REFRACTION IN Anne Cees Houtman CHILDREN UZ …...retinoscopy -0.15 ± 1.31 Cycloplegic AR -0.12 ± 1.41 Int Ophthalmol. 2013 Oct 10. [Epub ahead of print]- abstract Comparison of

Anne Cees

Houtman

UZ-VUB

REFRACTION IN

CHILDREN

M 7 days old 3640

Hyperextensibility joints

Mild retrognathia

Request eye assessment

What are you going to do

11-2-2014 refraction in children 2

WARD REFERRAL

Schisiservaringennl

Externally normal

Clear media

Normal fundi


WARD REFERRAL

Schisiservaringennl

A little history

What determines refraction

What is normal

The 5Wrsquos of refraction

Refractive error

A treatable condition Guidelines for prescribing

Refractive surgery in children

A bonus refraction as a differential diagnostic sign

Refract ion in

chi ldren


OUTLINE


A LITTLE

HISTORY

Tommaso da Modena Treviso

2112014 Refraction in children 6

KEPLER EN DESCARTES


SETTLED OPINIONS AND IGNORANCE

ldquothe mad fashion of wearing glassesrdquo against which we

ldquocannot warn too insistentlyrdquo

(Jaeger 1855)

Young persons wearing glasses were

ldquolooked on as dudesrdquo

(Hoyer 1836)

Text book of ophthalmology Vol IV Errors of refraction p4247 W Stewart Duke-Elder Henry Kimpton London


SCIENTIA TENEBRAS VINCERE

ldquoPhysiological opticsrdquo

(Helmholtz 1856)

ldquoAccommodation and refraction of the eyerdquo

(Donders 1864)

ldquoSkiascopy and its practical applications to the Study of

Refractionrdquo

(Jackson 1895)


11-2-2014 Refraction in children 9

WHAT

DETERMINES

REFRACTION

11-2-2014 10

ORGANOGENESIS

FOXC1

PITX2 neural crest

LMX1B

FOXE3 lens

MAF

CYP1B1 gt P450 enzyme

PAX6

Refraction in children

DEVELOPMENT OF REFRACTION


Cornea

Lens

Axial length



Cornea

Lens

Axial length

Genetics Environment

11-2-2014 Refraction in children

Twin studies

Parental refraction

Ethnicity

E-Asia S-Asia Eur Afr

Hereditary conditions

Visual input

Peripheral retinal defocus

Accommodation

Daylight hours

Education

Geography

Social-economic status

Outdoor activity

LBWIUGR

Maternal ageheight

Cigarettes

Height at adult age

13



ABNORMAL DEVELOPMENT WILL AFFECT REFRACTION



Matta NS Silbert DI High prevalence of amblyopia risk factors in

preverbal children with nasolacrimal duct obstruction JAAPOS 2011

Aug15(4)350-2

WHATrsquoS NORMAL



WHATrsquoS NORMAL


The prevalence of refractive errors among children adolescents and adults in Germany Jobke s et al Clin Ophthalmol 2008 (2) 3 601-7

N=536

WHATrsquoS NORMAL



N=536

Who

What

Where

When

Why

11-2-2014 19 refraction in children

THE 5 WrsquoS OF

REFRACTION

WHO IS GOING TO DO

IT


THE 5 WrsquoS

OF

REFRACTION

WHO IS GOING TO

HAVE IT DONE


THE 5 WrsquoS

OF

REFRACTION

ldquoEVERY CHILD HAS THE RIGHT OF A

CYCLOPLEGIC REFRACTIONrdquo

wwwcommunityniorg

WHO IS GOING TO

HAVE IT DONE


THE 5 WrsquoS

OF

REFRACTION

And remember

ldquoCycloplegic drops ought to be used as if they

were freerdquo

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

ldquoRetinoscopy is the most generally satisfactory and accurate

method for the objective determination of the refractionrdquo Textbook of ophthalmology Duke-Elder S Vol IV London Henry Kimpton 1950 p4386

