Refractive Error in Children

Question 1

What is the probability of emmetropization in a -5.00D 3 mo old?

Answer 1

50%

Question 2

An 8 year old child is seen for a 1st vision exam: +5.00 Diopter Sphere OU. Would you prescribe?

Answer 2

Yes, especially if stereo is reduced

Question 3

A 4 year old child is seen for a 1st vision exam: +5.00 Diopter Sphere OU. Would you prescribe?

Answer 3

Maybe.

• No if no complaints
• Yes if complaints

Question 4

A 1 year old child is seen for a 1st vision exam: Plano -3.00 x 180 OU. Would you prescribe?

Answer 4

Possible that emmetropization is still occuring

- monitor

Question 5

At what age is there a rapid decline in astigmatism?

Answer 5

at 24 mo

• any px under 2, just watch, dont prescribe
• any px over 2 = prescribe

Question 6

A 6 year old child is seen for a 1st vision exam: +1.00 OD +3.00 OS, Would you Rx?

Answer 6

Yes. Px is at risk for anisometropic amblyopia

- ruins binocularity

Question 7

T/F: Anisomeropia may appear and disappear between the ages of 1-4 yo.

Answer 7

True

- if px has aniso and is under 4 yo, just watch and monitor

Question 8

T/F: Aniso is more likely to remain if greater than 3 diopters or more.

Answer 8

True

- if less than 3D will usually disappear

Question 9

A 6yo, 3yo and 1yo with +1.00 OD; +3.00 OS. Would you Rx?

Answer 9

6 yo = Rx
3 yo = monitor for normal VA and BV
1 yo: monitor

Question 10

During what time is refractive error most dramatically changed?

Answer 10

during the first year of life

Question 11

What 2 things are we concerned about in newborns to 5yo pxs?

Answer 11

1. Stability of RE

2. Mod. to Severe RE

Question 12

At birth, what % of babies have astigmatism, hyperopia and myopia?

Answer 12

Astig = 60%
Hyper = 30%
Myo = 25%

Question 13

What’s the average rate of change for myopes? For hyperopes?

Answer 13

Myopes: .25-.50D per year
Hyperopes: .25-.50 every 6 years (decreases)

Question 14

A 7 yo with -0.50 RE, what’s their refraction at 16 yo.

Answer 14

9 x -0.25 = -2.25D

-2.25 + (-0.50) = -2.75D

Question 15

A 5yo with +2.00D. What’s her Rx by age 17?

Answer 15

+1.00 - +1.50D

Question 16

A 10yo with +1.00 . What’s Rx by 16?

Answer 16

+0.50 - +0.75

Question 17

T/F: Refractive conditions may cause increase in onset and severity of symptoms.

Answer 17

True

Question 18

What are the 2 reasons why we prescribe glasses to children?

Answer 18

1. Improve visual function

2. Preventing sensory, motor and developmental abnormalities

Question 19

When there is strabismus, we prescribe based on what?

Answer 19

based on AC/A

Question 20

What are the LEA norms for 3yo? 4/5yo? 6yo?

Answer 20

3 yo = 20/50
4/5yo = 20/40
6+ = 20/20

Question 21

What is the normal stereopsis on the PASS test; Randot?

Answer 21

Pass: 60 to 120 secs
Randot: 20secs

Question 22

Will giving hyperopia Rx impede emmetropization?

Answer 22

Partial Rx for hyperopia

Question 23

Patients with a high hyperopic, bilateral RE had a higher risk of getting what accommodative disorder?

Answer 23

convergence insufficiency

Question 24

What is the convergence demand for a PD of 52mm and test distance of 40cm? What’s their AC/A?

Answer 24

CD = (10x52)/40
CD = 13pd
13/2.5D = 5.2/1

Question 25

When do you prescribe the full correction for young patients?

Answer 25

1. Anisometropia

2. Astigmatism

Question 26

When prescribing full correctin for eso deviations, what are we considering?

Answer 26

AC/A ratio

Question 27

What is the highest risk factor for developing myopia?

Answer 27

2 parents being myopic

Question 28

When would you want to see the child back sooner than 1 year?

Answer 28

1. Amblyopia suspect
2. BV problem
3. Consideration for VT