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Kinzer Flashcards

1
Q

Refractive error at birth

A
  • normal bell curve distribution
  • skew towards hyperopia
  • Myopia:0-25% in newborns
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2
Q

As infant grows…

A
  • shift towards emmetropia
  • due to growth of eye
  • skew towards myopia
  • within first year of life
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3
Q

Emmetropization

A

-process in which refractive errors shift towards emmetropia

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4
Q

Ocular development between 5-15

A
  • development SLOWS
  • anterior chamber depth INCREASES (3D)
  • Vitreous chamber depth INCREASES(3D)
  • Axial length INCREASES(3D)
  • cornea is stable
  • Lens power DECREASES 1-2D
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5
Q

Prevalence of myopia percentages

A
  • 2% ages 7-8
  • 15% at age 15
  • total myopic prevalence: 25%
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6
Q

Juvenile-onset myopia

A
  • increase 0.5D per year in teens
  • reduced ability of lens to compensate for growth in axial length
  • slows 13-14 for Female and 15-16 in Males
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7
Q

Adult-onset myopia

A

-10% of population is moyopic after teens

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8
Q

Age

A
  • single most important determinant of distribution of refractive error
  • small portion of myopes at birth
  • infant myopia: premies
  • astigmatism in infants: most are under 1D cyl
  • ages 6-8-myopia first observed
  • Astigmatism decreases: ATR shift
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9
Q

High school

A

-refractive error stable

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10
Q

Beaver-dam study

A
  • decreases in prevalence of myopia in older age

- 40-80 see decrease

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11
Q

Gender

A

-trends in refractive error are inconclusive

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12
Q

Ethnicity

A
  • not enough data to determine id there is a trend in refractive error
  • other studies: asian>white>black
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13
Q

NHANES study

A
  • compared white to black

- whites were 2 times more prevalent

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14
Q

Orinda longitudinal study

A
  • kids 5-12

- different ocular components for groups with high prevalence and groups with low prevalence

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15
Q

Geography

A
  • results are messed with from other factors

- similar trends found in US ethnicity studies

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16
Q

Diet

A
  • results are unclear
  • cannot ethically take things out of a kids diet
  • Alaskan eskimos local food vs government= no conclusions
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17
Q

Time

A
  • inconclusive for studies that focus on different decades
  • different studies have different methods and differet characteristics of what determines “myopia”
  • over all, decrease prevalence in older age
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18
Q

Myopia personality

A
  • not strong data
  • introversion
  • no social leadership or activity
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19
Q

Hyperopia personality

A
  • not strong data
  • carefree
  • impulsive
  • hyperactive
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20
Q

Systemic/ocular conditions

A

-both effect development of the eye, so there will be an effect on refractive error

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21
Q

Hyperopic occular diseases

A
  • albinism(ocular form)
  • maculopathies
  • rod monochromacy
  • achromatopsia
  • nystagmus
  • microphthalmis(small eye)
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22
Q

Glaucoma Near work theory

A

prolonged reading=muscle contraction=increased eye pressure=elongate eye=myopia

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23
Q

Glaucoma Associated conditions theory

A
  • genetic link: high prevalence for positive steroid responce=glaucoma and myopia
  • risk of ocular hypertension is higher in myopes
  • risk of developing glaucoma is higher in myopes
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24
Q

