Pediatric optometry 1100-4BW25

The lecture is intended to prepare students for independent optometric work with children. Due to the responsibility of a specialist managing a minor, the topic is discussed in many threads. The lecture begins with a detailed description of the development of the visual system and human development as an inseparable whole. Piaget's division of human development is presented. Individual milestones in the development of the visual system and other systems, especially the motor system, are discussed by month (up to 2 years of age) and then by years (above 2 years of age). Awareness of the existence of milestones at individual stages of development allows future optometrists to assess the regularity of the child's vision development and implement appropriate measures before negative adaptive mechanisms become entrenched. Similarly, assessment of the child's body development allows for appropriate referral to another specialist. Then the lecture explores the psychological aspects of contact with the child and parent. The psychology of contact with a child is a very important, often overlooked area of work with a patient from this age group - it has a significant impact on the possibility of performing an examination of the child. The relationship built with the child and parent increases the chances of following the recommendations.
The components of the interview preceding the optometric examination are presented, including the child's health history (with prenatal history). Some other therapies that a child with visual impairment may undergo are mentioned for better collaboration with other specialists. Individual optometric tests used to diagnose various aspects of the visual system are discussed, along with the methodology of conducting them in children in particular age groups. Visual acuity tests are described for the group of infants and non-verbal children, such as: Lea Gratings, Teller Preferential Looking, visual evoked potentials (VEPs), method of assessing eye mobility in this age group, methods of assessing the state of refraction such as dynamic retinoscopy, Mohindra retinoscopy, photorefraction, autorefractometry and pharmacological agents for cycloplegia, tests for assessing the state of binocular vision such as the Hirschberg test (with the assessment of the kappa angle), the Krimsky test, the modified cover test, the Bruckner test, and tests for assessing stereoscopic vision. In order to provide appropriate primary care optometry and timely referrals for further diagnostics, methods of examining eye health, the most important diseases (including leukocoria, retinopathy of prematurity) occurring in this age group and their treatment are discussed. Optometric examination procedures used in older children are presented. Visual acuity, including using the Snellen test, LEA, broken whel test, tumbling E test, differential tests, refractive status with static retinoscopy, eye movement test with a detailed description of the NSUCO oculomotor test, tests to assess eye positioning, tests for assessing muscle paralysis in unaccompanied strabismus with particular emphasis on Parks' 3-step test, AC/A ratio, examination of binocular vision with a description of cases of the Worth test, examination of vergence ranges with the SILO concept, examination of retinal correspondence, examination of the state of fixation with a discussion of cases of eccentric fixation , and examination of the state of accommodation is discussed. Areas of visual perception are presented, including visual discrimination, figure/ground, visual closure, spatial relations, form stability, visual memory (short-term, sequential). Tests to assess visual information processing, visual-auditory integration and visual-motor integration are presented, including: Gesell Copy Forms​, Monroe Visual Three​, Incomplete Man​, Piaget Left/Right​, Motor-Free Visual Perception Test​, Beery-Buketnica Visual Motor Integration Test (Berry-VMI)​, Auditory-Visual Integration Test (AVIT)​, Developmental Eye Movement Test. A. M. Skeffington's model of vision and the model of near-point stress are presented, along with the adaptive mechanisms accompanying the phenomenon of near point stress and methods of managing patients with symptoms typical for near-point stress. The method of dealing with pseudomyopia is discussed. Optical methods of controlling the progression of myopia and the essence of visual hygiene in myopia are mentioned. Primary reflexes and the impact of persistent primary reflexes on the functioning of the body, in particular the visual system, are discussed. In particular, primary reflexes the persistence of which has the greatest impact on the visual system, such as the MORO reflex, tonic labyrinthine reflex, asymmetric tonic neck reflex, symmetric tonic neck reflex, Galant reflex, Palmar reflex are presented. The role of an optometrist in working with patients in autism spectrum disorder (ASD) is presented. The neurological basis of autism, the visual system symptoms typical for people in ASD and their neurological basis are presented. Tools used by optometrists to improve the functioning of the visual system (and/or behavioral changes) in children with ASD are discussed, in particular: compensatory lenses, therapeutic lenses, prisms, filters, sector occlusions, optometric vision therapy and optometric phototherapy.