Assessment of visual functioning with special reference to infants

1. Assessment of visual functioning with special reference to infants Lea Hyvärinen, MD, PhD, FAAP Professor h.c., Rehabilitation Sciences, University of Dortmund Senior Lecturer, Developmental Neuropsychology, Univ. of Helsinki www.lea-test.fi Tampa USF October 2011

2. Visual communication Social smile, active interaction at the age of 12 weeks. Eye contact, copying of expressions At 6 weeks, 8 weeks at the latest

3. Communication – at 8 weeks 3

4. Eye contact and social smile Normal eye contact at 6 weeks, social smile at 12 weeks. Insufficient accommodation Mirror neuron system

5. Eye contact and social smile Near correction Insufficient accommodation

6. Recommended assessments • Following functions should be assessed in all infants: • eye contact and social smile (accommodation ) • grating acuity as detection acuity • contrast sensitivity for communication

7. Grating Acuity & Heidi Face as detection acuity & communcation distance Preferential looking Detection tests 2.5%

8. Hiding Heidilow contrast pictures for assessment of communication distance Nordic faces and shadows of facial expressions are at low contrast.

9. Recommended assessments • Following functions should be assessed in all infants: • eye contact and social smile • grating acuity as detection acuity • contrast sensitivity for communication • refractive errors, confrontation visual fields • ocular motor functions, including accommodation • observation of hand functions and copying them

10. 10 At the Art Museum Pori, Finland Infant artists’ Mirrorneuron functions Photo: Päivi Setälä

11. Recommended assessments • Following functions should be assessed in all infants : • eye contact and social smile • grating acuity as detection acuity • contrast sensitivity for communication • refractive errors, confrontation visual fields • ocular motor functions, including accommodation • observation of hand functions and copying them • face recognition of family members

12. Infants at risk 12 Accommodation in Hypotonic infants

13. Compensating accommodation

14. Watching simple picturestwo years later

15. Infants at risk Delayed motor development in premaurely born infants Combined effect of visual and motor disorder delays the development of an infant in all functional areas.

16. Constricted visual field Large illuminated ball used by child’s own therapist.

17. Fixation Brief fixation on the middle size picture of face

18. Accommodationdifficult to measure when the infant does not look at Mother’s face and voice used as the target.

19. Eye contactwhen reading lenses give a clear image on the retina

20. Reaction during assessment of her brothernoises and body language show disapproval

21. Visually activeten weeks later: improved visual and motor functions RE: GrA less than in LE > training as a part of physiotherapy

22. Infants at risk • Infants with delays/difficulties in communcation • All hypotonic infants: brain damage, Down • All infants with Down syndrome, refraction • Infants with strabismus • All deaf and hard of hearing infants • All infants with syndrome based risk of VI

23. Early Intervention should start EARLY It should start during the assessment.

24. Assessment of visual functioning with special reference to infants Lea Hyvärinen, MD, PhD, FAAP Professor h.c., Rehabilitation Sciences, University of Dortmund Senior Lecturer, Developmental Neuropsychology, Univ. of Helsinki www.lea-test.fi Tampa USF October 2011

25. Accommodationeye contact and social smile Weak accommodation can be compensated with ”reading glasses.”