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Ophthalmic screening in children :children_crossing: (Postnatal anatomical…

- - - - At birth
        
        Horizontal palpebral fissure as long as childhood
        
        Vertical palpebral fissure = 1/2 size of adult
        
        Diameter of eye ~66% of adult
        
        Eye size (globe) about 80% of adult
        
        AP length:
        
        Infant 17 mm (as anatomy สั้นกว่าเลยทำให้ focus ยาวกว่าลูกตา so it's normal for infant to have สายตายาว)
        
        Older childhood (7-8 y/o) or Adult 22-24 mm
        
        All normal NB can have Hyperopic eye status
      - In Newborn
        
        Iris
        
        Dilator ms not well deve at birth ➭ miotic pupil in infant
        
        Additional pigment continue deposited in anterior iris stroma
        
        Retina
        
        1stmonth fovea mature
        
        Retinal vasculature start fr optic disc ➭ peripheral
        
        Nasal retina: start GA4mo. ➭ complete at GA8mo.
        
        Temporal retina: together w/ nasal retina but remain immature retinal vasculature until 2-3wk post delivery
        
        Sclera
        
        = 1/2 thickness of adult
      - :star2: 1-2 y/o is most important period of visual deve then
        Continue to development until 8-12 y/o (then many structure like adulthood)
  - - - CSM :rabbit:
      - Preferential looking
      - Visual-evoked potential (VEP)
      - Optokinetic nystagmus
      - depends on cognitive and interest
    - - birth ➭ VA 20/800 to 20/400 by VEP
      - 4mo. ➭ VA 20/200
      - 18-30mo. ➭ VA 20/20 (depend on many factor)
      - VEP จะได้ค่าเร็ว! 12mo. ➭ VA 20/20
        
        reasons?
        
        VEP อาศัย primary visual cortex but
        ขบวนการรับรู้ของเด็ก ต้องใช้ Higher cortical func ร่วมด้วย
        ➭ so VA by VEP ดีกว่าความเป็นจริง
        
        as VEP detect just Electrical activity ➭ เครื่องก็แปลว่า child can see ละ
      - CSM, Preferential looking & Optokinetic nystagmus
        need motor response in evaluation ➭ may got VA less than reality esp in child with Ocular motor apraxia
        :cherry_blossom: Ocular motor apraxia = motor speech disorder causing hard for child to speak
    - - :star:No eye contact 2-3mo. (allows up to 5 mo.):star:
      - Any nystagmus
      - Roving or Wandering eye movement (posterior visual PW defect)
      - Oculodigital sign
        (sign of retinal ds, it induce Phosphene)
  - - - normal = C (central) แสงตกกลางตา
      - abnormal = UC (uncentral)
    - - normal = S มองตามได้
      - abnormal = US (unsteadiness)
    - - normal = M มองตามได้หลังเปิดตาสองข้าง
      - abnormal -- can't maintain fixation ➭ meaning got difference of VA between both eyes ➭ that side risks of Amblyopia
- - - - 3-5 y/o pay attention to detail of toy
      - School child exam as game & child be the winner
    - - :one: need cooperation
      - :two: not need cooperation
        
        < 4 mo ➭ usu. exam on not need co-op ➭ Ant. & Post. segment, Retinoscope
        
        4 mo. ➭ good co-op may be exam on part VA, ocular alignment
        
        :bear: One toy One look rule
        (if many toys ➭will distract child resulting in unfocus child)
        
        Type of test
        
        Ophthamoscopy
        
        Pupil exmaination
        
        Retinoscopy
        (วัดเอาสะท้อนลูกตาแล้วปรับจนเห็นภาพ neutral)
        
        these tests don't need toys but if not co-op ➭ keep them hungry (ดูดนมขวดหรือดูดนมแม่ก่อนสักพัก) but if stll not co-op ➭ other options
        
        Sedate by Choral hydrate
        
        Restrain โดยใช้ผ้าห่อตัว
    - - :one: Inspection
        
        Lid fissure
        
        Head position
        
        Facial asymmetry
        
        Hypertelorism (ตาห่าง)
        
        Fixation preference (look for Amblyopia)
        
        Constant deviation
        
        Nystgamus
      - :two: Visual behavior
        
        Observation
        
        Eye contact
        
        Smile to smile
        
        Nystagmus
        
        Fixation and follow
        
        Examination
        
        Complete eye exam
        
        Pupil response
        
        OKN (Optokinetic nystagmus)
        
        CSM
        
        2-4 y/o:
        
        :one: Allen card
        
        :two: LEA symbol
        
        :three: HOTV (with matching)
        
        4y/o up:
        
        :one: Allen picture chart
        
        :two: E-chart
        
        :three: Standard Snellen chart
        
        If kid can't see ➭ confirm with electroretinogram (ERG), visual evoked potential (VEP)
        
        Teller acuity card
        (using preferential looking technique)
        
        Near fixation target
        (for accommodation stimulation)
        
        Distance fixation target
        (get attention)
      - :three: Eye examination :tokyo_tower: :recycle:
        
        Slit lamp
        
        if can't examine ➭ uses Direct ophthalmoscope
        
        Intraocular pressure
        
        Refraction
        
        Fundus examination
        
        Motility & Sensory examination
        
        Pupil exam
        
        Red reflex
        
        Visual filed