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”
Good-Lite 1155 Jansen
Farm Drive, Elgin, IL 60123
www.goodlite.com
www.richmondproducts.c
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www.schoolhealth.com
I have no commercial
interest !
Measure Acuity in Each Eye

>

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 ½ 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 1st 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 Children’s Vision Screening
PEDIATRICS Vol. 109 No. 3 March 2002, pp. 524-52

Use of Photoscreening for Children’s 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

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)

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 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 !