1. Eye and Vision Exams in the Outpatient Clinic Erika Beard-Irvine MD LCDR MC (FS) USN

2. Objective AAP practice parameters for red reflex and vision screening Techniques for red reflex and vision screening Disease processes Referral criteria

3. Terminology Myopia http://www.childrenshospital.org/az/Site1517/mainpageS1517P0.html http://www.ophthobook.com/chapters/pediatrics

4. Terminology Myopia Hyperopia http://www.childrenshospital.org/az/Site1517/mainpageS1517P0.html

5. Terminology Myopia Hyperopia Astigmatism http://www.childrenshospital.org/az/Site1517/mainpageS1517P0.html

6. Terminology Myopia Hyperopia Astigmatism Amblyopia Anisometropia http://www.ohioamblyoperegistry.com/

7. Red Reflex Examination Newborn examination All routine health supervision visits http://www.bartsandthelondon.nhs.uk/forgps/checking_for_the_red_reflex_in_children.asp

8. http://seeweimer.com/eye-anatomy/

9. Technique Ophthalmoscope power to 0 Lights off Simultaneously at 2-3 feet away Separately at 12-18 inches away http://www.ophthobook.com/chapters/pediatrics

10. Leukocoria http://www.daisyseyecancerfund.org/rb/eye/index.html http://www.orphancancer.org/ORbIT/leukocoria.html http://www.nature.com/onc/journal/v25/n38/fig_tab/1209622f1.html

11. Differential of Leukocoria Retinoblastoma Congenital cataract ROP PFV Coloboma Uveitis Toxocariasis Coats disease Vitreous hemorrhage Retinal dysplasia

12. Absent Red Reflex http://www.peds.ufl.edu/peds2/research/debusk/pages/page7_61.html

13. Absent Red Reflex http://www.bartsandthelondon.nhs.uk/forgps/checking_for_the_red_reflex_in_children.asp

14. Asymmetric Red Reflex http://www.abcd-vision.org/vision-screening/red-reflex.html

15. Asymmetric Red Reflex http://www.abcd-vision.org/vision-screening/bruckner.html

16. Asymmetric Red Reflex Mills, MD. The eye in childhood, Am Fam Physician. 1999 Sep 1;60(3):907-916.

18. Eye Evaluation Ocular history Vision assessment External inspection of the eye and lids Ocular motility assessment Pupil examination Red reflex examination Attempt at opthalmoscopy (>3 yo)

19. Ocular History Does you child seem to see well? Does your child hold objects close to his/her face when trying to focus? Do your childs eyes seem to cross or drift? Do your childs eyes appear unusual? Do your childs eyelids droop or does 1 eyelid tend to close? Have your childs eyes ever been injured? Family history of eye disorders or early eyeglass wear.

20. Vision Assessment Fix and follow Visual acuity measurement (>3 yo) Photoscreening

22. Screening for amblyogenic factors: Strabismus Media opacities Significant refractive errors Evaluate photo of red reflex and pupillary light reflex AAP says it could be helpful but recommends more study

23. External Examination Tearing or discharge Corneal clouding http://www.mps1disease.com/en/patients/about/signs-and-symptoms/corneal-clouding.aspx

24. External Examination Tearing or discharge Corneal clouding Ptosis http://www.cosmeticeyesandface.com/Pediatrics.html

25. External Examination Tearing or discharge Corneal clouding Ptosis Iris abnormalities http://www.glaucomaconsultantsnorthwest.com/glaucoma%20in%20children.html http://www.med.umn.edu/ophthalmology/faculty/schimmenti/home.html

26. Ocular Motility Corneal reflex test Extra-ocular movements Cover-uncover test Random dot E stereo test

27. Corneal Light Reflex http://health.utah.gov/cshcn/HSVS/photo.html Mills, MD. The eye in childhood, Am Fam Physician. 1999 Sep 1;60(3):907-916. http://www.wahajr.com/hajrvb/showthread.php?t=402925749&page=4

28. Ocular Motility Corneal reflex test Extra-ocular movements Cover-uncover test Random dot E stereo test

30. Ocular Motility Corneal reflex test Extra-ocular movements Cover-uncover test Random dot E stereo test

31. Random Dot E http://health.minnesota.gov/divs/fh/mch/webcourse/vision/mod7a.cfm

32. Pseudostrabismus http://www.sarawakeyecare.com/Atlasofophthalmology/paediatric/paediatricophthalmologytpicture4.htm

33. Pupil Exam http://www.atlasophthalmology.com/atlas/photo.jsf?node=5832&locale=en

34. Referral Criteria Leukocoria or absent red reflex Any abnormality on exam Persistent torticollis or head tilt FHx of retinoblastoma FHx corrective lenses in preschool or lazy eye Parent concern