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.