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Pediatrics > Pediatric Myopia > Flashcards

Pediatric Myopia Flashcards

1
Q

What amount of myopia should be corrected in infants?

A

> /= -5D, may not emmetropize, 20 cm clear working distance

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2
Q

How much can you undercorrect by to help with near vision?

A

3-4D

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3
Q

What amount of myopia do you Rx in a toddler?

A

> /= -3D

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4
Q

What amount of myopia do you Rx in a preschooler?

A

> /= -1D

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5
Q

What amount of myopia do you Rx in a school age child?

A

all of it, full correction based on VA <20/40 OU

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6
Q

What is juvenile onset myopia?

A

onset from 4/5/6-15 years old that progresses due to axial elongation

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7
Q

What is the expected progression/year for juvenile onset myopia?

A

0.50D/year

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8
Q

Which gender has higher myopia and a faster progression?

A

females

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9
Q

What is the US prevalence of myopia from 2004

A

41%, higher in east asia

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10
Q

How does the WHO define high myopia?

A

> /= -5D

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11
Q

What is the projected global prevalence of myopia for 2050?

A

50% aka

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12
Q

What are pathological consequence of myopia?

A

increased risk for glaucoma, RD, cataract, and myopic macular degeneration

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13
Q

What is myopic macular degeneration?

A

occurs younger than AMD, diffuse, patchy macular atrophy with or without lacquer cracks, CNVM, Fuch’s spot

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14
Q

What are other names for myopic macular degeneration?

A

myopic maculopathy, myopic retinopathy, myopic choroidal neovascularization

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15
Q

What are etiologies of myopia?

A

genetics, environment, peripheral hyperopic defocus/refraction, and binocular vision anomalies

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16
Q

What is a child’s risk for myopia if both parents are myopic?

A

50% chance, 5-6x risk

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17
Q

What is a child’s myopia risk if one parent is myopic?

A

25% chance, 2x risk

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18
Q

What gene is related to high myopia?

A

PAX6

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19
Q

What is peripheral hyperopic defocus a result of?

A

myopic lag of accommodation

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20
Q

T/F animal studies have shown that prolonged near environment leads to myopia

A

true

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21
Q

What is evidence for near work and myopia?

A

naval academy WWII, jewelers, law students post graduate vs high school graduate

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22
Q

What did the Australian study find about near work?

A

near work <30 cm=2.5x more likely and reading for fun=1.5x more likely to become myopic

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23
Q

What was the average lag of accommodation for the China study of myopes 6-13 yo?

A

1.52 aka high

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24
Q

T/F more stress tend to lead to a smaller working distance

A

true

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25
Q

What was the general range of working distance for the china study of myopes?

A

21-27 cm

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26
Q

T/F decreased distance with increased concentration and work load?

A

true

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27
Q

What behaviors might create nearsightedness?

A

lack of exposure to natural daylight, close working distance, accommodative lock

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28
Q

What might cause eyestrain complaints with near devices?

A

glare, binocular/accommodative problems

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29
Q

How are near devices related to dry eye?

A

decreased blink rate

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30
Q

What pupil size changes occur with digital devices?

A

dilated w/ video games, activates sympathetic system

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31
Q

What are negatives of near digital devices and health?

A

negative impact on sleep, problems with attention, addiction from digital heroin

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32
Q

What does the American Academy of Pediatrics recommend for screen time under 18 months?

A

video chat only

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33
Q

What does the AAP recommend for screen time from 18-24 months?

A

introduce high quality programming

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34
Q

What does the AAP recommend for screen time from 2-5 yeas old?

A

2 hours/day max

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35
Q

What does the AAP recommend for screen time for 6+ years old?

A

place limits and ensure sleep and physical activity, set up media free times or locations

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36
Q

Where is the focal point in hyperopic defocus?

A

behind the retina, only the fovea is in focus, the peripheral retina is hyperopic and the eye grows to get it focused

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37
Q

What is the only FDA approved method for myopia control?

A

MiSight CooperVision pediatric multifocal contact lenses approved November 2019

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38
Q

What is a list of tx possibilities for myopia control?

A

time outdoors, under correction, bifocal lenses, contact lenses, atropine, spectacle lenses

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39
Q

What is the 20-20-2 rule?

