Clinic Prep: Paediatrics Revision Flashcards
When to prescribe for myopia:
0-1 yo
1-2 yo
2-3 yo
3-4 yo
0-1: >/= -5.00D.
1-2: >/= -4.00D
2-3: >/= -3.00D
3-4: >/= -2.50D
Give full correction
When to prescribe for hyperopia (no strabismus):
0-1 yo
1-2 yo
2-3 yo
3-4 yo
0-1: >/= +6.00
1-2: >/= +5.00
2-3: >/= +4.50
3-4: >/= +3.50
Give partial Rx reduced by up to 50%
When to prescribe for hyperopia (with EsoT):
0-1 yo
1-2 yo
2-3 yo
3-4 yo
0-1: >/= +2.00
1-2: >/= +2.00
2-3: >/= +1.50
3-4: >/= +1.50
Give full correction
When to prescribe for astigmatism:
0-1 yo
1-2 yo
2-3 yo
3-4 yo
0-1: >/= 3.00
1-2: >/= +2.50
2-3: >/= +2.00
3-4: >/= +1.50
Give full correction
When to prescribe for anisometropia:
0-1 yo
1-2 yo
2-3 yo
3-4 yo
0-1: >/= +2.50
1-2: >/= +2.00
2-3: >/= +1.50
3-4: >/= +1.50
Susan Leat’s recommendation for hyperopic patients 4-5yo.
Prescribe hyperopia >+2.50, give 1 diopter less than full.
Susan Leat’s recommendation for hyperopic patients 5+ yo/school age
Prescribe full correction for hyperopia >1.25 or 1.50
Susan Leat’s recommendation for myopia patients 5+yo
Full correction for any myopia
Susan Leat’s recommendation for astigmatism, 15 months - 2 years
> 2.50DC, full correction
Susan Leat’s recommendation for astigmatism, >2 years
> 1.75DC, full correction
Susan Leat’s recommendation for astigmatism, >4 years
> 1.25DC, full correction
Susan Leat’s recommendation for astigmatism, school children
> 0.50DC, full correction
Susan Leat’s recommendation for anisometropia, >4 years
> 1.00D anisometropia, full.
For symptomatic adult patients, at what magnitudes do optometrists generally prescribe for the following:
Hyperopia
Reading add (presbyopia)
Astigmatism
Horizontal and Vertical heterophoria
Hyperopia: +1.00
Near add: +0.75
Astig: +0.75
Horizontal prism: 1.5
Vertical prism: 1
In general, do optometrists correct asymptomatic patients with hyperopic anomalies or heterophorias?
No, they do not, if the patient is asymptomatic
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
Hyperopia: >3.50 in any meridian
Myopia: >3.00 in any meridian
Astigmatism: >1.50 at 90 or 180; 1.0D in oblique
Anisometropia: >1.50 (sph or cyl)
Strabismus: any manifestation
Ptosis: = 1mm margin reflex distance
Media opacity: any opacity >1mm in size
By what age would ambylopia have fully developed? What magnitude of amblyopia should not be ignored?
By age 3
Greater than 1.00D should not be ignored
List 8 clinical tests you can perform on a patient under 3 years old
Objective cover test (incl HH)
Hirschberg test
Bruckner’s
Ocular motility
Fixation + coordination during play
Retinoscopy (dry, wet, near - MEM, Mohindra)
Pupils
Direct ophthalmoscopy/Retinal photos
How can you measure vision in a patient under 2 years?
VEP (Visual Evoked Potentials) most reliable. Try a preferential viewing chart/grating or OKN drum (optokinetic nystagmus)
How can you measure vision in a patient between 2-3 years old?
Consider matching games, if child is able
How do you perform Mohindra Retinoscopy?
@50cm in a dark room. Adjust your finding depending on age by:
-0.75 for infants (i.e. subtract 0.75)
-1.25 for 2+yo (i.e. subtract 1.25)
When might you perform Mohindra Retinoscopy?
As an alternative when you can’t cyloplege (e.g. due to timing, drop accessibility, safety)
List 5 additional tests you can perform on a patient between 3-6 years old
As for <3yo, +:
Lea symbols
Colour Vision and Stereopsis
BV (W4dot, prism doubling, phorias by school age)
Accom/Convergence (by school age)
Slit lamp/tonometry (on indication)
How should you perform subjective refraction (on >6 or >8 depending on child)? (2)
Start binocularly (to build confidence)
Do a blur function
How do you perform a blur function?
Using a trial frame
1. Add +1 to +1.50 over ret finding binocularly (monoc if asymmetrical vision)
2. Warn child of blur and will slowly make things clearer
3. Random chart, child reads a few letters as best as they can
4. Once they start making errors, reduce plus by 0.25 or 0.50
5. Keep going until plateau or get maximum plus to 6/6
How do you decide whether to measure phoria in a young child? (4)
Make sure they understand the concept of double vision before attempting to measure phoria with Howell prentice card:
1. Place in vertical prism over RE
2. Ask child if mum/dad looks funny/different
3. If child understands that mum has two heads, then you can have a go at measuring phoria
4. Take it slow to ensure child understands what is being asked of them
What is the general checklist for a paediatric examination? (12)
Vision: Binoc first, then monoc lea single presentation first
CT: Interesting targets
NPC: assess ability to converge + break
Excursions: check for head movement
Retinoscopy: dist/near/cyclo/ret lens rack
Stereo: randot lang fly
Colour Vision
Topography/Autorefraction: be patient with child (great objective test esp when VA down)
Refraction: objective, blur function, subjective if mature enough
Oc health: pupils, ophthalmoscopy, SL, photos, IOP
Binocularity: alignment, suppression
Visual efficiency: phoria, ac/a, verg/acc facility, reserves, MEM ret
List the minimum battery of tests for visual efficiency/BV (7)
CT (D+N)
NPC/NPA
HH
Phorias
Acc/Verg facility
MEM ret
Stereo
Provide the instructions for assessing:
Posture
Range
Facility
Amp
Posture: “measure how well you can focus at near”
Range: “see how close/far you can focus”
Facility: “measure how quickly you can change your focus”
Amp: “how well you can focus”
At what age is 6/6 vision typically achieved?
5-6 years of age
How can we measure visual acuity in infants? What would be the equivalent of 6/6 vision?
Forced preferential looking, usually involving a large card with gratings
30 cycles/deg is 6/6