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION ldquoIt is however an art which cannot be learned

from books for efficiency can only be attained

by long assiduous and painstaking practicerdquo

Textbook of ophthalmology Duke-Elder S Vol IV London Henry Kimpton 1950 p4377

Bowman 1859 CuignetMenginLandolt 1878 Parent 1880

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Retinoscopy simulators

wwweyeontechscom

wwwmrcophthcom ndash test yourself

wwwmedroundorg - $$

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Autorefractors

Retinomax

Plusoptix

Edinburghoptometryca

wwwcalcoastophthalmiccom

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Retinomax

Comparison of the Retinomax autorefractor with hand-held retinoscopy in 1-year old infants

Gole GA et al Clinical and Experimental Ophthalmology 2003 31 341-347

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Plusoptix

N=118 mean age 5

Plusoptix S08 -005 plusmn 161

Cycloplegic retinoscopy -015 plusmn 131

Cycloplegic AR -012 plusmn 141

Int Ophthalmol 2013 Oct 10 [Epub ahead of print]- abstract

Comparison of photorefraction autorefractometry and retinoscopy in children

Demirci G Arslan B Ozsuumltccediluuml M Eliaccedilık M Gulkilik G

UZ-VUB

2013

N=58 ( p r e l i m i n a r y r e s u l t s )


PLUSOPTIX

RETINOMAX

AR amp

RETINOSCOPY

Average non-cyclo ARRM seq RE -005

Average non-cyclo Plusoptix +013

Average cyclo ARRM

+054

And then we found the autorefractors and

retinoscopy may disagree by 275 D (spherical power) in some cases

And 175D for cylindershellip

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

ldquoYour best friendrdquo (D Taylor) Snellen and Landolt 1874

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Cycloplegia

atropine 1h 2w

cyclopentolate 30-60rsquo 48h

tropicamide 20-30rsquo 6h

Residual accommodation (6-12 yrs) tropicamide +047 D than cyclopentolate

(Mutti ea The effect of cycloplegia on measurement of the ocular components IOVS 1994)

Residual accommodation may be as much as 2D more than atropine according

to several authors

side effects hypersensitivity reactions fever dry mouth rapid pulse nausea vomiting

flushing and rarely behavioral changes

(several dozen case reports over a century ndash so probably safe)

WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION

Well anywhere reallyhellip

hellipas long as you do it

httptelemedicineorbisorg

WHEN


THE 5 WrsquoS

OF

REFRACTION

First visit

Check yearly

Frequently pseudophakiaaphakia glaucoma

eyelid lesions

Decrease in VA

Intolerance to glasses

Change in squint angle

WHY


THE 5 WrsquoS

OF

REFRACTION

Importance of vision for general development

Poor growthdevelopment may be associated

with visual problems

And think of refractive error as

a treatable condition (glasses have very few side effects)

a differential diagnostic sign

Guidelines

for

prescribing


A

TREATABLE

CONDITION

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT

Anisometropia hypermetropia 150

astigmatism 200

myopia 200

Isometropia hypermetropia 450

myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT

hyperopia (no tropia) gt +450D

hyperopia with esotropia gt +150D

astigmatism gt 200D

anisohyperopia gt 150D

myopia gt 200D

astigmatism gt 200D

myopia gt -300D

wwwaaoorgeducationlibrarypppindexcfm

MYOPIA

11-2-2014 myopie op de kinderleeftijd 40

Undercorrect or fully correct

The Cochrane Col laborat ion

Interventions to slow progression of myopia in children W a l l i n e J J L i n d s l e y K V e d u l a S S C o t t e r S A M u t t i D O T w e l k e r J D

ldquoLimited evidence favoring ful l correct ionrdquo

Undercorrection of myopia enhances rather than inhibits myopia progression Chung

K V is ion Res 2002422555 -9

The possible effect of undercorrection on myopic progression in children Adler D et

a l C l in Exp Optom 2006 Sep89(5) 315 -21

ldquoConsistent evidence of meaningful benefit with ant i -muscarinic drugs rdquo

