G.N. Getman Memorial G.N. Getman Memorial Lecture Lecture - - PowerPoint PPT Presentation

G.N. Getman Memorial G.N. Getman Memorial Lecture Lecture

Retinoscopy Observations Lead to Retinoscopy Observations Lead to Better Understanding of Human Better Understanding of Human Performance Performance

Glen T. Steele, O.D. FCOVD Glen T. Steele, O.D. FCOVD Professor, Southern College of Optometry Professor, Southern College of Optometry Pediatric Vision Associates, PLLC Pediatric Vision Associates, PLLC

Getman Getman

• Jerry Getman wrote on retinoscopy

Jerry Getman wrote on retinoscopy for many, many years for many, many years

• Honed during his experience at the

Honed during his experience at the Gesell Institute with Arnold Gesell Gesell Institute with Arnold Gesell and Miss Glenna Bullis and Miss Glenna Bullis

Getman Getman

• Initial phases of this lecture

Initial phases of this lecture

– – Describe Getman Describe Getman’ ’s observations from his s observations from his earlier works that he summarized in earlier works that he summarized in Developmental Optometry Developmental Optometry published by published by OEP OEP – – Add later research that supports his work Add later research that supports his work – – Describe a way to look at retinoscopy Describe a way to look at retinoscopy

• Last phase will be the re

Last phase will be the re-

• introduction

introduction

• f today
• f today’

’s summary in a technique s summary in a technique called called -

• Just Look! Retinoscopy

Just Look! Retinoscopy

Getman Getman

• Before there is any discussion of any

Before there is any discussion of any retinoscopic procedure, emphasis retinoscopic procedure, emphasis must be given to the hard clinical fact must be given to the hard clinical fact that there must be more than a single that there must be more than a single retinoscopic observation made of retinoscopic observation made of

• cular and visual status
• cular and visual status
• Retinoscopy is more than a number

Retinoscopy is more than a number

Getman Getman

• The three procedures to be discussed

The three procedures to be discussed here are: here are:

– – Observations of the retinoscopic reflex while Observations of the retinoscopic reflex while the patient is visually attending to a distant the patient is visually attending to a distant chart chart with some symbolic demand; with some symbolic demand; – – Retinoscopic reflexes while the patient is Retinoscopic reflexes while the patient is visually attending to a nearpoint chart visually attending to a nearpoint chart containing some simple symbols which do not containing some simple symbols which do not demand any response beyond identification, demand any response beyond identification, and; and;

Getman Getman

– – Observations of the retinoscopic reflexes Observations of the retinoscopic reflexes when the patient is required to visually when the patient is required to visually discriminate and interpret a paragraph or discriminate and interpret a paragraph or picture which demands some degree of picture which demands some degree of cognitive effort cognitive effort

Getman Getman

• “

“Emphasis must be given to the Emphasis must be given to the importance of both the appraisals while importance of both the appraisals while the patient the patient attends to a distant chart attends to a distant chart, , and also to a near chart and also to a near chart. If both of these . If both of these

• bservations are not made one might just
• bservations are not made one might just

as well do neither, since the comparisons as well do neither, since the comparisons

• f the patient's performance on both of
• f the patient's performance on both of

these can be more developmentally and these can be more developmentally and clinically significant than either one alone clinically significant than either one alone can be. can be.” ”

Steele Insertion Steele Insertion

• When changing from a distance

When changing from a distance finding to the near finding or from finding to the near finding or from near to distance, remove and cylinder near to distance, remove and cylinder and anisometropia found at either and anisometropia found at either distance in order to better determine distance in order to better determine any difference between distances any difference between distances

Getman Getman

• The more the retinoscope is used to

The more the retinoscope is used to

• bserve the visual performance of an
• bserve the visual performance of an

individual, the more the observer will individual, the more the observer will come to respect and appreciate the come to respect and appreciate the dynamics of the total visual system, dynamics of the total visual system, and all of the influences the total and all of the influences the total

• rganism will bring into the visual act.
• rganism will bring into the visual act.

