2/9/17

PEDIATRIC MASQUERADERS

CONFLICTS AND ACKNOWLEDGMENTS PARENTAL PERCEPTION VERSUS OPTOMETRIST PERCEPTION

NO CONFLICTS. ALL MEDICATIONS DISCUSSED ARE WHAT I TYPICALLY USE IN CLINICAL PRACTICE. THERE ARE MANY APPROPRIATE MEDICATIONS THAT I WILL NOT MENTION. REMEMBER SOMETIMES TO PARENTS THE SKY IS FALLING!!!

IT IS ME NOT THEM AND SOMETIMES IT IS, AND OTHER TIMES IT IS SOMETHING VERY SIMPLE I WOULD LIKE TO ACKNOWLEDGE DRS. KATIE CONNOLLY, KIMBERLY WARNER AND TOM LISLE § THEY GRACIOUSLY ALLOWED ME TO UTILIZE PATIENTS IN THIS LECTURE WE NEED TO MAKE CERTAIN WE ARE NOT JUST LOOKING FOR THE EASY ANSWER

§ ALSO WANT TO THANK MY SON FOR LETTING ME COME LECTURE TO THIS FINE AUDIENCE WE NEED TO ALWAYS THINK THE COMPLETE SET OF DIFFERENTIALS, COMMON, UNCOMMON, OR RARE

CORNEAL ABRASION

MOST OFTEN DIAGNOSED SIMPLY BY THE HISTORY § WITH BLUNT TRAUMATIC ABRASIONS NEED TO LOOK CAREFULLY FOR A HYPHEMA

TREATMENT FOR ABRASION IN INFANTS IS DIFFERENT FROM ADULTS § YOU MAY NEED TO PATCH THE EYE EPIPHORA § THIS WILL ENSURE THAT THE CHILD KEEPS THEIR FINGERS AWAY FROM THEIR EYE § ALSO IF DONE PROPERLY THE CHILD WILL FEEL BETTER ONCE THE PATCH IS PLACED AND IS LESS LIKELY TO TAKE IT OFF § SEE THEM DAILY WHILE THE PATCH IS ON AND EDUCATE THE PARENTS ABOUT THE SIGNS OF BACTERIAL INFECTION

FOR PRESCHOOLERS AND OLDER CHILDREN CAN TREAT AS AN ADULT WITH ANTIBIOTIC DROP AND POSSIBLE BANDAGE CONTACT LENS § MAY SEE THEM DAILY, DEPENDS ON SIZE OF ABRASION AND YOUR COMFORT LEVEL

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NASOLACRIMAL DUCT OBSTRUCTION NASOLACRIMAL DUCT OBSTRUCTION NASOLACRIMAL DUCT OBSTRUCTION DUE TO STENOSIS ARE PRESENT IN UP TO 30% OF NEWBORNS. SIGNS CONGENITAL NLDO § IN INFANTS THE OBSTRUCTION MAY BE DUE TO STENOSIS, CHRONIC INFECTIONS, ACUTE INFECTIONS, DEVELOPMENTAL ANOMALIES, OR § EPIPHORA (UNILATERAL OR BILATERAL) CAN BE CONTINUOUS TRAUMA § BREAKDOWN OF SKIN PERIORBITAL ESPECIALLY AT THE LATERAL CANTHI IFFERENTIAL DIAGNOSES FROM CONGENITAL NASOLACRIMAL DUCT D § MATTERING OF LIDS WITH DISCHARGE THROUGHOUT THE DAY OBSTRUCTION § CAN HAVE A CONCURRENT MIDDLE EAR INFECTION § BACTERIAL CONJUNCTIVITIS

§ ACUTE OR CHRONIC DACRYOCYSTITIS § CONGENITAL GLAUCOMA

TREATMENT OF NLDO TREATMENT OF NLDO SURGICAL TREATMENT MONITORING IS CONSIDERED TYPICALLY WHEN THE CHILD HAS REACHED THEIR SIXTH BIRTHDAY WITH: § MOST (90%) CONGENITAL NLDO WILL SPONTANEOUSLY OPEN BEFORE THE § CONSTANT DISCHARGE AND INFECTION AND AGE OF ONE YEAR § IT HAS BEEN A FEW MONTHS OF EPIPHORA WITH NO SIGNS OF DECREASING PEDIATRICIANS WILL TYPICALLY HOLD ONTO TO THESE, (MAYBE TOO LONG) § METHODS LACRIMAL MASSAGE IN ENCOURAGED § SIMPLE PROBING § BALLOON CATHETER DILATION § STENT PLACEMENT ANTIBIOTIC DROPS IF DISCHARGE IS PRESENT

