1. Examination techniques Lecture 4 Mutez Gharaibeh,MD

2. Start with inspection.

3. Be friendly Toys Avoid white coats Behave as a child, think as a man

4. History Why they are here Birth history Developmental history General health Family history

5. Symptoms Red spot in the eye

6. Squint

7. Epiphora

8. Rubbing his eyes

9. Uncomfortable in bright light (photophobia)

10. Others Sits close to TV Not good with colors Blinks a lot HeadacheAsthenopia …. Etc

11. Headache

12. Diplopia Monocular Vs Binocular MuscleNerveNeuromuscularOrbit Brain stem/Brain Refractive

13. Examination Visual acuity Inspection Hirschburg test ( cornea light reflex) Extraocular movements Cover/ uncover test Slit lamp test PupilsFundiStereopsis

14. Visual acuity <18 Mo Response to occlusion Hundreds and thousands ( > 6 mo)

15. CSM Central Steady Maintained UCUSUM

16. Visual acuity cards Forced choice preferential looking

17. The forced choice preferential looking The forced choice preferential looking technique is very similar to the preferential looking technique, except that two or more stimuli are presented at the same time. If the infant shows a preference for one stimulus over the other(s), the difference it and the others must be one that they can see. If the infant shows a preference for one stimulus over the other(s), the difference it and the others must be one that they can see. For the researcher to know which differences the infant is responding to, the stimuli should differ on only one dimension. For example, if used to study developmental changes in contrast sensitivity, the stimuli should differ only in contrast and not other dimensions such as spatial frequency or luminance. For the researcher to know which differences the infant is responding to, the stimuli should differ on only one dimension. For example, if used to study developmental changes in contrast sensitivity, the stimuli should differ only in contrast and not other dimensions such as spatial frequency or luminance.

18. Visual acuity cards Keeler acuity cards Teller acuity cards

19. Teller cards High contrast,black-White square grating patch on a uniform grey cards. Infants may appreciate the edge between the grating patch and the grey background ( overestimates visualacuity ). This is overcome by the Keeler cards.

20. Cardiff test > 12 Mo.

21. 18-36 Mo Acuity cards. Cardiff card. Kay pictures

22. Lea symbols

23. Sheridan-Gardiner test A,H,O,T,U,V

24. 3-5 yr Kay picture test Sheridan –Gardiner test > 5 r  …… Snellen charts / LogMAR charts … etc

25. Refraction Retinoscopy

26. Static retinoscopy Distance fixation retinoscopy. Cycloplegic refraction. Retinoscopy under sedation ( sleep). Near fixation retinoscopy( +/- Mohindra technique)

27. Who should have cycloplegic refraction ? Poor fixators Any child with squint When you suspect accommodatino spasm Variable dry refractino results When dry refraction --- manifest refraction donot match Newly diagnosed / rapidly increasing myopia Follow up of hypermetroipa

28. Dilating drops

29. Near fixation retinoscopy Near fixation retinoscopy Barret method Dim light Usually 67 cm working distance A lens of equivalent diopteric power in front of each eye Focus on featureless objects Fog nonexamined eye

30. PMT Subjective refraction is rarely possible < 5 yr of age. Guessing Short attention span

31. Continue your exam Next time Next time