Far Retinoscopy Far Retinoscopy

Getman Getman

• Early work at Gesell

Early work at Gesell

– – Young children would not allow lenses so the Young children would not allow lenses so the examiner scoped from 16 feet examiner scoped from 16 feet – – Differences in Differences in farpoint farpoint retinoscopy retinoscopy

• bservations when the child was attending and
• bservations when the child was attending and

when not attending (Miss Bullis observation) when not attending (Miss Bullis observation) – – Less with motion when the child was fully Less with motion when the child was fully attending attending

• Interesting that the beginning of

Interesting that the beginning of cognitive retinoscopy observations cognitive retinoscopy observations started at started at farpoint farpoint

Getman Getman

• Led to similar observations at

Led to similar observations at nearpoint when older children were nearpoint when older children were looking at books. looking at books.

– – Skeffington Skeffington – – Cognition Retinoscopy Cognition Retinoscopy – – Did not catch on and later became Did not catch on and later became “ “Book Book Retinoscopy Retinoscopy” ”

Getman Getman

• Optometric information sought while

Optometric information sought while using the retinoscope at any distance: using the retinoscope at any distance:

– – The brightness and stability of the The brightness and stability of the retinoscopic reflexes in both eyes. retinoscopic reflexes in both eyes. – – The influences of posture, and postural The influences of posture, and postural stresses upon these reflexes. stresses upon these reflexes. – – The particular influences of taction and The particular influences of taction and speech upon these reflexes. speech upon these reflexes.

Getman Getman

– – The dioptric status of each eye, and any The dioptric status of each eye, and any shifts shifts of this status when distance of target,

• f this status when distance of target,
• r content of target is changed.
• r content of target is changed.

– – The immediacy of changes in brightness, The immediacy of changes in brightness, stability, and/or dioptric status when lenses stability, and/or dioptric status when lenses are introduced either in trial lens form or in the are introduced either in trial lens form or in the phoropter. phoropter. – – The dioptric changes induced by the change The dioptric changes induced by the change in the distances of the target being visually in the distances of the target being visually inspected. inspected.

Getman Getman

– – The magnitude and stability of binocularity as The magnitude and stability of binocularity as indicated by the differences or equalities of indicated by the differences or equalities of these reflexes in each eye. these reflexes in each eye. – – The influence of cognitive efforts upon the The influence of cognitive efforts upon the brightness and color of these reflexes, and brightness and color of these reflexes, and the magnitude of dioptric change when the magnitude of dioptric change when interpretations are demanded interpretations are demanded

Cultural Relevance Cultural Relevance

• A stable, consistent and dependable visual

A stable, consistent and dependable visual system certainly would be advantageous system certainly would be advantageous to all cultural demands. to all cultural demands.

• It is important to emphasize that a visual

It is important to emphasize that a visual system with less than the expected, or system with less than the expected, or desired, abilities does NOT preclude desired, abilities does NOT preclude surprisingly adequate visual performance surprisingly adequate visual performance in many cultural tasks. in many cultural tasks.

Cultural Relevance Cultural Relevance

• There are many instances of individuals

There are many instances of individuals with severe impairments in their visual with severe impairments in their visual system who are more visually adept than system who are more visually adept than their fellows. their fellows.

• It is now well established that refractive

It is now well established that refractive conditions that fully respond to judiciously conditions that fully respond to judiciously prescribed lenses do not create any prescribed lenses do not create any significant deviations in visual significant deviations in visual performance. performance.

Cultural Relevance Cultural Relevance

• The major cultural relevancies will be

The major cultural relevancies will be found when there are no correlations found when there are no correlations between dioptric status and acuities, between dioptric status and acuities, as in the Streff Syndrome. as in the Streff Syndrome.

Cultural Relevance Cultural Relevance

• One must always remember that no

One must always remember that no matter how significant the matter how significant the

• bservations of the retinoscopic reflex
• bservations of the retinoscopic reflex

might be, the ultimate visual might be, the ultimate visual performance of the individual will be performance of the individual will be determined more by his, or her, determined more by his, or her, desires, motivations, needs, attitudes desires, motivations, needs, attitudes and experiential background than by and experiential background than by any isolated ocular or visual factor. any isolated ocular or visual factor.

Cultural Relevance Cultural Relevance

• Such is the developmental difference

Such is the developmental difference between sight and vision in the between sight and vision in the human. human.