§ FOR KIDS < 4 MONTHS YOU CAN USE POLYTRIM™ OPHTHALMIC SOLUTION IF THE CHILD IS TOO OLD OR WEIGHS TOO MUCH A IN-OFFICE PROCEDURE MAY NEED UP TO SIX TIMES QD FOR 7-10 DAYS TO BE TURNED INTO AN OUTPATIENT PROCEDURE § PERSONAL RX USE QID FOR 7-10 DAYS § FOR KIDS >4 MONTHS MOXEZA™ BID FOR 7 DAYS

DACRYOCYSTOCELE ALLERGIES CAUSING EPIPHORA WHEN TO SUSPECT ALLERGIES ANOTHER TYPE OF LUMP/BUMP CAN LEAD TO EPIPHORA § PATIENT ON SYSTEMIC ALLERGY MEDICATION RARELY, (0.1%), OF PATIENTS WITH NLDO MAY DEVELOP THIS § SEASONAL CHANGES § AMNIOCELE-ACCUMULATION OF AMNIOTIC FLUID IN § INTRODUCED INTO A NEW ENVIRONMENT LACRIMAL SYSTEM § REPEAT RED ITCHY EYES SAME TIME EACH YEAR § MUCOCELE-ACCUMULATION OF MUCUS IN LACRIMAL SYSTEM

TREATMENT VARIES SIGNS OF ALLERGY § MASSAGE § ITCHING § LACRIMAL PROBE § WATERY EYES § SURGICAL EXCISION § BOGGY CONJUNCTIVA § CONJUNCTIVAL REACTION

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HISTORY ASSESSMENT AND PLAN

VERNAL KERATOCONJUNCTIVITIS OU

TX: CROMOLYN OPHTHALMIC SOL 1GTT QID OU 8 YEAR OLD REFERRED BY PEDIATRICIAN, DX WITH SEASONAL ALLERGIES, NO OCULAR TREATMENT. +WHITISH DISCHARGE IN THE MORNING, OU LOTEMAX OPHTHALMIC SUS 1GTT QUID OU +ITCHING, OU RTC 1 WEEK FOR FU, SOONER, IF INCREASE REDNESS, PAIN MOM HAS NOTICED WHITE AREAS ON THE FRONT OF DAUGHTER’S EYES OR DISCHARGE NO MAJOR MEDICAL CONDITIONS, NO FHX OF MEDICAL CONDITIONS

NO HISTORY OF EYE PROBLEMS

NO COMPLICATIONS WITH PREGNANCY OR BIRTH

VERNAL VS. SEASONAL ALLERGIES VERNAL VS. SEASONAL ALLERGIES

VERNAL SEASONAL VERNAL SEASONAL

§ AFFECTS BOYS MORE THAN GIRLS § EQUAL BETWEEN BOYS AND GIRLS § AFFECTS BOYS MORE THAN GIRLS § EQUAL BETWEEN BOYS AND GIRLS

§ TYPICALLY SEEN IN SPRING § SEEN IN SPRING, AND AUTUMN § TYPICALLY SEEN IN SPRING § SEEN IN SPRING, AND AUTUMN § ORNEAL INVOLVEMENT TYPICALLY C § CORNEAL INVOLVEMENT NOT § CORNEAL INVOLVEMENT TYPICALLY § CORNEAL INVOLVEMENT NOT SEEN TYPICALLY SEEN SEEN TYPICALLY SEEN

