PEDIATRIC OPTOMETRY

January 14, 2000 lecture

Practice management

Communication

Examination suggestions

TYPES OF CASE PRESENTATION

  • Failed school screening
  • Family history of eye problems
  • Grandmother
  • Symptoms (in an older child)
  • Vision related learning problems
CHIEF COMPLAINTS-
SCHOOL ACHIEVEMENT
  • Poor reading achievement
  • Frequent reversal errors (dyslexia)
  • Loss of place when reading
  • Attention deficit disorder - distractibility
  • Slow, unable to finish work (reading, writing)
  • Poor copying, particularly the blackboard
OFFICE VARIABLES
  • Supply of toys and magazines for children
  • Length of waiting time
  • Children’s play area
  • Individual attention by personnel
  • …
  • Lighting
  • Crowding
  • Presence of children of different ages
  • Accessibility of office
SUGGESTIONS FOR COMMUNICATING
WITH YOUNG CHILDREN
  • Allow time to become comfortable with doctor
  • Talk to the parent if child is hesitant
  • Avoid "threatening" actions
  • Assume eye level position
  • Speak in a quiet voice, slowly
  • Speak clearly, using simple words and short sentences
  • Avoid multiple directions
  • Give no more than two choices
  • "Keep it simple stupid"
  • Talk directly to older children, not just parent(s)

 

TIPS FOR PEDIATRIC EXAMINATIONS
  • Use appropriate examination times
  • Have an "inviting" waiting room
    • Parents can bring familiar toys or objects
  • Have toys or fixation targets available
  • Utilize flash photographs from appropriate age intervals
  • "Ignore" an apprehensive or nervous child
  • Put child at ease
    • Hold hands
    • Use praise or compliments on performance
    • Positive comments about clothes, etc.
  • Touching is permitted

 

MORE TIPS
  • Put child at eye level
  • Be prepared to perform an exam with:
    • Child seated
    • Child seated on parent’s lap
    • Child standing
    • Child not in examination chair
  • Teach proper responses at home if necessary
  • Be prepared to re-schedule office visit
  • Just do it! Don’t explain
  • Test objectively with limited subjective involvement
  • Alter test sequence

 

ALTERED TEST SEQUENCE
  • Externals first
    • Ocular Motility
    • Cover test
    • NPC
    • Dynamic retinoscopy (MEM)
    • Bruckner
    • Visual acuity (near point)
    • External health assessment
    • Hirschberg
FURTHER TESTING
  • Distance retinoscopy
  • Distance visual acuity
  • Stereopsis
  • Vergence
  • Color vision
  • Direct ophthalmoscopy
  • Biomicroscopy
  • Indirect ophthalmoscopy
STILL MORE TIPS
  • Alternative testing methods
  • Discuss test results, diagnosis and management with parents
  • Don’t ignore the child if old enough to understand
  • Demonstrate problem to parent(s)
  • Send school report (with parental permission)
  • Referral or communication with other professionals as required
  • Follow-up at appropriate intervals
PARENT OBSERVATION
OF EXAMINATION & THERAPY
PROS & CONS
  •  

    Apprehensive child

    Assistance

    Very good PR

    Apprehensive examiner

    Interference

    Very poor PR (risk)

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