contrasting floor 3m away from child Pursuit Eye movements indicate that they are seen
  23. 23. Vision Test in 2-3 years
  24. 24. 1.Cardiff Acuity Test Principle: vanishing optotype Target - pictures, of the same overall size, drawn in decreasing widths of white space Acuity is determined by the narrowest white band for which the target is visible to the child Child naturally prefers to look at a target figure rather than the blank end of the stimulus.
  25. 25. 2.Miniature Toy Test Was previously used for Handicapped children and low Intellegence patient Component of STYCAR Test 2 sets of Miniature object are used One set is with Examiner standing at 10ft and child is asked to pickup similar objects from his own set
  26. 26. 3.Coin Test Coins of different sizes are shown to child and is Child picks up only those coins which he can see easily expected to pick them up
  27. 27. 4.LEA Symbol test Used in children age between 2- Good for amblyopic patient to avoid crowding phenomenon.
  28. 28. Vision test in 3-5 years
  29. 29. 1.Allen’s Picture Cards It is recorded same as Snellens Acuity test Instead of letters child identifies picture at a distance of 6m.
  30. 30. 2.Sheridan letter test It uses 5 letters HOTV & X A&U are added in 7 letter set Examiner shows cards having small range of letters at 3m Child points at one of the card identical to the examiner card
  31. 31. 3.Lippmans HOTV test Simpler version of Sheridan's test using only 4 letters HOTV. Test distance 3 meter
  32. 32. Vision Test in 5-6 Years and above
  33. 33. 1.Snellens Visual Acuity Test Most commonly used Smallest Object which can be resolved by the eye substends the same visual angle at the nodal point of the eye i.e 5 min of arc The test employs a chart with rows of letters with diminishing size
  34. 34. Each row is accorded a number indicating the distance in meters at which a person with normal visual acuity should correctly identify the letters Testing distance is 6m
  35. 35. 2.LogMAR Visual Acuity Charts Based on Minimum Angle of Resolution More Precise than Snellen Test Have regular progression in the size and spacing of the letters from one line to next Same number of letters on every line
  36. 36. 3.Tumbling E Test Based on Minimum Separable distance Task is to identify the direction in which the limb of E points Identification of the last line gives visual acuity
  37. 37. 4.Landolt’s Broken Ring Chart Most Commonly used Based on Minimum Separable distance. The rings are constructed on the same basis as that of Snellens Child is instructed to indicate by the motion of the hand at which point each one is broken Interpretation of the last line identified by the child determines visual acuity
  38. 38. Conclusion Despite the development of methods appropriate to different ages, measuring acuity remains difficult in infants. In addition, many techniques require special equipment and conditions, making them unsuitable for some settings
  39. 39. Cont……….. Whichever method is used to measure a child’s vision, it is important to assess vision corrected for any refractive errors, and to assess the eyes separately as well as together whenever possible
  40. 40. Thank You

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