Prescribing for the Hyperopic Child Raymond Chu, OD, MS, FAAO

Transcription

1 Prescribing for the Hyperopic Child Raymond Chu, OD, MS, FAAO Abstract: The prescribing of for reasons other than strabismus and amblyopia has often been challenged. Surveys between optometrists and ophthalmologists have revealed differences in prescribing philosophies, especially in the frequency of prescribing at lower levels of (<3.00D). This course will help practitioners in general practice with guidelines and examination strategies for making hyperopic prescribing decisions in children and adolescents. Learning Objectives: Develop a diagnostic strategy to aid in hyperopic prescribing decisions Recognize key indicators for hyperopic prescribing other than magnitude Explain the rationale for individual prescribing decisions

2 Infant 12 months old VA (Teller, Cardiff, or LEA Grating) Ocular Alignment (Hirschberg/Kappa) modative status (MEM) Cycloplegic Retinoscopy (0.5% Cyclopentolate) Low Hyperopia Moderate Hyperopia High Hyperopia No No Abnormal Normal Cut Rx by to DS Normal VA VA (< 6/100 or 20/333) Prescribe (+) to normalize

3 > 12 months to < 5 years VA (Cardiff, LEA, or HOTV) Ocular Alignment (Cover test, and/or Hirschberg/Kappa) modative status (MEM) Cycloplegic Retinoscopy (1.0% Cyclopentolate) Low Moderate High No No Consider: Developmental Academic performance Behavioral concerns * Normal VA Abnormal VA Prescribe (+) to normalize Normal Consider: Developmental Academic performance Behavioral concerns Cut Rx By +1.00

4 School-Aged Child > 5 years VA (HOTV, Snellen, or Sloan) Ocular Alignment (Cover test, Phorometry) modative status (MEM, Amplitude & Facility, NRA/PRA) Binocular function status (NPC, Vergence ranges, Stereopsis) Refractive status (Subjective refraction, Dry Retinoscopy, Cycloplegic Retinoscopy) Low/Moderate Hyperopia High Hyperopia No No Rx full (+)* Normal modative & Vergence skills Abnormal modative &/or Vergence skills Rx full (+)** Partial Rx Consider: Developmental Academic performance Behavioral concerns Prescribe to normalize modative AND Vergence systems * Consider trial full Rx for small angle, otherwise refer for strab tx ** Consider ability to tolerate full Rx at this age

5 Summary Definitions (AOA Clinical Practice Guidelines) Amblyopia and Strabismus not the only things to consider Infants- consider emmetropization Toddler/Preschoolerconsider developmental School Aged- consider school/near demands Hyperopia Significant Anisometropic Isoametropic Absolute Facultative Latent Manifest Physiologic Refractive condition in which the light entering the non-accommodated eye is focused behind the retina Any degree of sufficient to cause symptoms requiring remediation Unequal and significant hyperopic refractive error Equal and significant hyperopic refractive error Hyperopia that cannot be overcome by Hyperopia that can be overcome by Hyperopia that is habitually overcome by ; determined by cycloplegic refraction Hyperopia (either facultative or absolute) that is determined by non-cycloplegic refraction Hyperopia due to correlational or component having otherwise normal ocular anatomy * Pathologic Hyperopia due to abnormal anatomy, maldevelopment, ocular disease, or trauma, not to normal biological variation

6 Consensus resource guide for the prescribing of : Optometric Clinical Practice Guideline: Care of the Patient with Hyperopia ( Pediatric Eye Evaluations Preferred Practice Patterns: Guidelines for refractive correction in infants and young children ( Marsh-Tootle W. Infants, toddlers and children. In: Benjamin WJ, ed. Borish's Clinical Refraction. Philadelphia: WB Saunders,1998. P Ciner EB. Management of refractive error in infants, toddlers and preschool children. Probl Optom1990; 2: Leat, S.J. To prescribe of not prescribe: Guidelines for spectacle prescribing in infants and children. Clinical and Experimental Optometry (6): pp (