Pediatric Eye Examination Research Articles

Use of a capsule toy as a competent assistant for pediatric eye examination

Use of a capsule toy as a competent assistant for pediatric eye examination

Pediatric Ophthalmology: Amblyopia (Lazy Eye), Strabismus, and Pediatric Eye Examinations

The preset study was conducted to review updates of the literature regarding clinical problems related to pediatric ophthalmology including amblyopia (lazy Eye), strabismus, and pediatric eye examinations. The field of pediatric ophthalmology is responsible for the discovery and treatment of vision abnormalities in children, both of which are extremely important obligations that fall under its purview. This subspecialty of pediatrics focuses on the treatment of ocular disorders in children. Both amblyopia and strabismus are prevalent disorders that, if left untreated, can have long- term negative repercussions on a person's vision. Amblyopia is more common than strabismus. The condition known as amblyopia is defined by a lack of eye movement, whereas strabismus is characterized by eyes that are turned inward. It is only via the delivery of routine eye examinations to juvenile patients that it is possible to detect these diseases as well as other abnormalities of the eye at an early stage. This not only paves the way for fast treatment but also provides the best visual outcomes that are achievable. Eye exams should be a priority for both parents and healthcare providers so that children can reach their full potential in terms of their visual development. This will allow children to attain their full potential as adults. Because of this, the child's eyes will be able to grow and develop to their full potential.

Proposal for a Common Nomenclature and Risk-Based Approach to Pediatric Eye Health Screening and Examinations: Why, Who, and How?

Proposal for a Common Nomenclature and Risk-Based Approach to Pediatric Eye Health Screening and Examinations: Why, Who, and How?

Validation Comparison Between Near Visual Acuity Optotypes within a Pediatric Population

Near visual acuity measurement is an important aspect of pediatric eye examinations. Reduced near acuity may affect prescribed lenses or treatments, and can represent impactful visual dysfunction. The purpose of this study is to evaluate binocular near acuity using five different child-friendly common optotypes, and to contrast results among the optotypes and their consistency with binocular distance VA.

A study of referral pattern to pediatric ophthalmology department in a tertiary eye-care center of South-India.

Purpose:The study was aimed at finding out the present pattern of referrals to the Pediatric Ophthalmology outpatient department (OPD) in a tertiary eye care hospital and thus identify the discrepancy of referral, if any, which would help to modify and enhance the practice guidelines.Methods:The study was conducted by retrospectively collecting data from all referral letters that were already uploaded in the Electronic Medical Report (EMR) against all patients from June 2019 to December 2019. All pediatric patients in the age group of 0–16 years were included in the study. The practicing field of referring clinicians was noted along with the maximum information that could be collected from the referral letter and were thus assessed for the quality, accuracy, and timely referral.Results:Out of 77 referrals received in the study period, six referral letters neither had any mention of the designation of the referring clinician nor any specific diagnosis or details. Thus, only 71 patients were included for further study. The referring clinicians were mainly ophthalmologists, pediatricians, general practitioners (GPs), and others (cardiologists, neurologists). Maximum patients were referred by ophthalmologists (76%) but visual acuity was noted only for 30% of these patients. Almost half of the referral diagnosis was accurate. Pediatrician referrals were found to be more detailed and précised.Conclusion:There is a need for a standardized hospital-specific format of referrals and basic training to primary care providers on some simple tests (Lights reflex tests) for identifying the “red flags” in pediatric eye examination and thus enhancing the quality and timely referral per se.

