PRESCRIBING FOR
REFRACTIVE
ERRORS
Mithali Kamat-Paranjape M. Optom
To view more presentations and articles, visit www.eyen...
To view more presentations and articles, visit www.eyenirvaan.com
Myopia
Simple Myopia
Usually
increases as age
increases till
adulthood !
To view more presentations and articles, visit www.eyeni...
Myopia
• Optimal correction
• First time wearer: slight undercorrection may be
necessary
• Duochrome test is important
• I...
Myopia
• Some myopes more comfortable reading
without the distance Rx
• Prescribing multifocals/progressives for
myopes:
–...
Pseudomyopia
To view more presentations and articles, visit www.eyenirvaan.com
Pseudomyopia
• Over stimulation of parasympathetic nervous
system
– Ocular fatigue during exams or change in work
schedule...
Myopia
1. Blur distance vision
2. Consistent vision
3. Usually no headache
4. Consistent retinoscopy
5. Mid-dilated pupils...
Management
• Cycloplegic refraction
• If tendency for accommodative spasm
– Cycloplegic drops
– Plus over refraction
– Bif...
Exercise to increase the
Accommodative Facility
• Push up exercises
• Brock String
• Flippers
• Hart Charts
Hypermetropia
To view more presentations and articles, visit www.eyenirvaan.com
Hypermetropia
• Cycloplegic refraction is
a must
• Deduct for the tone of
the cilliary muscles
• Optimal correction or
sli...
Hypermetropia
Age: upto 7 yrs
• No correction required if
– Error is small
– VA & binocular vision is normal
– Asymptomati...
Hypermetropia
Age: 8 yrs and above
• Full correction advisable, but
slight under correction
acceptable
• After 35, full co...
Astigmatism
Up to 0.75D Low
1.00 to 1.50D Moderate
Above 1.50D High
To view more presentations and articles, visit www.eye...
Astigmatism
First time Astigmat
• Adult
– Try optimal correction
– Undercorrection is acceptable,
maintaining the spherica...
Astigmatism
First time Astigmat: Child
• Optimal correction
• Yearly monitoring
ATR→WTR→ATR
To view more presentations and...
Astigmatism
Already using astigmatic correction but
change in
• Power
– See patients comfort.
– May require undercorrectio...
Presbyopia
• Plus Build-up
• Near range determination
– With J.C.C
– Push up method
– RAF ruler
• Near duochrome
• Dynamic...
• JCC is placed with its negative axis at 90
• Patient is shown Jacques blur point card
To view more presentations and art...
• Hofstetters’ formulas
– Minimum expected
amplitude = 15 – 0.25
(age)
– Average expected
amplitude = 18.5 – 0.30
(age)
– ...
Donder’s table for age-referenced
amplitude of accommodation
To view more presentations and articles, visit www.eyenirvaan...
• Minimum plus lens
giving maximum vision
for the required
working distance
Age Add
40 +1.00
45 +1.50
50 +2.00
55 +2.50
60...
