In this presentation discuss the considerations for prescribing a refractive correction in infants and children up to school age We focus on children who do not have other disorders for example binocular vision anomalies such as strabismus or hetrophoria or convergence excess .However refractive ammblyoginic factors are discussed as is prescribing for refractive amblyopia also guidlines are proposed which indicate when to prescribe spectacles and what amount of refractive error should be corrected also discussing some facts about plus and minus lenses and its affect on binocular balance and ocular motility

1. Spectacles Prescription In Children
PRESENTER/OMER MONZAL -BSC(OPTOM)
ZAIN OPTICAL-MADINAH-KSA
Source-www.alamy.com

2. Contents
Introduction
Other case to prescribe &Conclusion
Developmental aspect
Why to Prescribe glasses For children ?
Factor Affecting prescribing decision
Prescription in case of Ametropia
References

3. Did you know that August is
Children's Eye Health and
Safety month…?
Preventblindness.org

4. Introduction

5. Definitions
Emmetropia
Is the refractive state in which parallel rays of light from a distant object are brought to
focus on the retina in the non accommodating eye
Ammetropia
Absence of emmetropia and it may be axial (short A.L in hyperopia and long in
myopia)or refractive(weak in hyperopia and strong refractive power in myopia)
Emmetropization
It defines as when growing , the relation between ocular axial length & ocular
refractive power has to be adjusted simultaneously to maintain a well working optical
system
Source-pointsdevue.com

6. Developmental aspect
Refractive state of the eye determined by axial length ,corneal
power ,lens power and anterior chamber depth
these elements change continuously as the eye grows.
At birth, most infants are hyperopic with an average cycloplegic
refractive error of +2.00 D with a standard
deviation of 2.00 D
Emmetropisation is essentially complete by six to seven years
and the myopic shift slowly sets in
Birth Adult
A.l 17mm 23mm
KR 56D 43D
Power 45D 24D

7. Why to Prescribe glasses For children ?
To improve visual acuity and visual functions
To provide proper binocular balance
To obtain clear retinal image
Source-kamaleyehospital.com

8. Factor Affecting prescribing decision
If a refractive error is detected, the decision of prescribing spectacles is determined by:-
The natural history of refractive errors
Magnitude of the refractive error
The age of the child
The visual needs of the child
The presence of anisometropia and associated strabismus

9. Convergence is very important for BSV
Plus lens relax accommodation as well as convergence
Minus lenses induce accommodation therefore convergence
Both of them have affect on ocular motility balance
Ongoing process of emmetropization

10. To know….
Source-master class.yotub dr same era

11. Source -ophthalmology times .com
Source-reviewofmm.com

12. <1 year–correction if error is 5D or more
In infants, near vision is needed more than distant vision.
Therefore, only very high refractive errors should be corrected.
1 to 3 years–correction given if error is more than 3D
In school going age, myopia should be corrected for function with full correction
In intermittent exotropia, myopia may be over corrected.
The considerations for prescribing spectacles for myopia are :-

13. Source-en.m.Wikipedia.org

14. Prescription in case of hyperopia:
Hypermetropia is very common in infants and children, and requires a full correction
in the presence of esophoria or esotropia.
Children < 2 years – correction may be given for large refractive errors or in cases of
anisometropia.
Children 2-5 years – correction should be prescribed if refractive error is more than
+ 2.5D.
Children > 5 years – correction should be given if refractive error is more than + 1D,
as more strenuous near work is required.

15. Prescription in case of Astigmatism
Source-istokphoto.com

16. A significant astigmatism should be corrected at the
earliest to prevent meridional amblyopia from setting in
Astigmatism associated with spherical error should always
be corrected.
Astigmatism more than -1.5 D is to be corrected.
Oblique astigmatism should always be corrected as it is
more amblyogenic
Prescription in case of Astigmatism

17. Source-researchgate.net Sourse-2020mag.com

18. The principal factors that govern the prescription of spectacles in anisometropia are
aniseikonia and amblyopia.
In cases of anisometropia, the best correction for each individual eye is assessed first.
Then the binocular correction is assessed, noting the following:
The presence of diplopia and whether this is due to aniseikonia or a manifest
strabismus , with the correction.
Binocular visual acuity for distance and near should be noted.
The patients’ binocular status should be noted (stereopsis).

19. Source-youngeyes.com

20. Aphakia and psudophakia
Strabismus
Single eye child
Nystagmus
Placebo

21. In infants and preverbal children, objective tests are the only means of checking for refractive errors. In
older children, both objective and subjective tests can be performed which allows for a greater refinement
in optical correction.
The art of prescribing spectacles in children is ruled by several considerations
In infants and young children, optical correction of refractive errors is indicated in high refractive errors
which may cause unilateral or bilateral amblyopia
Spectacles are also essential if the refractive error is associated with accommodative strabismus, and also in
aphakic or pseudophakic children.
After prescribing spectacles, the child should be advised a follow up visit after four to six weeks , which
allows time for the spectacles to be dispensed and for the child to adapt to them

22. References
Management of refractive errors and prescription of spectacles –Yogesh Shukla MD Professor-new
Delhi-2015 Pp (37-117)
American Academy of Ophthalmology Pediatric Ophthalmology/Strabismus Panel. Preferred Practice
Pattern. Guidelines. Pediatric Eye Evaluations 2007
Picckwell”s Binocular Vision Anomalies –Bruce J.W.EVANS-Fifth Edition-2007 Pp(39-43)
Pediatric spectacle prescription-Wang chuck Doma;Abhishek Dagar-Venu Eye institute &Researsh
Center 'New Delhi’india-October-December-2017
www.google.com

23. Thanks You