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Pediatrics > Strabismus and Amblyopia > Flashcards

Strabismus and Amblyopia Flashcards

1
Q

What is the ratio of esotropia to exotropia?

A

1 case of exotropia for 3-5 cases of esotropia

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2
Q

Which gender has more exotropia?

A

females

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3
Q

When does exotropia have its onset?

A

35-70% begin within first 2 years of life

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4
Q

What percent of exotropia is intermittent?

A

85%

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5
Q

Why should you be cautious in infants/young children with constant unilateral exotropia?

A

up to 70% is a neurological or ocular anomaly

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6
Q

T/F alternating exotropia is more common

A

true

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7
Q

16-52% of exotropes have an…

A

associated vertical component

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8
Q

What adaptations might be seen with exotropia?

A

close eye in sunlight, panoramic viewing

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9
Q

What are two goals of exotropia treatment?

A

improve stereopsis and improve cosmesis

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10
Q

What VT task is utilized for exotropia tx?

A

train convergence

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11
Q

Why might over-minus lenses be used for exotropia tx?

A

stimulates accommodative convergence, commonly used by OMDs, good short term until child old enough for tx, longterm wean off minus if good control

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12
Q

What amount over-minus is used for exotropia tx?

A

1-4D over cycloplegia

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13
Q

What does BI relieving prism do?

A

facilitates fusion with exotropia (does not fully correct)

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14
Q

How many hours a day is alternate patching used?

A

3-4 hrs, less benefit in older kids as compared to younger

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15
Q

What is the most common surgery for exotropia?

A

bilateral lateral rectus recession, then unilateral resect/recess

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16
Q

What magnitude of exotropia might surgery be done on?

A

15+ prism diopters

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17
Q

What should the acuity of exotropia be?

A

20/20

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18
Q

When the eyes are aligned during exotropia, what should the stereopsis be?

A

+ forms, decent Randot

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19
Q

When the eyes are deviated with exotropia what will the stereo acuity be like?

A

worse or no stereopsis

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20
Q

What is consecutive exotropia?

A

exotropia after surgical treatment for esotropia or after plus correction for esotropia

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21
Q

What would confirm consecutive exotropia?

A

eyes are exotropic but patient acts like esotrope, findings may not make sense aka uncrossed diplopia or amblyopia

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22
Q

What is the natural history of exotropia?

A

it improves over time quantitatively and qualitatively

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23
Q

What did PEDIG find in regards to untreated intermittent exotropia?

A

15% got worse but this is likely an overestimate

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24
Q

What are the concerns of using over-minused lenses as exotropia tx?

A

overminusing myopes leads to a risk of worsening myopia progression

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25
Q

What does a bilateral lateral rectus recession do?

A

moves the insertion back/posterior

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26
Q

What are three forms of esotropia?

A

infantile/congenital, accommodative and non-accommodative

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27
Q

What are the three subcategories of accommodative esotropia?

A

refractive, partially refractive, non-refractive

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28
Q

What is the onset of infantile esotropia?

A

birth to 6 months

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29
Q

57% of infantile esotropia is variable under ____ months

A

4 months

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30
Q

What are characteristics of infantile esotropia?

A

large angle, IOOA, DVD, latent nystagmus, refractive error >+3D, amblyopia

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31
Q

What counts as a large angle in esotropia?

A

greater than 40 prism diopters

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32
Q

What percent of children with large angle esotropia have >40D?

A

50%

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33
Q

What is the onset of DVD?

A

after age 2 or years after surgery, in 51-90% of infantile esotropia

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34
Q

What is latent nystagmus?

A

nystagmus after occlusion

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35
Q

How common is amblyopia in infantile esotropia?

A

50%

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36
Q

What is refractive accommodative esotropia?

A

esotropia within 10 prism diopters that has complete resolution with full RX

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37
Q

70% of refractive accommodative esotropia has a magnitude of deviation between…

A

11 and 45 prism diopters

38
Q

What refractive error is typical in refractive accommodative esotropia?

A

+2 to +6D

39
Q

What EOM is most likely the motor cause of refractive accommodative esotropia?

A

35% inferior oblique over-action

40
Q

What is partially accommodative esotropia?

A

incomplete resolution with full hyperopic correction… difference in magnitude of deviation sc and cc yields residual component

41
Q

How many of those with ET have partially accommodative esotropia?

A

33%

42
Q

What are characteristics of partially accommodative ET?

A

constant, primarily unilateral, amblyopia common

43
Q

What is non-refractive accommodative esotropia?

A

convergence excess esotropia

44
Q

What percent of ET is non-refractive accommodative?

A

5%

45
Q

What is the magnitude of deviation in non-refractive accommodative ET?

A

minimal at distance and 10 prism diopters or greater at near

46
Q

What is the typical refractive error of non-refractive accommodative ET?

A

minimal hyperopia

47
Q

What is the onset of non-accommodative esotropia?

