Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
157 Cards in this Set
- Front
- Back
|
New Course: Pediatrics
|
|
|
|
you need to go through the lecture notes because the flashcards are not comprehensive.
|
|
|
|
New lecture: 2 RE Development
|
|
|
|
what is the average refractive error in infancy
|
+2.00 D
|
|
|
what is the age where emmetropization completely finished? when is most of emmetropization finished?
|
end: 3-5 years most: 12 months
|
|
|
beyond 1 year of age, what level of refractive error is considered to be genetically determined based on our current research and what are the implications of this
|
at 1 year +/- 3 D is probably genetically determined (this includes the spherical component, cylindrical, and anisometropic component). if RE is genetically determined then it doesn't matter if we give them an rx or not, they are going to end up at the same refractive error as adults. if RE is environmentally determined, then when we rx, we are eliminating the blur that stimulates emmetropization and we are potentially causing them to end up with a final refractive error than if we did not give them glasses at all. remember though that RE left uncorrect can potentially cause strabismus and amblyopia.
|
|
|
what does the AOA recommend for an examination schedule on peds?
|
1st exam: btwn 6 mo. and 1 year 2nd exam: 3 years 3rd exam: 5 years
|
|
|
how does the lens power, cornea power, and axial length change between 3 and 9 months on average
|
crystalline lens: power decreases cornea: power decreases axial length: increases In order for hyperopia to decrease, the dioptric effects of axial growth to reduce hyperopia must exceed the effects of losses in corneal and lens power that would increase hyperopia
|
|
|
at what age do young peds gain the ability to accommodate as accurately as older children
|
3-6 months
|
|
|
how does the amount of time spend outdoors impact the risk of developing myopia
|
more hours is protective
|
|
|
what is the difference between prolate and oblate
|
a: prolate c: oblate
|
|
|
describe the physiological mechanism behind the development of myopia
|
The onset of myopia is characterized by a cessation of lens thinning (decrease in power) and an absence of the power loss needed to keep up with the growing eye (increase in axial length).
|
|
|
why is the peripheral refraction different from the refraction at the fovea
|
suggests prolate growth of the eye rather than oblate
|
|
|
how does accommodative response relate to emmetropization
|
Infants who emmetropized showed a good accommodative response; infants who showed the least robust emmetropization showed the poorest accommodative response.
|
|
|
is the emmetropization of astigmatism related to the emmetropization of the spherical RE or are they seperate processes
|
research indicates that they are independent.
|
|
|
up to what age is anisometropia transient
|
age 4
|
|
|
what level of anisometropia is stongly linked to strabismus and amblyopia
|
3 D. also tends to persist (not emmetropize)
|
|
|
after what age is the onset of anisometropia NOT amblyogenic
|
7 years old.
|
|
|
New lecture: 3 Visual Acuity Development
|
|
|
|
at what age can you first see the foveal light reflex
|
6 months (foveal depression is immature at birth. ganglion and inner nuclear cells migrate away while cones migrate in. the overall diameter of the fovea decreases.
|
|
|
at what age does the fovea fully mature
|
4 years old
|
|
|
at what age is myelination of the visual pathway complete
|
2 years
|
|
|
at what age does "selective pruning" of the visual cortex begin
|
8 months
|
|
|
how can we measure acuity in an infant before they can response verbally
|
1. optokinetic nystagmus 2. perferential looking 3. VEP
|
|
|
how do acuities taken with preferential looking technique compare to recognition acuities
|
recognition requires higher perceptual skills. so, studies have found that preferential looking will overestimate the acuity on pts with reduced acuity (especially ocular disease)
|
|
|
how do you convert between cycles per degree and snellen acuity
|
600 = CPD * snellen denomonator
|
|
|
at what age can children usually identify lea symbols
|
2.5-3 years old
|
|
|
at what age do you expect a child to get 20/30 with lea symbols (recognition acuity)? what about 20/20?
|
20/30: 3 years old 20/20: 4-5 years old
|
|
|
when would measuring contrast on a ped be useful
|
if they have reduced acuity.
|
|
|
New lecture: 5 BVdevelopment
|
|
|
|
up to what age is intermittent strabismus normal
|
intermittent strabismus is common in the first 3 months, but the eyes should be aligned 100% of the time by 3-4 months.
