PEDIATRIC PRESCRIPTION

Guidelines for spectacle prescribing in infants and children

Age group	Hypermetropia	Myopia	Astigmatism	Anisometropia
Infant --> 2yrs	>Up to +5D prescription +2D less than the error >For higher RE more than 2D can be subtracted but the pt should not be left mor than 4 hyp >Error less than 4D no need pre-scrip >Hyperopic children in this age group with more than .75D of astigmatism should have astigmatism correction >Pt with >2.5D of hyp should be FU yearly	>Up to -2 can be tolerated by pt in this age group >Higher amount of myopia should be correct less than 1 of the full correction >Astigmatism of .75D or more should be fully corrected	>1.5 D requires full correction >.5 less than full can be prescribed	>Hyperopia difference 1.5 should be pre scrip >Myopic 3D >Astigmatism of .75 or more in one eye full astigmatic correction >With astigmatism in ou the pt should be corrected so as leave more than .5D incorrect end in each eye
2---> 5 yrs In this age group if there is no significant refraction error and there is no symptoms myopia , hyperopia less than 3 and astigmatism less than .75 then there is no need for glasses	>Up to 4 with normal VA and no ocular symptoms no need for glasses >Greater than 4 and no ocular symptoms glasses are prescribed with 2 less than full and full astigmatism correction >FU	>These pt can tolerate RE of less than 1D >Large RE will require full correction with full astigmatism correction	>For astigmatism between 1 to 2 glasses are prescribed foe eye tasks only >For astigmatism >2 full correction and full time wear is recommended >When associated with hyp astigmatism as low as .75 should be prescribed	>Of 1.5 and no associated ocular symptoms glasses may not be prescribed but 6 month FU >If ocular symptoms are present , glasses are recommend to maintain fusion >For hyperopic pt glasses are prescribed 1.5 less than full equally in both eye so that equal accommodation in ou >For myopic pt full RE is given >For astigmatism any difference of .75D or more between the two eyes requires >For higher degrees of anisometropia (+5) CL are more useful to pt
5 yrs ---> and above Should bring VA to 20/20	>If pt shows symptoms RE of as low as +3D half the full correction is given with full astigmatic correction if needed >More than 3 glasses are prescribed with 2 less than full correction >FU	>Great than .75 the full correction is prescribed	>Pt with .5 to 1 complain because they are making constant efforts to keep their vision clear >With errors over .75 full correction should prescribed Care should be taken in prescribing for children with errors greater than 1.5D as they may not tolerate the glasses initially because of change in shape of objects the prescription should be worn constantly until the pt has adapted to their new perception of their surrounding.	>If error differ by 1.5Ds or 1Dc then amblyopia is likely to be present glasses and occlusion therapy are recommended.

Brown Syndrome

Brown Syndrome






What is Brown syndrome?
Brown syndrome is also known as Superior Oblique Tendon Sheath syndrome.
It is a mechanical problem in which the superior oblique muscle is unable to lengthen and therefore does not move freely. 
This makes looking up and in with the affected eye difficult Brown Syndrome may be present at birth (congenital) or begin later. It may be constant or intermittent.

What do the eyes of patients with Brown syndrome look like?

The eyes usually look normal except in side gaze positions. In side gaze (looking away from the affected side), one eye appears higher than the other, particularly when looking up. A vertical misalignment is sometimes noted when looking straight ahead.

Often the higher eye is mistakenly presumed to be the abnormal eye, but it is the lower eye that is affected. Brown syndrome causes the lower eye to have trouble looking upward and inwards towards the nose. Essentially the affected eye is “tethered” or held down by the tight superior oblique tendon.

What causes Brown syndrome?
The eyes usually look normal except in side gaze positions. In side gaze (looking away from the affected side), one eye appears higher than the other, particularly when looking up. A vertical misalignment is sometimes noted when looking straight ahead.

Often the higher eye is mistakenly presumed to be the abnormal eye, but it is the lower eye that is affected. Brown syndrome causes the lower eye to have trouble looking upward and inwards towards the nose. Essentially the affected eye is held down by the tight superior oblique tendon.

Is Brown syndrome hereditary?
Hereditary cases of Brown syndrome are rare. Most cases arise without a family history .

Can Brown syndrome be acquired?
Acquired Brown syndrome is uncommon but may be seen following surgery, after trauma or in association with inflammatory diseases. Trauma can cause a Brown Syndrome if a blunt object hits the eye socket in the upper inside corner near the nose. Surgery for the eyelid, frontal sinus, eyeball (retinal detachment) and teeth (dental extraction) have been linked to acquired Brown syndrome. Inflammation of the tendon-trochlea complex (from adult and juvenile rheumatoid arthritis, systemic lupus erythematosus and sinusitis) can be associated with development of the problem. Sometimes the cause is never identified.

