When & how to Rx glasses in children

Transcription

1 When & how to Rx glasses in children Nikos Kozeis MD, PhD, FEBO, MRCOphth Consultant Pediatric Ophthalmologist Thessaloniki, Greece

2 The menu of the talk When & How should we Rx glasses? * We ll discuss only about the general pediatric population (no disable children)

3 Let s agree first that Vision does not mean visual acuity! Vision develops during the first 8 years of life! Glasses = Visual aids not treatment! Glasses in adults = a rehabilitation aid Glasses in children = a developmental aid vs. Guzetta 2001

4 Even more Vision is the main information source for the brain 90% Vision helps the child to perceive, interpret & understand the world (environment) Vision affects a child s psychomotor development Pierrot- Deseilligny et al., 2002

5 Visual system: 3 functional units Sensory Oculomotor Perceptual Normal perception of the world Normal skills development

6 Sensory unit The developmental years 1. Dimensions 2. Refractive ability Corneal Power (D) Corneal Development Gordon & Donzis Woodrift Zadnik et al. Lens Power (D) Lens Development Gordon & Donzis Zadnik et al Age (years) Age (years) Target: The brain information Emmetropization

7 Who guides the emmetropization? Genes vs. Environment The initial poor central vision Eye (Lond) Feb The initial poor peripheral vision Seidemann et al., 2002, Wallman 2004, Stone2004, Charman, 2005, Mutti et al., 2007 The continuous changes of needs for accommodation

8 Oculomotor & Visuoperceptual units Parallel development with CNS Harmonic development of the 3 units = Good visual function J Optom 2014

9 The vast majority of children have normal visuo developmental process 3 mo color vision 6 mo 3D 4 years visual function at adulthood level (in quantity) 8 years visual function at adulthood level (in quantity & quality)

10 Studies show that Most children < 5 yo have mild hypermetropia < D More than 80% of children 5-7 yo have hypermetropia D to D Children 7-14 yo appear with a tendency for myopia

11 Who needs glasses? 6 mo 5 yo: 5% needed glasses (significant hypermetropia & astigmatism) Baltimore Pediatric Eye Disease study (May 29, 2009)

12 Rx glasses in children is not an easy task! Individualize by checking the 3 functional units: - Sensory - Oculomotor - Visuo-perceptual

13 Assessing the sensory unit * Visual acuity (central vision) * Color vision * Contrast sensitivity * Peripheral vision * Binocular single vision (stereo) * Accommodation range * Refractive ability

14 Assesing the oculomotor unit * Strabismus or not * Ophthalmokinetic reserves for BSV * Fixation smooth pursuits - saccades * Convergence divergence

15 Assessing the visuoperceptual unit * Visuospatial skills * Visual agnosias * Visuomotor coordination

16 Why is that important? Sensory Oculomotor Perceptual Good vision requires well developing units

17 Looking for simple guidelines...

18 Key questions before Rx in a preschooler How the large is the ref error? Is there strabismus or large phoria? Child s age Range of accommodation Child s visual needs Risk for developing amblyopia

19 Isomyopia high: Rx early (may be step by step) After the age of 5 Rx it all Anisomyopia: Rx it all Astigmatism: Rx only if > 1.5 D or if anisoastigmatism Isohypermetropia: >+4.00 D (with or without astigmatism) Rx part of it >+7.00 D Rx all or almost all Anisohypermetropia: Rx all if aamblyopia Equal reduction to both eyes if no amblyopia * Isenberg, Arch Ophthalmol. 2004

20 American Academy of Ophthalmology Preferred Practice Patterns guidelines for preschool children AGE 0-1 YEARS 1-2 YEARS 2-3 YEARS ISOMETROPIA Myopia Hyperopia Hyperopia+squint Astigmatism ANISOMETROPIA Myopia Hyperopia Astigmatism Harvey EM, J AAPOS AAPOS 2010

21 When we Rx during the year of life Hypermetropia: > D : reduce by 1D if esotropia: Rx the cycloplegic measurement Myopia: >= D : reduce by 2D Astigmatism Harvey EM, JAAPOS. 2005

22 Key questions before Rx in a schooler Is there reduced visual acuity? Are there symptoms (asthenopia, double vision etc)? Are there risk factors? - Inheritence - Prematurity - Late pregnancy - Smoker mother - Excessive close work

23 Isohypermetropia : (no strabismus) Rx by reducing 1 D (with strabismus) Rx all if > D Isomyopia (no strabismus) Rx all Astigmatism Rx if > 1.00 D (particularly if oblique axes) Anisometropia Rx if the difference > 1.00 D (with esophoria or esotropia) Rx reduced * Isenberg, Arch Ophthalmol. 2004

24 Key points to remember 3-4% of pre- & schoolers have strabismus Many children have asthenopia due to not well controlled phorias 5% of children have either convergence or accommodative insufficiency Early high myopia does not usually increase a lot In the majority of children hyperetropia reduces in school years J Optom 2014

25 Conclusions Rx glasses in children is not an easy task Follow guidelines BUT individualize the cases You can affect the psychomotor development of a child either positive or negative

26 Thank you for your attention