|
|
|
at what age does convergence in a ped reach adult levels (6-10 cm)
|
6 months
|
|
|
by what age should a ped first have stereopsis
|
6 months (research setting). can't elicit stereo response in a clinical setting until 9-12 months.
|
|
|
by what age should a ped have adult level stereopsis (20 arc seconds)
|
5 years (often won't demonstrate in clinical setting until 7-8 years)
|
|
|
at what age will deprivation perminently decrease vision acuity
|
first year is most crucial, but deprivation as late as age 7-9 can still affect acuity perminently.
|
|
|
`what does the amblyopia treatment study tell us about what how old an amblyope can be and still recieve benefit from amblyopia treatment
|
53% of 7-12 year olds responded to treatment. 25% of 13-17 year olds responded to treatment.
|
|
|
describe the critical period for stereopsis
|
critical period is 3-9 months. however deprivation (acquired palsy for example) can lead to reduction in stereo, even after resultion of diplopia, long after stereopsis has reached maturity. -strabismus during this critical period leads to very poor outcomes unless the strabismus is corrected quickly.
|
|
|
is refractive amblyopia every caused by myopia
|
almost always hyperopia. if you think about it a myope can still see clearly at near. a hyperope can't see clearly at any distance.
|
|
|
New lecture: 6 Case Hx.Development Screening
|
|
|
|
what is considered a normal birth weight
|
above 5.5 pounds.
|
|
|
how long of gestation is considered pre-mature
|
less than 37 weeks.
|
|
|
at what age do kids usually start crawling
|
9 months
|
|
|
at what age do kids normall start walking
|
12 months
|
|
|
what are the 4 categories on the Denver Developmental Screening Test (developmental screening test)
|
personal/social, fine motor, language, gross motor
|
|
|
New lecture: 7 Peds Exam.BV
|
|
|
|
what characteristics do you need to asses if you see a strabismus
|
1. direction/laterality 2. frequency 3. magnitude 4. concomitency
|
|
|
what physiologic condition can give you a false positive on the bruchner test
|
anisocoria
|
|
|
is it positve or negative for nasal displacement of the reflex on hirshberg
|
nasal: positive temporal: negative
|
|
|
what conditions will increase the likelihood of anamolyous corespondance
|
if a constant strabismus is present and there is no significant amblyopia, the liklihood of AC is high, but not certain.
|
|
|
New lecture: 4 VM system development
|
|
|
|
at what age are infants able to make a single saccade to fixate an object (rather than making multiple small saccades).
|
6-8 months
|
|
|
at what age are pursuit eye movements first seen
|
seen as early as 1-4 weeks. they are of very poor quality though, there is a large latency period and many catch up saccades. by 4 months they show much more accuragte pursuits.
|
|
|
at what age are pupil responses seen in peds
|
present at birth in full-term and premature infants.
|
|
|
at what age does accommodative accuracy reach adult levels
|
3-4 months
|
|
|
New lecture: 8 Peds Exam, VA and accommodation
|
|
|
|
do you want to do monocular or binocular acuities first on a ped
|
binocular. mononular is tough to get, this orients them to the test before attempting monoular. For monocular you want to test the eye with suspected poorer vision first because they will run out of gas and binocular is a representation of vision in the better eye.
|
|
|
what are these cards called (type of acuity and specific card)
|
Preferential looking acuity. specifically they are teller cards.
|
|
|
what is the name of these cards
|
Cardiff acuity cards
|
|
|
when would you use teller cards vs. cardiff cards
|
teller cards best for less than 10 months (but useful with older toddlers). cardiff cards better for keeping attention in kids 9 months old and up.
|
|
|
what are the names of the two types of acuity
|
recognition acuity preferential looking
|
|
|
a difference of how many lines is significant for a differnece in VA between the two eyes for a preferential looking acuity
|
IOD > 2 sequential levels for PL cards is significant
|
|
|
which is better for detecting amblyopia preferential looking acuity or recognition acuity
|
recognition. if you suspect amblyopia or reduced vision of any kind you should try to get recognition acuities (make copies of leas symbols and have parent take them home for practice before next visit).
|
|
|
describe the staircase method of testing acuity so that you don't lose a peds attention
|
start with the first card well above expected threshold. then jump down to 2 levels above expected threshold. present 2-3 at each level going down and move on if they get 2/3 at any level.