The Pediatric Examination Assessment Rubric (PEAR) toolkit: reliability study

The Pediatric Examination Assessment Rubric (PEAR) toolkit consists of an examination sheet and rubric designed to assess ophthalmology residents' performance on the pediatric eye examination. The purpose of this study was to evaluate the reliability of the PEAR toolkit. Six ophthalmology residents (2 PGY-2, 4 PGY-3) at a single ACGME-accredited US program participated in 11 video-recorded pediatric ophthalmology patient encounters. Two pediatric ophthalmologists reviewed the videos and the residents' examination sheets to complete a PEAR evaluation. The inter-rater reliability of the rating for each of the 12 examination skills evaluated using PEAR was determined using kappa statistics, and reliability strength was categorized based on published guidelines (≤0, poor; 0-0.20, slight; 0.21-0.40, fair; 0.41-0.60, moderate; 0.41-0.60, substantial; 0.81-1.00, almost perfect). Eleven video encounters were completed. Of the 12 examination skills evaluated using PEAR, 9 had kappa scores with strengths of moderate to almost perfect reliability. Two examination skills, Worth 4-Dot and alignment, showed fair reliability. A kappa score could not be calculated for stereoacuity because of the lack of variability among the evaluators' raw scores. In our small sample of residents from a single institution, the PEAR toolkit showed inter-rater reliability.

Enhancing Strabismus Education through Interactive Learning Multimedia

The objective of our project was to create an interactive online educational module that integrates biomechanics of the eye with its underlying anatomy to allow for a comprehensive understanding of pediatric strabismus and its clinical detection to prevent amblyopia.Amblyopia is the leading cause of monocular vision loss in the pediatric population, affecting 3–5% of children. Untreated, it leads to irreversible visual impairment in an otherwise structurally normal eye and can have significant effects on quality of life that impact self‐esteem and restrict career opportunities due to loss of stereopsis. Majority of cases are caused by strabismus, a condition resulting in the ocular misalignment of the eye. Early intervention significantly improves vision outcomes and psychosocial well‐being of the patient, however requires prompt and skilled detection. The pediatric eye examination can be inherently challenging, particularly considering the low emphasis on ophthalmology teaching in medical school curricula. Primary care residents and undergraduate medical student trainees often report low levels of comfort performing screening eye examinations and managing common pediatric ophthalmological presentations. Integration of open educational resources such as interactive clinical skills modules can effectively advance ophthalmology education and promote prompt detection of pediatric strabismus, with the goal of mitigating serious ophthalmic complications and improving overall patient care.To effectively address these educational challenges, we have developed an innovative online module that correlates ocular anatomy to biomechanical mechanisms, and provides practical guidelines to clinical examination. The module focuses on the pediatric eye examination, evaluating for amblyopia & strabismus, and was created through an international collaboration with experts in anatomy, education, and neuro‐ophthalmology to optimize content delivery and integrate clinical relevance. It offers a variety of interactive activities to engage student learning and concludes with a set of virtual cases entailing simulated clinical examination to assess acquired knowledge. Critical feedback will be collected using a student experience survey at the beginning and end of the module to solicit response regarding effectiveness of content delivery, preference of educational media, and comfort conducting a strabismus clinical examination.This international effort aims to significantly improve confidence performing clinical examination, guide prompt amblyopia detection in the pediatric population, and prevent development of its irrevocable complications.

National consensus statement regarding pediatric eye examination, refraction, and amblyopia management.

Childhood blindness causes significant social and economic burden. Even though pediatric eye care has gained priority under Vision 2020, it continues to come under the purview of tertiary care centers due to lack of knowhow and facilities at primary and secondary level. Currently, India does not have standard guidelines on pediatric eye examination, refraction, and amblyopia management and therefore these are being managed inadequately or inappropriately. In view of this, an expert group of pediatric ophthalmologists from across the country met under the aegis of All India Ophthalmological Society, and deliberated to reach a consensus on the correct method of pediatric eye examination, treating refractive error in children and managing amblyopia. The purpose of the consensus statement was to enable all ophthalmologists to have a broad set of guidelines, which can form the basic framework for managing common pediatric eye conditions, in most ophthalmic setups. The consensus statement is divided into three broad categories: Pediatric eye examination, pediatric refraction, and amblyopia management. The pediatric eye exam subsection discusses the recommended clinical history, which should be taken and the essential components of an ophthalmic examination including pediatric vision assessment. Additionally, it discusses the role of special tests and investigations such as imaging and electrophysiology. The section on pediatric refraction emphasizes the correct use of cycloplegia and prescribing glasses in the Indian context. The final section on amblyopia management presents the various options of treating amblyopia and provides standard guidelines for the use of occlusion therapy and its weaning over time.

