Pediatric Hyperopia Flashcards
What components should prescribing be based on?
retinoscopy, symptoms, child’s age, binocularity, VA sc, VA cc or w/ modified Rx, prior Rx
Who should pick out the frames?
the child, even if the parents don’t like them
What is important about children and glasses?
make sure frames are kid friendly and make sure the child uses them properly
What company makes glasses specifically designed for patients with down syndrome?
Specs 4 Us, changed the nose pads
How can you demonstrate myopia and hyperopia to a child’s parents?
trial frame +8D and -8 D + reading respectively
What is the full term average of hyperopia in infants?
+2.00 D or pl to +4
When does infantile hyperopia significantly decrease?
between 3 and 9 months
When is emmetropization?
= +2.00 at 18 months
T/F Usually when older than 9 months you need to Rx?
true
What are the two options of a hyperope?
1) try hard to make it clear so an eye turns in leaving one clear eye or 2) eyes stay ortho but vision is blurry OU
What are the two risks of hyperopia?
strabismus (esotropia) or bilateral amblyopia with +5.00
Does prescribing at age 6+ months significantly lower risk of amblyopia and strabismus?
no
Infants with >+3.50 are ____ more prone to strabismus by age 4 and ____ more prone to amblyopia
13 times, 6 times
Approximately what percent of infants have hyperopia greater than 3.25 according to Atkinson and Braddick?
3-6%
Who were the subjects in the VIP (Vision in Preschoolers) study?
ages 3-5 with > +3.25 D
What percent of children in VIP had amblyopia?
34.5%
What percent of children in VIP had strabismus?
17%
1 out of ___ children who are not reading proficiently in 3rd grade do not graduate from high school on time
6, 4x greater risk than proficient readers
What percent of low, below-basic readers drop out or fail to finish high school on time?
23%
What percent of 3rd graders in Shelby country are proficient in reading?
24%
What is TOPEL?
literacy test, print knowledge, definitional vocabulary, phonological awareness
T/F In general children with hyperopia > +1.25 (dry) have lower achievement test scores in grades 1-5
true
One study found that full correction of hyperopia >+0.75 improved…
1 minute reading score by 13%
Over-minusing/underplusing a child by 2D can cause…
ADHD symptoms
What are AAO hyperopia guidelines for Rx <3 years and >4years
+4.50 and as necessary to improve acuity or alleviate esotropia respectively
What are the AOA hyperopia Rx guidelines for infant, young child, and adolescent?
+3.50, +2.50 and +1.50 respectively
What is the general hyperopia Rx pattern for optometrists compared to ophthalmologist?
optometrist more likely to Rx because of consideration of age, magnitude, VA, phoria, accommodation, school performance etc
In esotropes…
push plus!
When has emmetropization finished?
mostly by 9 months maybe 18
When do you Rx in infant/toddler age 1+?
consider >+3.50
What should you do to cycloplegic refraction before prescribing for infant or toddler?
cut 1-2D symmetrically
In preschooler why might you Rx lower amounts of hyperopia?
stereo, near VA, symptoms
When do you Rx a preschooler?
> +2.50
What do you do to cycloplegic refraction before prescribing for preschooler?
cut cycloplegic 1-2 D
What are symptoms of hyperopia in school aged children?
blurry vision consistent with refractive error (+0.50), HA when reading, blurry as reading, below grade level for reading, tired when reading, avoids reading
What binocularity reasons may you use for prescribing for a school aged hyperope?
esophoria at distance/near, esotropia distance/near, reduced stereopsis
What accommodation reasons might you use for prescribing for a school aged hyperope?
insufficiency, high lag, variable reflex
When do you Rx a school aged child?
> +1.50 without symptoms
Why might you prescribe lower amounts of hyperopia for a school aged child?
symptoms, reduced near VA, binocularity
What should you do to the cycloplegic refraction of a school aged child?
cut if high hyperopia and no prior Rx, if lower amount cutting is not always necessary
