BVP - Clinical Management of Refractive Error in Children - PAP Week 1

Question 1

List 7 factors that need to be taken into consideration when determining whether to prescribe glasses for a child?

Answer 1

1. Magnitude of refractive error
   - how much?
2. Age of the patient
3. Visual acuity of the patient
   - is it age appropriate?
4. Type of refractive error
   - myopia/hyperopia/astigmatism
5. Other risk factors for visual impairment
   - downs syndrome/cerebral palsy
6. Other risk factors associated with learning/development
   - learning difficulties/dyslexia
7. Other amblyogenic risk factors
   - strabismus/anisometropia/monocular: cataract, keratopathy, ptosis, haemangioma

Question 2

Which of the following can place an infant, toddler, or child at significant risk for visual impairment?
Low birth weight
Low oxygen at birth
Prematurity

Answer 2

All three

Question 3

Family history of what 4 diseases may place an infant, toddler, or child at significant risk for visual impairment?

Answer 3

Retinoblastoma
Congenital cataracts
Metabolic diseases
Genetic diseases

Question 4

Infection of the mother by what 6 diseases during pregnancy can place the child at risk?

Answer 4

Rubella
Toxoplasmosis
Venereal disease (STIs)
Herpes
HIV (AIDS)
Cytomegalovirus

Question 5

What is difficult or assisted labour often associated with (2) and does this have any impact on the visual functioning of the child?

Answer 5

Associated with foetal distress or low apgar scores

May place the infant at significant risk for visual impairment

Question 6

Which of the following may place an infant, toddler, or child at significant risk for visual impairment:
High refractive error
Strabismus
Anisometropia

Answer 6

All three

Question 7

What does the literature show of the link between hyperopes and lags, if any? Explain.

Answer 7

Hyperopes of school age were more likely to manifest lags
in the development of visual perceptual skills than that of
emmetropes/myopes of equivalent age.

Question 8

True or false

Treating hyperopes by age four has the same outcome as treating hyperopes after age four.

Answer 8

False

Hyperopes treated before age four have better visual outcomes vs those treated after age four

Question 9

What effect does simulation of binocular near stress with -2.00D lenses have on performance (time taken to complete a task) and what does this mimick?

Answer 9

Performance was significantly reduced, and mimicks the effect of uncorrected hyperopia on performance

Question 10

Is there a correlation between uncorrected refractive error and poor reading development? What about myopia specifically? Explain.

Answer 10

High correlation between uncorrected refractive error and poor reading development
Myopia is noted as an exception to correlate with high reading ability
No evidence to indicate any causation between refractive error and poor reading

Question 11

What does the literature say on prescribing for hyperopia vs observation?

Answer 11

Inconclusive and suggests only a moderate benefit with Rx vs observation

Question 12

Consider a scenario for hyperopia where VA or stereopsis is reduced and they have Rx that is borderline, what is the better course of action, prescribing lenses or observing?

Answer 12

Should be prescribing

Question 13

List 12 risk factors for amblyopia.

Answer 13

Ptosis
Infection (keratitis)
Cataract
Premature birth
Strabismus
Anisometropia
Keratopathy
Haemangioma
Low birth weight
Cerebral palsy
Downs syndrome
Family history

Question 14

Is it beneficial for children with a risk factor for amblyopia to have a comprehensive ophthalmic exam in addition to annual screening or is there no benefit?

Answer 14

They should have both

Question 15

List the evidence-based guidelines for amblyogenic factors to be detected by vision screening for the following:
Hyperopia
Myopia
Astigmatism
Anisometropia
Strabismus
Ptosis
Media opacity

Answer 15

Hyperopia - >3.50D in any meridian
Myopia - >3.00D in any meridian
Astigmatism - >1.50D at 90 or 180 or 1.00D oblique (more than 10 from 90/180)
Anisometropia - >1.50D spherical or cylindrical
Strabismus - any manifestation
Ptosis - less than or equal to 1mm margin reflex distance
Media opacity - any >1mm in size

Question 16

By what age would ambylopia have fully developed? What magnitude of amblyopia should not be ignored?

Answer 16

By age 3

Greater than 1.00D should not be ignored

Question 17

Does the depth of amblyopia increase or decrease in severity with age?

Answer 17

Increases

Question 18

Is severe amblyopia common or rare in children up to age 3?

Answer 18

Rare

Question 19

Can correcting refractive error alone improve visual acuity in children?

Answer 19

Yesd

Question 20

Can bilateral amblyopia be effectively treated with spectacles?

Answer 20

Yes, binocular acuity improved almost 4 lines after 1 year in the PEDIG study

Question 21

List 5 questions to consider when considering whether to prescribe glasses or not for infants and children.

Answer 21

Is the refractive error within the normal range for the child’s age?
Will this particular child’s refractive error emmetropise?
Will this level of refractive error disrupt normal visual development or functional vision?
Will prescribing spectacles improve visual function or functional vision?
Will prescribing glasses interfere with the normal process of emmetropisation?

Question 22

In general, do optometrists correct asymptomatic patients with hyperopic anomalies or heterophorias?

Answer 22

No, they do not, if the patient is asymptomatic

Question 23

For symtomatic patients, at what magnitude do optometrists generally prescribe for the following:
Hyperopia
Reading add (presbyopia)
Astigmatism
Horizontal and vertical heterophoria

Answer 23

Hyperopia - +1.00D
Near add - +0.75D
Astigmatism - 0.75DC
Horizontal prism - 1.50D
Veritcal prism - 1.00D
Only if symptomatic