8.3 Prescribing Spectacles

The Objectives of Treatment:

  1. Good vision in each eye
  2. Good alignment
  3. Comfort

1. Cycloplegia

  • Younger than 12 months of age – cyclopentolate 0.5% ± phenylephrine 2.5%
  • Older than 12 months of age – cyclopentolate 1.0% ± alcaine ± phenylephrine 2.5%)
  • If this is not successful, consider atropine refraction from 1 to 5 years of age (instil one drop twice a day, for 3 days prior to the appointment)

2. Prescribing Spectacles For:

i. Amblyopia (Ensure Full Time Wear of Glasses)
  • Add plus / minus spheres (as accommodation is not an issue) to maximise visual acuity, asking “Do you prefer lens 1 or 2” etc

Isometropia

  • Astigmatism > + 1.50D
  • Hypermetropia > + 4.00D

Anisometropia

  • Astigmatism > + 1.50D
  • Hypermetropia > + 1.50D
  • Myopia > - 3.0D

ii. Esotropia (Ensure Full Time Wear of Glasses)
  • Fully correct the hypermetropia (do NOT take off any for cycloplegia)
  • Fully correct anisometropia
  • Fully correct astigmatism (adults won’t tolerate a large change in astigmatic correction)
  • If there is a high AC/A ratio, add + 3.0D bifocal with an executive lens bisecting the pupil or a short corridor, wide reading zone multifocal lens
iii. Hypermetropia (No Esotropia)
  • Under correct hypermetropia by approximately +2.0D
  • Fully correct anisometropia
  • Fully correct astigmatism
iv. Astigmatism
  • Under-correct hypermetropia (kids do NOT like full plus correction)
  • Consider giving minus overcorrection if subtracting 2.0D changes the sphere from plus to minus
  • Fully correct anisometropia
  • Fully correct astigmatism
v. Myopia
  • Fully correct myopia
  • Fully correct anisometropia
  • Fully correct astigmatism

3. Management of a Squint

  • Glasses, Patching, Orthoptic Exercises, Surgery

4. Follow-Up

  1. Check glasses are made correctly
  2. Don’t panic when the VA is poorer. Fully corrected hypermetropes may record worse at their first visit following spectacle prescription and it is wise to counsel patients and their parents about this at the time of prescribing glasses. Astigmatic patients take time for vision to improve
  3. Don’t try subjective refraction in younger children under 7 or 8 years of age or in an amblyopic eye. Only consider it once they can read the Snellen chart well

          

All rights reserved. No part of this publication which includes all images and diagrams may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the authors, except in the case of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by copyright law.

Vitreoretinal Surgery Online
This open-source textbook provides step-by-step instructions for the full spectrum of vitreoretinal surgical procedures. An international collaboration from over 90 authors worldwide, this text is rich in high quality videos and illustrations.

© 2021 WESTMEAD EYE MANUAL

Website by WebInjection