Paeds: Optometric Mx of EsoT STRAB - Week 5 Flashcards
List 6 differential diagnoses of EsoT
Accommodative EsoT
Non-accommodative EsoT
Pseudo-EsoT
Infantile EsoT
Duane’s syndrome
Pathological STRAB (6th palsy or other)
List and describe correction for the 3 subgroups of accommodative EsoT
Totally accommodative EsoT: near add fully corrects
Partially accommodative EsoT: near add partially corrects (I.e. corrects >/=50%)
Accommodative excess: EsoT N>D. Correct with distance Rx for distance + near add for near
Which type of EsoT is the most common type of strabismus?
Accommodative
Suppose a child has R +3 and L +4 DS. Which eye will she typically choose for clear vision? Why
Right eye. Usually choose to accommodate the least amount for clear vision, because our system is lazy
List 3 reasons for when you should prescribe spectacles for EsoT
Hyperopia > +2
EsoT responds to plus lenses (positive Raab +3 test)
Hyperopia < +2 BUT high AC/A (indicates C.E)
What is Gunter Von Noorden’s general policy for strabismic hyperopic correction?
“It is our policy to correct all strabismic hyperopes over +2.50 before considering surgery” (i.e. without even needing to look at anything else)
(NB: this is for atropine, when using cyclopentolate change +2.50 to +2.00)
Describe the Raab +3 test
Checks for accommodative component to strab/EsoT
Add +3.00 lenses in front of patient’s eyes and direct them to a near target. Look at position of eyes. If position changes with lenses in place = there is an accommodative component to this strab/EsoT.
If prescribing a bifocal for children with accommodative EsoT, where should the segment be located?
segment should be prescribed on the datum/middle of the frame
List 3 complications in diagnosing EsoT in the first visit
Won’t necessarily find all the hyperopia
EsoT may respond better to plus after a few weeks
Motor examination is done before cycloplegic and cannot be reliably repeated on the day (as accomm. is paralysed)
What is the dosage used for cycloplegia in children? If older than 6 months or under 6 months?
Under 6 months: 0.5%
Over 6 months: 1%
How long should you wait after cyclopleging children to perform retinoscopy?
40 minutes
How much more plus is revealed by atropine compared to cyclopentolate?
Reveals 0-0.50D more plus.
List 1 advantage and 1 disadvantage of atropine
Adv: does not sting (great for kids)
Disadv: takes 4-6 hours to give adequate cycloplegia
Kowal: ET and high hyperopia study (ARVO 2008) of 86 hyperopic toddlers with >+6 diopters and EsoT:
In a mean follow up period of 20 months, what happened to the hyperopia of these patients after prescription with full cyloplegic?
36% showed increase in hyperopia >1.25 diopters
(NB: the lecturer’s practice found an average change of refraction of +1.00DS in an 8 year follow up with a different cohort)
For what percentage of paediatric patients will you not have found all the plus on initial consult? What does this mean?
25-50%. This means you need to confirm whether you have found all the plus at reviews (NB: should use two different measures for this e.g. ret + max plus)