Measuring Refractive Error and Cycloplegia (M1) Flashcards
Is the autorefractor usually over or under plussed if no cycloplegic yet?
underplussed
What is the typical cycloplegic (s) given to a child older than 1 year old and suspect hyperopia?
- 1gtt 1% cyclopentolate
2. 1gtt 1% tropicamide
What is the maximum action time of tropicamide? 1. When is it an inadequate cycloplegia? 2
- 30 min
2. hyperopia, accommodative esotropia, refractive amblyopia
What are the cons of photorefraction?
- long time to interpret
- various interpretations
- age-dependent
- pupil size-dependent
What percentage of peds referrals are for refractive error? 1. BV? 2. Ocular health? 3
- 48%
- 18%
- 2.5%
What patients are more likely to have SE’s from cholinergic antagonists?
- down syndrome
- CNS problems
- lightly pigmented
How long does atropine work for? 1. What are the side effects? 2
- 1 week
2. irritability, dry mouth, blushing, poor vision (“mad as a hatter, dry as a bone, red as a beet, blind as a bat”)
What is different about a child’s subjective refractive technique compared to adult?
no more than 0.50D past first 20/20 instead of 0.75D
What is the technique to administer spray cycloplegics?
- spray on lashes 2 to 4 cm away
2. count to 10 and blink
For photorefraction, what is the reflex for a emmetrope? 1. Hyperope? 2. Myope? 3. Greater error than 6.00 D? 4. Patient with corneal opacity? 5. Cataract? 6
- red reflex
- opposite side of flash
- same side of flash
- pupil filled with white
- bluish
- black or bluish
What ages is dynamic retinoscopy typically used for? 1. What are used for the lenses? 2. What should you subtract from the gross lenses used? 3
- all ages but if under 2 need to get attention with noises, etc
- loose lenses
- nothing (accommodating to me)
What should be analyzed while the patient is cyclopleged for their refraction?
push plus and don’t do cylinder again
What is the method to test the child’s reliability during a subjective refraction?
- add 1D plus to ret and ask if made blurry
2. change axis 20-30 deg and see if bring you back to ret value
What are the objective measurements of refractive error?
- retinoscopy
- autorefractors
- photorefractors
What ages is Mohindra (Near) retinoscopy typically used for? 1. What are used for the lenses? 2. What should you subtract from the gross lenses used? 3. Does this usually over or under plus hyperopes? 4
- children under 3 yo
- loose lenses
- 1.00D
- under-plusses
What is the typical cycloplegic (s) given to a child older children, no problems or myope?
1gtt 1% tropicamide
At what age is a subjective refraction attempted? 1. What age is it reliable? 2
- 6
2. 8
When must you cycloplege your patients?
- inconsistent distance fixation during RE assessment
- low confidence in dry ret
- esotropia, anisometropia, amblyopia
- suspect latent hyperopia
- 1st visit to your office
While performing static retinoscopy, what should be used for the lenses for kids under the age of 5 or 6?
- loose lenses
- lens bars
- ret glasses
What is dynamic retinoscopy good for determining?
estimate cycloplegic refractive error for poor accommodators esp hyperopes
What are group should static ret not be used for?
under 2 because little distance fixation
What are the cholinergic antagonists used?
- tropicamide
- cyclopentolate
- atropine
What aspects need to be considered while determining what type of cycloplegic to give?
- age
- iris color
- refractive error
- previously cylcopleged
- tolerability
What is the maximum action time of cyclopentolate? 1. How long does it last? 2. What are the side effects? 3
- 45 min (but ok after 25)
- 24hrs
- irritability and blushing