§ GIANT PAPILLAE TYPICALLY SEEN § SMALL PAPILLAE SEEN

§ SIGNIFICANT MUCUS PRODUCTION § MINIMAL MUCUS SEEN TYPICALLY

§ REQUIRES STEROID, MAST CELL § RARELY REQUIRES STEROID Trantas Dots STABILIZER AND ANTIHISTAMINE

TREATMENT OF SEASONAL ALLERGIES CONGENITAL GLAUCOMA IN PEDIATRIC PATIENTS

3 YEARS AND OLDER

§ PATANOL OR PATADAY PRIMARY CONGENITAL GLAUCOMA: ASSOCIATED WITH DEVELOPMENTAL ANOMALIES OF THE EYE WHICH ARE PRESENT AT BIRTH. THE DISEASE USUALLY § ZADITOR PRESENTS WITHIN THE FIRST YEAR OF LIFE OCCURS IN APPROXIMATELY 1:10,000 § EXTREME CASES MAY NEED A STEROID FRONT LOADED LIVE BIRTHS § LOTEMAX [SAFETY AND EFFICACY PROFILE IN PEDIATRIC § CONGENITAL GLAUCOMA: CHILD BORN WITH ENLARGED EYES PATIENTS HAS NOT BEEN ESTABLISHED] § INANTILE GLAUCOMA PRESENTS BY 3RD BIRTHDAY § JUVENILE GLAUCOMA PRESENTS BETWEEN 3-16 YEARS OF AGE

SECONDARY GLAUCOMA: GLAUCOMA RESULTING FROM TRAUMA, CATARACT SURGERY, NEOPLASMS, SEVERE RETINOPATHY OF PREMATURITY, OR INFLAMMATION

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CONGENITAL GLAUCOMA CORNEAL CONGENITAL GLAUCOMA DIAMETER

PARENTS COME IN WITH COMPLAINTS OF THEIR We will typically see: § Epiphora THE CORNEA IS STRETCHED AS A RESULT OF THE INCREASED PRESSURE INSIDE THE EYE. CHILD: § Enlarged corneal diameter § TEARING EXCESSIVELY § Corneal clouding WHEN TO BE SUSPICIOUS? § Haab’s Stria § SHYING AWAY FROM BRIGHT LIGHTS § Increased IOP’s AGE NORMAL DIAMETER SUSPICIOUS NEWBORN 9.5-11.5 MM > 11.5 MM § CONSTANT BLINKING § Increased cupping of optic 1 YEAR OLD 10-11.5 MM > 12-12.5 MM nerve head(s) 2 YEAR OLD 11-12 MM > 12.5 MM § Increased axial length leading to 3 YEAR OLD 12 MM > 13MM increased myopia

Decreased Increased IOP Goniodysgenesis Outflow of Leading to Aqueous clinical signs

CONGENITAL GLAUCOMA CONGENITAL GLAUCOMA

TREATMENT

INCREASED IOP’S § SURGICAL TREATMENT IS INITIAL TREATMENT FOR CONGENITAL GLAUCOMA INTRAOCULAR PRESSURE MEASUREMENTS IN CHILDREN IOP IN GLAUCOMATOUS IOP IN NORMAL EYES EYES N=159 N=74 § MEDICAL THERAPY IS USED IN CONJUNCTION TO MANAGE IOP POST < 21MMHG 14 < 15MMHG 26 SURGICAL 21-24MMHG 0 15-21MMHG 39 >24MMHG 145 >21MMHG 9

BACTERIAL CONJUNCTIVITIS

• MORE COMMONLY FOUND IN PEDIATRIC PATIENTS THEN IN ADULTS

• CLINICAL SIGNS OF BACTERIAL CONJUNCTIVITIS

• MUCOPURLUENT DISCHARGE

• MODERATE CONJUNCTIVAL HYPEREMIA INFLAMMATION • MATTERING IN A.M. • COMMON ORGANISMS CAUSING INFECTION

• S. PNEUMONIAE

• H. INFLUENZA

• STAPH. AUREUS

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BACTERIAL CONJUNCTIVITIS INFLAMMATION CASE

§ 3 YEAR OLD FEMALE PRESENTS WITH COMPLAINTS OF SWOLLEN LEFT UPPER LID, ALSO TREATMENT COMPLAINS OF A LOW GRADE FEVER FOR A FEW DAYS

§ CHILDREN <4 MONTHS OF AGE § HAS BEEN ON AUGMENTIN FOR 2 WEEKS WITHOUT IMPROVEMENT IN SYMPTOMS, ACTUALLY GETTING WORSE POLYTRIM QID § SEEN BY OMD TOLD TO CONTINUE MEDICATION, NO FURTHER TESTING COMPLETED § CHILDREN >4 MONTHS OF AGE

