The document discusses guidelines for prescribing eyeglasses in children based on visual acuity tests, manifest and cycloplegic refraction results. It presents several case studies of children ages 3 to 6 years old with various eye alignment and refractive error characteristics. For each case, it asks the reader to choose the best prescription from a set of options, then provides the recommended answer. The overall document provides an educational test to teach practitioners the proper procedure for determining eyeglass prescriptions in young children.

1. Prescribing
Eyeglasses in
Children
POST-TEST
by
Alvina Pauline D. Santiago, MD
Pediatric Ophthalmology
© AP Santiago 2019. All rights reserved.
#eyeglasses4kids

2. © AP Santiago 2019. All rights reserved.#eyeglasses4kids
© AP Santiago 2019. All rights reserved.#eyeglasses4kids

3. Post-Test
© AP Santiago 2019. All rights reserved.#eyeglasses4kids

4. 1. 3 years old, orthotropic
u VA:
RE 20/50 single
optotype
LE 20/40 single
optotype
u Manifest refraction:
unable
u Cycloplegic
refraction:
RE: +3.00
LE: +2.50
A. Observe
B. Prescribe full cycloplegic
refraction
RE: +3.00
LE: +2.50
C. Prescribe half the cycloplegic
refraction
RE: +1.50
LE: +1.25
D. Prescribe reduced plus from
cycloplegic refraction
RE: +2.00
LE: +1.50
© AP Santiago 2019. All rights reserved.#eyeglasses4kids

5. 2. 6 years old, orthotropic
u VA:
RE 20/50 linear
LE 20/40 linear
u Manifest refraction:
RE +1.00 20/40
LE +0.50 20/30
u Cycloplegic refraction:
RE: +3.00
LE: +2.50
A. Observe
B. Prescribe full cycloplegic refraction
RE: +3.00
LE: +2.50
C. Prescribe half the cycloplegic refraction
RE: +1.50
LE: +1.25
D. Prescribe manifest refraction
RE: +1.00
LE: +0.50
E. Prescribe reduced plus from cycloplegic
refraction
RE: +2.00
LE: +1.50
© AP Santiago 2019. All rights reserved.#eyeglasses4kids

6. 3. 3years old, esotropic
u VA:
RE 20/50 single
optotype
LE 20/40 single optotype
u Manifest refraction:
unable
u Cycloplegic refraction
(Tropicamide):
RE: +3.00
LE: +2.50
u Cycloplegic refraction
(Atropine):
RE: +4.50
LE: +4.00
A. Observe
B. Prescribe full atropine cycloplegic
refraction
RE: +4.50
LE: +4.00
C. Prescribe half the atropine
cycloplegic refraction
RE: +2.25
LE: +2.00
D. Prescribe reduced plus from
atropine cycloplegic refraction
RE: +3.00
LE: +2.50
© AP Santiago 2019. All rights reserved.#eyeglasses4kids

7. 4. 3 years old, exotropic
u VA:
RE 20/50 single optotype
LE 20/40 single optotype
u Manifest refraction:
unable
u Cycloplegic refraction
(Tropicamide):
RE: +3.00
LE: +2.50
u Cycloplegic refraction
(Atropine):
RE: +4.50
LE: +4.00
A. Observe
B. Prescribe full atropine cycloplegic
refraction
RE: +4.50
LE: +4.00
C. Prescribe half the atropine
cycloplegic refraction
RE: +2.25
LE: +2.00
D. Prescribe reduced plus from
atropine cycloplegic refraction
RE: +3.00
LE: +2.50
© AP Santiago 2019. All rights reserved.#eyeglasses4kids

8. 5. 6 years old, exotropic
u VA:
RE 20/50 linear
LE 20/40 linear
u Manifest refraction:
RE +1.00 20/40
LE +0.50 20/30
u Cycloplegic refraction
(tropicamide):
RE: +3.00
LE: +2.50
u Cycloplegic refraction
(atropine):
RE: +4.50
LE: +4.00
A. Observe
B. Prescribe full cyclopentolate
cycloplegic refraction
RE: +3.00 LE: +2.50
C. Prescribe half the cycloplegic
refraction
RE: +1.50 LE: +1.25
D. Prescribe manifest refraction
RE: +1.00 LE: +0.50
E. Prescribe reduced plus from
cycloplegic refraction
RE: +2.00 LE: +1.50
F. Prescribe full atropine refraction
RE: +4.50 LE: +4.00
© AP Santiago 2019. All rights reserved.#eyeglasses4kids

9. 6. 6 years old, esotropic
u VA:
RE 20/50 linear
LE 20/40 linear
u Manifest refraction:
RE +1.00 20/40
LE +0.50 20/30
u Cycloplegic refraction
(tropicamide):
RE: +3.00
LE: +2.50
u Cycloplegic refraction
(atropine):
RE: +4.50
LE: +4.00
A. Observe
B. Prescribe full cyclopentolate
cycloplegic refraction
RE: +3.00 LE: +2.50
C. Prescribe half the cycloplegic
refraction
RE: +1.50 LE: +1.25
D. Prescribe manifest refraction
RE: +1.00 LE: +0.50
E. Prescribe reduced plus from
cycloplegic refraction
RE: +2.00 LE: +1.50
F. Prescribe full atropine refraction
RE: +4.50 LE: +4.00
© AP Santiago 2019. All rights reserved.#eyeglasses4kids