|
|
|
what type of acuity are the lea symbols
|
recognition acuity
|
|
|
what are the expected VAs for preferential looking for 1 mo, 2 mo, 3-4 mo, 6 mo, 12 mo, and 24 months
|
1 mo: 20/800 2 mo: 20/400-20/800 3 mo: 20/200-20/400 6 mo: 20/100 12 mo: 20/50 24 mo: 20/20-20/25
|
|
|
at what age ranges are lea symbols appropriate
|
3-5 years
|
|
|
what can you do if a kid is not responding to lea symbols to try to get a response out of them
|
forced choice: show them two symbols and ask which one is the apple
|
|
|
what is the problem with allen figures
|
the shapes are so distinctive that they can be recognized beyond threshold acuity. they should not be used.
|
|
|
what is important to record along with the numbers when you take acuity on a child
|
how sure you are of their response
|
|
|
at what amount of hyperopia are kids at risk for developmental challenges, esotropia and amblyopia
|
above 3 diopters -accommodation is important to assess, because poor accommodative responses are less likely to emmetropize and are more at risk for amblyopia. in boarderline amounts of hyperopia, accommodation can be the difference btwn deciding to rx or not.
|
|
|
New lecture: 9 Peds Exam.Health
|
|
|
|
what are the three main things you want to assess in a pediatric eye exam
|
refractive status, binocularity, health
|
|
|
how do you interperate bruckner results
|
the brighter eye might be strabismic or have a higher refractive error. you are also looking for refractive crescents.
|
|
|
what is the hirshberg test
|
you can do it during bruckner. you look at the light reflex on the cornea. it should be in the same position on the cornea between the two eyes, if not this indicates strabismus.
|
|
|
what are the only two ocular diseases in the peripheral retinal that are progressive and need treatment in peds
|
retinopathy of prematurity (and they will come in already diagnosed), and retinal detachment resulting from truama (and will will have history of trauma). So you are not really worried about seeing way out into the periphery unless the history incidates it. most congenital retinal problems are in the POSTERIOR pole (but they really need to be dilated even if you are just looking at the posterior pole to see anything that might be there)
|
|
|
do we really need IOP in the pediatric population
|
no. congenital glaucoma has plenty of signs other than IOP. we don't really need to do it from a medical standpoint, the only reason we should do it is from a legal standpoint.
|
|
|
at what age can you start to do goldmann
|
6 to 8 (need to be a really good 6 year old)
|
|
|
what should do if you think you have a legitamate problem on confrontational fields
|
you can't realistically get a ped to do an automated visual field. you are looking for gross defects though (like a hemianopsia), so you could do an amsler grid (works suprisingly well). -goldmann perimetry is the only thing we could get reasonable results and we are most likely not going to have access to it.
|
|
|
what is the purpose of doing color vision testing on a ped
|
for education and health Albinism Juvenile Hereditary Retinoschisis Congenital Glaucoma/Cataract Diabetes - before visible retinal changes Retinitis Pigmentosa Juvenile Macular Dystrophy Optic Nerve Disorders Leber's Congenital Amaurosis
|
|
|
at what age are the ishihara plates appropriate
|
6 years old and up
|
|
|
what is the color vision testing method of choice
|
color vision testing made easy
|
|
|
when might you want to test contrast for peds
|
amblyopia
|
|
|
New lecture: 10 Peds Exam.refraction
|
|
|
|
when is autorefractor very useful for in peds not cyclopleged
|
very accurate and helpful for astigmatism power and axis. more accurate than your dry ret because it measures both meridians simultaneously (during your ret the meridians will be shifting as their accommodation fluctuates)
|
|
|
what are all the things you should be looking at when you do a screening with your ophthalmoscope on a ped
|
look at the ocular media look for one reflex being brighter than the other (brukner) look for refractive crescents in both meridians look at corneal reflex (hirshber) look at lashes look at conj limbal glow (for assesment of angle) look at cornea look at iris look at the ONH and macula
|
|
|
how do you interperate what you see on brukner
|
|
|
|
how do you tell if a refractive crescent is hyperopic or myopic
|
if it is toward the head of the ophthalmoscope then it is a hyperopic crescent (hyperopic-head)
|
|
|
what can you do if you think that the reflex on hirshberg is unequal but you are not sure
|
cover up the eye that you think is fixating and see if the reflex changes in brightness or in position on the cornea.