• Damien Smith

Damien Smith – – “ “6/6 does not mean 6/6 does not mean diddleysquat diddleysquat” ”

Near Retinoscopy Near Retinoscopy

Near Retinoscopy Near Retinoscopy

• Make careful note of the dioptric

Make careful note of the dioptric amounts of the meridional amounts of the meridional differences. differences.

• Make special note of any unusual

Make special note of any unusual postural changes when patient's postural changes when patient's attention is maintained on the near attention is maintained on the near chart. chart.

Near Retinoscopy Near Retinoscopy

• Be careful NOT to use a chart that

Be careful NOT to use a chart that demands interpretations and demands interpretations and comprehension of the contents. comprehension of the contents.

Cylinder Differences Cylinder Differences

• Do NOT assume that the cylindrical

Do NOT assume that the cylindrical lens powers will be the same at "far" lens powers will be the same at "far" and at "near." and at "near."

• If the cylindrical amount is less on

If the cylindrical amount is less on near observations than it is at far, near observations than it is at far, prescribe only the most appropriate prescribe only the most appropriate plus lenses, with the most equal plus plus lenses, with the most equal plus possible for both eyes. possible for both eyes.

Cylinder Differences Cylinder Differences

• If, in contrast, the cylindrical amount

If, in contrast, the cylindrical amount is more on near observations than it is more on near observations than it is at far, prescribe the least possible is at far, prescribe the least possible amount of cylinder, and "make the amount of cylinder, and "make the patient earn it" by critical judgments patient earn it" by critical judgments

• f discriminations at both far and
• f discriminations at both far and

near. near.

Cultural Relevance Cultural Relevance

• The significance of nearpoint

The significance of nearpoint

• bservations made by the behavioral
• bservations made by the behavioral
• ptometrist must be emphasized. It is
• ptometrist must be emphasized. It is

these observations which allow the these observations which allow the informed optometrist to consider and informed optometrist to consider and mediate so many of the cultural mediate so many of the cultural impacts upon the visual system. impacts upon the visual system.

Cultural Relevance Cultural Relevance

• “

“The relevance between near The relevance between near-

• point

point visual abilities and the nearpoint visual abilities and the nearpoint visual tasks of the classroom, or visual tasks of the classroom, or

• ffice, are so obvious it is difficult to
• ffice, are so obvious it is difficult to

understand the lack of attention being understand the lack of attention being given to them by so many clinicians given to them by so many clinicians and educators. These are probably and educators. These are probably the most critical points in all of the the most critical points in all of the considerations of visual performance considerations of visual performance in the contemporary culture. in the contemporary culture.” ”

Cognitive Retinoscopy Cognitive Retinoscopy

Cognitive Retinoscopy Cognitive Retinoscopy

• This procedure's importance to the

This procedure's importance to the behavioral optometrist now comes as behavioral optometrist now comes as it is used to determine the immediacy it is used to determine the immediacy and quality of the patient's response and quality of the patient's response to lenses. Clinical practice now shows to lenses. Clinical practice now shows the following identifiable responses: the following identifiable responses:

Cognitive Retinoscopy Cognitive Retinoscopy

• If there is a definitely observable

If there is a definitely observable brightening and stabilization of the brightening and stabilization of the retinoscopic reflex when the patient is retinoscopic reflex when the patient is reading through the analytically reading through the analytically-

• determined lens powers, the

determined lens powers, the immediacy of the visual benefits from immediacy of the visual benefits from this lens can be expected this lens can be expected -

• and

and predicted. predicted.

Cognitive Retinoscopy Cognitive Retinoscopy

• If, however, the reflex does not

If, however, the reflex does not brighten, and does not show the brighten, and does not show the stability expected, the necessity of the stability expected, the necessity of the lens is NOT negated, but there will lens is NOT negated, but there will probably have to be some time for the probably have to be some time for the visual system's adjustment to the lens visual system's adjustment to the lens power before the prescription benefits power before the prescription benefits are fully appreciated. are fully appreciated.

