Visual assessment of the multiply handicapped patient. 1989

D Orel-Bixler, and G Haegerstrom-Portnoy, and A Hall
School of Optometry, University of California, Berkeley.

The visual capabilities of the multiply handicapped and/or developmentally delayed patient are difficult to assess with methods that depend on the patient's subjective responses. Fifty-nine patients with multiple neurological handicaps and unknown visual capabilities were examined using a modified ophthalmic examination which included visual acuity measures using visual evoked potential (VEP) and preferential looking (PL) techniques. Patients ranged in age from 3 to 33 years; median age 9 years. Significant refractive error (in 73%) and strabismus (in 71%) were the most common ocular disorders. Of the 43 patients with a significant refractive error, only 16 (37%) were wearing their proper correction (ranging from -21 to +20 D). In 27 patients the uncorrected refractive error ranged from -10 to +20 D. Binocular acuities (with refractive correction) could be obtained from 56 patients (95%) using a spatial frequency sweep VEP technique, and in 41 patients (70%) using PL grating acuity cards. The VEP and PL grating acuity measures agreed to within 1 octave (a factor of 2 in minimum angle of resolution) in 27 of 41 patients. VEP acuity was 1.1 to 2.7 octaves higher in 12 patients. Grating acuity of at least 6/12 (20/40) was estimated in 12 patients. Residual vision can be measured in "difficult to examine" multiply handicapped patients with VEP and PL techniques.

UI MeSH Term Description Entries
D008607 Intellectual Disability Subnormal intellectual functioning which originates during the developmental period. This has multiple potential etiologies, including genetic defects and perinatal insults. Intelligence quotient (IQ) scores are commonly used to determine whether an individual has an intellectual disability. IQ scores between 70 and 79 are in the borderline range. Scores below 67 are in the disabled range. (from Joynt, Clinical Neurology, 1992, Ch55, p28) Disability, Intellectual,Idiocy,Mental Retardation,Retardation, Mental,Deficiency, Mental,Intellectual Development Disorder,Mental Deficiency,Mental Retardation, Psychosocial,Deficiencies, Mental,Development Disorder, Intellectual,Development Disorders, Intellectual,Disabilities, Intellectual,Disorder, Intellectual Development,Disorders, Intellectual Development,Intellectual Development Disorders,Intellectual Disabilities,Mental Deficiencies,Mental Retardations, Psychosocial,Psychosocial Mental Retardation,Psychosocial Mental Retardations,Retardation, Psychosocial Mental,Retardations, Psychosocial Mental
D012030 Refractive Errors Deviations from the average or standard indices of refraction of the eye through its dioptric or refractive apparatus. Ametropia,Refractive Disorders,Ametropias,Disorder, Refractive,Disorders, Refractive,Error, Refractive,Errors, Refractive,Refractive Disorder,Refractive Error
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D002675 Child, Preschool A child between the ages of 2 and 5. Children, Preschool,Preschool Child,Preschool Children
D005074 Evoked Potentials, Visual The electric response evoked in the cerebral cortex by visual stimulation or stimulation of the visual pathways. Visual Evoked Response,Evoked Potential, Visual,Evoked Response, Visual,Evoked Responses, Visual,Potential, Visual Evoked,Potentials, Visual Evoked,Response, Visual Evoked,Responses, Visual Evoked,Visual Evoked Potential,Visual Evoked Potentials,Visual Evoked Responses
D006233 Disabled Persons Persons with physical or mental disabilities that affect or limit their activities of daily living and that may require special accommodations. Handicapped,People with Disabilities,Persons with Disabilities,Physically Challenged,Physically Handicapped,Physically Disabled,Disabilities, People with,Disabilities, Persons with,Disability, Persons with,Disabled Person,Disabled, Physically,Handicapped, Physically,People with Disability,Person, Disabled,Persons with Disability,Persons, Disabled
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000293 Adolescent A person 13 to 18 years of age. Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D013285 Strabismus Misalignment of the visual axes of the eyes. In comitant strabismus the degree of ocular misalignment does not vary with the direction of gaze. In noncomitant strabismus the degree of misalignment varies depending on direction of gaze or which eye is fixating on the target. (Miller, Walsh & Hoyt's Clinical Neuro-Ophthalmology, 4th ed, p641) Concomitant Strabismus,Dissociated Horizontal Deviation,Dissociated Vertical Deviation,Heterophoria,Heterotropias,Hypertropia,Non-Concomitant Strabismus,Nonconcomitant Strabismus,Phorias,Squint,Strabismus, Comitant,Strabismus, Noncomitant,Convergent Comitant Strabismus,Mechanical Strabismus,Comitant Strabismus,Comitant Strabismus, Convergent,Deviation, Dissociated Horizontal,Dissociated Horizontal Deviations,Dissociated Vertical Deviations,Heterophorias,Heterotropia,Horizontal Deviation, Dissociated,Hypertropias,Non Concomitant Strabismus,Noncomitant Strabismus,Phoria,Strabismus, Concomitant,Strabismus, Convergent Comitant,Strabismus, Mechanical,Strabismus, Non-Concomitant,Strabismus, Nonconcomitant

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