To view more presentations and articles, visit www.eyenirvaan.com
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Prescribing for refractive errors - presentation at www.eyenirvaan.com

  1. 1. PRESCRIBING FOR REFRACTIVE ERRORS Mithali Kamat-Paranjape M. Optom To view more presentations and articles, visit www.eyenirvaan.com
  2. 2. To view more presentations and articles, visit www.eyenirvaan.com
  3. 3. Myopia
  4. 4. Simple Myopia Usually increases as age increases till adulthood ! To view more presentations and articles, visit www.eyenirvaan.com
  5. 5. Myopia • Optimal correction • First time wearer: slight undercorrection may be necessary • Duochrome test is important • If large lag of accommodation is noticed- slight under correction • Check comfort for near vision • Exophoric patients benefit from spectacles than CL To view more presentations and articles, visit www.eyenirvaan.com
  6. 6. Myopia • Some myopes more comfortable reading without the distance Rx • Prescribing multifocals/progressives for myopes: – Ease of changing from distance to near focus (depending on accommodation/convergence relationship) – Myopia control
  7. 7. Pseudomyopia To view more presentations and articles, visit www.eyenirvaan.com
  8. 8. Pseudomyopia • Over stimulation of parasympathetic nervous system – Ocular fatigue during exams or change in work schedule – Active ocular inflammations like uveitis • Diseased like – Uncontrolled type 2 diabetes – Myasthenia gravis • Medicines that can cause pseudomyopia include: – Hydralazine hydrochloride. – Phenothiazines. These are antipsychotics, tranquillizers, and drugs to reduce nausea. To view more presentations and articles, visit www.eyenirvaan.com
  9. 9. Myopia 1. Blur distance vision 2. Consistent vision 3. Usually no headache 4. Consistent retinoscopy 5. Mid-dilated pupils 6. Exophoric tendency 7. Similar manifestation on cycloplegic refraction Pseudomyopia 1. Blur distance vision 2. Fluctuating vision 3. Headache & asthenopia, aggravated on near work 4. Fluctuating retinoscopy 5. Miotic pupils 6. Esophoric tendency 7. Very different manifestation on cycloplegic refraction 8. Psychogenic factors usually present To view more presentations and articles, visit www.eyenirvaan.com
  10. 10. Management • Cycloplegic refraction • If tendency for accommodative spasm – Cycloplegic drops – Plus over refraction – Bifocal spectacles • Exercises to increase the accommodative facility and amplitude. To view more presentations and articles, visit www.eyenirvaan.com
  11. 11. Exercise to increase the Accommodative Facility • Push up exercises • Brock String • Flippers • Hart Charts
  12. 12. Hypermetropia To view more presentations and articles, visit www.eyenirvaan.com
  13. 13. Hypermetropia • Cycloplegic refraction is a must • Deduct for the tone of the cilliary muscles • Optimal correction or slight overcorrection in case of accommodative esotropia
  14. 14. Hypermetropia Age: upto 7 yrs • No correction required if – Error is small – VA & binocular vision is normal – Asymptomatic patient – No anomalies of muscle imbalance • If error is more than 1.50D, correct to avoide strabismus • Be careful while undercorrecting • Monitor every 6 months To view more presentations and articles, visit www.eyenirvaan.com
  15. 15. Hypermetropia Age: 8 yrs and above • Full correction advisable, but slight under correction acceptable • After 35, full correction necessary To view more presentations and articles, visit www.eyenirvaan.com
  16. 16. Astigmatism Up to 0.75D Low 1.00 to 1.50D Moderate Above 1.50D High To view more presentations and articles, visit www.eyenirvaan.com
  17. 17. Astigmatism First time Astigmat • Adult – Try optimal correction – Undercorrection is acceptable, maintaining the spherical equivalent – Rotate axis towards 90 and 180 – Check binocular vision – Adjust one or both of the axis to be parallel – In-clinic trials To view more presentations and articles, visit www.eyenirvaan.com
  18. 18. Astigmatism First time Astigmat: Child • Optimal correction • Yearly monitoring ATR→WTR→ATR To view more presentations and articles, visit www.eyenirvaan.com
  19. 19. Astigmatism Already using astigmatic correction but change in • Power – See patients comfort. – May require undercorrection • Axis – Check binocular vision – Try maintaing the previous axis To view more presentations and articles, visit www.eyenirvaan.com
  20. 20. Presbyopia • Plus Build-up • Near range determination – With J.C.C – Push up method – RAF ruler • Near duochrome • Dynamic near retinoscopy
  21. 21. • JCC is placed with its negative axis at 90 • Patient is shown Jacques blur point card To view more presentations and articles, visit www.eyenirvaan.com
  22. 22. • Hofstetters’ formulas – Minimum expected amplitude = 15 – 0.25 (age) – Average expected amplitude = 18.5 – 0.30 (age) – Maximum expected amplitude = 25 – 0.40 (age) To view more presentations and articles, visit www.eyenirvaan.com
  23. 23. Donder’s table for age-referenced amplitude of accommodation To view more presentations and articles, visit www.eyenirvaan.com
  24. 24. • Minimum plus lens giving maximum vision for the required working distance Age Add 40 +1.00 45 +1.50 50 +2.00 55 +2.50 60 +3.00
  25. 25. To view more presentations and articles, visit www.eyenirvaan.com

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