Cognitive Retinoscopy Cognitive Retinoscopy

• This information can well mean the

This information can well mean the difference where a child avoids difference where a child avoids wearing the glasses because, wearing the glasses because, “ “I can I can’ ’t t tell any difference whether I wear the tell any difference whether I wear the glasses or not. glasses or not.” ”

Procedure Procedure

• There are some critical differences

There are some critical differences

• here. The patient must hold the target
• here. The patient must hold the target

materials in his, or her, hands. There materials in his, or her, hands. There will not be the same responses if the will not be the same responses if the book is held by another person. book is held by another person.

Procedure Procedure

• The optometrist must place the

The optometrist must place the retinoscope into the same plane as retinoscope into the same plane as the book, and as close to the visual the book, and as close to the visual axis as possible. axis as possible.

• Since the observations are primarily

Since the observations are primarily

• f brightness and stability of the
• f brightness and stability of the

reflex, it is not necessary that the reflex, it is not necessary that the retinoscope be "on the line of sight." retinoscope be "on the line of sight."

Procedure Procedure

• Trial lenses should be used to obtain

Trial lenses should be used to obtain a measure of the amount of dioptric a measure of the amount of dioptric shifts which may occur here. shifts which may occur here.

• Strongly urge the patient to "read for

Strongly urge the patient to "read for comprehension because I will be comprehension because I will be asking questions about the material asking questions about the material later." later."

Procedure Procedure

• This instruction makes the distinct

This instruction makes the distinct differences between this procedure differences between this procedure and the usual nearpoint retinoscopic and the usual nearpoint retinoscopic

• bservations.
• bservations.

Watch for and Record Watch for and Record

• The dioptric shifts into "against"

The dioptric shifts into "against" motion and the exact circumstances motion and the exact circumstances in which it happens. in which it happens.

• The dioptric shifts into decreased

The dioptric shifts into decreased "against" motion or into "with" motion "against" motion or into "with" motion amounts and exact circumstances in amounts and exact circumstances in which these happen. which these happen.

Watch for and Record Watch for and Record

• Any extreme dulling of the reflex that

Any extreme dulling of the reflex that was not observed in any previous was not observed in any previous retinoscopic observations. retinoscopic observations.

• Carefully note any sort of "scissors"

Carefully note any sort of "scissors" motion of the reflex that was not motion of the reflex that was not

• bserved in other retinoscopic
• bserved in other retinoscopic

routines. routines.

Watch for and Record Watch for and Record

• Give special attention to the color,

Give special attention to the color, brightness and stability of the reflex brightness and stability of the reflex when amblyopia of any degree is when amblyopia of any degree is suspected. suspected.

• Carefully note any differences in the

Carefully note any differences in the retinoscopic reflex when there is more retinoscopic reflex when there is more interpretation and cognition being interpretation and cognition being demonstrated by the patient. demonstrated by the patient.

Getman Getman

• “

“Now, with more than 40 years Now, with more than 40 years (Getman (Getman’ ’s words in 1988) of s words in 1988) of acquaintance with this clinical clue, its acquaintance with this clinical clue, its greatest value lies in its confirmation greatest value lies in its confirmation

• f the most appropriate lens power for
• f the most appropriate lens power for

the stabilization and efficacy of the the stabilization and efficacy of the visual response during cognitive visual response during cognitive demands. demands.” ”

Getman Getman

• “

“This clinical data thus becomes This clinical data thus becomes another of the viable appraisals of the another of the viable appraisals of the visual abilities to inspect, discriminate visual abilities to inspect, discriminate and interpret the information coming and interpret the information coming from the lighted environment. from the lighted environment.” ”

Getman Getman

• In addition to this are the clues the

In addition to this are the clues the retinoscopic reflex holds about the retinoscopic reflex holds about the attitudes and decision attitudes and decision-

• making

making capabilities of the patient being capabilities of the patient being

• bserved while engaged in visually
• bserved while engaged in visually-
• centered tasks.

centered tasks.

