Lec 3 & 4 Refraction and Prescribing for Infants and Young Children Flashcards
Axial length increases within the first 5 years of life from __mm to __mm.
17, 21
During ocular growth, the cornea _____ slightly, decrease power.
flattens
T/F Mismatch between axial growth and corneal and lens changes can result in refractive error.
True
What are the objective examination procedures?
Retinoscopy, Autorefraction and photorefraction
What are the subjective examination procedures?
phoropter and trial frame
T/F Mohindra Technique is a technique using cycloplegic drops.
False, it’s non-cycloplegic
T/F Mohindra Technique (Near Retinoscopy) underestimates hyperopia in children less than 2.
True. It’s not an appropriate way to determine true refractive error in this population.
Is Mohindra Technique a binocular or monocular test?
Monocular
T/F Distance (Static) Retinoscopy is a Non-cycloplegic technique.
True
Is Distance (Static) Retinoscopy a binocular or monocular test?
binocular
The Distance (Static) Retinoscopy is most reliable in younger or older children?
older
T/F Distance (Static) Retinoscopy overestimates true amount of hyperopia.
False. Underestimates just like the near ret
What test is the most accurate way to define true refractive error of the eye?
Cycloplegic Retinoscopy
T/F Cycloplegic Retinoscopy is the Gold Standard for infants/toddlers/preschoolers
True
Does the MEM measure refractive error?
NO
Which Ret test don’t have to subtract working distance?
Mohindra technique and MEM
Autorefraction is useful in children that are older than ____.
3
Autorefraction tends to _____ noncycloleged children.
over minus
VIP study found photorefraction is ______ sensitive than autorefractors at identifying vision problems.
less
What is the Bruckner test for?
it gives a gross estimate of the equality of refractive error between the two eyes.
Typically, the phoropter is not used when children is under the age of ___.
7
Children under 1 years, use ___% cyclopentolate, over 1 years, use ___% cyclopentolate.
premature or LBW, use _______.
0.5
1.0
1gtt Cyclomydril (0.2% cyclopentolate & 1% phenylephrine)
How much astigmatism difference between the two eyes can possibly cause amblyopia?
> 1.50 D
How much Hyperopia difference between the two eyes can possibly cause amblyopia?
> 1.00 D
How much myopia difference between the two eyes can possibly cause amblyopia?
> 3.00 D
How much astigmatism similar on two eyes can possibly cause amblyopia?
> 2.50 D
How much hyperopia similar on two eyes can possibly cause amblyopia?
> 5.00 D
How much myopia similar on two eyes can possibly cause amblyopia?
> 8.00 D
What’s consider low hyperopia?
What’s consider moderate hyperopia?
+2.00 D to +5.00 D
What’s consider high hyperopia?
> +5.00 D
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.
4
A majority of practitioners would consider prescribing glasses for _____, _____ hyperopia stable over 2 visits. when..
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
What would you do if infants & toddlers have bilateral high hyperopia of >+5.00 D with no associated esotropia?
- Monitor for stability for 2-3 month intervals
- When stable, consider partial correction
What would you do if infants & toddlers have bilateral moderate hyperopia of +2.00 D to +5.00 D with no associated esotropia?
- monitor 3-6 months intervals, depending on risk factors and amount of hyperopia (more concern if > +3.50 D)
What would you do if pre-school children (3-5) have bilateral high hyperopia of >+5.00 D with no associated estropia?
- partial correction recommended
- consider binocular status when determining amount to prescribe
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?
- consider partial prescription depending on signs, symptoms and ability to compensate for hyperopia
- likely to prescribe if stable and >+3.00D
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.
+3.00
Would you prescribe to the child with hyperopia associated with esotropia?
- 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.
From birth to 3 years, ______ astigmatism is more common.
against the rule
After 5, _____ astigmatism is more common.
with the rule
Will you find meridional astigmatism in the first 2 years of life?
no
AR astigmatism is most likely to _______ with age. However, when stable, it is more associated with the development of amblyopia.
decrease
Oblique stigmatism tends to remain _____ or _____ with age resulting in high risk for amblyopia.
stable, increase
Do you manage infant’s astigmatism under the age of 1?
No unless it’s >4.00.
monitor significant astigmatism at 3 month intervals
What would you do if the child from 1-3 years old has astigmatism >1.50 D?
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
Would you prescribe full or partial astigmatism correction?
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.
When would you prescribe to infant and toddlers if they have anisometropia?
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
When would you prescribe to children age 3 and over if they have anisometropia?
prescribe if they have aniometropia of 1.00D or greater or if their acuity or binocularity is compromised.
What to prescribe for anisometropia?
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.
Myopes with near esophoria tend to progress more quickly and more likely to have progression slowed by ____ prescription.
bifocal
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.
> -5.00
-3.00
-1.00
