Pxs with developmental issues

1. communication barriers - H&S, subjective

2. cognitive - may not understand instructions for test/ low attention span

3. sensory issues- hyper sensitive so need a calm environment, consider lighting, anxiety/discomfort/refusal to do certain tests

4. time constraint- tests may need to be in shorter seesions - avoid px fatigue = non cooperation

1. Modify communication- speed, clarity, calm, sign language, instruction = short and simple, respectful, non patronising, allow time for response, involve carer AND px

2. Gain consent- ensure px = happy to proceed with test ( close contact)

3. H&S- RFV, POH, GH, meds, FOH, curent signs eg head tilt, strab, eye rubbing, hobbies,

4. VAs- use approppriate chart ( dyslexia), be encouraging. For CS, Pelli-Robson might be complex so use Cardiff Cards

5. Rx- may be high, use interesting distance target, near ret( reduced acom) ( careful of room light off), cyclo( rm lights on),

6. Strab- CT, stereopsis ( Titmus or Randot)

7. Nystagmus - worse in certain directions= ocular motility

8. Slit lamp-( room lights off), gain consent, use volk( longer WD)

1. Rx- full +Rx, optimise near VA ( bifocals/PPLs), differentiate btwn NVA blur and diplopia

2. LVAs- mag, enhanced lighting/contrast, auditory devices, tinted lenses( glare), prism

3. consider school/ work set up, in front of class/

4. Follow up- 3 months

1. media opacities

2. reported falls

3. symptoms of glare

4. glaucoma

5. ONH disorders

6. DR

7. Retinitis pigmentosa

Glaucoma - risk factors

Diabetic

dry eye

cataract

mac oedema

keratoconus

pterygium

medications- antieliptics, tamixifen, cortisteroids

driver -