wk11: CL/M - Non surgical mx of Hyperopia Flashcards
When does the major post-natal growth of the eye occur?
during the first 3 years of life
How long is the axial length for the neonatal eye, infant eye (3 yrs), and adult eye (16 yrs)
Neonatal: 16.5mm
Infant: 22.5mm
Adult: 23.5mm
According to research by Mayer et al. 2001 on refractive error distribution in children over the first 48 months of life: during what time period was a wider spread of refractive errors noticed?
In first year of life
According to research from Mayer et al. 2001, what was the average spherical equivalent mean refraction for 1 month old and 48 month old?
1 month: +2.20 diopters
48 months: +1.13 diopters
According to Ip et al., 2008: What level of hyperopia (in diopters) do most children up to 6 years old have?
Below +2.00DS
According to Ip et al. 2008: What is the prevalence of moderate hyperopia (+2.00D or more) in 6 year olds? What about 12 year olds?
6 year olds: 13%
12 year olds: 5%
How good of an indication is refractive state measured soon after birth for the final refractive error of the child? Explain
Good. With those myopic early in infancy eventually regressing back to myopia despite emmetropising in early childhood
How can we measure refractive error? (3))
Auto-refractor
Non-cycloplegic ret
Cycloplegic ret
Which method of measuring refractive error in children is the gold standard?
cycloplegic retinoscopy (using cyclopentolate obviously)
What should we aim for when doing cylcoplegic retinoscopy?
Maximum plus
Is subjective refraction reliable in a child younger than 7-8 years of age?
No.
What did The Vision in Preschoolers Study group conclude when comparing 11 preschool vision screening tests by licensed eye care professionals?
- Screening tests vary widely in performance
- With 90% specificity, the best tests detected only 2/3rds of chilren having >/= 1 targeted condition, but nearly 90% of children with the most important conditions
- The 2 tests that use static photorefractive technology were less accurate than 3 tests that assess refractive errors in other ways
In the study of screening tests by The Vision in Preschoolers Study, how did the sensitivity and specificity of non-cycloplegic retinoscopy compare to auto-refractors?
had a higher overall sensitivity and specificity for detecting refractive error than any of the measured auto-refractors
What is the gold standard for refractive assessment in children under 4 and children with esotropia?
Cycloplegic ret (with cyclopentolate)
Will you be able to determine the final hyperopia measure by the end of the first visit with a child under 4 or with esotropia?
No you won’t be able to determine this
For what level of hyperopia in children should clinicians prescribe optical correction for? (3)
moderate to high hyperopia. For 2-3 year olds, many practitioners use a threshold of +3.00D bilateral aysmptomatic hyperopia, while others use a threshold of +5.00D
What does the American Academy of Ophthalmology state as the prescribing standards for:
- Hyperopia in 0-1 year old px
- Hyperopia in 1-2 year old px
- Hyperopia in 2-3 year old px
0-1: >+6.00D
1-2: >+5.00D
2-3: >+4.50D
What does the American Academy of Ophthalmology state as the prescribing standards for:
- Hyperopia with esotropia in 0-1 year old px
- Hyperopia with esotropia in 1-2 year old px
- Hyperopia with esotropia in 2-3 year old px
0-1: >+3.00D
1-2: >+2.00D
2-3: >+1.50D
What considerations are there when considering prescribing a child an optical correction for their hyperopia? (4)
- Will you interrupt the normal emmetropisation process by prescribing for hyperopia?
- Will you improve, or disturb the binocular function of the infant or child?
- What is the risk of convergent strabismus (esotropia) if you don’t prescribe?
- What is the risk of amblyopia if the hypermetropia is different in the two eyes and you don’t prescribe?
What is the most common origin for esotropia? What percentage?
Refractive. Over 50% of all esotropes are refractive
What percentage of 48 children aged 9 months with over +4.00D with a prescription became strabismic by age 4? How does this compare to 76 children who did not wear a prescription?
6% vs 21%
Does prescribing harm emmetropisation?
No. In children with uncorrected and corrected hyperopia, the rate of reduction of hyperopia with age was a function of the initial level of hyperopia, not whether they were corrected.
If uncorrected hyperopia results in the accommodative demand being greater, what can this result in? (5)
Blur Abnormal phorias and possible strabismus Asthenopic symptoms Reduced reading efficiency, fluency, accuracy Avoiding of reading
What are the considerations you should make for management of hyperopia in children? (8)
Magnitude of hyperopia (relative to age) Px ability to accommodate Acceptance of plus at distance vs near Binocular alignment and function Visual needs and demands Visual acuity Risk of amblyopia Symptoms
What tests should you undertake in a child with hyperopia? (6)
Dry retinoscopy Subjective refraction (if appropriate) Blur function Binocular vision and stereopsis Accommodative function Cycloplegic retinoscopy
What does dynamic retinoscopy allow?
rapid assessment of accommodative ability
Why should you quickly neutralise the reflex in MEM ret?
otherwise the lens alters the accommoative response
What does MEM ret provide a measure of? What should you observe when doing this? (3)
accommodative response (posture). Observe: magnitude, stability, equality
What is the aim when prescribing from MEM ret? (3)
Aim to prescribe the minimum plus that provides:
- equal lag of accommodation
- stable lag of accommodation
- low lag of accommodation
What tests and procedures should you do when assessing hyperopia in young adults? (6)
Dry ret
Binocular refraction
Push Plus! (that’s not really a test though, more like advice)
Oculomotor balance (for phorias at both distance and near)
Dynamic ret (to achieve accommodative posture at habitual reading distance)
Amplitude of accommodation (is amplitude low for age?)
What is the earliest age that research has found a narrowing of the refractive distribution and a shift nearer to emmetropia?
3 months
