Paediatric Prescribing - ahalya

Question 1

what 5 questions do we need to consider when prescribing from birth to 6yrs?

Answer 1

• is ref error within normal age range?
• is the ref error expected to emmetropise?
• will ref error disrupt normal visual development or functional vision?
• will prescribing gls help with visual function?
• will gls interfere with normal process of emmetropisation?

Question 2

what is emmetropisation?

Answer 2

naturally overcoming/ ‘growing out of’ any ametropia

Question 3

why can gls interfere with emmetropisation

Answer 3

giving a child an rx before they have completely emmetropised can affect the process

Question 4

at what age does a childs visual system finish developing

Answer 4

1 yrs old

Question 5

why is monitoring between birth and 6 yrs the most crucial period?

Answer 5

this is when the most changes occur in childs eyes

Question 6

what type of ref error is most common from birth to 3 years?

Answer 6

mainly hyperopia

Question 7

at what age period is the emmetropisation process quickest to occur and vision to stabilise?

Answer 7

3-12 months

Question 8

what is an advantage of having a large ref error when young?

Answer 8

quicker to emmetropise

Question 9

are small low ref errors/hyperopia in young children quicker or slower to emmetropise?

Answer 9

slower

Question 10

what other factor can we consider when looking at ref errors in children?? ( non rx related)

Answer 10

ethnicity

Question 11

is there a higher or lower percentage of astig at birth ?

Answer 11

higher

Question 12

what % of FT new borns have astigmatism of 1.00dc or more?

Answer 12

69%

Question 13

at what age do babies lose astigmatism as they emmetropise?

Answer 13

between 9 and 21 months

Question 14

what eye condition is prevalent in new borns?

Answer 14

anisometropia

Question 15

true or false: anisometropia more common in kids than adults

Answer 15

true

Question 16

at what cyl power does astigmatism be classed as ‘high degree’

Answer 16

3.00dc or more

Question 17

what is the percentage of young children that have anisometropia?

Answer 17

17-30%

Question 18

are higher levels of anisometropia (5Ds) in young children more likely to remain?

Answer 18

yes

Question 19

in the emmetropisation stage, how do we manage a chlld with a suspect ref error ?

Answer 19

put on 4-6 month recall- predict if they can emmetropise or not

Question 20

is there an association between lack of emmetropisation and strabismus?

Answer 20

yes

Question 21

what should VA be at 6 years old?

Answer 21

6/6 (hint: just think 6/6/6)

Question 22

what is the risk of amblyopia and strabismus if you have a child with uncorrected hyperopia?

Answer 22

13x more risk of strab, 6x risk of amb

Question 23

what is a high risk factor for amblyopia

Answer 23

uncorected ref error (including anisometropia)

Question 24

what age group is at an increased risk of amblyopia if cycls = > 3.50ds in one meridian?

Answer 24

1 y/o

Question 25

with what rx are 4 y/o at an increased risk of amblyopia?

Answer 25

if they have a hypermetropic ref meridian of 2.00 or more

Question 26

does prescribing gls improve visual function?

Answer 26

yes- esp if high hyperopia- can correct and reduce strab x4 and 2.5x amblyopia ins

Question 27

by how much (stats) does prescribing gls improve visual function?

Answer 27

strab reduces down from 13x to 4x and if corrected amblyopia goes down from 6x amblyopia to 2.5x amblyopia

Question 28

what are negative effects of uncorrected hyp in school children?

Answer 28

poor academic performance

Question 29

can prescribing spx interfere with emmetropisation?

Answer 29

results inconclusive: animal study shows compliant spx wearers emmetropise less than non compliant spec wearers/ controls

Question 30

main aims of presrbing during emmetropisation process?

Answer 30

gls shoulnt interfere with process aND OFFER IMPROVE VAS

Question 31

what happens if we under correct myopia in school children?

Answer 31

may lead to further progression of myopia

Question 32

what factors should be considered when prescribing (relevant tests etc)

Answer 32

- child age -rx -visions and va's -BIN VA status- do CT and dynamic Ret -FH- squint, amblyopia

Question 33

what rx can we consider prescribing from even if child asymptomatic?

Answer 33

+1.50ds

Question 34

what is an advnatage of testing older children over young kids?

Answer 34

tests will be symptom lead

Question 35

what are social impacts on school children that wear gls

Answer 35

they can get bullied more :')

Question 36

what two things do we consider before prescribing gls?

Answer 36

identify children who follow abnormal patterns Gls should be of benefit to child

Question 37

why would we prescribe a reduced rx and what pxs are good candidates for this?

Answer 37

we want to give some room to emmetropise- hyperopes under 6, good bv no strab

Question 38

when do we give a full rx

Answer 38

if px is myopic

Question 39

what qs do we consider when doing H+S?

Answer 39

how old is child? rx of child? unaided/aided va- age appropiate? BV status, FH squint? FH amb?

Question 40

what BV status tests can we do?

Answer 40

CT, 20 BO test, dynamic ret, stereoacuity,

Question 41

what situations do we prescribe in?

Answer 41

-Accom lag -mod hyperopia -poor controlled SOP -vision decreased for age

Question 42

eg case scenario- 3 yo with poor SOP would we need to manage?

Answer 42

yes- can break down into tropia

Question 43

what type of rx is associated with amblyopia?

Answer 43

frequently unchanging or increasing rxs

Question 44

when do we give full correction of rx- hint think of strab too

Answer 44

Hyperopia with Esotropia, also any anisometropia difference in strab or amblyopic px (check AAO guidelines)

Question 45

which pxs do we undercorrect in?

Answer 45

pre-school kids in absence of strab or amb

Question 46

how much do we undercorrect by?

Answer 46

between 1.00ds to 2.00ds- give room to emmetropise

Question 47

normal va acuities from birth to 6 y/o

Answer 47

0 y/o = 6/120 3 y/o = 6/12 4 y/0 = 6/9 5-6 y/o = 6/6

Question 48

how do we treat amblyopia?

Answer 48

start with gls correction, if no VA improvement consider patching, atropine etc

Question 49

what does isotropic mean ( from AAO guidelines)

Answer 49

rx similar in both eyes

Question 50

what are other things to consider for young children (links to dispensing)

Answer 50

compliance + also spectacle fitting

Question 51

- check case studies at end of lecture

Answer 51

- check case studies at end of lecture