Paediatric Prescribing - ahalya Flashcards
what 5 questions do we need to consider when prescribing from birth to 6yrs?
- is ref error within normal age range?
- is the ref error expected to emmetropise?
- will ref error disrupt normal visual development or functional vision?
- will prescribing gls help with visual function?
- will gls interfere with normal process of emmetropisation?
what is emmetropisation?
naturally overcoming/ ‘growing out of’ any ametropia
why can gls interfere with emmetropisation
giving a child an rx before they have completely emmetropised can affect the process
at what age does a childs visual system finish developing
1 yrs old
why is monitoring between birth and 6 yrs the most crucial period?
this is when the most changes occur in childs eyes
what type of ref error is most common from birth to 3 years?
mainly hyperopia
at what age period is the emmetropisation process quickest to occur and vision to stabilise?
3-12 months
what is an advantage of having a large ref error when young?
quicker to emmetropise
are small low ref errors/hyperopia in young children quicker or slower to emmetropise?
slower
what other factor can we consider when looking at ref errors in children?? ( non rx related)
ethnicity
is there a higher or lower percentage of astig at birth ?
higher
what % of FT new borns have astigmatism of 1.00dc or more?
69%
at what age do babies lose astigmatism as they emmetropise?
between 9 and 21 months
what eye condition is prevalent in new borns?
anisometropia
true or false: anisometropia more common in kids than adults
true
at what cyl power does astigmatism be classed as ‘high degree’
3.00dc or more
what is the percentage of young children that have anisometropia?
17-30%
are higher levels of anisometropia (5Ds) in young children more likely to remain?
yes
in the emmetropisation stage, how do we manage a chlld with a suspect ref error ?
put on 4-6 month recall- predict if they can emmetropise or not
is there an association between lack of emmetropisation and strabismus?
yes
what should VA be at 6 years old?
6/6 (hint: just think 6/6/6)
what is the risk of amblyopia and strabismus if you have a child with uncorrected hyperopia?
13x more risk of strab, 6x risk of amb
what is a high risk factor for amblyopia
uncorected ref error (including anisometropia)
what age group is at an increased risk of amblyopia if cycls = > 3.50ds in one meridian?
1 y/o
with what rx are 4 y/o at an increased risk of amblyopia?
if they have a hypermetropic ref meridian of 2.00 or more
does prescribing gls improve visual function?
yes- esp if high hyperopia- can correct and reduce strab x4 and 2.5x amblyopia ins
by how much (stats) does prescribing gls improve visual function?
strab reduces down from 13x to 4x and if corrected amblyopia goes down from 6x amblyopia to 2.5x amblyopia
what are negative effects of uncorrected hyp in school children?
poor academic performance
can prescribing spx interfere with emmetropisation?
results inconclusive: animal study shows compliant spx wearers emmetropise less than non compliant spec wearers/ controls
main aims of presrbing during emmetropisation process?
gls shoulnt interfere with process aND OFFER IMPROVE VAS
what happens if we under correct myopia in school children?
may lead to further progression of myopia
what factors should be considered when prescribing (relevant tests etc)
- child age
-rx
-visions and va’s
-BIN VA status- do CT and dynamic Ret
-FH- squint, amblyopia
what rx can we consider prescribing from even if child asymptomatic?
+1.50ds
what is an advnatage of testing older children over young kids?
tests will be symptom lead
what are social impacts on school children that wear gls
they can get bullied more :’)
what two things do we consider before prescribing gls?
identify children who follow abnormal patterns
Gls should be of benefit to child
why would we prescribe a reduced rx and what pxs are good candidates for this?
we want to give some room to emmetropise- hyperopes under 6, good bv no strab
when do we give a full rx
if px is myopic
what qs do we consider when doing H+S?
how old is child? rx of child? unaided/aided va- age appropiate? BV status, FH squint? FH amb?
what BV status tests can we do?
CT, 20 BO test, dynamic ret, stereoacuity,
what situations do we prescribe in?
-Accom lag
-mod hyperopia
-poor controlled SOP
-vision decreased for age
eg case scenario- 3 yo with poor SOP would we need to manage?
yes- can break down into tropia
what type of rx is associated with amblyopia?
frequently unchanging or increasing rxs
when do we give full correction of rx- hint think of strab too
Hyperopia with Esotropia, also any anisometropia difference in strab or amblyopic px (check AAO guidelines)
which pxs do we undercorrect in?
pre-school kids in absence of strab or amb
how much do we undercorrect by?
between 1.00ds to 2.00ds- give room to emmetropise
normal va acuities from birth to 6 y/o
0 y/o = 6/120
3 y/o = 6/12
4 y/0 = 6/9
5-6 y/o = 6/6
how do we treat amblyopia?
start with gls correction, if no VA improvement consider patching, atropine etc
what does isotropic mean ( from AAO guidelines)
rx similar in both eyes
what are other things to consider for young children (links to dispensing)
compliance + also spectacle fitting
- check case studies at end of lecture
- check case studies at end of lecture