A

20 minutes of screen, 20 second break at distance, and 2 hours outside

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40
Q

Why may time outdoors help myopia?

A

distance viewing, sunlight, UV exposure, retinal dopamine, not doing work?

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41
Q

How much time should kids spend outside?

A

1-2 hrs/day

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42
Q

Who benefits from time spent outdoors?

A

low hyperopes/plano, once myopic doesn’t help much

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43
Q

How are under correction and myopia related?

A

under correction is associated with increase in progression of myopia or no change as compared to fully corrected controls

44
Q

What did the Chung under correction study show?

A

myopes 9-14 full correction v. under corrected by 0.75, after two years under correction progressed -1D and full correction progress -0.75D

45
Q

What are the two theories for bifocal lenses in myopia control?

A

myopes have poor accommodation, control the accommodative response

46
Q

Do bifocal lenses produce a significant difference in myopia progression?

A

NO, except in esophoric patients

47
Q

What was the result of an executive bifocal and BI prism?

A

45% slowing of myopia progression

48
Q

What is the COMET study 2003?

A

prospective, double masked RCT with PAL vs single vision for myopes Rx -1.25 to -4.50 age 6-11

49
Q

What was the finding of the COMET study?

A

after 3 years, statistically significant but clinically insignificant decrease in myopia of 0.2 D, and after 5 years insignificant decrease of 0.1D

50
Q

Specifically with esophoria and accommodative lag, what did the COMET study find?

A

after 3 years, children with esophoria and larger accommodative lag decrease in myopia of 0.64D, and actual benefit

51
Q

What did the COMET 2 2011 study look at?

A

esophoria and accommodative lag

52
Q

What were the findings of COMET 2?

A

after 3 years, statistically significant, clinically insignificant decrease in myopia of 0.28D

53
Q

What did the Japenese single vision/PAL crossover study look find?

A

overall 0.17 D treatment effect but better for EP and high lag

54
Q

T/F there was a significant change in axial elongation after 2 years of contact lenses vs specs in myopia

A

false, no change

55
Q

What did the COMET 2009 contact lens study find?

A

small statistically significant, clinically insignificant increase in myopia, no real difference in myopia progression, definitely will not make it worse than specs

56
Q

Which technique is approved for myopia correction but not myopia control?

A

orthokeratology

57
Q

What is orthokeratology?

A

temporary decrease in myopia from CLs due to corneal reshaping overnight

58
Q

What is the OrthoK myopia control mechanism?

A

peripheral hyperopic defocus… flattens central cornea steepening the mid-peripheral cornea, the peripheral myopia decreases peripheral hyperopic defocus

59
Q

Does OrthoK cause corneal damage?

A

no, redistribution of epithelial cells, not bending

60
Q

What does OrthoK do to accommodation?

A

improves accommodation

61
Q

What were the findings of OrthoK studies like LORIC, CRAYON, ROMIO?

A

orthoK decreased axial length (A scan ultrasound) and decreased myopia progression (retinoscopy)

62
Q

What are the lens designs for multifocal contact lenses?

A

distance center, near center, aspheric

63
Q

What is a concentric CL?

A

distance power in the center typically, surrounded by concentric rings of near and distance powers

64
Q

What is aspheric CL?

A

distance or near power is in the center, with a gradual transition to other powers as you move away from the center, slight blur involved

65
Q

What have multifocal CL studies found?

A

slow myopia progression (10% increase to 79% decrease), slow axial elongation (0-79%)

66
Q

What is the BLINK study?

A

bifocal lenses in nearsighted kids, compared add powers of distance center multifocals for kids 7-11 with myopia

67
Q

What did the BLINK study find?

A

43% decrease in myopia and 36% decrease in axial length, with the high add of +2.50 being most successful

68
Q

Who are the MiSight lenses approved for?

A

ages 8-12, Rx -0.75 to -4.00

69
Q

What tech is in the MiSight lenses?

A

dual focus center distance concentric, all rings equal in surface area, pupil size not limiting

70
Q

What is the mechanism of atropine 1%?

A

prior: paralysis of accommodation, now: biochemical effect on eye growth

71
Q

What is the effect of atropine on asians vs. caucasian?