MOXEZA® BID FOR 7 DAYS § CHILDREN ONE YEAR AND OLDER

BESIVANCE® ONE DROP TID FOR UP TO 7 DAYS

ZYMAXID® 1 DROP Q2HRS FIRST DAY THEN 1 DROP BID OR QID DAYS 2-7

INFLAMMATION PRESEPTAL CELLULITIS

§ PARENTS WENT TO PCP WHO ORDERED CT CLINICAL SIGNS TREATMENT

§ LID EDEMA CAN BE BOTH SUPERIOR AND INFERIOR § FIRST RULE OUT ORBITAL CELLULITIS LIDS AND MAY EXTEND PAST THE LIDS § IF AFEBRILE MAY BE TREATED WITH ORAL ANTIBIOTICS § CHEMOSIS OF THE CONJUNCTIVA § IF FEBRILE OR LETHARGIC, HOSPITALIZATION MAY BE § PAIN NECESSARY WITH FOLLOW-UP WITH HOSPITAL § CONCURRENT SINUS INFECTION OR URI CREDENTIALED PHYSICIANS

Keflex (Cephalexin) Write for generic Pediatric dosage 40mg/kg/day (divided q6hr)

§ REFERRED TO RILEY CHILDREN’S HOSPITAL: DX LANGERHAN’S CELL HISTIOCYTOSIS Augmentin Pediatric dosage § WHITE BLOOD CELLS THAT CAN FORM TUMORS <40kg 20-40mg/kg/day (divided dose every 8 hours) § TX OPTIONS MONITOR, (SELF-RESOLVING), STEROIDS, EXCISION, RADIATION, CHEMOTHERAPY >40kg one 500-mg tablet every 12 hours or one 250-mg tablet every 8 hours.

ORBITAL CELLULITIS UNSPECIFIED AMBLYOPIA

SCARIEST DIAGNOSIS TO EXIST!!!!!!!!! CLINICAL SIGNS TREATMENT

§ PAIN § HOSPITALIZATION WITH IV ANTIBIOTICS

§ HEADACHE AND/OR FEVER § THEY WILL UNDERGO A MRI

§ LID EDEMA § THEY WILL BE SEEN DAILY AND MORE THEN LIKELY HAVE A CONSULTATION WITH A PEDIATRIC ENT § APD (POSSIBLE)

§ ABNORMAL EOM WITH POSSIBLE DIPLOPIA

§ PAIN WITH EYE MOVEMENT

§ PROPTOSIS

§ CHILDREN CAN BE VERY SICK, LETHARGIC

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UNSPECIFIED AMBLYOPIA CASE DIAGNOSED AS UNSPECIFIED AMBLYOPIA

10 YEAR OLD WITH PREVIOUS DX OF AMBLYOPIA HERE FOR COMPREHENSIVE EXAMINATION § VA 20/20 OD, 20/200 OS ECALL FOR UNCTIONAL MBLYOPIA YOU R F A § CT IXT OS MUST HAVE: § PUPILS OD NORMAL, OS 3+ APD • STRABISMUS § RET +2.50-2.75X025 OD +1.25-3.25X005 OS § ANTERIOR HEALTH OU NORMAL • ANISOMETROPIA § POSTERIOR HEALTH OD NORMAL CD 0.2/0.2 OS 0.05/0.05 WITH DOUBLE RING • COMBINATION § OCT OD NORMAL OS REDUCED NFL AND NERVE AREA OS • FORM DEPRIVATION § MRI ORDERED LEADING TO DIAGNOSIS OF SEPTO OPTIC DYSPLASIA DURING THE CRITICAL OR SENSITIVE PERIOD

SEPTO OPTIC DYSPLASIA AKA DEMORSIER’S SYNDROME PATIENT WITH VISION LOSS-AMBLYOPIA?