|
|
|
what is important to remember about your positioning while you are doing ret on a ped
|
you need to be on axis
|
|
|
in what circumstances would you need to do keratometry on a ped
|
rare: pediatric CL fit, or ectasias (see a scissor reflex on ret)
|
|
|
with what cycloplegic agent are you worried about systemic side effects like syncope
|
cyclopentolate. if you don't really need to cycloplege consider just using tropicamide
|
|
|
which has a stronger cycloplegic effect cyclopentolate or atropine
|
atropine; but the onset of action is 3-6 hours and duration of action is 7-14 days, which makes it impractical for clinical evaluation of refractive error
|
|
|
what procedural thing do you HAVE to remember when using cyclopentolate
|
punctal occlude.
|
|
|
how many drops of cyclopentolate and what percent are recommended for peds
|
1 drop of 1%; or 1 drop of 0.5% for infants under 6 months old.
|
|
|
according to the literature how many drops of cyclopentolate do you need to use for adequate cycloplegia for assessment of refractive error
|
only 1 drop needed for adequate cycloplegia. more drops only increase side effects.
|
|
|
does tropicamide or cyclopentolate give a better mydriatic effect
|
tropicamide.
|
|
|
what cycloplegic agent should you use on special populations
|
tropicamide
|
|
|
what percent of accommodation is left in tact with cyclopentolate? with tropicamide?
|
cyclopentolate: 15-20% tropicamide: 30-40%
|
|
|
for what range of refractive errors is tropicamide sufficient for cycloplegic assessment of refractive error
|
myopes, mixed astigmates and low hyperopes (less than 1 D on dry ret)
|
|
|
what dilating agents do you need to avoid in pts w/ down syndrome, cerebral palsy, and seizure or other neurologic disease
|
do not use cyclopentolate or atropine -accommodative system doesn't work that well in special pops anyway.
|
|
|
if you use a cycloplegic spray what additional proceedural step do you NEED to remember
|
have them plug their nose so they don't get cyclopentolate in systemic absorption (remember to punctal occlude as well)
|
|
|
New lecture: 11 peds management
|
|
|
|
at what age do kids develop stranger warines
|
6 months
|
|
|
at what age do children develop social referencing (cueing on their partents reaction and interaction with you)
|
9-12 months. -history is a good time for the child to watch you interacting with the parent and become less weary of you
|
|
|
New lecture: 12 Hyperopia Management
|
|
|
|
what age ranges are considered infants, toddlers, preschoolers, school-aged children
|
infants: 3-12 months toddlers: 1-3 years preschoolers: 3-5 years school aged: 5 years and older
|
|
|
how does accommodative ability relate to emmetropization
|
infants who emmetropized showed a good accommodative response; infants who showed the least robust emmetroization showed the poorest accommodative response. (clinically you should do MEM)
|
|
|
what are the hyperopic prescribing recommendations besed on the effects on VA and near visual behaviors of leaving hyperopia uncorrected
|
infants: rx if greater than or equal to +5.00 toddlers: rx if greater than or equal to +3.00 preschoolers: rx if greater than or equal to +2.00 -values are full cycloplegic retinoscopic findings -consider basing it on accommodative accurancy (MEM) because it is a good indicator of emmetropization. -5D of any type of RE puts you outside the range of normal emmetropization at any age.
|
|
|
by what age is the majority of emmetropiztion finished
|
12 months
|
|
|
what is the most common age range to see accommodative esotropia develop
|
2.5 years to 3.5 years. -that is why you consider rxing at lower than 3 D for preschoolers (2D).
|
|
|
how much of the hyperopia do you rx for a hyperopic ped with orthophoria at far and near
|
cut the full cycloplegia by 1 to 2 D
|
|
|
is it easier or harder to cut plus an a hyperope with higher hyperopia
|
higher hyperopes tend to accept the FULL correction better than lower hyperopes. (you can think of them almost as an amblyope)
|
|
|
how much do you rx for hyperopic peds with greater than 20 pd esodeviations? what about less than 20 pd?
