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.fiTampa USF October 2011
Visual communication
Eye contact, copying of expressionsAt 6 weeks, 8 weeks at the latest
Social smile, active interaction at the age of 12 weeks.
Communication – at 8 weeks
3
Eye contact and social smile
Normal eye contact at 6 weeks, social smile at 12 weeks.
Insufficient accommodationMirror neuron system
Eye contact and social smile
Insufficient accommodation
Near correction
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
Grating Acuity & Heidi Face as detection acuity & communcation distance
Detection tests
Preferential looking
2.5%
Hiding Heidilow contrast pictures for assessment of communication distance
Nordic faces and shadows of facial expressions are at low contrast.
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
Infant artists’
Mirror neuron functions
Photo: Päivi Setälä
At the Art MuseumPori, Finland
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
Infants at risk
12
Accommodation inHypotonic infants
Compensating accommodation
13
Watching simple picturestwo years later
14
Infants at risk Delayed motor development in premaurely born infants
15Combined effect of visual and motor disorder delays the development of an infant in all functional areas.
Constricted visual field
16
Large illuminated ball used by child’s own therapist.
Fixation
17
Brief fixation on the middlesize picture of face
Accommodationdifficult to measure when the infant does not look at
18
Mother’s face and voiceused as the target.
Eye contactwhen reading lenses give a clear image on the retina
19
Reaction during assessment of her brothernoises and body language show disapproval
20
Visually activeten weeks later: improved visual and motor functions
21RE: GrA less than in LE > trainingas a part of physiotherapy
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
Early Intervention
should start EARLY
It should start during the assessment.
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.fiTampa USF October 2011
Accommodationeye contact and social smile
Weak accommodation can be compensated with ”reading glasses.”