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Pediatrics_Dr. Liu > Lec 3 & 4 Refraction and Prescribing for Infants and Young Children > Flashcards

Lec 3 & 4 Refraction and Prescribing for Infants and Young Children Flashcards

1
Q

Axial length increases within the first 5 years of life from __mm to __mm.

A

17, 21

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2
Q

During ocular growth, the cornea _____ slightly, decrease power.

A

flattens

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3
Q

T/F Mismatch between axial growth and corneal and lens changes can result in refractive error.

A

True

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4
Q

What are the objective examination procedures?

A

Retinoscopy, Autorefraction and photorefraction

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5
Q

What are the subjective examination procedures?

A

phoropter and trial frame

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6
Q

T/F Mohindra Technique is a technique using cycloplegic drops.

A

False, it’s non-cycloplegic

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7
Q

T/F Mohindra Technique (Near Retinoscopy) underestimates hyperopia in children less than 2.

A

True. It’s not an appropriate way to determine true refractive error in this population.

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8
Q

Is Mohindra Technique a binocular or monocular test?

A

Monocular

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9
Q

T/F Distance (Static) Retinoscopy is a Non-cycloplegic technique.

A

True

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10
Q

Is Distance (Static) Retinoscopy a binocular or monocular test?

A

binocular

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11
Q

The Distance (Static) Retinoscopy is most reliable in younger or older children?

A

older

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12
Q

T/F Distance (Static) Retinoscopy overestimates true amount of hyperopia.

A

False. Underestimates just like the near ret

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13
Q

What test is the most accurate way to define true refractive error of the eye?

A

Cycloplegic Retinoscopy

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14
Q

T/F Cycloplegic Retinoscopy is the Gold Standard for infants/toddlers/preschoolers

A

True

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15
Q

Does the MEM measure refractive error?

A

NO

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16
Q

Which Ret test don’t have to subtract working distance?

A

Mohindra technique and MEM

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17
Q

Autorefraction is useful in children that are older than ____.

A

3

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18
Q

Autorefraction tends to _____ noncycloleged children.

A

over minus

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19
Q

VIP study found photorefraction is ______ sensitive than autorefractors at identifying vision problems.

A

less

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20
Q

What is the Bruckner test for?

A

it gives a gross estimate of the equality of refractive error between the two eyes.

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21
Q

Typically, the phoropter is not used when children is under the age of ___.

A

7

22
Q

Children under 1 years, use ___% cyclopentolate, over 1 years, use ___% cyclopentolate.
premature or LBW, use _______.

A

0.5
1.0
1gtt Cyclomydril (0.2% cyclopentolate & 1% phenylephrine)

23
Q

How much astigmatism difference between the two eyes can possibly cause amblyopia?

A

> 1.50 D

24
Q

How much Hyperopia difference between the two eyes can possibly cause amblyopia?

A

> 1.00 D

25
Q

How much myopia difference between the two eyes can possibly cause amblyopia?

A

> 3.00 D

26
Q

How much astigmatism similar on two eyes can possibly cause amblyopia?

A

> 2.50 D

27
Q

How much hyperopia similar on two eyes can possibly cause amblyopia?

A

> 5.00 D

28
Q

How much myopia similar on two eyes can possibly cause amblyopia?

A

> 8.00 D

29
Q

What’s consider low hyperopia?

A
30
Q

What’s consider moderate hyperopia?

A

+2.00 D to +5.00 D

31
Q

What’s consider high hyperopia?

A

> +5.00 D

32
Q

Partial refractive correction may reduce the risk for development of strabismus and amblyopia in patients who have > +3.25 D of hyperopia by ____times less.

A

4

33
Q

A majority of practitioners would consider prescribing glasses for _____, _____ hyperopia stable over 2 visits. when..

A

bilateral, asymptomatic
> +5.00 in 6 months olds
> +3.00 to +5.00 in 2 years
> +3.00 to +5.00 in 4 years old

34
Q

What would you do if infants & toddlers have bilateral high hyperopia of >+5.00 D with no associated esotropia?

A
  • Monitor for stability for 2-3 month intervals

- When stable, consider partial correction

35
Q

What would you do if infants & toddlers have bilateral moderate hyperopia of +2.00 D to +5.00 D with no associated esotropia?

A
  • monitor 3-6 months intervals, depending on risk factors and amount of hyperopia (more concern if > +3.50 D)
36
Q

What would you do if pre-school children (3-5) have bilateral high hyperopia of >+5.00 D with no associated estropia?

A
  • partial correction recommended

- consider binocular status when determining amount to prescribe

37
Q

What would you do if pre-school children (3-5) have bilateral moderate hyperopia of +2.00 D to +5.00 D with no associated esotropia?

A
  • consider partial prescription depending on signs, symptoms and ability to compensate for hyperopia
  • likely to prescribe if stable and >+3.00D
38
Q

Most school-age children (age >6) can compensate for about ____ D without symptoms. if symptoatic, consider partial Rx. May need glasses for part-time wear, during prolonged near work.

A

+3.00

39
Q

Would you prescribe to the child with hyperopia associated with esotropia?

A
  • yes, regardless of age, prescribe to achieve ocular alignment and facilitate development of binocular vision.
  • generally, full or close to full cycloplegic precription is prescribed.
40
Q

From birth to 3 years, ______ astigmatism is more common.

A

against the rule

41
Q

After 5, _____ astigmatism is more common.

A

with the rule

42
Q

Will you find meridional astigmatism in the first 2 years of life?

A

no

43
Q

AR astigmatism is most likely to _______ with age. However, when stable, it is more associated with the development of amblyopia.

A

decrease

44
Q

Oblique stigmatism tends to remain _____ or _____ with age resulting in high risk for amblyopia.

A

stable, increase

45
Q

Do you manage infant’s astigmatism under the age of 1?

A

No unless it’s >4.00.

monitor significant astigmatism at 3 month intervals

46
Q

What would you do if the child from 1-3 years old has astigmatism >1.50 D?

A

give glasses:

  • if it’s stable or increasing in amount over 3 visits
  • it if has an oblique axis or associated anisometropia
  • if >2.50D and stable, prescribe to prevent amblyopia
47
Q

Would you prescribe full or partial astigmatism correction?

A

mostly full.
if the older ( ~ 10 years old) children has significant astigmatism that have never worn correction, consider a partial Rx based on subjective responses before cycloplegia.

48
Q

When would you prescribe to infant and toddlers if they have anisometropia?

A

monitor at 3 month intervals for stability
prescribe if
- >3.00 D of aniso stable over 2-3 visits
- increasing amounts of anisometropia
- strabismus/amblyopia is present

49
Q

When would you prescribe to children age 3 and over if they have anisometropia?

A

prescribe if they have aniometropia of 1.00D or greater or if their acuity or binocularity is compromised.

50
Q

What to prescribe for anisometropia?

A

prescribe entire anisometropic difference in spherical refractive error.

  • give max hyperopia if esotropia is present
  • give hyperopia that’s a little undercorrected if no strabismus is present.
  • give full myopia correction.
51
Q

Myopes with near esophoria tend to progress more quickly and more likely to have progression slowed by ____ prescription.

A

bifocal

52
Q

In infants, prescribe if _____ D,
Age 1-3, consider prescribing for myopia _____ D.
Age 3-5, myopia _____ D should be corrected.
Full correction in school aged children.

A

> -5.00
-3.00
-1.00

Pediatrics_Dr. Liu (3 decks)

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