Examination techniques Examination techniques Lecture 4 Lecture 4 Mutez Gharaibeh,MD Mutez Gharaibeh,MD
Examination techniquesExamination techniques
Lecture 4 Lecture 4
Mutez Gharaibeh,MDMutez Gharaibeh,MD
Be friendly Be friendly Toys Toys Avoid white coatsAvoid white coats
Behave as a child , think as a man Behave as a child , think as a man
HistoryHistory
Why they are here Why they are here
Birth history Birth history
Developmental history Developmental history
General health General health
Family history Family history
OthersOthers
Sits close to TV Sits close to TV
Not good with colors Not good with colors
Blinks a lot Blinks a lot
HeadacheHeadache
AsthenopiaAsthenopia
……. Etc . Etc
DiplopiaDiplopia
Monocular Vs BinocularMonocular Vs Binocular
Muscle Muscle Nerve Nerve Neuromuscular Neuromuscular Orbit Orbit Brain stem/BrainBrain stem/Brain
Refractive Refractive
ExaminationExamination
Visual acuity Visual acuity InspectionInspectionHirschburg test ( cornea light reflex)Hirschburg test ( cornea light reflex)Extraocular movements Extraocular movements Cover/ uncover testCover/ uncover testSlit lamp test Slit lamp test Pupils Pupils FundiFundiStereopsisStereopsis
Visual acuityVisual acuity<18 Mo<18 Mo
Response to occlusion Response to occlusion
Hundreds and thousands ( > 6 mo)Hundreds and thousands ( > 6 mo)
Visual acuity cardsVisual acuity cards
Forced choice preferential looking Forced choice preferential looking
The forced choice preferential lookingThe forced choice preferential looking
The forced choice preferential looking technique is very The forced choice preferential looking technique is very similar to the preferential looking technique, except that similar to the preferential looking technique, except that two or more stimuli are presented at the same timetwo or more stimuli are presented at the same time.. If the infant shows a preference for one stimulus over If the infant shows a preference for one stimulus over the otherthe other((ss)), the difference it and the others must be one , the difference it and the others must be one that they can seethat they can see.. For the researcher to know which differences the infant For the researcher to know which differences the infant is responding to, the stimuli should differ on only one is responding to, the stimuli should differ on only one dimensiondimension. . For example, if used to study developmental For example, if used to study developmental changes in contrast sensitivity, the stimuli should differ changes in contrast sensitivity, the stimuli should differ only in contrast and not other dimensions such as spatial only in contrast and not other dimensions such as spatial frequency or luminancefrequency or luminance..
Visual acuity cardsVisual acuity cards
Keeler acuity cardsKeeler acuity cards
Teller acuity cardsTeller acuity cards
Teller cardsTeller cards
High contrast ,black-White square grating High contrast ,black-White square grating patch on a uniform grey cards.patch on a uniform grey cards.
Infants may appreciate the edge between Infants may appreciate the edge between the grating patch and the grey background the grating patch and the grey background ( overestimates visualacuity ).( overestimates visualacuity ).
This is overcome by the Keeler cards.This is overcome by the Keeler cards.
3-53-5 yryr
Kay picture test Kay picture test
Sheridan –Gardiner testSheridan –Gardiner test
> 5 r> 5 r …… …… Snellen charts / LogMAR charts … Snellen charts / LogMAR charts …
etc etc
Static retinoscopyStatic retinoscopy
Distance fixation retinoscopy.Distance fixation retinoscopy.
Cycloplegic refraction.Cycloplegic refraction.
Retinoscopy under sedation ( sleep).Retinoscopy under sedation ( sleep).
Near fixation retinoscopy( +/- Mohindra Near fixation retinoscopy( +/- Mohindra technique)technique)
Who should have cycloplegic Who should have cycloplegic refractionrefraction? ?
Poor fixators Poor fixators
Any child with squint Any child with squint
When you suspect accommodatino spasm When you suspect accommodatino spasm
Variable dry refractino results Variable dry refractino results
When dry refraction --- manifest refraction donot When dry refraction --- manifest refraction donot match match
Newly diagnosed / rapidly increasing myopia Newly diagnosed / rapidly increasing myopia
Follow up of hypermetroipa Follow up of hypermetroipa
Near fixation retinoscopyNear fixation retinoscopy
Barret methodBarret methodDim lightDim lightUsually 67 cm working distance Usually 67 cm working distance A lens of equivalent diopteric power in A lens of equivalent diopteric power in front of each eyefront of each eyeFocus on featureless objectsFocus on featureless objectsFog nonexamined eyeFog nonexamined eye
PMTPMT
Subjective refraction is rarely possible < 5 Subjective refraction is rarely possible < 5 yr of age .yr of age .
Guessing Guessing
Short attention spanShort attention span