Examination techniquesExamination techniques

Lecture 4 Lecture 4

Mutez Gharaibeh,MDMutez Gharaibeh,MD

Start with inspection.Start with inspection.

Be friendly Be friendly Toys Toys Avoid white coatsAvoid white coats

Behave as a child , think as a man Behave as a child , think as a man

HistoryHistory

Why they are here Why they are here

Birth history Birth history

Developmental history Developmental history

General health General health

Family history Family history

SymptomsSymptoms

Red spot in the eye Red spot in the eye

Squint Squint

Epiphora Epiphora

Rubbing his eyes Rubbing his eyes

Uncomfortable in bright light (photophobia)Uncomfortable in bright light (photophobia)

OthersOthers

Sits close to TV Sits close to TV

Not good with colors Not good with colors

Blinks a lot Blinks a lot

HeadacheHeadache

AsthenopiaAsthenopia

……. Etc . Etc

HeadacheHeadache

DiplopiaDiplopia

Monocular Vs BinocularMonocular Vs Binocular

Muscle Muscle Nerve Nerve Neuromuscular Neuromuscular Orbit Orbit Brain stem/BrainBrain stem/Brain

Refractive Refractive

ExaminationExamination

Visual acuity Visual acuity InspectionInspectionHirschburg test ( cornea light reflex)Hirschburg test ( cornea light reflex)Extraocular movements Extraocular movements Cover/ uncover testCover/ uncover testSlit lamp test Slit lamp test Pupils Pupils FundiFundiStereopsisStereopsis

Visual acuityVisual acuity<18 Mo<18 Mo

Response to occlusion Response to occlusion

Hundreds and thousands ( > 6 mo)Hundreds and thousands ( > 6 mo)

CSMCSM

Central Steady MaintainedCentral Steady Maintained

UCUSUMUCUSUM

Visual acuity cardsVisual acuity cards

Forced choice preferential looking Forced choice preferential looking

The forced choice preferential lookingThe forced choice preferential looking

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

Visual acuity cardsVisual acuity cards

Keeler acuity cardsKeeler acuity cards

Teller acuity cardsTeller acuity cards

Teller cardsTeller cards

High contrast ,black-White square grating High contrast ,black-White square grating patch on a uniform grey cards.patch on a uniform grey cards.

Infants may appreciate the edge between Infants may appreciate the edge between the grating patch and the grey background the grating patch and the grey background ( overestimates visualacuity ).( overestimates visualacuity ).

This is overcome by the Keeler cards.This is overcome by the Keeler cards.

Cardiff testCardiff test

> 12 Mo.> 12 Mo.

18-3618-36 MoMo

Acuity cards .Acuity cards .

Cardiff card.Cardiff card.

Kay pictures Kay pictures

Lea symbolsLea symbols

Sheridan-Gardiner testSheridan-Gardiner test

A,H,O,T,U,VA,H,O,T,U,V

3-53-5 yryr

Kay picture test Kay picture test

Sheridan –Gardiner testSheridan –Gardiner test

> 5 r> 5 r …… …… Snellen charts / LogMAR charts … Snellen charts / LogMAR charts …

etc etc

RefractionRefraction

RetinoscopyRetinoscopy

Static retinoscopyStatic retinoscopy

Distance fixation retinoscopy.Distance fixation retinoscopy.

Cycloplegic refraction.Cycloplegic refraction.

Retinoscopy under sedation ( sleep).Retinoscopy under sedation ( sleep).

Near fixation retinoscopy( +/- Mohindra Near fixation retinoscopy( +/- Mohindra technique)technique)

Who should have cycloplegic Who should have cycloplegic refractionrefraction? ?

Poor fixators Poor fixators

Any child with squint Any child with squint

When you suspect accommodatino spasm When you suspect accommodatino spasm

Variable dry refractino results Variable dry refractino results

When dry refraction --- manifest refraction donot When dry refraction --- manifest refraction donot match match

Newly diagnosed / rapidly increasing myopia Newly diagnosed / rapidly increasing myopia

Follow up of hypermetroipa Follow up of hypermetroipa

Dilating dropsDilating drops

Near fixation retinoscopyNear fixation retinoscopy

Barret methodBarret methodDim lightDim lightUsually 67 cm working distance Usually 67 cm working distance A lens of equivalent diopteric power in A lens of equivalent diopteric power in front of each eyefront of each eyeFocus on featureless objectsFocus on featureless objectsFog nonexamined eyeFog nonexamined eye

PMTPMT

Subjective refraction is rarely possible < 5 Subjective refraction is rarely possible < 5 yr of age .yr of age .

Guessing Guessing

Short attention spanShort attention span

Continue your examContinue your exam

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