A

greater effect in asians 0.55D vs 0.35D in caucasian

72
Q

What was the myopia progression of compliant vs partly compliant myopes with 1% atropine weekly?

A

0.08D/year and 0.23D/year respectively

73
Q

What is the ATOM study?

A

Atropine for Treatment of childhood myopia 2006, Singapore age 6-13, 1 drop daily and photochromic PALs for two years

74
Q

What were the results of the ATOM study?

A

myopia progression of placebo=1.20 D vs 0.28D in atropine, 77% reduction in amount of myopia progression

75
Q

When did the ATOM study follow up occur?

A

2009, after at least 1 year of cessation of treatment

76
Q

Over a 3 year period after the ATOM study, what were the results?

A

less myopia in atropine treated than placebo with a large rebound in the 3rd year which may have been accommodative not real myopia progression

77
Q

What is the ATOM2 study?

A

2011 Atropine for Treatment of Childhood Myopia, 400 Asian children 6-12, at least -2D, study duration of 2 years

78
Q

What percentage of atropine won’t fully cycloplege… muscarinic receptor?

A

0.01%

79
Q

Which atropine concentration slowed myopia progression the most?

A

1.0% atropine slowed to 0.14D/year vs 0.60D/year with placebo

80
Q

What result did atropine have on mean axial length?

A

atropine treatment decreased mean axial length

81
Q

What was the LAMP study?

A

low-concentration atropine for myopia progression 2019, 438 Chinese children 4-12 years for 1 year

82
Q

What was the conclusion of the LAMP atropine study?

A

0.05% atropine is the best concentration to slow myopia progression and axial length growth

83
Q

What is the optimal dose of atropine to control myopia progression?

A

0.01% I think

84
Q

What is the lowest dose of atropine that can be given without symptoms?

A

0.02% does not have blur and photophobia?

85
Q

What is an example of combination myopia control?

A

atropine and bifocal contact lens

86
Q

What two studies are in FDA phase 3 clinical trials?

A

CHAMP 0.01% atropine and Chaperone testing 0.01 and 0.1 microdose (spray)

87
Q

What new spectacles treatments are for myopia progression?

A

MyoSmart Hoya (China and Canada) 60% less myopia progression and 21.5% halted AND Myo Vision Zeiss single vision with peripheral blur to decrease peripheral hyperopia

88
Q

What is the reduction for bifocal spectacles?

A

12-15%

89
Q

What is the reduction for bifocal spectacles on esophoric patients

A

20-45%

90
Q

What is the reduction for othroK?

A

32-42%

91
Q

What is the reduction for multifocal contacts?

A

50-70%

92
Q

What is the reduction for atropine?

A

58-90 aka 77%

93
Q

What is the benefit of bifocal/PAL treatment?

A

low cost, easy to fit, may help with EP

94
Q

What is the concern for bifocal/PALs?

A

cosmesis, is child using it correctly

95
Q

What are the benefits of orthoK?

A

better efficacy, cosmesis

96
Q

What are the concerns of Ortho K?

A

comfort, infections, training (doc), cost, multiple exams

97
Q

What are the benefits of multifocal CLs?

A

better efficacy, cosmesis, ease of fitting, comfort, FDA approved!!

98
Q

What are the concerns of multifocal CLs?

A

infections and cost

99
Q

What is the benefit of atropine?

A

best efficacy

100
Q

What are the concerns of atropine?

A

optimal dose, symptoms, compounding

101
Q

What is incipient myopia?

A

accommodative insufficiency but not myopic yet

102
Q

What are signs of accommodative insufficiency?

A

low PRA, low amplitude, higher FCC, accommodative infacility (minus)

103
Q

What are characteristics of incipient myopia?

A

accommodative insufficiency, EP’ or low XP’, ATR astigmatism, hyperopia on wet ret, symptoms of distance blur after near work and close working distances

104
Q

What is the treatment for incipient myopia?

A

low plus lenses

105
Q

What is the mechanism of action of atropine in controlling myopia ptrogression?

A

not accommodation, muscarinic effects on the retina, choroid, and sclera

Pediatrics (22 decks)

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