Olson, Hendrickson and Lutes Olson, Hendrickson and Lutes

A Timeline of Retinoscopy A Timeline of Retinoscopy

• Carried through the decades for

Carried through the decades for Getman Getman’ ’s initial observations through s initial observations through most recent research in 2006 most recent research in 2006

Getman Getman -

• OEP Papers

OEP Papers-

• 1950

1950’ ’s s

• Scissors motion at near

Scissors motion at near -

• spherical

spherical at intermediate and far at intermediate and far

• (

(-

• ) X 90 at near

) X 90 at near -

• sph

sph at at int int and far and far

– – Playing with cars on a table or high Playing with cars on a table or high chair chair

• (

(-

• ) X 180 at near

) X 180 at near -

• sph

sph at at int int at far at far

– – Building towers Building towers

Getman Getman -

• OEP Papers

OEP Papers-

• 1950

1950’ ’s s

• Spherical at near, int. and far

Spherical at near, int. and far

• Went through the same process at

Went through the same process at intermediate and far distances intermediate and far distances

• Suggests that measure of refractive

Suggests that measure of refractive state closely parallels the action of state closely parallels the action of the child during development the child during development

• Development involves the entire

Development involves the entire body and it body and it’ ’s processes s processes

Emmetropization Emmetropization

• Most born with moderate hyperopia

Most born with moderate hyperopia and against the rule astigmatism and against the rule astigmatism ( (-

• X90)

X90)

• Moves to less hyperopia and with the

Moves to less hyperopia and with the rule ( rule (-

• X180) as they mature

X180) as they mature

• Coincidence or purpose

Coincidence or purpose

Forrest Article AAO Forrest Article AAO – – 1970 1970’ ’s s

• Pl

Pl – –6.00 X 090 OU 20/20 6.00 X 090 OU 20/20

• Auto accident

Auto accident -

• placed in traction

placed in traction

• C/O difficulty seeing with glasses

C/O difficulty seeing with glasses

• Pl

Pl – – 1.25 X 090 20/20 1.25 X 090 20/20

• Project reported in AAO Journal

Project reported in AAO Journal

• Limitation of eye movement in the

Limitation of eye movement in the power meridian is associated with power meridian is associated with higher measurable astigmatism higher measurable astigmatism

Tom Norton Tom Norton – – UAB UAB -

• 1980

1980’ ’s s

• One

One-

• half ping pong ball on laboratory

half ping pong ball on laboratory animal animal’ ’s eye s eye

• The part of the retina receiving

The part of the retina receiving stimulation showed normal growth stimulation showed normal growth

• The part of the retina with no form

The part of the retina with no form stimulation developed significant stimulation developed significant myopia myopia – – in some cases, over 10D in some cases, over 10D

Earl Smith Earl Smith – – UHCO UHCO – – 1990 1990’ ’s s

• +5.00,

+5.00, -

• 5.00, +10.00,

5.00, +10.00, -

• 10.00

10.00

• Eyes tend to grow toward the

Eyes tend to grow toward the stimulus except for the +10.00 which stimulus except for the +10.00 which also grew toward myopia also grew toward myopia

Whatham Whatham and Judge and Judge -

• 2001

2001

• Ten infant marmosets (8

Ten infant marmosets (8-

• 13 weeks of

13 weeks of age) wore soft CTL in one eye on a daily age) wore soft CTL in one eye on a daily basis for 5 basis for 5-

• 9 weeks

9 weeks

• Eyes with hyperopic lenses were more

Eyes with hyperopic lenses were more hyperopic (+2.39) and eye with the hyperopic (+2.39) and eye with the myopic lenses were more myopic ( myopic lenses were more myopic (-

• 2.48)

2.48)

• Fellow eyes were unaffected

Fellow eyes were unaffected

• Plano lenses did not affect eye growth

Plano lenses did not affect eye growth

Mutti Mutti, Mitchell, , Mitchell, Moeschberger Moeschberger, , Jones, Jones, and and Zadnik Zadnik -

• 2002

2002

• CONCLUSIONS.
• CONCLUSIONS. Heredity was the most

Heredity was the most important factor associated with juvenile important factor associated with juvenile myopia, with smaller independent myopia, with smaller independent contributions from more near work, higher contributions from more near work, higher school achievement, and less time in school achievement, and less time in sports activity. There was no evidence that sports activity. There was no evidence that children inherit a children inherit a myopigenic myopigenic environment environment

• r a susceptibility to the effects of near
• r a susceptibility to the effects of near

work from their parents. ( work from their parents. (Invest Invest Ophthalmol Ophthalmol Vis Vis Sci Sci. . 2002;43:3633 2002;43:3633– –3640) 3640)

Ge Ge Jian Jian -

• 2006

2006

• Repeated Smith

Repeated Smith’ ’s work s work

• The pax

The pax-

• 6 gene expression in the

6 gene expression in the retinas of the defocused right eyes retinas of the defocused right eyes was significantly higher than in those was significantly higher than in those

• f the control left eyes.
• f the control left eyes.

