Vision Screening

Rudolph S. Wagner, MD

Director of Pediatric Ophthalmology and
Strabismus
UMDNJ New Jersey Medical School

August 2010 - Vietnam
Visual Acuity Testing
In what age groups should it be done ?
How should it be done ?
What diseases and conditions are we looking for ?
What constitutes a failed test ?
What do we do once a problem is identified ?
Birth to Three Years
Ocular History
Vision assessment
External Inspection
Ocular Motility
Assessment
Pupil examination
Red reflex
Examination


Visual Acuity Measurement
3 Years of Age
Picture Charts (LEA, LH, Allen,)
5 years of age (Snellen letters, E game, HOTV
Charts on wall at 3m (10ft) Note: Distance Acuity !!
Measure Binocularly First
Record Acuity in Each Eye Independently
Attempt Ophthalmoscopy

Failed Visual Acuity Screening
Fewer than 4 of 6 correct in either eye on the 10/20
(20/40) or 3/6 (6/12)
Any two line difference between eyes
Avoid Crowding Phenomenon

LEA Symbols Blur to OOOO
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Measure Acuity in Each Eye
>
V
Examiner Must Control
The Exam !
Refraction: Pin Hole ?
Astigmatism
Hyperopia
Myopia
Sure Sight Autorefractor
Slit Lamp and Ophthalmoscope
Cataract Screening
Screening Pre-Verbal Children
Screening for a Red Reflex
Reduce Room Lights and Focus at meter with 0 lens and
largest diameter of light
http://aappolicy.aappublications.org (AAP) Policy
statement on Red Reflex Exam

Leukocoria or White Pupil
Blurred Vision
Cataracts: Not All Visually
Significant
Not Always Cataracts !
Poor Vision Following Cataract
Surgery
YAG Laser Capsulotomy
Vision screening for pre-verbal and beyond
86% of children entering 1
st
grade have had no eye exam

20-25% of children enter school with vision problems that can affect
their development and progress

70% of school-age children who have learning disability have some
form of visual impairment

95% of visions disorders can be corrected if detected early

The best defense is early detection

Vision Assessment
Evaluate ability to fix and follow objects
Try cover/uncover test
Observe for Nystagmus
Developmental milestones: Smile to face (6 - 8 weeks)
, follow objects (3months)
Get the Child Happy and
Interested
Cover Each Eye and Observe Fixation and
Reaction to Occlusion
Left Eye Covered Right Eye Covered
Teller Acuity Cards
Assess visual acuity in
infants
Labor intensive
procedure!
Mostly used in
research studies
Photo Screening
Polaroid Instant
Photograph
Refractive Errors
Strabismus or Squint
Check aap.org
American Academy of
Pediatrics
AMERICAN ACADEMY OF PEDIATRICS
Use of Photoscreening for Childrens Vision Screening
PEDIATRICS Vol. 109 No. 3 March 2002, pp. 524-52



Use of Photoscreening for Childrens Vision Screening
This statement asserts that all children should be screened

for risk factors associated with amblyopia. Guidelines are
suggested

for the use of photoscreening as a technique for
the detection

of amblyopia and strabismus in children of
various age groups.

The American Academy of Pediatrics
favors additional research

of the efficacy and cost-
effectiveness of photoscreening as

a vision screening tool.


PediaVision PlusOptix S04
The PediaVision solution assists in the detection of :

Refractive errors
Amblyopia
Strabismus
Anisocoria
Central Media Opacities


Confidential
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http://www.pediavision.com/
Pediavision Instant Screening Results


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Pass/Refer results are user defined
and based on the following:

Near-sightedness (myopia)
Far-sightedness (hyperopia)
Unequal refractive power
(anisometropia)
Blurred vision, eye structure
problem (astigmatism)
Pupil size deviations (anisocoria)

The PediaVision Solution
The measuring principle is based on eccentric photo-retinoscopy.
Infrared light is projected through the pupil onto the retina.

Depending on the refractive error the reflected light forms a specific
brightness pattern within the pupil. The spherical refraction is
calculated based on this crescent pattern. To determine cylinder
and axis, the same measurement is repeated in three meridians.

Please refer to the Technical Information module for more specific
information on screening results.


PediaVision PlusOptix S04
The fully automated solution conducts:

a comprehensive refractive assessment
analyzes the pupil size
creates a gaze deviation chart
uses advanced digital imaging for quick reference
of more advanced issues



Field Testing of the PlusOPtix
S04
Arthur et al. AAPOS abstract 2008
94% agreement camera and exam
Sensitivity 83% Specificity 96%
Positive predictive value 74%
Only 1% untestable rate
Vision Screening: Anyone can
do it !