Optometric Management of Fetal Alcohol Syndrome
Diagnosis
Terminology: Fetal Alcohol Spectrum Disorders (FASD)
Syndrome vs. Trait(s) according to the Centers for Disease Control
Four Cardinal FASD features:
1. Prenatal alcohol exposure
2. Height and/or weight below 10th percentile
3. CNS structural and/or functional damage (leading cause of mental handicap)
4. Three facial features
o Flat philtrum
o Thin upper lip
o Small palpebral fissures
FASD is composed of four subgroups
1. Fetal alcohol syndrome (FAS)
2. Partial fetal alcohol syndrome (PFAS)
3. Alcohol-related birth defects (ARBD)
4. Alcohol-related neurodevelpmental disorder (ARND)
Diagnostic Scales
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Current screening tests for pregnant women with harmful drinking habits
o T-ACE test
o TWEAK test
Diagnostic guidelines for FASD
o The 4-Digit Diagnostic Code for FASD University of Washington
o Institute of Medicine Guidelines
o Hoyme diagnostic guidelines
o Hybrid of the above two according developed in Canada
Differential Diagnosis
Rule out prenatal exposure to:
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Crack Cocaine
Methamphetamine
Toluene
Also rule out genetic disorders that can cause mental handicap, such as:
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Fragile X (facial appearance similarities and differences)
Phenylketonuria (PKU, inability to metabolize phenylalanine)
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Williams Syndrome (chromosome 7 deletion causing color blindness, perceptual
deficits)
Postnatal Insult:
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High fever
Concussion
TBI, including Shaken Baby Syndrome
Systemic Complications
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Heart Valve/Septal birth defects, Tetrology of Fallot
Joint/Integumentary defects (fingers, nails, hair)
Horseshoe or other kidney defects
Ocular defects:
o Optic nerve hypoplasia
o Strabismus/amblyopia
o Micro-ophthalmia
o Ptosis and/or small palpebral fissures
Treatment
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Optic nerve anomalies and microophthalmia – low vision aids
Amblyopia – occlusion or atropine penalization
Strabismus – prisms (if small), vision therapy (if moderate) or surgery (if large)
Medications – stimulants for attention problems?
Behavioral interventions – most effective treatment, besides prevention
Public Health education-100% preventable