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Pediatrics > Retinoscopy/Refraction > Flashcards

Retinoscopy/Refraction Flashcards

1
Q

What is static retinoscopy?

A

Control for accommodation (cycloplegia, fog, distance fixation)

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2
Q

What is dynamic retinoscopy?

A

Does not control accommodation, often used to determine the near Rx

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3
Q

How can you perform infant retinoscopy?

A

Loose lenses or skiascopy, cyclopligia, finger puppet or light for target

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4
Q

Why and how is cycloplegia used in infant ret?

A

Preferred due to the robustness of accommodative response and small pupil size, infants use 0.5% cyclopentolate (1% tropicamide 2nd choice), 12 months + 1% cyclopentolate

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5
Q

What is Mohindra near ret?

A

Technique for assessment of distance refractive error, has good correlation with cycloplegic results

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6
Q

What is the Mohindra technique?

A

Dark room, infant fixates on ret light at 50 cm, determine magnitude of with/against with skiascopy bars, then subtract 1.25 D from result

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7
Q

What techniques are used for toddler/preschool ret?

A

Loose lenses or skiascopy bars

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8
Q

How is toddler/preschool ret performed?

A

Movie as fixation target, ret and trial frame the results

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9
Q

When is cycloplegia indicated for toddlers/preschoolers?

A

Decreased VA, esotropia, high hyperopia or a variable reflex

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10
Q

What cycloplegia is used of toddler/preschooler?

A

Cyclopentolate 1% is a wet refraction (tropicamide 1% is damp because not full cycloplegia)

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11
Q

At what age can a child sit in the phoropter?

A

8+

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12
Q

What is the indication for cycloplegia in school aged ret?

A

Decreased VA, esotropia, variable reflex

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13
Q

Can school aged children understand JCC?

A

Normally yes

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14
Q

What is the average refractive error of full term newborns?

A

+2.00, 88% between Plano and +4

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15
Q

What is the standard deviation for refractive error of full term newborns?

A

2.00 +/_ 2.75

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16
Q

What percent of full term newborns have astigmatism?

A

30%

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17
Q

What is emmetropization?

A

Tendency for the refractive state of the eye to change close to plano, converges to low hyperopia

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18
Q

What is the standard deviation after emmetropization?

A

+0.50 to -1.00 +/- 1.00

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19
Q

Theories of active emmetropization?

A

Regulated by retinal image- eye interprets retinal blur and adjusts, sustained near vision and myopia, animal studies make functional myopia/hyperopia, eye is growing/increase axial length

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20
Q

What is the evidence for emmetropization regulated by retinal image?

A

Media opacities ROP, myopia more common

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21
Q

What is the “evidence” for sustained near vision and myopia?

A

Law students/jewelers

22
Q

What are theories of passive emmetropization?

A

Physical changes- refractive errors move to emmetropia initially, genetics affect Rx, changes in corneal/lenticular power

23
Q

How do genetics contribute to passive emmetropization?

A

If both parents are myopic you have a 42% chance, if one is you have a 22.5% change, if neither is you have an 8% chance

24
Q

What could changes in corneal/lenticular power be in response to?

A

Increase axial length, creates balance for emmetropization

25
Q

What are the structural changes of emmetropization?

A

Crystalline lens adds layers, increase net weight, and flattens; corneal power decrease, axial growth occurs

26
Q

What does the BIBS study stand for and when was it conducted?

A

Berkeley Infant Biometry Study 2009

27
Q

How many infants participated in the BIBS study and at what ages?

A

262 infants, ages 3, 9, and 18 months

28
Q

What was the body weight for the BIBS study?

A

> 2500 g

29
Q

What test did BIBS conduct?

A

Cycloplegic, near and Mohindra ret, visual acuity

30
Q

What did the BIBS study find?

A

bidirectional emmetropization

31
Q

What was the best predictor in the BIBS study?

A

Cycloplegic refraction

32
Q

Higher magnitude = _____ likely to be emmetropized at 18 months

A

Less

33
Q

T/F large amounts of astigmatism are common in children < 3 years old

A

True, +1 D in 30% of newborns

34
Q

Which is more common in <3 years old, WTR or ATR?

A

ATR

35
Q

When is astigmatism highest and when does it reach adult levels?

A

Highest in the first two years, adult levels by age 4-5

36
Q

T/F if little astigmatism in 1st year of life, not likely to acquire

A

True

37
Q

What is MEPEDS and when was it?

A

Multi Ethnic Pediatric Eye Disease Study 2011

38
Q

What did MEPEDS look at?

A

Astigmatism in children ages 6-72 months

39
Q

What did MEPEDS find?

A

> 1.50 D astigmatism in 16.8% of Hispanic children and 12.7% AA; >3.00 D astigmatism in 2.9% of Hispanic and 1% AA

40
Q

T/F the majority of the astigmatism found in MEPEDS was WTR and decreased with age

A

True

41
Q

What percent of preschoolers failed an exam two times in LA?

A

18%

42
Q

How many preschoolers had vision screenings in LA?

A

56%

43
Q

What percent of preschoolers in LA had myopia >-0.50 D?

A

20%

44
Q

What percent of preschoolers in LA had hyperopia >+0.50 D?

A

59%

45
Q

What percent of preschoolers had astigmatism > -1.50D in LA?

A

66%

46
Q

Which ethnicity was the least hyperopia and which was the most?

A

Least-Asian, most-white

47
Q

Which ethnicity had the most astigmatism?

A

Latino (68%) AA (61%)

48
Q

Most children starting school (5-7 years old) have ____ refractive error

A

+0.50 to +3.00 refractive error

49
Q

When is the lowest prevalence of myopia?

A

5-7 years old

50
Q

T/F 5-6 year olds with plano to +0.25 D are likely to become myopic by teenage years

A

True

51
Q

Do girls or boys become myopic faster?

A

Girls

52
Q

T/F refractive error changes faster in children with myopia than hyperopia

A

True

Pediatrics (22 decks)

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