Course Title: OPTO 497: Pediatric Optometry
Instructor: Safiah Mulla MSc, BSc, OC(C)
King Saud University
College of Applied Medical Science
Telephone: 01-4355010 Ext 107
This course is broken down into weeks and each week consists of one in- depth power point lecture, often with additional readings that you will receive in advance. Typically this takes about 2 hours for the in-class delivery, so plan on committing that much time per week for the first read- through. I will provide you with a written copy of the lectures, additionally, please view the lectures on the internet (via your email).
There will be 1 continuous assessment tests (written exam) during the course of this semester. It will be in the form of multiple-choice and short answer quizzes during the lecture periods or short essays on topics already covered. Other forms of evaluation include assignments, discussion questions, and final written exams. Please read on for details...
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 affect 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 4 months of age,
(b) Infant - from 4 months to 1 year of age,
(c) Toddler - from 1 year to about 4 years of age.
The students will have a general recap of the visual pathway and the clinical assessment and management of the young patient (birth through preschool) 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.
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.
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. At this stage we will look into some aspects of development that may be associated with premature birth. Differences between conceptual age and gestation age should be noted.
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.
4. Factors affecting normal development: Next we will look at Factors that may affect normal visual development. The possible effects of these factors on the visual system will also be discussed. Some of the factors that will be discussed include:
(a) Parental or Genetic factors
(b) Drugs or Medication used during pregnancy
(c) Trauma during pregnancy or at birth
(d) Environmental and social factors
5. Examination , diagnosis and treatments
1- 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 i.e. members of the family with similar problems,
• History of mother’s health, medication (anti-convulsants, hormones), use of drugs (alcohol, tobacco, tea, coffee) or any other difficulties or complications during pregnancy.
• Events surrounding the delivery of the patient, complications at birth, did the patient breath immediately, was there jaundice requiring specific treatment, did the baby pass on the APGAR score, was the baby full-term or premature, the babies birth weight etc.
• For older infants the examiner should be interested in whether the patient meets the various developmental milestones for age; visually, physically, acoustically and socially.
2- 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.
As a clinician you want the patient to leave the clinic with the same or better level of acuity than they came in 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 type of test used will depend on the age and level of cooperation of the patient. The three major methods of VA determination will also be discussed i.e. OKN, VEP and PL. These will be compared and contrasted, and benefits and disadvantages of the methods will be looked into. Teller, Keller and Cardiff acuity cards will also be discussed.
3- Objective examination
This will include external eye examination; the overall appearance and physical health of the eye will be examined for any abnormalities within and/or between the eyes e.g. coloboma, ptosis (unilateral or bilateral), aniridia, obvious squint etc.
A pen torch with a slit and magnifier can then be used to examine the anterior chamber, cornea, conjunctiva, iris aqueous humour and anterior surface of the lens.
Monocular indirect ophthalmoscope can be performed to ascertain the health of the vitreous and the retina (FUNDUS).
Up until about the age of 3 .5 years, method of preference for Retinoscopy is dynamic, followed by cycloplegic if necessary. We will consider both methods in greater detail, and look at the advantages and necessity of using either method.
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
2- 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
4- 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. About two or three interesting cases studies will be discussed in the lectures.
You are required text for the course:
1. Clinical Procedures in Optometry, J. Boyd Eskridge, J.F. Adams and J.D. Bartlett.
2. Paediatric Optometry, Jerome Rosner and Joy Rosner.
3. Optometry Primary Care, Theodore Grosvenor
4. Lecture handouts
5. Assignments power point presentation
1. By the start of the course you would receive:
· Weekly printed copies of lectures, accompanying readings for each lecture, course outline, calendar, etc.
· Student’s assignments (power point presentation) at the end of the course.
1. Power Point Assignment and Written Paper (15 %)
2. Discussion Questions (10 %)
3. Class Participation (5 %)
4. Midterm Exam (30 %)
5. Final exam (40 %)
Detailed Course Evaluation by Component:
1- Power Point Assignment & Written Paper (15%)
Please find the assignment section of your course and you will see that you have (Assignment #1) due at the end of the course. This involves a power point presentation that is sent to the entire class. It will be from these presentations that you will study this topic and no other lectures will be provided. Please see me for more details.
2- Class Participation (5 %)
Class participation includes quality oral responses to lecture material and reading assignments. Your participation in class discussion and questions will greatly impact your class participation grade for the course
3- Discussion Questions (10%)
Weekly (will be indicated in the course calendar and course summary by weeks), I will post questions for discussion (Assignment #2). These are designed to explore the content of the class and develop collaborative skills between students. You are required to respond to all discussion questions posted within a week of the posting time. Your participation in discussion questions will greatly impact your class participation grade for the course. Please be positive in your approach to others while we discuss the questions posed together. Our goal is to be collaborative, never combative!
4-Midterm Exam (30%)
This will be a short answer and multiple-choice test to be completed within 2 hours under the supervision of a proctor. This exam will be sent to your proctor and they will administer it and then send it to me for grading.
5-Final Written Exam (40%)
Similar to the midterm, but usually requires 3 hours to complete and includes all course material.
Please Note: Examinations must be written during allotted times and make- ups will be permitted only due to illness or other very exceptional circumstances. You must notify me before the scheduled exam if you will be absent. A physician’s medical report dated that day of the missed examination will be necessary to document legitimate illness.
Late assignments will be accepted with the following penalties:
1 day late10% penaltY
2 days kite20% penalty
3 days late 30% penalty and so on....