Webinar
Early intervention today
In this webinar: Babies’ low vision needs are different than adults, especially those with additional disabilities. The ophthalmologist can help in the early identification of babies with suspected visual impairment and refer the family to a team to start interventions at a very early age.
In this webinar:
Babies’ low vision needs are different than adults, especially those with additional disabilities. The ophthalmologist can help in the early identification of babies with suspected visual impairment and refer the family to a team to start interventions at a very early age.
Presenter
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Dr. Linda Lawrence, M.D.
Pediatric Ophthalmologist and consultant at the Kansas State School for the Blind
Speaker Q&A
Could you please explain the relationship between vision loss and ASD or ADHD? Can there be a child who has a vision impairment but it is misdiagnosed as another thing? Is it possible, and how can we understand, especially if the child is born full term (no history that made us think about CVI)?
Yes, you can be full term with a normal MRI and have CVI. ASD and ADHD have some cross over behaviors that can look like CVI, and they also can co-exist with CVI. Careful assessment is needed and definitely more research! Recent research shows that many children with ASD have vision conditions. Here are some articles that look more in depth at CVI, ASD and ADHD:
Are there specific glasses for intermittent exotropia? What about lower visual field loss?
This article is the most recent article that shows minus glasses for exotropia only work as long as they are worn, and the effect wears off after the glasses are discontinued. This is good research, there are many trials and articles, but this one looks at the long term. Yoked prisms (base down) have been used in lower visual field defects. There is no good research/data on the effectiveness. I have tried myself on a few patients, but I’m not really sure it was effective.
Are prisms used on little children?
Prisms are not typically prescribed in babies.
What should be the minimum distance of holding a toy to get the infant visually engaged?
Where they can see it! Start at 6-8 inches, 8-12 inches (about 30 cm) is considered the communication distance.
Do you prescribe prisms for children with CVI?
When would you consider including prisms in a prescription? I have tried them for a couple of children with lower visual field defects. I can’t really say that they worked. So I don’t routinely do this.
My baby has ventriculomegaly, ponto cerebellar hypoplasia and he cannot give eye contact, focus, or track an object. Also, the vision therapist told me he is sensitive to light. Is there any possibility my baby can see like a normal baby?
We can not really predict the future. But your baby should have proper assessments and interventions to help him to the best of his ability.
Our child has coloboma of the optic nerve resulting in blindness in one eye and very low vision in the other eye. She’s 14 months old and we’ve been told glasses won’t help her. Thoughts?
I am a strong proponent of glasses. How do we know they cannot work if we don’t try them? I have been amazed by the amount of vision some children with colobomas have. We can not always predict vision by the appearance of the coloboma. Ask your eye care provider to try to give the best prescription they can. Safety glasses in children with low vision are mandatory for protection, so why not put the proper prescription in place?
I have a child with CVI who is 3 years old. What tests and exams do you recommend for an annual exam?
Eye health, refraction, and accommodation. We have a battery of developmental tests we do as the child gets older including stereopsis, and color vision. All testing should be according to age and ability. We typically do a cycloplegic refraction yearly.
My child has a rare genetic condition and is suspected to have CVI along with confirmed optic nerve hypoplasia. Do you have any information around whether optic nerve hypoplasia is degenerative and if there are any assessments to get a baseline on the optic nerves?
The most important thing is a comprehensive endocrinology work-up as the optic nerves are derived from the diencephalon, the same as the pituitary gland. Here is a PowerPoint I did a few years ago. Typically optic nerve hypoplasia is not degenerative, but I would have to know the underlying genetic disorder to better understand how to answer you.
For strabismus surgery timing: what about alternating strabismus (one eye sometimes and the other eye some other times)?
Timing for strabismus surgery is individualized for each patient, depending on function, safety of general anesthesia, and getting a good exam so proper measurements can be done to plan the surgery. The goal is better overall function/development for the child, being able to see in midline, and getting the two eyes to work together the best they can. Surgery is not always a “cure”, often glasses and patching, and close follow-up is still needed.
Are LEA gratings helpful for a child with cvi and autism?
I use LEA gratings for preverbal and nonverbal children. They are helpful in order to compare a child to themselves, and they can give you an idea of what the child sees.
What are your thoughts on patching for exotropia?
It really depends on each child. Patching is done to treat amblyopia, it doesn’t straighten the eyes. If only one eye is exotropic, it may be indicated to treat/prevent amblyopia.
Our baby has ponto cerebellar hypoplasia. He is six months old and cannot make eye contact. His vision therapist told us he has light sensitivity. Can you please tell me whether my baby can have normal vision like other babies?
We can not really predict the future, but your baby should have proper assessments and interventions to help him to the best of his ability.
Dr. Linda Lawrence, what kind of glasses would you recommend for the purpose of keeping monocular sight safe, for a 1 year old?
Polycarbonate safety lenses. There are several good frame brands on the market that have plastic frames.
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