CLINICAL PICTURE 5 YEAR OLD HERE FOR FIRST EXAM PARENTS CONCERNED WITH VISION IN LEFT EYE HAS NOTICED A § ASSOCIATE WITH OPTIC NERVE HYPOPLASIA, ABSENCE OF SEPTUM PELLUCIDUM AND PITUITARY LIGHTER PUPIL IN PHOTOS FOR THE LAST FEW MONTHS HORMONE DEFICIENCIES § PATIENTS MAY HAVE STRABISMUS, NYSTAGMUS AND REDUCED ACUITIES CLINICAL EXAMINATION § PATIENTS CAN HAVE DEVELOPMENTAL AND GROWTH DELAYS DUE TO THE ENDOCRINE DYSFUNCTION § 20/20 OD 20/150 OS

§ CT NO STRABISMUS NOTED Our patient diagnosed with septo optic dysplasia with secondary relative amblyopia was § BRUCKNER LIGHTER BRIGHTER OS referred to PCP and began growth hormone therapy and initiated part time patching § STEREO >400” ARC Relative amblyopia does not equal unspecified amblyopia It is functional amblyopia in the presence of pathology. How much of the vision loss is due to functional amblyopia and how § PUPILS NORMAL much is due to pathology? § CYCLO RET +2.00 OD +2.50 OS

Will not know unless treatment attempted. § ANTERIOR HEALTH NORMAL OU

5 YEAR OLD COAT’S DISEASE

§ POSTERIOR HEALTH DIAGNOSIS COAT’S DISEASE REFER TO RILEY § USUALLY SEEN IN MALES IN LATE CHILD HOOD BUT CAN PRESENT AT CHILDREN’S HOSPITAL A MUCH YOUNGER AGE § OD NORMAL FINDINGS IN COAT’S § MORE COMMONLY UNILATERAL § OS § VASCULAR TELANGIECTASIAS AND RETINAL § IT IS A CONGENITAL ABNORMALITY OF RETINAL BLOOD VESSELS EXUDATES § THE LESIONS ARE MOST OFTEN SEEN IN THE SUPERIOR TEMPORAL § LEUKOCORIA QUADRANT § YOU WILL SEE ENGORGED VESSELS WITH SEROUS FLUID AND EXUDATIVE CHANGES PATIENT HAD FA TO CONFIRM DX § EASILY MISDIAGNOSED AS RETINOBLASTOMA

PATIENT UNDERWENT PHOTOCOAGULATION TX

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RETINOBLASTOMA CASE SEEN BY MY COLLEAGUE DR. KATIE CONNOLLY

9 MONTH OLD WHITE MALE PRESENTED UPON REFERRAL FROM PEDIATRICIAN § MOST COMMON TYPE OF PEDIATRIC TUMOR INCIDENCE IS 1:15,000 § HEREDITARY FORM, (40% OF CASES) PRESENTS AROUND 1 YEAR OF AGE, 80- CC: REFERRAL DUE TO ABNORMAL ESOTROPIA/RED REFLEX OS, PT WAS SEEN BY PEDIATRICIAN 90% BILATERAL EARLIER THAT DAY § NON-HEREDITARY FORM (60% OF CASES), UNILATERAL, PRESENTS AROUND 2 YEARS OF AGE § ONSET 2 MONTHS AND WORSENING § CLINICAL FEATURES ST • LEUKOCORIA 90-95% OF PRESENTING PATIENTS § 1 EVALUATION WITH PEDIATRICIAN 2 MONTHS AGO - UNREMARKABLE VISION SCREENING • STRABISMUS SECOND MOST COMMON FINDING § MOM NOTED WHITE PUPIL IN PICTURES X 2 MONTHS • RUBEOSIS § TREATMENT OPTIONS § PT ABLE TO GRAB TOYS WELL AND SPOT PEOPLE ACROSS THE ROOM • CHEMO § UNREMARKABLE SYSTEMIC HEALTH, NKDA, NO MEDICATIONS • ENUCLEATION • RADIATION (EXTERNAL AND PLAQUE) § NORMAL DELIVERY AND DEVELOPMENT THUS FAR

