Introduction to Pediatric Optometry

Dr. Amr Abdulaziz Hamzah

MBBS,CABO,JBO,FICO,FPOS
Pediatric ophthalmology consultant
 Marks distribution
• 1st quiz ( 10 marks)

• Mid-term (20 marks) “ short answers + MCQ”

• Evaluation (10 marks)

• Assignment (15 marks)

• Final ( 45 marks) “ short answers + MCQ”

 Objective and Course Content
•A child's eye is not just a smaller version of an adult's eye.

• The child's visual system is not fully developed or mature until the age of eight or nine years.

•Because of the immaturity of the visual system, disorders that have little or no effect on an adult may cause severe visual loss in a child if not

detected and treated early in life.

•This class will introduce the student to the normal development of the structures of the eye and their stage of development at birth. Of

importance will be categorizing them into different age brackets.

• This is necessary because of the continual differentiation of the visual system.

The various categories are:

(a) Newborn - from birth to 1 month of age,

(b) Infant - from 2 months to 1 year of age,

(c) Toddler - from 1 year to 3 years of age.

 Objective and Course Content
•The students will have a general recap of the visual pathway and the clinical assessment and management of
the young patients with emphasis on the modification of standard clinical procedures to accommodate the
very young patient and how the development of various visual functions impacts treatment and management
decisions.

•This will be achieved through lectures with clinical scenarios in which the student will be required to engage
in direct patient care, including factors that may affect normal visual development and the possible effects of
these factors on the child visual system.
 Objective and Course Content

This class will provide the student with the knowledge and experience specific to
pediatric optometry so that the student will show the following understanding and
abilities:

 Knowledge of the developments of the eye and the child visual system
 The ability to select and administrate diagnostic tools to evaluate the child visual
system and identify anomalies in a patient scenario.
 The ability to selects an alternate method to diagnose and evaluate the child visual
system and identify anomalies in a patient scenario.
 The ability to determine the appropriate sequence and application of tests for
sensory visual evaluation, based on the findings of ophthalmic examination.
 Objective and Course Content

Topics

1. Embryology: Is the study of the formation and development of the eye from conception, till birth.
We will be looking at the normal development of the structures of the eye and their stage of development at birth.
We will then consider the more common abnormalities associated with structural development of the e that can be
noticed at birth.

2. Visual pathway: We will have a general recap of the visual pathway, considering the myelination of the optic
nerve fibers, decussating of the fibers and connections to various layers of the visual cortex. We will also look at
the OKN pathways through the superior colliculus. This is important in the consideration of findings when OKN
methods are used in the examination of visual acuity.

3. Visual function and perceptual skills: Here, we will be looking at the developmental norms of vision i.e.
visual acuity, stereopsis, fusional ability and refractive errors, taking into consideration further differentiation,
migration and maturation of the hardware involved in normal visual perception. Of particular interest will be the
Rods and Cones migration to the periphery and macular regions and how this affects visual perception.
 Objective and Course Content
Topics
4. Examination , diagnosis and treatments

A- Case history:

For good and proper examination of the patient, it is of paramount importance that a very good and exhaustive CASE
HISTORY of the patient is taken.
Depending on the age of the patient, and the CHIEF COMPLAINT, the examiner should have as part of the case history,
• The Family history
• History of mother’s health, medication , use of drugs or any other difficulties or complications during pregnancy.
• Events surrounding the delivery of the patient, complications at birth.
• For older infants the examiner should be interested in whether the patient meets the various developmental milestones for
age; visually, physically, acoustically and socially.

B. Visual acuity

Following the case history, the patients VISUAL ACUITY is then determined. This is done first as in adult
cases so as to know the level of vision the patient came into the examination room with.
We will discuss the types of visual acuity usually measured in the clinic, viz.; Recognition, Resolution and
Detection acuities depending on the type of acuity test used. The three major methods of VA determination
 Objective and Course Content
Topics
4. Examination , diagnosis and treatments
C- Objective examination

This will include external eye examination.

• A pen torch with a slit and magnifier can then be used to examine the anterior segment.
• Indirect ophthalmoscope can be performed to ascertain the health of the vitreous and the retina (FUNDUS).
• Cycloplegic refraction & retinoscopy .

Other important tests that we will look at as part of the basic tests to be performed be the Optometrist as essential parts of the basic routine
in Pediatric patients are the COVER TEST, Test of STEREOPSIS, PUPILLARY REFLEXES and ACCOMMODATION.
These tests will be discussed in detail, as they are objective tests that inform us about the integrity of the visual pathway and cortex

D- Subjective examination
The tests used in subjective examination are the same as for adult population. It follows therefore that these groups of tests will be
performed on the older more cooperative children

E- Treatments and case study

We will look at the treatment and prescription criteria for a number of conditions that we are likely to come across in practice. We will
consider treatment for tropias, amblyopia, Nystagmus, vergences problems etc. Interesting cases studies will be discussed in the lectures.
 Course Plan
Lecture
Topics
Introduction 1
Embryology & congenital ocular anomalies 2
Visual pathways & OKN 3
Visual function & developmental milestones 4
Revision & 1st quiz 5
History taking & examination (A) 6
History taking & examination (B) 7
Mid-Term Exam 8
History taking & examination (C) 9
History taking & examination (D) 10
Case presentations (1) 11
Case presentations (2) 12
Students presentations 13
Final Exam 14
Importance of pediatric optometry
 Magnitude of the problem
• 46% of Yemeni population under 15 years of age.(15 million children).

• Prevalence of childhood blindness.

• Overall, 60%-70% of blindness in children is avoidable and/or treatable.

• Rest 30% require low vision & rehabilitation care.

 Impact of treating children !
• The vision that you save in childhood will serve your patients their whole
lives.

• Operate adult cataract: gain 20 years of vision!

• Operate infantile cataract: gain 80 years of vision!

• If amblyopia is treated appropriately, you will have patients coming back with
dramatically better vision at each visit, knowing that they will get to keep this
their whole life !
Discussion