Managing Rf Errors Flashcards
T/F: most kids with +4.00D or less will still be able to emmetropize.
TRUE - 80% of them! Decreases w/ increasing hyperopia.
50% if ~+5.00D
30% if ~+6.00
Does astigmatism emmetropize w/I the expected 12-18 months?
NO - takes 2-3 years. OBLIQUE is most stable; AR is most likely to emmetropize (Born ATR, die ATR)
CONGENITAL abnormalities or EARLY ONSET OC dz. often result in high…
A) Myopia
B) Hyperopia
C) Astigmatism
HYPEROPIA.
-Myopia would be from things like form deprivation (causing eye to elongate - 2’ to cataract, ptosis, Vit heme, ROP)
What the MOST COMMON refractive error in children? Around what dioptric value does it begin to become amblypgenic?
HYPEROPIA - around +3-4-5.00D, esp +4.00 - +5.00D.
What DEGREE of UNCORRECTED hyperopia is associated with ACADEMIC DIFFICULTIES and DELAYS in visual/perceptual skills?
MODERATE hyperopia (+2.00-+5.00), Esp toward higher end of that range.
-Cause big time issues w/ literacy and reading skills.
although most kids are born w/ +2.00D hyperopia at birth, keep in mind that up to a QUARTER (25%) of them will have MORE than that.
And remember than kids w/ >+3.50D of hyperopia are at 13X greater risk of developing a STRAB by 4Y/O.
What 3 bits of info are CRUCIAL to obtain in an exam of a child w/ known hyperopia?
1) MANIFEST hyperopia - subjective
2) Is accomm sufficient to OVERCOME hyperopia? (MEM/Amps)
3) LATENT hyperopia - cyclo them to find out residual.
Cardinal rule any time an ESO is present w/ hyperopia?
PRESCRIBE. FULL CYCLO. FOR ANY ESO. PERIOD.
–If residual ET @ N, Rx an Add - and make sure it bisects (or is barely below) the pupil
If a bilateral hyperopia is present WITHOUT a strabismus, do you Rx?
Depends. Do it if:
1) >+5.00D in 6 month olds
2) >+3.00-+5.00D in 2-4 Y/O - but commonly, should CUT BACK hyperopia off what you found on cyclo - they weren’t symptomatic before, would just blur them unnecessarily.
-DON’T cut back more than +3.00D - why? Induce RAET if they have a high AC/A! You gave them just enough to make them try to want to accommodate thru what’s left - induced an ET that wasn’t originally there
Do you correct bilateral high hyperopia in infants/toddlers w/ no ESO and +5.00 hyperopia?
-How about school-aged kids w/ the same Rf error/CT?
Infants - no…but monitor closely.
School-age…yes, but just partial and see what they’re doing.
Generally, kids ok w/ +3.00 compensation W/O sx development.
Is astigmatism >1.00D common infants?
- LARGE or SMALL magnitudes are more stable?
- MOST COMMON type in Caucasians? Everyone else?
- MOST STABLE type of astig?
YES, common.
- LARGE = stable (gonna stick around)
- ATR in Caucasians, WTR in everyone else - WR also more common in Asians after age 5.
- OBL - most stable/unlikely to change.
**ATR astigmatism (increases/decreases) w/ age?
**OBL astigmatism (increases/decreases) w/ age?
ATR: DECREASES w/ age, OBL: STABLE, or INCREASE w/ age–> and likely more amblyogenic for that reason.
Is astigmatism ever corrected in the first year of life?
RARELY - unless OVER 3.00D.
-always remember where CLC (and thus SE) is in proximity to the retina
If a 4Y/O pt has 2.00 of STABLE astigmatism, do you correct it?
T/F: most school-aged children DON’T have astigmatism >0.50D
YES - also correct if it’s less than that (moderate) and is found in association w/ spherical Rf error
TRUE - wierd. But true. If they have more, correct it - usually FULLY (adapt pretty well to astig), unless they’re older than 10ish.
When it comes to anisometropia, it’s generally a good idea to monitor aniso every ___ months for stability, and ALWAYS Rx if >___D over 2-3 visits, if the aniso is increasing, or if ANY ___ is present.
3 months - stability
>2.00D
Increasing aniso, or ANY STRAB present.
