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Binocular Vision > Paediatric Prescribing - ahalya > Flashcards

Paediatric Prescribing - ahalya Flashcards

1
Q

what 5 questions do we need to consider when prescribing from birth to 6yrs?

A
  • 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?
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2
Q

what is emmetropisation?

A

naturally overcoming/ ‘growing out of’ any ametropia

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3
Q

why can gls interfere with emmetropisation

A

giving a child an rx before they have completely emmetropised can affect the process

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4
Q

at what age does a childs visual system finish developing

A

1 yrs old

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5
Q

why is monitoring between birth and 6 yrs the most crucial period?

A

this is when the most changes occur in childs eyes

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6
Q

what type of ref error is most common from birth to 3 years?

A

mainly hyperopia

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7
Q

at what age period is the emmetropisation process quickest to occur and vision to stabilise?

A

3-12 months

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8
Q

what is an advantage of having a large ref error when young?

A

quicker to emmetropise

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9
Q

are small low ref errors/hyperopia in young children quicker or slower to emmetropise?

A

slower

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10
Q

what other factor can we consider when looking at ref errors in children?? ( non rx related)

A

ethnicity

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11
Q

is there a higher or lower percentage of astig at birth ?

A

higher

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12
Q

what % of FT new borns have astigmatism of 1.00dc or more?

A

69%

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13
Q

at what age do babies lose astigmatism as they emmetropise?

A

between 9 and 21 months

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14
Q

what eye condition is prevalent in new borns?

A

anisometropia

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15
Q

true or false: anisometropia more common in kids than adults

A

true

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16
Q

at what cyl power does astigmatism be classed as ‘high degree’

A

3.00dc or more

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17
Q

what is the percentage of young children that have anisometropia?

A

17-30%

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18
Q

are higher levels of anisometropia (5Ds) in young children more likely to remain?

A

yes

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19
Q

in the emmetropisation stage, how do we manage a chlld with a suspect ref error ?

A

put on 4-6 month recall- predict if they can emmetropise or not

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20
Q

is there an association between lack of emmetropisation and strabismus?

A

yes

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21
Q

what should VA be at 6 years old?

A

6/6 (hint: just think 6/6/6)

22
Q

what is the risk of amblyopia and strabismus if you have a child with uncorrected hyperopia?

A

13x more risk of strab, 6x risk of amb

23
Q

what is a high risk factor for amblyopia

A

uncorected ref error (including anisometropia)

24
Q

what age group is at an increased risk of amblyopia if cycls = > 3.50ds in one meridian?

A

1 y/o

25
Q

with what rx are 4 y/o at an increased risk of amblyopia?

A

if they have a hypermetropic ref meridian of 2.00 or more

26
Q

does prescribing gls improve visual function?

A

yes- esp if high hyperopia- can correct and reduce strab x4 and 2.5x amblyopia ins

27
Q

by how much (stats) does prescribing gls improve visual function?

A

strab reduces down from 13x to 4x and if corrected amblyopia goes down from 6x amblyopia to 2.5x amblyopia

28
Q

what are negative effects of uncorrected hyp in school children?

A

poor academic performance

29
Q

can prescribing spx interfere with emmetropisation?

A

results inconclusive: animal study shows compliant spx wearers emmetropise less than non compliant spec wearers/ controls

30
Q

main aims of presrbing during emmetropisation process?

A

gls shoulnt interfere with process aND OFFER IMPROVE VAS

31
Q

what happens if we under correct myopia in school children?

A

may lead to further progression of myopia

32
Q

what factors should be considered when prescribing (relevant tests etc)

A
  • child age
    -rx
    -visions and va’s
    -BIN VA status- do CT and dynamic Ret
    -FH- squint, amblyopia
33
Q

what rx can we consider prescribing from even if child asymptomatic?

A

+1.50ds

34
Q

what is an advnatage of testing older children over young kids?

A

tests will be symptom lead

35
Q

what are social impacts on school children that wear gls

A

they can get bullied more :’)

36
Q

what two things do we consider before prescribing gls?

A

identify children who follow abnormal patterns
Gls should be of benefit to child

37
Q

why would we prescribe a reduced rx and what pxs are good candidates for this?

A

we want to give some room to emmetropise- hyperopes under 6, good bv no strab

38
Q

when do we give a full rx

A

if px is myopic

39
Q

what qs do we consider when doing H+S?

A

how old is child? rx of child? unaided/aided va- age appropiate? BV status, FH squint? FH amb?

40
Q

what BV status tests can we do?

A

CT, 20 BO test, dynamic ret, stereoacuity,

41
Q

what situations do we prescribe in?

A

-Accom lag
-mod hyperopia
-poor controlled SOP
-vision decreased for age

42
Q

eg case scenario- 3 yo with poor SOP would we need to manage?

A

yes- can break down into tropia

43
Q

what type of rx is associated with amblyopia?

A

frequently unchanging or increasing rxs

44
Q

when do we give full correction of rx- hint think of strab too

A

Hyperopia with Esotropia, also any anisometropia difference in strab or amblyopic px (check AAO guidelines)

45
Q

which pxs do we undercorrect in?

A

pre-school kids in absence of strab or amb

46
Q

how much do we undercorrect by?

A

between 1.00ds to 2.00ds- give room to emmetropise

47
Q

normal va acuities from birth to 6 y/o

A

0 y/o = 6/120
3 y/o = 6/12
4 y/0 = 6/9
5-6 y/o = 6/6

48
Q

how do we treat amblyopia?

A

start with gls correction, if no VA improvement consider patching, atropine etc

49
Q

what does isotropic mean ( from AAO guidelines)

A

rx similar in both eyes

50
Q

what are other things to consider for young children (links to dispensing)

A

compliance + also spectacle fitting

51
Q
  • check case studies at end of lecture
A
  • check case studies at end of lecture

Binocular Vision (30 decks)

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