Cycloplegia

Question 1

Indications for cyclo

Answer 1

<4yo - 1st/repeat exams
<7yo - 1st exam 
Limited subjective 
Dry ret difficult 
Latent hyperopia - (find dry subjective would be lot less +ve than ret - e.g. ret +4.00 -> subj +1.50)
Suspect accom disorder 
Lead/lag of accom >1.00
Case hx - problems focusing

Question 2

Cyclopentolate

Answer 2

Muscarinic antagonist
Prevent accom/pupil dilation
3mths-11yr - 1drop 1% -30-60mins prior
12-17yr - 1drop 0.5% 30-60min prior

Question 3

Side effects of cyclopentolate

Answer 3

Blurred vision
Photophobia
Psychosis, hallucinations, ataxia, incoherent speech (OD)

Question 4

Indications for mohindra

Answer 4

Unable to fixate on dist target
Cyclo unsuitable - px/carer
Freq follow up apps - risk of adverse effects/OD

Question 5

Mohindra compensation

Answer 5

-0.75D diff from traditional ret
Consider WD (50cm=2D)
Total adjustment = +1.25D subtracted from final rx

Question 6

Mohindra assumptions

Answer 6

Ret light no effective stimulus to accom
Eye assumes tonic accom - 0.75D
Tonic accom varies with rx (0-4D)
Hyperopes have closer dark focus than myopes - can therefore underestimate hyperopia