10. Post-Test
ANSWERS
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11. 1. 3 years old, orthotropic
u VA: RE 20/50 single
optotype
LE 20/40 single
optotype
u Manifest refraction:
unable
u Cycloplegic refraction:
u RE: +3.00
u LE: +2.50
A. Observe
B. Prescribe full
cycloplegic refraction
RE: +3.00
LE: +2.50
C. Prescribe half the
cycloplegic refraction
RE: +1.50
LE: +1.25
D. Prescribe reduced plus
from cycloplegic
refraction
RE: +2.00
LE: +1.50
© AP Santiago 2019. All rights reserved.#eyeglasses4kids

12. 2. 6 years old, orthotropic
u VA:
RE 20/50 linear
LE 20/40 linear
u Manifest refraction:
RE +1.00 20/40
LE +0.50 20/30
u Cycloplegic refraction:
RE: +3.00
LE: +2.50
A. Observe
B. Prescribe full cycloplegic refraction
RE: +3.00
LE: +2.50
C. Prescribe half the cycloplegic refraction
RE: +1.50
LE: +1.25
D. Prescribe manifest refraction
RE: +1.00
LE: +0.50
E. Prescribe reduced plus from cycloplegic
refraction
RE: +2.00
LE: +1.50
© AP Santiago 2019. All rights reserved.#eyeglasses4kids

13. 3. 3 years old, esotropic
u VA:
RE 20/50 single
optotype
LE 20/40 single optotype
u Manifest refraction:
unable
u Cycloplegic refraction
(Tropicamide):
RE: +3.00
LE: +2.50
u Cycloplegic refraction
(Atropine):
RE: +4.50
LE: +4.00
A. Observe
B. Prescribe full atropine
cycloplegic refraction
RE: +4.50
LE: +4.00
C. Prescribe half the atropine
cycloplegic refraction
RE: +2.25
LE: +2.00
D. Prescribe reduced plus from
atropine cycloplegic refraction
RE: +3.00
LE: +2.50
© AP Santiago 2019. All rights reserved.#eyeglasses4kids

14. 4. 3 years old, exotropic
u VA:
RE 20/50 single optotype
LE 20/40 single optotype
u Manifest refraction:
unable
u Cycloplegic refraction
(Tropicamide):
RE: +3.00
LE: +2.50
u Cycloplegic refraction
(Atropine):
RE: +4.50
LE: +4.00
A. Observe
B. Prescribe full atropine cycloplegic
refraction
RE: +4.50
LE: +4.00
C. Prescribe half the atropine
cycloplegic refraction
RE: +2.25
LE: +2.00
D. Prescribe reduced plus from
atropine cycloplegic refraction
RE: +3.00
LE: +2.50
© AP Santiago 2019. All rights reserved.#eyeglasses4kids

15. 5. 6 years old, esotropic
u VA:
RE 20/50 linear
LE 20/40 linear
u Manifest refraction:
RE +1.00 20/40
LE +0.50 20/30
u Cycloplegic refraction
(tropicamide):
RE: +3.00
LE: +2.50
u Cycloplegic refraction
(atropine):
RE: +4.50
LE: +4.00
A. Observe
B. Prescribe full cyclopentolate
cycloplegic refraction
RE: +3.00 LE: +2.50
C. Prescribe half the cycloplegic
refraction
RE: +1.50 LE: +1.25
D. Prescribe manifest refraction
RE: +1.00 LE: +0.50
E. Prescribe reduced plus from
cycloplegic refraction
RE: +2.00 LE: +1.50
F. Prescribe full atropine refraction
RE: +4.50 LE: +4.00
© AP Santiago 2019. All rights reserved.#eyeglasses4kids
Then Push Plus

16. 6. 6 years old, exotropic
u VA:
RE 20/50 linear
LE 20/40 linear
u Manifest refraction:
RE +1.00 20/40
LE +0.50 20/30
u Cycloplegic refraction
(tropicamide):
RE: +3.00
LE: +2.50
u Cycloplegic refraction
(atropine):
RE: +4.50
LE: +4.00
A. Observe
B. Prescribe full cyclopentolate
cycloplegic refraction
RE: +3.00 LE: +2.50
C. Prescribe half the cycloplegic refraction
RE: +1.50 LE: +1.25
D. Prescribe manifest refraction
RE: +1.00 LE: +0.50
E. Prescribe reduced plus from cycloplegic
refraction
RE: +2.00 LE: +1.50
F. Prescribe full atropine refraction
RE: +4.50 LE: +4.00
© AP Santiago 2019. All rights reserved.#eyeglasses4kids
Reduced Plus,
good VA