Managing refractive error Flashcards
What are the advantages of cycloplegic retinoscopy?
Accommodation is paralysed - child can look at ret light (better attention)
What are the disadvantages of cycloplegic retinoscopy?
Increased abberations due to dilated pupils
Drops hurt
Child may develop fear of eye tests
Possible side effects
Have to wait for drops to work
Can’t measure corrected VA, near function or BV
Glare/photophobia until drops wear off
No near work for rest of the day
Why should accommodation be measured?
Children do a lot of near tasks
Those with additional needs often have accommodation issues
To determine if a hyperopic child needs correction (accommodation issues - will need for near tasks)
To measure impact of accommodation on squint
What is a more child friendly way of measuring AoA?
Push down - ask child to tell you what the picture is when they can see it (older children)
How do you perform MEM?
Lights on
Distance correction
Eyes level with each other
Px focuses on target
Vertical streak
Correct with trial lenses
What is considered a normal accommodative lag?
Up to +0.75D
How do you perform Nott?
Dim lights
Distance correction
Do it at child’s habitual WD (closer than 40cm)
Ret alongside target (vertical streak)
Move depending on reflex movement
Calculate lead/lag
How do you calculate accommodative lead/lag from Nott ret?
Expected accommodation at WD - actual accommodation
What is a normal rx for a 3 month old?
+3.00
What is a normal rx for a 6 month old?
+2.50
What is a normal rx for a 9 month old?
+2.25
What is a normal rx for a 1 year old?
+2.00
What is a normal rx for a 18 month old?
+1.50
What is a normal rx for a 2 year old?
+1.25
What is a normal rx for a 3 year old?
+1.00
What is a normal rx for a 4-6 year old?
+0.50
When should you consider prescribing for children (of any age)?
Extreme RE for their age
Strabismus
Amblyopia
Persistent anisometropia
What are the prescribing guidelines for under 2s?
Monitor RE
What are the prescribing guidelines for over 2s?
Consider prescribing if significant RE which isn’t decreasing
Prescribe reduced amount (-1.00D) if no BV anomalies
Prescribe full amount when child needs clear distance vision
What is a significant RE in children over 2 years?
+3.00 or more
-0.75 or more
-2.50 cyl or more
What are the ways of checking posterior eye health?
Volk
Direct ophthalmoscopy
Headset BIO
Monocular Indirect Ophthalmoscopy
What can Bruckner’s test be used for?
Assess RE, strabismus, health issues
What distance should Bruckner be done at?
0.2-1m and 3-4m
On Bruckner, what would a cataract look like?
Darker reflex on side of cataract at close and further away