A

6 months-2 years

48
Q

What is the typical magnitude of deviation of non-accommodative esotropia?

A

30 to 70 prism diopters

49
Q

What is the prevalence of ocular disease in non-accommodative esotropia?

A

11% retinoblastoma

50
Q

Which ET has a better prognosis for binocular vision development?

A

non-accommodative esotropia

51
Q

T/F diplopia may be present in non-accommodative esotropia

A

true

52
Q

What are common esotropia treatments?

A

refractive error correction, prism, VT, or surgery

53
Q

What is the refractive error correction for esotropia treatment?

A

plus, cycloplegic refraction is indicated

54
Q

Is VT harder for esotropia or exotropia?

A

esotropia… harder to diverge the eyes

55
Q

What are surgery options for esotropia?

A

bilateral medial rectus recession, and bilateral lateral rectus resection

56
Q

What is the AOA definition of amblyopia?

A

poorer that 20/20 in the absence of any obvious structural anomalies or ocular disease

57
Q

Those with amblyopia may have decreased…

A

fine motor skills and luminance perception

58
Q

What is the amblyopia syndrome definition?

A

poor visual acuity plus spatial distortion, poor accommodation, decreased constant sensitivity, poor tracking and poor monocular fixation

59
Q

What are contour interactions?

A

first and last letters of the chart are easier and single letter is easiest

60
Q

What is the critical period for amblyopia development

A

1st 8 years of life

61
Q

What are the functional amblyopia categories?

A

refractive, strabismic, both, image degredation, and 90% aniso/strab/combo

62
Q

What are the two subcategories of refractive amblyopia?

A

isoametropic or anisometropic

63
Q

T/F those under 7 years have more amblyopia than those under 3 years

A

true except strabismus is higher in younger than 3

64
Q

What are physical obstruction examples that cause image degredation?

A

cataract, ptosis, hyphema, prolonged patching or occlusion

65
Q

Does unilateral or bilateral congenital cataracts have a better prognosis?

A

bilateral

66
Q

What is organic amblyopia?

A

not true amblyopia, due to structural anomalies of the eye or brain independent of sensory input

67
Q

What are examples of structural anomalies that lead to organic amblyopia?

A

optic atrophy, optic nerve hypophemia, macular scar, anoxic occipital brain damage

68
Q

What is the isoametropic hyperopia magnitude?

A

> +5D

69
Q

What is the isoametropic myopia magnitude?

A

> -8D

70
Q

What is the isoametropic astigmatism magnitude?

A

> 2.50D

71
Q

What is the anisometropic hyperopia magnitude? AOA/AAO

A

> 1D/>2D

72
Q

What is the anisometropic myopia magnitude? AOA/AAO

A

> -3/>-3

73
Q

What is the anisometropic astigmatism magnitude? AOA/AAO

A

> 1.50/>2.00

74
Q

Strabismus has poorer VA than ____

A

refractive amblyopes

75
Q

What was the inter acuity difference in the amblyopia treatment studies?

A

3+ lines in ages 3-7

76
Q

When should you consider contact lenses in anisometropic amblyopia treatment?

A

> 5D difference

77
Q

When might you use a bifocal in a treatment plan?

A

if deviation is greater at near than distance

78
Q

T/F treatment for amblyopia is better than no treatment

A

true

79
Q

If VAs are 20/40-20/80 how often do you patch?

A

2hrs/day

80
Q

If VAs are 20/100-20/400 how often do you patch?

A

2-6 hrs/day

81
Q

When should you reassess a treatment plan for amblyopia?

A

8-12 weeks

82
Q

Why might you use atropine 1%?

A

weekend as effective as daily atropine and patching

83
Q

T/F bangerter foils are just as effective as patching

A

true

84
Q

T/F teenagers are too old to treat

A

false, ages 13+ did well if no prior treatment

85
Q

How much improvement is found in teenage treatment of amblyopia?

A

25% of teenagers had 2 lines of improvement

86
Q

How often is there regression in amblyopia treatment?

A

24%

87
Q

What causes a greater possibility of patching treatment regression?

A

greater in 1st 13 weeks after discontinuing patching and greater if abrupt discontinuation

88
Q

What activities can be done while patching?

A

fine motor type activities like drawing, leggos, mazes, video games, eating

89
Q

What are examples of activities one should not do while patching?

A

not riding a bike, not doing homework

90
Q

What are vision therapy treatments for amblyopia?

A

accommodation, vergence, and antisuppression therapies

91
Q

What was the result of dichoptic video games?

A

after 8 weeks VA improved 2 lines, after 10 hours stereopsis improved by factor of 4 (no improvement in patching)

92
Q

What did the PEDIG study find in relation to dichoptic video games vs patching?

A

16 weeks iPad 1hr vs patch 2hr, both improved especially in ages 5 to 7, VA better in patching

Pediatrics (22 decks)

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