Pediatric ophthalmology, strabismus and neuro-ophthalmology practice in the COVID-19 era: All India Ophthalmological Society guidelines.

The COVID-19 Pandemic has prompted substantial changes in the way ophthalmology is practiced globally. General guidelines on safe ophthalmic practice have been issued by various bodies across the globe including the All India Ophthalmological Society. While these are suitable to ophthalmology overall, they are not entirely suitable to a subspecialty practice, particularly pediatric ophthalmology, strabismus and neuro-ophthalmology, which entails dealing with children, surgery under general anesthesia and managing possible life threatening situations. A group of sub-specialists and anesthetists met virtually and arrived at a consensus with regard to practice and general anesthesia protocols pertaining to these subspecialties of ophthalmology. The recommendations made by the expert group are specific yet can be universally followed to ensure the best and safest outcome for the practitioner and patient alike. The recommendations pertain to listing conditions which need emergency or urgent care in the fields of pediatric ophthalmology and neuro-ophthalmology, precautions and technique of pediatric and neuro-ophthalmic eye examination and a protocol for delivering a safe general anesthesia for a pediatriceye surgery.

Evidence-Based Clinical Practice Guideline: Comprehensive Pediatric Eye and Vision Examination

Republished with written permission granted from the American Optometric Association, October 2, 2020.

Commentary: Teleophthalmology is a different ball game for kids.

Playing doctor with children Working with kids and clinically examining children is difficult, while a proper ophthalmic examination is even more difficult Besides the obvious difficulty in getting a reliable history, one needs special skills and a kid-friendly personality to do a complete pediatric eye examination Pediatric ophthalmology outpatient departments are often specially designed with pictures, toys, entertainment, treats and play areas to put the children at ease so that parents and doctors can cajole the kids to allow a good eye examination Photo slit lamps and fundus cameras are used to send clinical images to the ophthalmologist, while vision, refraction and intraocular pressures are measured by the skilled personnel with specialized equipment

School bus accommodation-relaxing skiascopy.

ObjectiveAccurate estimation of hyperopia and astigmatism is challenging in delayed children. Conventional skiascopy holds rows of increasing power ± lenses vertically in front of one eye. The school bus accommodation-relaxing skiascopy (SBA-RS) design holds child-friendly, lenses +1 to +10D horizontally so that a higher power fogs the nontested eye-relaxing accommodation without cycloplegia.MethodsDesign: Evaluation of diagnostic test. Subjects: Patients undergoing comprehensive eye examination in a pediatric ophthalmology practice. Cycloplegic (cyclopentolate 1%) retinoscopy was compared to dry SBA-RS and Retinomax (Righton, Japan) during pediatric eye examinations. Outcome measures: correlations, Chi-square and receiver operating characteristic (ROC) curve.ResultsOf 470 patients with a median age 6 years, 238 were under the age of 60 months and 110 had developmental delays. For those with cycloplegic spherical equivalent hyperopia over 0.7 D, median (90% CI) value for retinoscopy was +2.63 D (+0.75, +6.88), for SBA-RS was +2.50 D (+0.50, +6.75) and less for 184 with Retinomax +1.88 D (−1.56, +6.13) but similar despite delays. Astigmatic cylinder SBA-RS +1.50 D (+0.25, +4.00) lagged retinoscopy +1.75 D (+0.75,+4.50) but Retinomax was greater +2.00 D (+0.25, +4.64). Cycloplegic refractive components such as spherical equivalent, cylinder, and J0 and J45 power vectors correlated highly and were near unity with SBA-RS and Retinomax with the latter deviating greater. SBA-RS screened for amblyopia risk factors up to 92% sensitive and 94% specific.ConclusionAccommodation-relaxing horizontal skiascopy very precisely estimates astigmatism power and axis and only lags cycloplegic refraction by about 0.15D in hyperopic patients fairly independent of neurodevelopmental delay. This technique can quickly estimate refraction even in delayed patients potentially reducing some need for cycloplegia.Clinical Trials RegistryNCT03668067.