HYPERMETROPIA


Accommodation convergence strabismus asthenopia

Well-known since the mid-19 th century but neglected often

Strongly consider partial or full correction in non-strabismic

hypermetropia eg gt +45 D (risk of ametropic amblyopia)

Full correction in strabismus

Hypermetropic correction does not influence emmetropization

I n f a n t H y p e r o p i a D e t e c t i o n D i s t r i b u t i o n C h a n g e s a n d C o r r e l a t e s mdash O u t c o m e s F r o m t h e C a m b r i d g e I n f a n t S c r e e n i n g P r o g r a m s

A t k i n s o n J e t a l O p t o m e t r y a n d V i s i o n S c i e n c e 2 0 0 7 8 4 8 4 ndash 9 6

Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN

Refractive surgery may be

considered in

High anisometropia and isoametropia

associated with amblyopia when standard

treatment fails

Neurobehavioural disorders

Techniques corneal refractive surgery

intraocular surgery


eg

Phakic intraocular lens correction of high ametropia in children with neurobehavioural

disorders Tychsen L Hoekel J Ghasia F Yoon-Huang G Journal of AAPOS 200812282-289

Preop -2275 to -100 D (-149 D N=11 18 eyes)

Directly postop -03 D(+-11)

Regression +06 D (+-15D)

Postop +02 D (+- 08)

Preop UCVA 203400 (logMAR 223 +-057)

Postop UCVA 2057 (logMAR 046 +- 028)

60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION

A differential diagnostic sign

High hypermetropia

Leber congenital amaurosis

Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy


What about that ward referral

Brother RE -12 LE -10

vitreous lacunae

high arched palate gtgt Stickler

Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO


REFRACTION IN CHILDREN

littlefoureyescom

M 7 days old 3640

Hyperextensibility joints

Mild retrognathia

Request eye assessment

What are you going to do


WARD REFERRAL

Schisiservaringennl

Externally normal

Clear media

Normal fundi


WARD REFERRAL

Schisiservaringennl

A little history


What is normal


Refractive error




Refract ion in

chi ldren


OUTLINE


A LITTLE

HISTORY



KEPLER EN DESCARTES





(Jaeger 1855)



(Hoyer 1836)





(Helmholtz 1856)


(Donders 1864)


Refractionrdquo

(Jackson 1895)



WHAT

DETERMINES

REFRACTION

11-2-2014 10

ORGANOGENESIS

FOXC1

PITX2 neural crest

LMX1B

FOXE3 lens

MAF


PAX6




Cornea

Lens

Axial length



Cornea

Lens

Axial length



Twin studies

Parental refraction

Ethnicity



Visual input


Accommodation

Daylight hours

Education

Geography


Outdoor activity

LBWIUGR

Maternal ageheight

Cigarettes

Height at adult age

13








Aug15(4)350-2

WHATrsquoS NORMAL



WHATrsquoS NORMAL



N=536

WHATrsquoS NORMAL



N=536

Who

What

Where

When

Why


THE 5 WrsquoS OF

REFRACTION

WHO IS GOING TO DO

IT


THE 5 WrsquoS

OF

REFRACTION

WHO IS GOING TO

HAVE IT DONE


THE 5 WrsquoS

OF

REFRACTION



wwwcommunityniorg

WHO IS GOING TO

HAVE IT DONE


THE 5 WrsquoS

OF

REFRACTION

And remember


were freerdquo

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF






WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION


wwweyeontechscom


wwwmedroundorg - $$

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Autorefractors

Retinomax

Plusoptix



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Retinomax



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Plusoptix

N=118 mean age 5







UZ-VUB

2013



PLUSOPTIX

RETINOMAX

AR amp

RETINOSCOPY



Average cyclo ARRM

+054




WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION


WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

REFRACTION

First visit

Check yearly


eyelid lesions

Decrease in VA



WHY


THE 5 WrsquoS

OF

REFRACTION







Guidelines

for

prescribing


A

TREATABLE

CONDITION

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

Externally normal

Clear media

Normal fundi


WARD REFERRAL

Schisiservaringennl

A little history


What is normal


Refractive error




Refract ion in

chi ldren


OUTLINE


A LITTLE

HISTORY



KEPLER EN DESCARTES





(Jaeger 1855)



