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Basic of Pediatric Refraction

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200 views

Basic of Pediatric Refraction

Uploaded by

Sujon Paul
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Basic of Pediatric

Refraction

Speaker
Dr. Nafiz Mahmood
DO student, NIOH
Chairman
Dr. Khair Ahmed Choudhury
Associate professor
Dpt. Of Pediatric ophthalmology
NIOH

Moderator
Dr. Utpal Sen
Jr. consultant
Dept. Pediatric Ophthalmology
NIOH
Refractive state of eye

An interplay among –
o corneal power,
o lens power, and
o axial length
Dimensions of Newborn and Adult Eyes:-
Newbo Adult
rn
Axial length (mm) 15-17 23-24

Corneal horizontal 9.5-10.5 12


diameter (mm)

Radius of corneal 6.6-7.4 7.4-8.4


curvature (mm)
Development of vision
At birth Eyes move randomly , no central
fixation.

At 6 weeks Apparent fixation reflex , can follow


bright light at short distance .

At 4-6 Convergence established . foveal reflex


months developed at 4th month. central fixation
at 6th month.

At 6 years Fovea develop completely with VA 6/6.


• Eyes are hypermetropic at birth
• Miopic shift towards plano until adult
dimension
• At Birth, Visual Acuity is poorly developed .
• First 2-3 months are associated with rapid
visual development (Critical period of Visual
Development ).
• V/A improves more slowly after this period
and reaches 6/6 by 6 years.
Presentation
O Blurring of vision.

O Inability to read.

O Sitting too close to the


television.

O Squinting.

O Poor performance in school.


• Intolerence to light .

• Frequent blinking.

• Watering from eyes.

• Headache .

• Recurrent stye or chalazion.


Evaluation of a pediatric
Establish friendlypatient
relation with child & parents.

•Proper history taking :


- Family history.
- Congenital malformation.
- History of pregnancy .
- H/O trauma .
- Past medical & surgical history.
.
• History of pregnancy
-maternal health and disease
-gestational age of baby at the time of
birth
-birth weight
-neonatal history
-developmental milestone
O Clinical examination
including :
- visual acuity
- measurement of deviation
- ocular motility
- fundoscopy
- refraction
Pediatric refraction

O Upto 6 years age:


- cycloplegic refraction

O Above 6 years :
- subjective refraction
Examination under anesthesia
(EUA)
Indication :

O Children below 2 years age.


O Non cooperative patients.
O Child having nystagmus.
Cycloplegic refraction

Cycloplegic refraction is a procedure used to


determine a refractive error by temporarily
paralyzing the ciliary muscles.
Cycloplegic agents

Atropine sulphate :
OFormulation : eye ointment
OConcentration : 0.5%, 1.0%
OMaximum cycloplegia : 1-2 hour
ODuration of cycloplegia :7-14 days
Cycloplegic agents
Cyclopentolate :

OFormulation : eye drop


OConcentration : 0.5%, 1.0%
OMaximum cycloplegia : 1 hour
ODuration of cycloplegia :1-2 days
Medication Administration Duration of
schedule action

Atropine Ointment : bd x 3 days 1-2 wks


(0.5%,1%)
eye No ointment on the day
ointment of refraction
Cyclopentola 1drop , 5 min×2, wait 8-24 hrs
te eye 1 hour
drop
(0.5%,1%)
Adverse effects of
cycloplegic agents
Atropine

• Blurred Vision,
• Flushing of face
• Cutaneous • Xerostomia
eruption • Fever
• Headache
• Tachycardia
• Vomiting
Cyclopentolate :

O CNS toxicity
O Cardiopulmonary toxicity
O Gastrointestinal toxicity
O Local allergic reactions
INDICATION OF
CYCLOPLEGIC REFRACTION

O All children upto 6 years of age.

O squint .

O Suspected cases of amblyopia.


Preparing the subject

O Counseling to parents and the


patient.
O Visual acuity assessment prior
cycloplegia.
O Cover test to detect latent
strabismus.
Procedure
Before performing refraction:

Atropine 1% eye Ointment :

O 2 times daily for 3 consecutive days .


O Refraction on 4th day.
O No ointment given on the day of
refraction.
Cyclopentolate eye drop ( 0.5% or
1.0%)

O 1 drop 5 min interval for 2-3 applications.

O Refraction after one hour


O Instillation of topical anaesthesthetic agent

prior cyclopentolate prevents ocular

irritation and reflex tearing.

O Ensures better retention of the drug and thus

effective cycloplegia.
OSet up distant fixation target.

ODim the light of the room.

ORetinoscopy is performed.
Steps of Retinoscopy
O Positioning of the child
by facing the distant
fixation target

O The right eye is


measured first

O Examiners right eye


should be directed to
the child's right eye
Othe trial frame placed on the
childs face

OHand held trial lens can be used

OProcedure is repeated for the left


eye
When to prescribe
HYPERMETROPIA

O Usually correction is not given upto +4.0 D

in children in absence of SQUINT.

O greater Hypermetropia 2/3 correcrion

(usually)

O In case of esotropia full cycloplegic

correction should be given even under 2 Y


Astigmatism

O A cylinder of 1.50 D or more should be

prescribed

(specially with Anisometropia after age -18

months)
Myopia

O 2 years : -5.00D or more should be corrected

O 2-4 years : -3.00D should be corrected

O > 4 years : low myopia should be corrected


Anisometropia

After age of 3yr : anisometropia >1D should be prescribed


Follow up:
O Children having strabismus should be examined
6 monthly.

O More frequently in children with poor visual


acuity.

O In aphakic children initially monthly follow up


may be necessary.

O 6 monthly checkup for teenager myopes.


Take home message

O In children having suspected


amblyopia, squint , hypermetropia -
cycloplegic refraction is mandatory.
O Appropriate , timed intervention in

children with refractive error is


essential to prevent amblyopia.

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