|
greater than 20: if 5 years old or younger rx full cycloplegia; if 6 or older rx cycloplegic less 1 D. less than 20: cut the full cycloplegic by 1 D -on all these kids you want to rx the full cycloplegic if you can. also you need to consider stepping them into it, bceause if they don't wear their correction at all then it won't do them any good.
|
|
|
what is a common way to step kids into plus without using contacts or changing lenses
|
bifocals. very common option.
|
|
|
for a ped what value do you multiply the calculated AC/A by to get a more clinically accurate number
|
calculate the AC/A and then multiply it by 80% (this is because of the response curve)
|
|
|
what age is too young for a bifocal
|
under 2 years old. give them an intermediate or near SV lens.
|
|
|
where should you set the bifocal for kids 3-5, 6-8, and 9 and up
|
3-5: set @ mid-pupil 6-8: set @ lower pupil margin (raise if compliance is in question) 9 and up: optional to set at lower lid margin.
|
|
|
how do you train a ped to use a bifocal or progressive
|
every day for the first two weeks of the rx, put a piece of scotch tape over the top portion of the lens and have them do a near task through their bifocal. kids are very adaptive and will learn to use it.
|
|
|
progressives can be worn successfully in ped if you take a couple steps. most important is training them to use the add power with scotch tape. what other adjustments are necessary
|
increase the power of the add by up to +0.50 D and raise up to 2 mm above mid-pupil.
|
|
|
New lecture: 13 Myopia Treatment
|
|
|
|
at what level of myopia are kids at risk for retinal detachment, glaucoma, chorioretinal atrophy etc.
|
6 D of myopia
|
|
|
how is myopia prevented during normal growth of the eye
|
thinning of the crystaline lens (probably more complex that this in reality)
|
|
|
name the ways in which we can (attempt) to control myopia
|
1. bifocals (reduce accommodation) 2. under correction (reduce accommodation) 3. multifocal contact lenses (affects peripheral refractive error) 4. ortho-k (affects peripheral refractive error) 5. aspheric spectacle lenses (affects peripheral refractive error) 6. drugs (atropine/pirenzepine; probably not a good option)
|
|
|
is undercorrection a good option for contolling myopia
|
no. undercorrected groups showed increased myopia progression as compared to control groups with full correction.
|
|
|
are bifocals a good option for contol of myopia progression
|
standard bifocals showed limited treatment effect. COMET study showed that progressive addition lenses had a clinically significant effect (.64 less progression) ONLY for children with a large lag of accommodation and esophoria at near.
|
|
|
is atropine effective at controlling myopia progression? do we use it?
|
very effective at controlling myopia progression. probably not useful clinically because of side effects.
|
|
|
why is atropine effective at controlling myopia progression
|
we are not really sure.
|
|
|
how does standard correction of myopia affect the peripheral refractive error
|
hyperopic defocus in the pheripheral retina
|
|
|
do we think that correction at the fovea has a large impact on the development of refractive error? what has the most significant impact according to Dr. earl smith.?
|
no, foveal oblation in rhesus monkeys studied by Dr. earl smith, showed no effect on axial length elongation. however, lenses that create peripheral hyperopic deficus increased axial myopia.
|
|
|
name some ways that we can change the pheripheral refractive error to prevent myopia progression while providing optimal correction at the fovea
|
1. ortho-k 2. multifocal (aspheric) contact lenses 3. aspheric spectacle lenses
|
|
|
do preliminary studies show that ortho-k is effective in controlling myopia progression
|
yes (see LORIC study, and the walline CRT study)
|
|
|
do preliminary studies show bifocal contacts to be effective in myopia control
|
yes
|
|
|
have studies shown aspherical spectacle lenses to be effective in prevention of myopia progression.
|
preliminary results are not impressive.
|
|
|
is it safe to measure refractive error in a myope with a dry autorefracter
|
no, they have a tendency to accommodate (pseudomyopia) and will come back overminused and symptomatic if you rx off the dry autorefractor
|
|
|
how does being outside impact myopia progression
|
children who spend more time outside are LESS likely to become myopia regardless of how much time is spent in near work. we don't know why at this point.
