Lecture 3 - 4 - Refraction and Prescribing for Infants and Young children

Question 1

Axial length increase within the first ___ years of life.

Answer 1

5 years

Question 2

Every ___ of growth can cause 1.00D of refractive change

Answer 2

1/3 mm

Question 3

Majority of infants have what type of refractive error?

Answer 3

Hyperopia

Question 4

What is the percentage of astigmatism in infancy?

Answer 4

50%

Question 5

Mohindra retinoscopy (Near) is a good non cycloplegic technique. But it _________ hyperopia, so it is NOT appropriate to determine true refractive error.

Answer 5

Underestimates

Note: Mohindra suggests 1.25D to be subtracted from your findings while Saunders says 0.75 for children under 2

Question 6

Out of all the retinoscopy techniques, which is the most RELIABLE?

Answer 6

Static (Distance)

Note: It still does underestimates

Question 7

What is the most ACCURATE retinoscopy?

Answer 7

Cycloplegic retinoscopy

Note: Gold standard

Question 8

True or False. MEM measures refractive error?

Answer 8

False

Question 9

What measurement device is excellent in finding astigmatism?

Answer 9

Autorefraction

Question 10

What test gives you the gross estimation of equality of refractive error between the two eyes?

Answer 10

Bruckner

Question 11

True or False. The phoropter will induce astigmatism?

Answer 11

True

Question 12

What spectacle lens material is best suited for infants?

Answer 12

Polycarbonate or Trivex

Question 13

What are the ranges in identifying amblyopia?

Answer 13

Anisometropia
Astigmatism = >1.50D
Hyperopia = >1.00D
Myopia = >3.00D

Isometropia
Astigmatism >2.50D
Hyperopia >5.00D
Myopia >8.00D

Question 14

If a hyperopic pt is uncorrected and excessive amount of accommodation is notice, what is their likely deviation to occur with their eye?

Answer 14

ESO deviation

Note: Symptoms are strongest at near

Question 15

What is the usual birth refractive error?

Answer 15

+2.00D

Question 16

What is the likelyhood of a infant with RE greater than +3.50D will develop strabismus?

Answer 16

13x higher

Question 17

What would you do with a Bilateral High Hyperopia (>+5.00D) with no associated esotropia in an Infant, preschooler, and school children?

Answer 17

Infant = Partial correction given

Preschool children (3 to 5) = Partial correction

School children (3 to 5) = Partial correction but can tolerate all the way upto 3.00D

Question 18

What would you do with a Bilateral Moderate Hyperopia (+2.00D to +5.00D) with no associated esotropia in an Infant, preschooler, and school children?

Answer 18

Infant = Monitor 3 to 6 Months

Preschool = Partial correction

School children = Full Rx., or partial correction if symptomatic

Question 19

True or False. regardless of age you will give the full prescription to achieve ocular alignment when esotropia is associated with hyperopia

Answer 19

True

Question 20

At birth what is the most common type of astigmatism, ATR or WTR?

Answer 20

ATR

Question 21

True or False. Decreased acuity in the orientation of maximum blur caused by astigmatic refractive error is considered Meridional Amblyopia?

Answer 21

True.

Note: This is only present after 2 years of age

Question 22

At what ages should you consider prescribing, when the refractive power is greater than 1.50D?

Answer 22

1 to 3 years but should be associated with
•It is stable or increasing in amount over 3 visits

• It has an oblique axis or associated anisometropia
• If > 2.50 D and stable, prescribe to prevent amblyopia

Question 23

At what age group do children present with less than 0.50D of cylinder

Answer 23

3 to 5 years of age

Question 24

What is a normal amount of Aniso found in infants?

Answer 24

> 1.00D

Question 25

What is the percentage of remaining aniso in school age children?

Answer 25

3 to 4%

Question 26

When should you be concerned about Aniso when they are 1 years of age?

Answer 26

>3.00D, this will likely presist into childhood

Question 27

What is the management protocol for infants with Aniso?

Answer 27

–Monitor at 3 month intervals for stability –Prescribe if •> 3.00 D of anisometropia stable over 2-3 visits •Increasing amounts of anisometropia •Strabismus/amblyopia is present

Question 28

What is the management of Aniso for children age 3 and over?

Answer 28

–Anisometropia of 1.00 D or greater | –If acuity or binocularity is compromised

Question 29

what should you prescribe in the presence of Aniso?

Answer 29

Prescribe entire anisometropic difference in spherical refractive error •Hyperopic -If esotropia is present, prescribe maximum hyperopic correction •Hyperopic -If no strabismus, can under correct both eyes by the same amount, especially before school-age •Myopic –prescribe the full minus

Question 30

What type of infants show a common sign of myopia?

Answer 30

Myopia Females tend to develop myopia soon than males.

Question 31

Which of the two drugs, Atropine or Pirenzipine, is considered safer to use to minimize the progression of myopia?

Answer 31

Pirenzipine