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

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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

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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

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Accommodation inHypotonic infants

Compensating accommodation

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Watching simple picturestwo years later

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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

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Large illuminated ball used by child’s own therapist.

Fixation

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Brief fixation on the middlesize picture of face

Accommodationdifficult to measure when the infant does not look at

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Mother’s face and voiceused as the target.

Eye contactwhen reading lenses give a clear image on the retina

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Reaction during assessment of her brothernoises and body language show disapproval

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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.”