How is Brown syndrome diagnosed?
The eyes are usually straight when looking directly ahead and down. The hallmark sign of Brown syndrome is decreased ability to look upward and inward. In some situations the eyes turn outward (exotropia) when looking up.

Brown syndrome can be associated with an abnormal head position (chin up, face turn, head tilt) for better eye cooperation. The affected eye can get “stuck” after looking up or down for long periods of time. When the eye becomes unstuck, a click is often heard and may be accompanied by pain or discomfort.

Brown syndrome may be more noticeable in children since they often look upward toward adults.

Does Brown syndrome affect one or both eyes?
Ninety percent of patients have only one affected eye, more commonly the right.

Does Brown syndrome cause eye problems besides abnormal eye movements?
Some children with Brown syndrome have poor binocular vision (which can result in poor depth perception), amblyopia or exotropia.

How is Brown syndrome treated?
Treatment recommendations for Brown syndrome vary according to the cause and severity of the movement disorder. Close observation alone is usually sufficient in mild cases. Visual acuity and the ability to use both eyes at the same time (binocular vision) should be monitored closely in young children. Nonsurgical treatment is often advised for recently acquired, traumatic and variable cases. Systemic and locally injected corticosteroids have been used to treat inflammatory cases of acquired Brown syndrome. Non-steroidal anti-inflammatory agents (like Ibuprofen) have also been used. Surgical treatment is usually recommended if any of the following are present: eye turns down when looking straight ahead, significant double vision, compromised binocular vision or pronounced abnormal head position. More than one surgery may be needed for optimal management.

Albinism and the Vision Problems

What is Albinism?

The word “albinism” refers to a group of inherited conditions. People with albinism have little or no pigment in their eyes, skin, or hair. They have inherited altered genes that do not make the usual amounts of a pigment called melanin. One person in 17,000 in the U.S.A. has some type of albinism. Albinism affects people from all races. Most children with albinism are born to parents who have normal hair and eye color for their ethnic backgrounds. Sometimes people do not recognize that they have albinism. A common myth is that people with albinism have red eyes. In fact there are different types of albinism and the amount of pigment in the eyes varies. Although some individuals with albinism have reddish or violet eyes, most have blue eyes. Some have hazel or brown eyes. However, all forms of albinism are associated with vision problems.

0. Vision Problems 

   
   
   
   
   
   People with albinism always have problems with vision (not correctable with eyeglasses) and many have low vision. The degree of vision impairment varies with the different types of albinism and many people with albinism are “legally blind,” but most use their vision for many tasks including reading and do not use Braille. Some people with albinism have sufficient vision to drive a car. Vision problems in albinism result from abnormal development of the retina and abnormal patterns of nerve connections between the eye and the brain. It is the presence of these eye problems that defines the diagnosis of albinism. Therefore the main test for albinism is simply an eye examination.
   

   Vision Rehabilitation

   Eye problems in albinism result from abnormal development of the eye because of lack of pigment and often include:
   

   • Nystagmus: regular horizontal back and forth movement of the eyes
   • Strabismus: muscle imbalance of the eyes, “crossed eyes” (esotropia), “lazy eye” or an eye that deviates out (exotropia)
   • Photophobia: sensitivity to bright light and glare
   • People with albinism may be either far-sighted or near-sighted and usually have astigmatism
   • Foveal hypoplasia: the retina, the surface inside the eye that receives light, does not develop normally before birth and in infancy
   • Optic nerve misrouting: the nerve signals from the retina to the brain do not follow the usual nerve routes
   • The iris, the colored area in the center of the eye, has little to no pigment to screen out stray light coming into the eye. (Light normally enters the eye only through the pupil, the dark opening in the center of the iris, but in albinism light can pass through the iris as well.)

