Pediatric Myopia Flashcards
(105 cards)
1
Q
What amount of myopia should be corrected in infants?
A
> /= -5D, may not emmetropize, 20 cm clear working distance
2
Q
How much can you undercorrect by to help with near vision?
A
3-4D
3
Q
What amount of myopia do you Rx in a toddler?
A
> /= -3D
4
Q
What amount of myopia do you Rx in a preschooler?
A
> /= -1D
5
Q
What amount of myopia do you Rx in a school age child?
A
all of it, full correction based on VA <20/40 OU
6
Q
What is juvenile onset myopia?
A
onset from 4/5/6-15 years old that progresses due to axial elongation
7
Q
What is the expected progression/year for juvenile onset myopia?
A
0.50D/year
8
Q
Which gender has higher myopia and a faster progression?
A
females
9
Q
What is the US prevalence of myopia from 2004
A
41%, higher in east asia
10
Q
How does the WHO define high myopia?
A
> /= -5D
11
Q
What is the projected global prevalence of myopia for 2050?
A
50% aka
12
Q
What are pathological consequence of myopia?
A
increased risk for glaucoma, RD, cataract, and myopic macular degeneration
13
Q
What is myopic macular degeneration?
A
occurs younger than AMD, diffuse, patchy macular atrophy with or without lacquer cracks, CNVM, Fuch’s spot
14
Q
What are other names for myopic macular degeneration?
A
myopic maculopathy, myopic retinopathy, myopic choroidal neovascularization
15
Q
What are etiologies of myopia?
A
genetics, environment, peripheral hyperopic defocus/refraction, and binocular vision anomalies
16
Q
What is a child’s risk for myopia if both parents are myopic?
A
50% chance, 5-6x risk
17
Q
What is a child’s myopia risk if one parent is myopic?
A
25% chance, 2x risk
18
Q
What gene is related to high myopia?
A
PAX6
19
Q
What is peripheral hyperopic defocus a result of?
A
myopic lag of accommodation
20
Q
T/F animal studies have shown that prolonged near environment leads to myopia
A
true
21
Q
What is evidence for near work and myopia?
A
naval academy WWII, jewelers, law students post graduate vs high school graduate
22
Q
What did the Australian study find about near work?
A
near work <30 cm=2.5x more likely and reading for fun=1.5x more likely to become myopic
23
Q
What was the average lag of accommodation for the China study of myopes 6-13 yo?
A
1.52 aka high
24
Q
T/F more stress tend to lead to a smaller working distance
A
true
25
What was the general range of working distance for the china study of myopes?
21-27 cm
26
T/F decreased distance with increased concentration and work load?
true
27
What behaviors might create nearsightedness?
lack of exposure to natural daylight, close working distance, accommodative lock
28
What might cause eyestrain complaints with near devices?
glare, binocular/accommodative problems
29
How are near devices related to dry eye?
decreased blink rate
30
What pupil size changes occur with digital devices?
dilated w/ video games, activates sympathetic system
31
What are negatives of near digital devices and health?
negative impact on sleep, problems with attention, addiction from digital heroin
32
What does the American Academy of Pediatrics recommend for screen time under 18 months?
video chat only
33
What does the AAP recommend for screen time from 18-24 months?
introduce high quality programming
34
What does the AAP recommend for screen time from 2-5 yeas old?
2 hours/day max
35
What does the AAP recommend for screen time for 6+ years old?
place limits and ensure sleep and physical activity, set up media free times or locations
36
Where is the focal point in hyperopic defocus?
behind the retina, only the fovea is in focus, the peripheral retina is hyperopic and the eye grows to get it focused
37
What is the only FDA approved method for myopia control?
MiSight CooperVision pediatric multifocal contact lenses approved November 2019
38
What is a list of tx possibilities for myopia control?
time outdoors, under correction, bifocal lenses, contact lenses, atropine, spectacle lenses
39
What is the 20-20-2 rule?
20 minutes of screen, 20 second break at distance, and 2 hours outside
40
Why may time outdoors help myopia?
distance viewing, sunlight, UV exposure, retinal dopamine, not doing work?
41
How much time should kids spend outside?
1-2 hrs/day
42
Who benefits from time spent outdoors?
low hyperopes/plano, once myopic doesn't help much
43
How are under correction and myopia related?
under correction is associated with increase in progression of myopia or no change as compared to fully corrected controls
44
What did the Chung under correction study show?
myopes 9-14 full correction v. under corrected by 0.75, after two years under correction progressed -1D and full correction progress -0.75D
45
What are the two theories for bifocal lenses in myopia control?
myopes have poor accommodation, control the accommodative response
46
Do bifocal lenses produce a significant difference in myopia progression?
NO, except in esophoric patients
47
What was the result of an executive bifocal and BI prism?
45% slowing of myopia progression
48
What is the COMET study 2003?
prospective, double masked RCT with PAL vs single vision for myopes Rx -1.25 to -4.50 age 6-11
49
What was the finding of the COMET study?
after 3 years, statistically significant but clinically insignificant decrease in myopia of 0.2 D, and after 5 years insignificant decrease of 0.1D
50
Specifically with esophoria and accommodative lag, what did the COMET study find?
after 3 years, children with esophoria and larger accommodative lag decrease in myopia of 0.64D, and actual benefit
51
What did the COMET 2 2011 study look at?
esophoria and accommodative lag
52
What were the findings of COMET 2?
after 3 years, statistically significant, clinically insignificant decrease in myopia of 0.28D
53
What did the Japenese single vision/PAL crossover study look find?