Against the rule astigmatism

A
  • myopia
  • pellucid marginal degeneration
  • thins inferior cornea and flattens vertical corneal meridian
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25
Factors that for sure have an effect on refractive error
- age - ocular diseases - systemic diseases
26
Factors that are inconclusive
- gender - ethnicity - geography - time - personality - diet
27
Name the 4 factors associated with refractive error
- hereditary - Near work Theory - intelligence - socioeconomic status
28
Hereditary factor
Parent/child - axial length and corneal power - 1 parent=0-20% chance - 2 parents=30-40% chance Twins - axial length, corneal power, refractive error - monozygotic twins are more similar
29
Near work theory factor
- excessive reading in childhood - increase in myopia among educated eskimos - decrease in myopia in WWII in Japan - adult onset myopia in college EXCESSIVE AXIAL LENGTH AND MYOPIA IS LINKED TO READING, SCHOOLING, STUDYING, AND NEAR WORK
30
Intelligence factor
- myopes have higher scores on tests of intelligence - compared tests for same age group - hyperopes read worse and perceptual anomalies are more frequent
31
Socioeconomic factor
- two large studies - myopes more frequent in HIGH socioeconomic levels - connection to intelligence and education
32
First month of life refractive error distribution of refractive error
from -10D of myopia to +5D of hyperopia - Mean refracted error: -0.7D - shift toward emmetropia with age - decrease in ATR in first few years - higher degree of of myopia in premature babies
33
Change in refraction in school aged years
- see most refractive changes - linear change between 7 and 12 years old - children who are myopic at age 5 will become MORE myopic - children entering school with 0-+0.5D of hyperopia will become myopic - children entering school with +0.5-+1,24D will be emmetropic at age 13 - children entering with +1.50D of hyperopia or more will still be hyperopic
34
Changes in hyperopes Vs myopes in school aged kids
- greatest changes in refractive error occur in myopes | - rate of progression is FASTER when a child crosses FROM hyperopia TO myopia`
35
Four types of myopia
1. congenital:birth 2. Youth-onset:school aged 3. Early adult onset (late teens- 40s) 4. Late adult onset (40 and up)
36
Youth-onset
- most common myopia - 5-6 years prevalence: 2% - 15-16 year prevalence: 20-25% - onset for females is 2 years earlier than males
37
Ocular optical component in progression of myopia in school aged kids
- AXIAL ELONGATION continues into late teens | - increased vitreous chamber is more prevalent than increased anterior chamber depth
38
Ocular optical component in progression of hyperopia in school aged kids
- decrease in refractive power - decrease in corneal lens and crystalline lens - axial length stops at early teens - experience changes, but they are all proportional
39
Myopic in comparison to emmetropes
- greater vitreous depth - greater corneal power - greater posterior crystalline lens radius
40
Females vs males
- shorter eyes - steeper cornea - more powerful crystalline lens
41
Factors that affect the rate of childhood myopia
- earlier the onset of myopia occurs, the greater the progression and faster - more reading - better readers - more time inside - higher IOP - temporal crescents inside the eye - near work
42
Why is a shorter reading distance associated with myopia?
-shorter distance=more accomodation=more axial length=more myopia
43
Childhood myopia and astigmatism
- children with ATR at 5-6 develop myopia more than kids with WTR - once myopic, ATR do not have a greater progression
44
Myopic control
- medication - rigid CL - biofcals glasses - progressive glasses
45
Medication control of myopia
Atropine and pirenzepine - used in dilation - knocks off focusing muscles - affects development of retinal ganglion cells - complete cyclo - distortion from dilation - possible allergies - once you stop treatment, myopia ACCELERATES
46
Rigid CL myopic control
- flattens cornea(axial elongation continues) - increases hyperopia - Gas permeable CL are effective, but only when CL wearing is continued
47
Bifocals and progressives
- bifocals have line and progressives have intermediates - reading add=less strain=less elongation=less myopia - can also be used for vergence and accomodation problems - rates of myopic progression are less in bifocals than single vision - MOST EFFECTIVE FOR CHILDREN WITH ESOPHORIA AT NEAR. SHIFTS IS TO ORTHO/LOW EXO RANGE (changes postrure)
48
Refractive changes in young adulthood
- refractive errors stabilize - some may have an onset of myopia(college) - some have very small shift in hyperopic direction
49
Mean annual change in refractive error in young adults
- 20-34: -0.05D a year | - 35-53: +0.03D a year
50
Early Adult onset Myopia
- onset in 20-40 years - prevalence for myopia increases from 20% at 20 years old to 30% at 40 years old - progression rate is less in early adult than in youth-onset
51
Difference in Youth-onset and Early adult onset
- Youth-onset: before puberty | - Early-adult onset: after puberty
52
3 possibilities of myopia
- adult stabilization - adult continuation - adult acceleration
53
Adult stabilization
-childhood myopia progression is followed by stabilization of refractive error in young adulthood
54
Adult continuation
childhood myopia progression followed by a general slower progression of myopia in young adulthood
55
Adult acceleration
-refractive change in the myopic direction accelerates in young adulthood
56
Myopia and corneal power
- adults with increases in myopia tend to have increases in corneal power - still a decrease in crystalline lens power
57
Myopia progression and college
less than 10% of emmetropes and low hyperopes will develop myopia before age 40 in populations where subjects are not in college - 20-40% of emmetropes and low hyperopes are likely to become myopic before age 40 when they go to college or are in the military - unlikely for high hyperopes to be myopic even after college
58
overall trend in young adults
-emmetropes and low hyperopes shift towards myopia is LESS COMMON AND LESS IN AMOUNT than myopes
59
age different low hyperopes and early adult onset myopia
-17-18 year old low hyperopes are more likely to become myopic in near work situations than older low hyperopes
60
Astigmatism in young-adult
-overall shift to being WTR
61
Refractive changes from age 40 and up
- trend toward hyperopia - refractive error increases in plus from 40-60 then DECREASES from 60 up - +1.24D change over 24 years - mean yearly rate change: +0.5D
62
Nuclear cataract
- age related nuclear cataracts give a shift to myopia | - some old people will notice they can read better so thats why
63
Astigmatism and Age 40 and up
-shift towards ATR
64
Emmetropization considerations
- peak of refractive error distributions occurs at emmetropia and low hyperopia - coordinated growth of the eye AND some form of vision-dependent feedback system
65
Changes in ocular optical components
Separately: large changes in refractive error Together: less changes in refractive error
66
Vitreous depth
-in childhood: increases which means myopic
67
Anterior chamber depth
-increases in children=myopia
68
Crystalline lens
power and thickness decrease for hyperopia | -posterior surface mostly involved in emmetropization
69
Vision dependent feeback system
- axial length changes based on vision input - large refractive errors occur when eye does not have normal ocular imagery - treatment of spectacles aids in emmetropization process and reduces amblyopia
70
High myopia eye things
- lid hemangiomas - ptosis - neonatal eyelid closure - retinopathy of prematurity
71
Theories of myopic development
- etiology unknown - genetic inheritance(+some lifestyle and environmental) - near work
72
Primary theory for myopia
- near work theory | - accommodation increases IOP and leads to stretching of the posterior segment of the eye and axial longation
73
Mechanical forces on the sclera
-tension from extraocular muscles and IOP increase axial elongation
74
Retinal defocus
- defocus itself alters axial length | - not a mechanism of accommodation
75
Retinal biochemistry
-some molecules stop myopia and some induce it
76
theories of astigmatism
- eyelid tension steepens the vertical corneal meridian and causes WTR - corneal WTR decreases when the eyelid is lifted - increases when palpebral aperature is narrowed - shift towards ATR in over 40 because decreased lid tension

Methods Block 2 (7 decks)

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