   For the most part, treatment of the eye conditions consists of visual rehabilitation. Surgery to correct strabismus may improve the appearance of the eyes. However, since surgery will not correct the misrouting of nerves from the eyes to the brain, surgery will not improve eyesight or fine binocular vision. In the case of esotropia or “crossed eyes,” surgery may help vision by expanding the visual field (the area that the eyes can see while looking at one point).
   People with albinism are sensitive to glare, but they do not prefer to be in the dark, and they need light to see just like anyone else. Sunglasses or tinted contact lenses help outdoors. Indoors, it is important to place lights for reading or close work over a shoulder rather than in front.
   Various optical aids are helpful to people with albinism and the choice of an optical aid depends on how a person uses his or her eyes in jobs, hobbies, or other usual activities. Some people do well using bifocals which have a strong reading lens, prescription reading glasses, or contact lenses. Others use hand-held magnifiers or special small telescopes and some prefer to use screen magnification products on computers.
   Some people with albinism use bioptics, glasses which have small telescopes mounted on, in, or behind their regular lenses, so that one can look through either the regular lens or the telescope. Newer designs of bioptics use smaller light-weight lenses. Some states allow the use of bioptic telescopes for driving.
   Optometrists or ophthalmologists who are experienced in working with low vision patients can recommend various optical aids. Clinics should provide aids on trial loan and provide instruction in their use. The American Foundation for the Blind maintains a directory of low vision clinics. In Canada, support is available from the Canadian National Institute for the Blind.
   
   
   
   

Pinkeye (Conjunctivitis)

Pinkeye (Conjunctivitis)

Pinkeye (also called conjunctivitis) is redness and swelling of the conjunctiva, the mucous membrane that lines the eyelid and eye surface. The lining of the eye is usually clear. If irritation or infection occurs, the lining becomes red and swollen.

Pinkeye is very common. It usually is not serious and goes away in 7 to 10 days without medical treatment.
Most cases of pinkeye are caused by:

• Infections caused by viruses or bacteria.

• Dry eyes from lack of tears or exposure to wind and sun.

• Chemicals, fumes, or smoke (chemical conjunctivitis).

• Allergies.

Viral and bacterial pinkeye are contagious and spread very easily. Since most pinkeye is caused by viruses for which there is usually no medical treatment, preventing its spread is important. Poor hand-washing is the main cause of the spread of pinkeye. Sharing an object, such as a washcloth or towel, with a person who has pinkeye can spread the infection.

Allergic conjunctivitis is typified by an, 'itchy' feeling and is prevalent in our patient population with allergies. 

very similar in appearance to viral conjunctivitis but accompanied by nasal congestion ,sneezing ,eyelid swelling and sensitivity to light both eyes are affected .

 Symptoms may be seasonal with fluctuations in their severity over certain months.

Viral conjunctivitis is very common, especially in children. Viral conjunctivitis is usually associated with a recent cold or flu or sore throat. Supportive therapy and artificial tears are a common treatment.

appearance red, itching ,watery eye can effect one or both eyes .

Bacterial conjunctivitis is caused by various bacteria strains such as staphylococcus and streptococcus. The severity of the infection depends on the type of bacteria involved, and the treatment will vary accordingly.

a red eye with sticky yellow or green discharge can affect one or both eyes usually spread by direct contact only . 

Presbyopia

Presbyopia

What is presbyopia? Presbyopia is a common type of vision disorder that occurs as you age. It is often referred to as the aging eye condition. Presbyopia results in the inability to focus up close, a problem associated with refraction in the eye. How does presbyopia occur? Presbyopia happens naturally in people as they age.The eye is not able to focus light directly onto the retina due to the hardening of the natural lens. Aging also affects muscle fibers around the lens, making it harder for the eye to focus on up-close objects.The ineffective lens causes light to focus behind the retina, causing poor close-up vision. When you are younger, the lens of the eye is soft and flexible, allowing the tiny muscles inside the eye to easily reshape the lens to focus on close and distant objects. Who is at risk for presbyopia? Anyone over the age of 35 is at risk for developing presbyopia. Everyone experiences some loss of focusing power for near objects as they age, but some will notice this more than others. What are the signs and symptoms of presbyopia?

Signs and symptoms include the following:

• Hard time reading small print
  
• The need to hold reading material farther
  than arm’s distance
  
• Problems seeing objects that are close to you
  
• Headaches
  
• Eye strain
  If you experience any of these symptoms, you may want to visit an eye care professional for a comprehensive dilated eye examination. If you wear glasses or contact lenses and still have these issues, a new prescription might be needed.
  
  Can I have presbyopia and another type of refractive error at the same time?
  Yes. It is common to have presbyopia and another type of refractive error at the same
  time. There are several other types of refractive errors: nearsightedness (myopia), farsightedness (hyperopia), and astigmatism. An individual may have one type of refractive error in one eye and a different type of refractive error in the other.
  

How is presbyopia corrected?
Eyeglasses are the simplest and safest means of correcting presbyopia. Eyeglasses for presbyopia have higher focusing power in the lower portion of the lens. This allows you to read through the lower portion of the lens and clearly see distant objects through the upper portion of the lens. It is also possible to purchase reading eyeglasses. These types of glasses do not require a prescription and can help with reading vision.