CLINICAL EXAM CLINICAL EXAM

§ ASSESSMENT: § POSTERIOR SEGMENT: § MALIGANT NEOPLASM OF RETINA, OU § OD: § ANTERIOR CHAMBER ANGLES: 4+ OD, 1+ OS § RETINOBLASTOMA OS>OD, § VAS: 20/63 OU WITH TELLER § C/D 0.20/0.20 PINK, DISTINCT § NORMAL ADNEXA OU ENDOPHYTIC (TOWARD VITREOUS) § STRONG AVERSION TO OCCLUSION OD § FLAT, +FLR, NORMAL MACULA § SCLERA AND CONJUNCTIVA: QUIET OU § PLAN: § EOM’S: FULL AND SMOOTH § NORMAL SUPERIOR MID PERIPHERY § CORNEA: CLEAR OU § DISCUSSION WITH PARENTS § SLUGGISH PUPIL OS WITH LEUKOCORIA § FLAT IRIS APPROACH OD, BOWED/CONVEX IRIS § INFERIOR MID PERIPHERY: § 10 PD ILET – “SEARCHING” § URGENT REFERRAL TO RILEY PED. APPROACH OS § ELEVATED/BULLOUS MASS WITH OPHTHALMOLOGY § DRY RET: +1.50 OD, NO REFLEX OS § DILATED WITH 0.50% TROPICAMIDE OU WELL DEMARCATED BORDERS § BUSINESS CARD TO MOM § OS: LARGE MASS FILLING VITREOUS CAVITY, § PHONE CALL TO PEDIATRICIAN UNABLE TO VIEW ANY STRUCTURES AND EXAM NOTES SENT

OPHTHALMOLOGY VISIT MRI RESULTS

§ SEEN 2 DAYS AFTER OPTOMETRY VISIT FOR CONSULTATION

§ NO CHANGE IN FINDINGS: AGREED WITH DIAGNOSIS

§ ORDERED EXAM UNDER ANESTHESIA AND MRI OF BRAIN, ORBIT AND NECK § MRI RESULTS:

§ BILATERAL RETINOBLASTOMA

§ 2 AREAS OF NODULAR THICKENING WITH CONTRAST ENHANCEMENT. LARGEST LESION TO RIGHT OF OPTIC DISC MEASURING 11X3 MM. SMALLEST LESION LEFT OF OPTIC DISK MEASURING 4X3MM.

§ LARGE ENHANCING MASS OCCUPIES GLOBE OS

§ NO EVIDENCE OF TUMOR INVASION TO EITHER OPTIC NERVE OR RETRO-ORBITAL SPACE

§ NORMAL BRAIN

7 2/9/17

EXAM UNDER ANESTHESIA OPHTHALMOLOGY VISIT #2

OD OS § PT WAS SEEN 10/15 (NOW ONE YEAR OLD) FOR EXAM UNDER ANESTHESIA § ASSESSMENT:

§ OD: PERFORMED RED DIODE LASER ON NEW TUMORS AND THOSE NOT REGRESSING

§ OS: NO PROGRESSION, NO ANTERIOR CHAMBER INFILTRATION

§ PLAN:

§ RECOMMEND ADDITIONAL CHEMO.

§ PERFORM EXAM UNDER ANESTHESIA AFTER NEXT ROUND OF CHEMO IN 2 MONTHS.

Assessment: - Extensive bilateral retinoblastoma Plan: - Recommend chemo, then try to salvage right eye

RETINOPATHY OF PREMATURITY RETINOPATHY OF PREMATURITY

§ CAN BE ASSOCIATED WITH RETINAL CHANGES THAT LEAD TO STRABISMUS AND REDUCED ZONES OF INVOLVEMENT VISION

§ TYPICALLY SEEN IN INFANTS BORN <1500 GRAMS, (3.3 LBS) OR IF IT WAS AN UNSTABLE ZONE 1 EXTENDS TWICE THE PREGNANCY DISTANCE FROM THE OPTIC NERVE TO THE MACULA IN A CIRCLE § CHILDREN WITH HISTORY OF ROP MAY HAVE .

§ HIGH MYOPIA AND ANISOMETROPIA, (HIGHER MYOPIA IN THE EYE IMPACTED BY ROP) ZONE 2 IS A CIRCLE SURROUNDING § STRABIMSUS THE ZONE 1 CIRCLE WITH THE NASAL § MACULAR DRAGGING LEADING TO REDUCED VISUAL ACUITY ORA SERRATA AS ITS NASAL BORDER. § NYSTAGMUS ZONE 3 IS THE CRESCENT THAT THE CIRCLE OF ZONE 2 DID NOT ENCOMPASS TEMPORALLY