Ge Ge Jian Jian -

• 2006

2006

• The result of the study makes it more

The result of the study makes it more convincing that the increasing tendency convincing that the increasing tendency

• f children to stay indoors watching
• f children to stay indoors watching

televisions, playing computer games or televisions, playing computer games or reading books too closely to their eyes reading books too closely to their eyes can cause short can cause short-

• sightedness

sightedness

• Basic gene may lead to myopia

Basic gene may lead to myopia

Seminar Observation Seminar Observation -

• 2005

2005

• 10 month old

10 month old

• Parent has high astigmatism

Parent has high astigmatism

• In mother

In mother’ ’s lap, child shows moderate s lap, child shows moderate to high astigmatism >2.00 X 180 to high astigmatism >2.00 X 180 when casually looking when casually looking

• When looks at near target, response

When looks at near target, response is spherical in both eyes is spherical in both eyes

• When relaxes

When relaxes – – goes back to goes back to astig astig

Just Look! Just Look! Retinoscopy Retinoscopy

Just Look! Retinoscopy Just Look! Retinoscopy

Just Look! Retinoscopy Just Look! Retinoscopy

• After years of telling students and

After years of telling students and doctors to doctors to – – Just Look! Just Look!

• Similar to Getman and others

Similar to Getman and others

• Carefully note any sort of "scissors"

Carefully note any sort of "scissors" motion of the reflex that was not motion of the reflex that was not

• bserved in other retinoscopic
• bserved in other retinoscopic

routines. routines.

Just Look! Retinoscopy Just Look! Retinoscopy

• ..

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• ..

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Just Look! Retinoscopy Just Look! Retinoscopy

• What does one hope to find?

What does one hope to find?

• Do the eyes look alike?

Do the eyes look alike?

– – Likenesses and differences Likenesses and differences

• Motion

Motion

• Brightness

Brightness

• Color

Color

• Variation from expected

Variation from expected

• Response to different tasks

Response to different tasks

Just Look! Retinoscopy Just Look! Retinoscopy

• Response to lenses

Response to lenses – – not looking for not looking for neutralization neutralization

• The patient who has difficulty

The patient who has difficulty accommodating to the task accommodating to the task – – too too much, too little, stressed, sluggish, much, too little, stressed, sluggish, uncontrolled, unequal, etc., is one uncontrolled, unequal, etc., is one who has a visual problem who has a visual problem

Just Look! Retinoscopy Just Look! Retinoscopy

• A direct observation of the stability

A direct observation of the stability

• f the visual process
• f the visual process
• A direct observation of the patient

A direct observation of the patient’ ’s s response to lenses response to lenses

• A direct observation of the patient

A direct observation of the patient’ ’s s response at the specific working response at the specific working distance distance

Just Look! Retinoscopy Just Look! Retinoscopy

• You can do this:

You can do this:

– – At any point in your examination At any point in your examination – – Where the patient does most of the Where the patient does most of the work work – – Do what you have to do to observe Do what you have to do to observe the reflex the reflex -

• You may have to get on

You may have to get on the floor the floor – – Don Don’ ’t put your patient in an unnatural t put your patient in an unnatural position position

Just Look! Retinoscopy Just Look! Retinoscopy

• STOP!

STOP!

• LOOK!

LOOK!

