University of Edinburgh
 

Functional Assessment of Vision

Presented 19-20 March 2008

Case Study

6th December 2005

FUNCTIONAL VISION ASSESSMENT REPORT

Name: Date of Birth: 02

Address: Date of Assessment: 05

Location: Camelon Sensory Centre

Hospital Number:

Accompanied By: Mother

Assessors: Anne Anderson - Orthoptist
Dawn Swan - Orthoptist
Christine Stones - TVI
Jane I Robertson - THI
Dr A Sinclair - Staff Grade Community Paediatrician

Referrer: Dr J Gillen - Consultant Ophthalmologist

Purposes of Assessment: To ascertain the child's visual abilities in the light of known Ophthalmological problems and the likelihood of cerebral visual impairment. To find the most favourable ways for the child to access visual information.

Past Medical History
The child was born prematurely at 25 weeks with a chronic lung condition requiring oxygen, and brain haemorrhage leading to hydrocephalus and requiring a shunt (inserted at 6 months). The child has quadriplegic cerebral palsy and epilepsy, and hearing difficulty for which the child wears bilateral hearing aids.

Past Ophthalmic History
The child has been successfully treated for Retinopathy of Prematurity and has been seen by Professor Dutton in the past. The child is now under the care of Dr J Gillen and noted to have a right convergent squint, and to fix steadily with the left eye. Glasses have been prescribed for right myopic astigmatism and the child has healthy optic discs with peripheral laser scars.

03.06.02

General Abilities and Functional Vision History
The child has motor difficulties and a persistent ATNR (baby reflex). We found the best way of examining the child's vision was with the child lying on his/her side on the floor. The child is awaiting appropriate head supports to be fixed to his/her chair. Hand control is poor but nevertheless the child is learning to make Makaton signs and can hit a switch and understand cause and effect.

Significantly the child is also communicating by eye pointing.

Functional Vision History
The child reacts to light, opens his/her mouth for food, and is reported to reach for a 1" diameter marble - the child's mother reports that the child recognises faces and noticed a different taxi driver. The child is reported to recognise objects, shapes, colour probably up to about 3 metres and ''blanks out" if there is too much information. The child enjoys watching the Teletubbies and Tweenies and will watch the news (single face) and laugh!

Assessment

Observation
The child was assessed with his/her glasses on. The child appeared to have a better response to the right and slow to the left. The child followed light and had good eye contact at about 50cm.

Visual Acuity
Using the Keeler preferential looking cards the child achieved 6/90 (definite) and 6/60 (possible) at about 40cm.

Contrast sensitivity
The child responded best to strong contrast for example the child has a good response to a white ball on a dark blue carpet at about 30-40cm, with little response to a red ball.

Visual field
The child had a definite response to the upper left and right field but a doubtful response in both lower fields.

Orthoptic examination
The child had a right convergent squint with no binocular single vision. Eye movements were full with no nystagmus. The child was quick to follow from primary position to his/her right with slower jerky movements to his/her left.

Colour vision
The child responded positively to different coloured objects.

Detection vision
The child had a definite response to a 3cm Stycar rolling ball at about 50cm (while lying on the floor on his/her left side).

Recognition distances
The child recognised a face at 1.5m and appeared to enjoy a 6cm size green frog at 30-40cm.

Conclusion

Despite the child's history of ROP. and known Astigmatism, short-sightedness, squint and motor difficulties, the child uses his/her vision well within a fairly close range and uses it purposefully (eye pointing).

There have been problems with the use of his/her glasses mainly from a mechanical point of view.

Consistent with cerebral visual impairment (CVI) there will be some constraints in how he/she is able to process visual information, for example, with "crowding", that is when presented with cluttered material, the child lost interest. Distant view will similarly be too complex. Other aspects of CVI, for example, the child's lower field vision was not clear and we will review the child's visual function in a year's time. In the meantime the following recommendations should be helpful.