CLM - Non-Surgical Management of Hyperopia - Week 11

Question 1

During what period does the major post-natal growth of the eye occur?

Answer 1

First three years

Question 2

What magnitude is most hyperopia in childhood below?

Answer 2

Below +2.00DD

Question 3

Is the refractive state of a child soon after birth a good indication of the final refractive error of the child? Describe whay may happens with children who are myopic early in infancy as an example.

Answer 3

It is a good indication

Those with myopia early in infancy will eventually regress back to myopia despite emmetropisation in early childhood

Question 4

In what three ways can neonatal refractive error be measured and which is the gold standard?

Answer 4

Autorefractor
Non-cycloplegic retinoscopy
Cycloplegic retinoscopy - gold standard

Question 5

Below what age is subjective refraction not reliable?

Answer 5

Younger than 7-8

Question 6

What eyedrop is the gold standard for refractive assessment in children under four and children with esotropia?

Answer 6

Cyclopentolate

Question 7

Given the standing of cyclopentolate for refraction, what may some practitioners believe of this method and is it correct? Explain.

Answer 7

Because it is the gold standard, some believe incorrectly that this is the final hyperopia measurement
You wont be able to determine this by the end of the first visit

Question 8

What level of hyperopia is it generally recommended to prescribe correction for young children (2)?

Answer 8

Moderate to high hyperopia

Question 9

What are four considerations that should be given when considering whether to prescribe a young child with hyperopic correction?

Answer 9

Will you interrupt the normal emmetropisation process by prescribing for the hyperopia?
Will you improve or disturb the binocular function of the infant or child if you prescribe?
What is the risk of convergent strabismus if you dont prescribe?
What is the risk of amblyopia if the hyperopia is different in the two eyes and you dont prescribe?

Question 10

What origin does most esotropia have?

Answer 10

Most is refractive in origin

Question 11

Is there a risk of strabismus with infant hyperopia?

Answer 11

Yes

Question 12

Does prescribing harm emmetropisation? Explain.

Answer 12

No
In children with corrected and uncorrected hyperopia, the rate of hyperopia reduction with age was a function of the initial level of hyperopia and not correction status.

Question 13

What can uncorrected hyperopia result in concerning accommodation? What 6 things can occur as a consequence?

Answer 13

Results in the accommodative demand being greater than for an automatic and accurate response. This can result in:
Blur
Abnormal phorias
Possible strabismus
Asthenopic symptoms
Reduced reading efficiency, fluency, accuracy
Avoidance of reading

Question 14

What 6 tests should be undertaken when prescribing infants and young children hyperopia correction?

Answer 14

Dry retinoscopy
Subjective refraction (if appropriate)
Blur function
Binocular vision and stereopsis
Accommodative function
Cycloplegic retinoscopy

Question 15

When doing MEM retinoscopy and you prescribe plus lenses, what should be aimed for in terms of MEM results (3)?

Answer 15

Stable, equal, and low lag of accommodation when plus lenses are worn

Question 16

What is the normal refractive status for newborns, infants, and young children?

Answer 16

Newborn - plano to +4.00D
0-3 months - plano to +2.00D
6 - 8 years - plano to +2.00D (but mostly plano, narrower spread)