RETINOPATHY OF PREMATURITY LEUKOCORIA

§ FIVE STAGES OF ROP

§ STAGE 1- DEMARCATION LINE BETWEEN VASCULAR AND AVASCULAR ZONE

§ STAGE 2- RIDGE OR THICKENING OF THE DEMARCATION LINE • DIFFERENTIALS

§ STAGE 3- RIDGE OF FIBROVASCULAR PROLIFERATION • ANISOMETROPIA • HIGH REFRACTIVE ERROR § STAGE 4- PARTIAL RETINAL DETACHMENT • RETINOBLASTOMA § STAGE 5- COMPLETE RETINAL DETACHMENT • COAT’S DISEASE

• RETINOPATHY OF PREMATURITY

• PHPV (PERSISTENT HYPERPLASTIC PRIMARY VITREOUS)

• CONGENITAL CATARACT

• RETINAL ASTROCYTOMA

8 2/9/17

CORTICAL VISION IMPAIRMENT CORTICAL VISION IMPAIRMENT

WHEN YOU HAVE SEEN ONE CHILD WITH CVI YOU HAVE SEEN ONE CHILD WITH CVI DEFINED IN RELATION TO EDUCATIONAL AREA “A NEUROLOGICAL DISORDER WHICH RESULTS IN UNIQUE VISUAL RESPONSES TO PEOPLE, EDUCATIONAL MATERIALS AND TO THE ENVIRONMENT” § CORTICAL IMPAIRMENT TYPICALLY SEEN IN FULL TERM INFANTS AND LESS LIKELY TO HAVE (AMERICAN PRINTING HOUSE FOR THE BLIND, 2004) STRABISMUS OR NYSTAGMUS § SUB-CORTICAL, (PVL), TYPICALLY HAVE NYSTAGMUS AND STRABISMUS, MAY NOT SHOW AS MUCH RECOVERY IN THEIR VISION

FOR US IT IS REDUCED VISUAL ACUITY WITHOUT OBVIOUS SIGNS OF PATHOLOGY OR FUNCTIONAL § SOME MAY HAVE “BLIND SIGHT” AMBLYOPIA, PATIENTS CAN HAVE NORMAL PUPILLARY RESPONSE WITH HOMONYMOUS VISUAL FIELD DEFECT WHEN YOU HAVE TALKED TO ONE PARENT WITH A CHILD WITH CVI, YOU HAVE TALKED TO ONE PARENT OF A CHILD WITH CVI BABIES WITH MAJOR MEDICAL CONDITIONS ARE BEING BORN AND MOST IMPORTANTLY § MOST PARENTS FEEL LOST AND CONFUSED WHEN THEIR CHILD RECEIVES THIS DIAGNOSIS SURVIVING AT A HIGHER RATE. IN THESE INFANTS CVI IS ASSOCIATED WITH INFECTIONS, § WE GIVE THE DIAGNOSIS AND WALK OUT OF THE ROOM, ONTO THE NEXT PATIENT. THEY WALK HYDROCEPHALUS, TRAUMA, OTHER VASCULAR INSULTS OUT WITH THEIR CHILD WHO HAS CVI

CORTICAL VISION IMPAIRMENT VISUALLY IMPAIRED PRESCHOOL SERVICES, (VIPS)

WHAT CAN WE DO?

§ PROVIDE THE BEST EYE EXAM AS YOU CAN

§ GIVE THE PARENTS AS MUCH INFORMATION AS YOU CAN § IN MISSOURI UTILIZE FIRST STEPS

§ IT IS A NATIONAL PROGRAM RAN AT A STATE LEVEL

§ TYPICALLY HAVE TEACHERS FOR VISUALLY IMPAIRED OR PROFESSIONALS TRAINED TO WORK WITH THESE CHILDREN AND THEIR FAMILIES Program in Indiana and Kentucky to work with children and families

Previous patient’s mother single handily started the Indiana Chapter

VIPS.ORG

CONCLUSION

§ SOME OF WERE TAUGHT, WHENEVER YOU HEAR HOOF BEATS LOOK FOR A HORSE AND NOT A ZEBRA.

§ BUT I LIKE TO ADD, DO NOT TOTALLY DISCOUNT THE FACT THAT A ZEBRA COULD BE AROUND

§ WHEN EVALUATING CHILDREN YOU NEED TO KEEP AN OPEN MIND AND MAKE SURE THAT EVERYTHING THAT IT COULD BE IS DISMISSED BASED UPON YOUR CLINICAL EXAMINATION.

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