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Flashcards in Managing Rf Errors Deck (19):
1

T/F: most kids with +4.00D or less will still be able to emmetropize.

TRUE - 80% of them! Decreases w/ increasing hyperopia.

50% if ~+5.00D
30% if ~+6.00

2

Does astigmatism emmetropize w/I the expected 12-18 months?

NO - takes 2-3 years. OBLIQUE is most stable; AR is most likely to emmetropize (Born ATR, die ATR)

3

CONGENITAL abnormalities or EARLY ONSET OC dz. often result in high...

A) Myopia
B) Hyperopia
C) Astigmatism

HYPEROPIA.

-Myopia would be from things like form deprivation (causing eye to elongate - 2' to cataract, ptosis, Vit heme, ROP)

4

What the MOST COMMON refractive error in children? Around what dioptric value does it begin to become amblypgenic?

HYPEROPIA - around +3-4-5.00D, esp +4.00 - +5.00D.

5

What DEGREE of UNCORRECTED hyperopia is associated with ACADEMIC DIFFICULTIES and DELAYS in visual/perceptual skills?

MODERATE hyperopia (+2.00-+5.00), Esp toward higher end of that range.

-Cause big time issues w/ literacy and reading skills.

6

although most kids are born w/ +2.00D hyperopia at birth, keep in mind that up to a QUARTER (25%) of them will have MORE than that.

And remember than kids w/ >+3.50D of hyperopia are at 13X greater risk of developing a STRAB by 4Y/O.

7

What 3 bits of info are CRUCIAL to obtain in an exam of a child w/ known hyperopia?

1) MANIFEST hyperopia - subjective
2) Is accomm sufficient to OVERCOME hyperopia? (MEM/Amps)
3) LATENT hyperopia - cyclo them to find out residual.

8

Cardinal rule any time an ESO is present w/ hyperopia?

PRESCRIBE. FULL CYCLO. FOR ANY ESO. PERIOD.
--If residual ET @ N, Rx an Add - and make sure it bisects (or is barely below) the pupil

9

If a bilateral hyperopia is present WITHOUT a strabismus, do you Rx?

Depends. Do it if:

1) >+5.00D in 6 month olds
2) >+3.00-+5.00D in 2-4 Y/O - but commonly, should CUT BACK hyperopia off what you found on cyclo - they weren't symptomatic before, would just blur them unnecessarily.

-DON'T cut back more than +3.00D - why? Induce RAET if they have a high AC/A! You gave them just enough to make them try to want to accommodate thru what's left - induced an ET that wasn't originally there

10

Do you correct bilateral high hyperopia in infants/toddlers w/ no ESO and +5.00 hyperopia?

-How about school-aged kids w/ the same Rf error/CT?

Infants - no...but monitor closely.

School-age...yes, but just partial and see what they're doing.

Generally, kids ok w/ +3.00 compensation W/O sx development.

11

Is astigmatism >1.00D common infants?
-LARGE or SMALL magnitudes are more stable?
-MOST COMMON type in Caucasians? Everyone else?
-MOST STABLE type of astig?

YES, common.
-LARGE = stable (gonna stick around)
-ATR in Caucasians, WTR in everyone else - WR also more common in Asians after age 5.
-OBL - most stable/unlikely to change.

12

**ATR astigmatism (increases/decreases) w/ age?

**OBL astigmatism (increases/decreases) w/ age?

ATR: DECREASES w/ age, OBL: STABLE, or INCREASE w/ age--> and likely more amblyogenic for that reason.

13

Is astigmatism ever corrected in the first year of life?

RARELY - unless OVER 3.00D.

-always remember where CLC (and thus SE) is in proximity to the retina

14

If a 4Y/O pt has 2.00 of STABLE astigmatism, do you correct it?

T/F: most school-aged children DON'T have astigmatism >0.50D

YES - also correct if it's less than that (moderate) and is found in association w/ spherical Rf error

TRUE - wierd. But true. If they have more, correct it - usually FULLY (adapt pretty well to astig), unless they're older than 10ish.

15

When it comes to anisometropia, it's generally a good idea to monitor aniso every ___ months for stability, and ALWAYS Rx if >___D over 2-3 visits, if the aniso is increasing, or if ANY ___ is present.

3 months - stability
>2.00D
Increasing aniso, or ANY STRAB present.

16

Rx decision in aniso?

FULL CYL, FULL ANISO difference b/w eyes - you knew this.

25% chance of COMPLETE resolution of amblyo JUST by correcting this.

If ESO - FULLY CORRECT Hyper (and push plus!)

17

Myopia in infants - common or rare? What should you be concerned about if you see it?

Myopia in teens - you can expect it to progress how quickly?

RARE - premie birth, myopic parents, OC dz present, LBW.

-0.50D increase EACH YEAR. -Usually limits itself out @ -6.00D.

18

Correct myopia to w/I ___ diopter if in a 3-5 Y/O. (They don't need pristine, give them a little flexibility)

Correct school-age myopes ____.

3-5: w/I 1 diopter is sufficient.

School-age: FULL correction. No reason why not, and their needs demand it.

19

What's the average refractive error at birth? At school age?

Emmetropization mostly DONE by what age?

Birth = +2.00D, School age = Mild hyperopia (~+0.75D)

Emmetropization by 1 yr-18 months - change is FASTER with higher Rf error