• COMPARE

COMPARE

• Use lenses as probes and in pairs

Use lenses as probes and in pairs

• Evaluate responses to lenses rather

Evaluate responses to lenses rather than try to neutralize than try to neutralize

• Evaluate responses in time

Evaluate responses in time

What to Watch For What to Watch For

• Excessive Plus

Excessive Plus – – more than 2.00 more than 2.00

• No plus or any minus

No plus or any minus

• Fluctuations not induced by difficulty

Fluctuations not induced by difficulty

• f task indicating lack of control
• f task indicating lack of control
• Anisometropic changes

Anisometropic changes

• Anisocoria or mydriasis

Anisocoria or mydriasis

What to Watch For What to Watch For

• Astigmatism, especially changes

Astigmatism, especially changes from far from far

• Difficulty in completing the task

Difficulty in completing the task

• Interferences in the visual pathway

Interferences in the visual pathway

• Dulling or horizontal striations

Dulling or horizontal striations

• Eyes drying

Eyes drying

Responses to Plus Lenses + Responses to Plus Lenses +

• Decrease in with motion

Decrease in with motion

• Decrease in against motion

Decrease in against motion

• Decrease in cylinder

Decrease in cylinder

• Increase in brightness

Increase in brightness

• Increase in pupil size

Increase in pupil size

• Increase in equality between eyes

Increase in equality between eyes

• Increase in color response

Increase in color response

• Increase in reading quality

Increase in reading quality

Responses to Plus Lenses Responses to Plus Lenses -

• Increase in with motion

Increase in with motion

• Increase in against motion

Increase in against motion

• Increase in cylinder

Increase in cylinder

• Decrease in brightness

Decrease in brightness

• Decrease in pupil size

Decrease in pupil size

• Decrease in equality between eyes

Decrease in equality between eyes

• Decrease in color response

Decrease in color response

• Decrease in reading quality

Decrease in reading quality

Expected Expected

Brick Red Brick Red-

• Dirty

Dirty – – Reduced Reduced Contact Contact

Intense Central Intense Central – – Often Often Associated With Hyperopia Associated With Hyperopia

Scanning Minus Axis 180 Scanning Minus Axis 180

Scanning Minus Axis 90 Scanning Minus Axis 90

Scanning Minus Axis 180 Scanning Minus Axis 180

Scanning Minus Axis 90 Scanning Minus Axis 90

Cyl Cyl axis 090 axis 090

Cyl Cyl Axis 180 Axis 180

Decreased Central Decreased Central Performance Performance

Doughnut Doughnut – – Avoids Contact Avoids Contact

Just Look! Retinoscopy Just Look! Retinoscopy

• Stop!

Stop!

• Look!

Look!

• Compare!

Compare!

• Just Look! at the two eyes as a pair

Just Look! at the two eyes as a pair rather than an eye rather than an eye

Just Look! Retinoscopy Just Look! Retinoscopy

• Stop! Look! Compare!

Stop! Look! Compare!

• Probe with

Probe with pairs of lenses pairs of lenses to to determine if you can change a determine if you can change a negative appearance to a more negative appearance to a more positive appearance positive appearance

• The greater the change, the greater

The greater the change, the greater the likelihood of making a difference the likelihood of making a difference in the patient in the patient’ ’s life s life

Thank You! Thank You!

Infant Vision and Vision Infant Vision and Vision Development Track Development Track

Saturday 22 April Saturday 22 April

Parent Focus Group Parent Focus Group

• All have our own involvement whether

All have our own involvement whether basic assessment or very in basic assessment or very in-

• depth

depth assessment assessment

• What happens when we look outside the

What happens when we look outside the box? box?

• C:

C:\ \Documents and Settings Documents and Settings\ \gsteele gsteele\ \My My Documents Documents\ \Videos Videos\ \MomsForDVD.mpeg MomsForDVD.mpeg

Infant Vision Track Infant Vision Track

• Well Baby Examination

Well Baby Examination – – Rateau Rateau

• Survey of Research

Survey of Research – – Aalberg Aalberg

• Special Needs Babies

Special Needs Babies – – Maino Maino

• Infant Strabismus

Infant Strabismus – – Baxtrom Baxtrom

• Vision Development Activities for Human

Vision Development Activities for Human Intelligence Intelligence – – Kitchener Kitchener

• Primitive Reflexes

Primitive Reflexes – – Holland Holland

• Kindy

Kindy Toddler Toddler Gymbaroo Gymbaroo -

• Sasse

Sasse