overall 0.17 D treatment effect but better for EP and high lag
54
T/F there was a significant change in axial elongation after 2 years of contact lenses vs specs in myopia
false, no change
55
What did the COMET 2009 contact lens study find?
small statistically significant, clinically insignificant increase in myopia, no real difference in myopia progression, definitely will not make it worse than specs
56
Which technique is approved for myopia correction but not myopia control?
orthokeratology
57
What is orthokeratology?
temporary decrease in myopia from CLs due to corneal reshaping overnight
58
What is the OrthoK myopia control mechanism?
peripheral hyperopic defocus... flattens central cornea steepening the mid-peripheral cornea, the peripheral myopia decreases peripheral hyperopic defocus
59
Does OrthoK cause corneal damage?
no, redistribution of epithelial cells, not bending
60
What does OrthoK do to accommodation?
improves accommodation
61
What were the findings of OrthoK studies like LORIC, CRAYON, ROMIO?
orthoK decreased axial length (A scan ultrasound) and decreased myopia progression (retinoscopy)
62
What are the lens designs for multifocal contact lenses?
distance center, near center, aspheric
63
What is a concentric CL?
distance power in the center typically, surrounded by concentric rings of near and distance powers
64
What is aspheric CL?
distance or near power is in the center, with a gradual transition to other powers as you move away from the center, slight blur involved
65
What have multifocal CL studies found?
slow myopia progression (10% increase to 79% decrease), slow axial elongation (0-79%)
66
What is the BLINK study?
bifocal lenses in nearsighted kids, compared add powers of distance center multifocals for kids 7-11 with myopia
67
What did the BLINK study find?
43% decrease in myopia and 36% decrease in axial length, with the high add of +2.50 being most successful
68
Who are the MiSight lenses approved for?
ages 8-12, Rx -0.75 to -4.00
69
What tech is in the MiSight lenses?
dual focus center distance concentric, all rings equal in surface area, pupil size not limiting
70
What is the mechanism of atropine 1%?
prior: paralysis of accommodation, now: biochemical effect on eye growth
71
What is the effect of atropine on asians vs. caucasian?
greater effect in asians 0.55D vs 0.35D in caucasian
72
What was the myopia progression of compliant vs partly compliant myopes with 1% atropine weekly?
0.08D/year and 0.23D/year respectively
73
What is the ATOM study?
Atropine for Treatment of childhood myopia 2006, Singapore age 6-13, 1 drop daily and photochromic PALs for two years
74
What were the results of the ATOM study?
myopia progression of placebo=1.20 D vs 0.28D in atropine, 77% reduction in amount of myopia progression
75
When did the ATOM study follow up occur?
2009, after at least 1 year of cessation of treatment
76
Over a 3 year period after the ATOM study, what were the results?
less myopia in atropine treated than placebo with a large rebound in the 3rd year which may have been accommodative not real myopia progression
77
What is the ATOM2 study?
2011 Atropine for Treatment of Childhood Myopia, 400 Asian children 6-12, at least -2D, study duration of 2 years
78
What percentage of atropine won't fully cycloplege... muscarinic receptor?
0.01%
79
Which atropine concentration slowed myopia progression the most?
1.0% atropine slowed to 0.14D/year vs 0.60D/year with placebo
80
What result did atropine have on mean axial length?
atropine treatment decreased mean axial length
81
What was the LAMP study?
low-concentration atropine for myopia progression 2019, 438 Chinese children 4-12 years for 1 year
82
What was the conclusion of the LAMP atropine study?
0.05% atropine is the best concentration to slow myopia progression and axial length growth
83
What is the optimal dose of atropine to control myopia progression?
0.01% I think
84
What is the lowest dose of atropine that can be given without symptoms?
0.02% does not have blur and photophobia?
85
What is an example of combination myopia control?
atropine and bifocal contact lens
86
What two studies are in FDA phase 3 clinical trials?
CHAMP 0.01% atropine and Chaperone testing 0.01 and 0.1 microdose (spray)
87
What new spectacles treatments are for myopia progression?
MyoSmart Hoya (China and Canada) 60% less myopia progression and 21.5% halted AND Myo Vision Zeiss single vision with peripheral blur to decrease peripheral hyperopia
88
What is the reduction for bifocal spectacles?
12-15%
89
What is the reduction for bifocal spectacles on esophoric patients
20-45%
90
What is the reduction for othroK?
32-42%
91
What is the reduction for multifocal contacts?
50-70%
92
What is the reduction for atropine?
58-90 aka 77%
93
What is the benefit of bifocal/PAL treatment?
low cost, easy to fit, may help with EP
94
What is the concern for bifocal/PALs?
cosmesis, is child using it correctly
95
What are the benefits of orthoK?
better efficacy, cosmesis
96
What are the concerns of Ortho K?
comfort, infections, training (doc), cost, multiple exams
97
What are the benefits of multifocal CLs?
better efficacy, cosmesis, ease of fitting, comfort, FDA approved!!
98
What are the concerns of multifocal CLs?
infections and cost
99
What is the benefit of atropine?
best efficacy
100
What are the concerns of atropine?
optimal dose, symptoms, compounding
101
What is incipient myopia?
accommodative insufficiency but not myopic yet
102
What are signs of accommodative insufficiency?
low PRA, low amplitude, higher FCC, accommodative infacility (minus)
103
What are characteristics of incipient myopia?
accommodative insufficiency, EP' or low XP', ATR astigmatism, hyperopia on wet ret, symptoms of distance blur after near work and close working distances
104
What is the treatment for incipient myopia?
low plus lenses
105
What is the mechanism of action of atropine in controlling myopia ptrogression?
not accommodation, muscarinic effects on the retina, choroid, and sclera