|
|
|
New lecture: 14 Astigmatism.Anisometropia Management
|
|
|
|
at what amount of refractive error would you consider rxing for a myopic ped
|
infants: consider rx @ 5 D toddlers: consider rx @ 2 D preschoolers: consider rx @ 1 D
|
|
|
would you consider rxing for a myopic ped with ROP, congenital glaucoma/cataracts or some other disease? why or why not
|
remember that one of the prerequisites for emmetropization is that they eyes are healthy. so, kids with ocular disease do not emmetropize as a normal child would (rxing would be okay, because you are not interfering with emmetropization anyway).
|
|
|
how much myopia before you would be worried about amblyopia if it were equal between the two eyes.
|
6-8 D of myopia (this is bilateral amblyopia)
|
|
|
when is the critical period for the development of amblyopia
|
first 4-6 years.
|
|
|
for a myopic ped should you rx the full rx or cut it
|
studies showed that cutting the rx actually resulted in more progression than giving the full correction. anything you cut is going to directly affect their VA; this is not the case with hyperopes.
|
|
|
if you are going to cut a myopic peds rx how much should you cut it by
|
you don't want their acuity worse than 20/20 or 20/25. the challenge is getting an acurate acuity.
|
|
|
how soon do you want to see them back if you rx glasses for a ped
|
6 week (1 month of solid wear time). long-term, follow them yearly.
|
|
|
for a pediatric divergence excess case, how much would you overminus them
|
almost always going to be 2 D (don't know why). rx 2 D add, so they are not overminused at near.
|
|
|
at what amount of astigmatism would you consider rxing for a ped
|
infants: 5 D or strab/amblyopia (don't want to rx unless you have to) toddlers: rx greater than 1.25 D preschoolers: rx greater than 1.25 D
|
|
|
what is the problem with rxing an astigmatic ped
|
astigmatism is highly variable (if you remeasure it again in 3 months it is likely to be different)
|
|
|
what is the 3X3 rule for pediatric lens rxing
|
you want to see them 3 times before you rx for asigmatism and you want the follow ups to be 3 months apart (initial exam, 3 months, 6 months). you want the astigmatism to be stable before you rx for it.
|
|
|
with what orientation of astigmatism can you see the best and why
|
WTR: all you have to do is squint and you eliminate the meridian with the astigmatism in it.
|
|
|
at what age did the earliest reported case of meridional amblyopia develop
|
age 4 (and it resolved quickly)
|
|
|
should you rx the full astigmatism or cut it
|
same as with myopia, you can cut 0.25 or 0.50, but you don't want to cut more than that.
|
|
|
up to what age and refractive error does anisometropia tend to be transient
|
transient up to age 4. aniso greater than or equal to 3 diopters tends to persist
|
|
|
how much anisometropia does it take to cause amblyopia and/or strabismus?
|
hyperopia: greater than or equal to 1 D myopia: greater than or equal to 2 D astigmatism: greater than or equal to 1.25 D
|
|
|
why does it take more myopic anisometropia to cause amblyopia than it does for hyperopia
|
because myopes still get a clear image at near part of the time.
|
|
|
at what amount would you consider rxing for anisometropia for peds
|
infants: monitor stability; rx if 5 D or strab/amblyope toddlers: monitor stability; rx if 5 D or strab/amblyope preschoolers: rx if greater than 1 D *a more conservative approach would be to rx at 3 D instead of 5. -the reason that we monitor and wait until 5 D to rx is because anisometropia is so transient. transient because our body does not always grow evenly on each side, but in the end we usually have pretty good symmetry. most tranient aniso is due to difference in axial length.
|
|
|
can you cut an aniso rx
|
you can cut the hyperopia in an anisometropic rx, but you CAN NOT change the aniso. if you cut plus from one eye, you HAVE to cut that same amount from the other eye (otherwise you will have unequal accommodation between the two eyes). this is very important. -rx from the cycloplegic aniso
|
|
|
at what amount of aniso would you want to do CLs, and why
|
3D. each diopter gives you 1% image size difference between the two eyes. at 3% image size difference we are symptomatic. kids won't report this like adults will, because they are not as perceptive; so you need to take it into consideration and not rely on pt complaints. if you have to do glasses you need to get them lenses that correct for image size differences.
|
|
|
what are the lenses called that correct for image size differences created in anisometropia
|
isoconic lenses
|