Don’t Miss This! Red Flags in the Pediatric Eye Examination: Acquired Nystagmus

ABSTRACTWhen a new patient presents with a chief complaint of nystagmus, the clinician must know what further action is necessary in order to identify vision or life-threatening diseases. Some types of acquired nystagmus include upbeat nystagmus, downbeat nystagmus, see-saw nystagmus, and period alternating nystagmus. By identifying the characteristics and causes, acquired nystagmus can be recognized as a “red flag.” In contrast, children diagnosed with infantile or physiological nystagmus generally will not need neurological testing. As crucial as it is to recognize acquired nystagmus, it is equally important to differentiate among the specific subtypes and to be familiar with the key features of infantile nystagmus.

Don’t Miss This! Red Flags in the Pediatric Eye Examination: Introduction and Essential Concepts

ABSTRACTAlthough the pediatric eye examination can be made more challenging by inattention, poor cooperation, sleep, or just the wiggles, these should never be justification for an inadequate assessment of the child. In fact, a challenging patient should make the examiner ever more careful to get a good history and to look carefully for potential red flags that should be examined in greater detail. Missing a history of diplopia, or not noticing an abnormal pupil, or blurred disc margins, to name a few, may delay the diagnosis and treatment of potentially life-threatening entities. In this symposium, red flags in the pediatric eye examination will be reviewed in depth with emphasis on diagnosis, testing, and referral.

Don’t Miss This! Red Flags in the Pediatric Eye Examination: Ophthalmoplegia in Childhood

ABSTRACTParalytic strabismus in children is rare, occurring in about 0.1% of children. This rate is far less common than the 3% rate usually noted for comitant strabismus. The relative rates of ocular motor pareses were fourth nerve palsies in 36%, sixth in 33%, third in 22%, with multiple ocular motor nerve palsies in 9%. In a single population series from Minnesota, few cases were associated with neoplasm. However, institutional case series reports a high rate of neoplasm for acquired third nerve and sixth nerve palsies after excluding trauma and congenital causes. Tumor is rare in children with fourth cranial nerve palsies, usually associated with other neurologic disease. Rare causes of external ophthalmoplegia, to be considered when the motility pattern is variable or not fitting an ocular motor nerve pattern, include myasthenia gravis and congenital fibrosis of the extraocular muscles. Myasthenia most often presents as ptosis with exotropia. Rarer still is involvement of the extraocular muscles in childhood thyroid disease.

Don't Miss This! Red Flags in the Pediatric Eye Examination: Subnormal Acuity

ABSTRACTSubnormal vision can be a harbinger of threating disease. Recognizing certain “red flags” on history or examination can facilitate early diagnosis in the pediatric patient. These objective tests or subjective complaints may help differentiate true organic causes of vision loss from possible functional overlay, amblyopia or poor results due to an uncooperative child.

New Release of Evidence-Based Clinical Practice Guideline: Comprehensive Pediatric Eye and Vision Examination

New Release of Evidence-Based Clinical Practice Guideline: Comprehensive Pediatric Eye and Vision Examination

New Release of Evidence-Based Clinical Practice Guideline: Comprehensive Pediatric Eye and Vision Examination

New Release of Evidence-Based Clinical Practice Guideline: Comprehensive Pediatric Eye and Vision Examination

The Pediatric Eye Examination for Pediatric Neurologists

The pediatric eye examination can be challenging but may provide important diagnostic information to the pediatric neurologist. Most of the examination can be accomplished with toys (visual fixation targets), a penlight, and a direct ophthalmoscope. The most important aspect of assessing the afferent system is visual acuity testing. Based on the patient's age, this may be accomplished by testing the child's response to light, a moving visual target, or a formal visual acuity chart. Evaluation of pupillary size and response to light is critical to assessing both the afferent and efferent visual systems. Other components of efferent testing include evaluation of extraocular motility and ocular alignment. General ophthalmologic examination is important to assess for ocular pathology that may accompany neurologic disorders in children. Referral to ophthalmology for further testing should be considered in any child with an abnormality on the pediatric eye examination.

Physician effort in pediatric eye examination under anesthesia

Physician effort in pediatric eye examination under anesthesia