(Hoyer 1836)





(Helmholtz 1856)


(Donders 1864)


Refractionrdquo

(Jackson 1895)



WHAT

DETERMINES

REFRACTION

11-2-2014 10

ORGANOGENESIS

FOXC1

PITX2 neural crest

LMX1B

FOXE3 lens

MAF


PAX6




Cornea

Lens

Axial length



Cornea

Lens

Axial length



Twin studies

Parental refraction

Ethnicity



Visual input


Accommodation

Daylight hours

Education

Geography


Outdoor activity

LBWIUGR

Maternal ageheight

Cigarettes

Height at adult age

13








Aug15(4)350-2

WHATrsquoS NORMAL



WHATrsquoS NORMAL



N=536

WHATrsquoS NORMAL



N=536

Who

What

Where

When

Why


THE 5 WrsquoS OF

REFRACTION

WHO IS GOING TO DO

IT


THE 5 WrsquoS

OF

REFRACTION

WHO IS GOING TO

HAVE IT DONE


THE 5 WrsquoS

OF

REFRACTION



wwwcommunityniorg

WHO IS GOING TO

HAVE IT DONE


THE 5 WrsquoS

OF

REFRACTION

And remember


were freerdquo

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF






WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION


wwweyeontechscom


wwwmedroundorg - $$

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Autorefractors

Retinomax

Plusoptix



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Retinomax



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Plusoptix

N=118 mean age 5







UZ-VUB

2013



PLUSOPTIX

RETINOMAX

AR amp

RETINOSCOPY



Average cyclo ARRM

+054




WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION


WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

REFRACTION

First visit

Check yearly


eyelid lesions

Decrease in VA



WHY


THE 5 WrsquoS

OF

REFRACTION







Guidelines

for

prescribing


A

TREATABLE

CONDITION

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

A little history


What is normal


Refractive error




Refract ion in

chi ldren


OUTLINE


A LITTLE

HISTORY



KEPLER EN DESCARTES





(Jaeger 1855)



(Hoyer 1836)





(Helmholtz 1856)


(Donders 1864)


Refractionrdquo

(Jackson 1895)



WHAT

DETERMINES

REFRACTION

11-2-2014 10

ORGANOGENESIS

FOXC1

PITX2 neural crest

LMX1B

FOXE3 lens

MAF


PAX6




Cornea

Lens

Axial length



Cornea

Lens

Axial length



Twin studies

Parental refraction

Ethnicity



Visual input


Accommodation

Daylight hours

Education

Geography


Outdoor activity

LBWIUGR

Maternal ageheight

Cigarettes

Height at adult age

13








Aug15(4)350-2

WHATrsquoS NORMAL



WHATrsquoS NORMAL



N=536

WHATrsquoS NORMAL



N=536

Who

What

Where

When

Why


THE 5 WrsquoS OF

REFRACTION

WHO IS GOING TO DO

IT


THE 5 WrsquoS

OF

REFRACTION

WHO IS GOING TO

HAVE IT DONE


THE 5 WrsquoS

OF

REFRACTION



wwwcommunityniorg

WHO IS GOING TO

HAVE IT DONE


THE 5 WrsquoS

OF

REFRACTION

And remember


were freerdquo

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF






WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION


wwweyeontechscom


wwwmedroundorg - $$

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Autorefractors

Retinomax

Plusoptix



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Retinomax



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Plusoptix

N=118 mean age 5







UZ-VUB

2013



PLUSOPTIX

RETINOMAX

AR amp

RETINOSCOPY



Average cyclo ARRM

+054




WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION


WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

REFRACTION

First visit

Check yearly


eyelid lesions

Decrease in VA



WHY


THE 5 WrsquoS

OF

REFRACTION







Guidelines

for

prescribing


A

TREATABLE

CONDITION

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom


A LITTLE

HISTORY



KEPLER EN DESCARTES





(Jaeger 1855)



(Hoyer 1836)





(Helmholtz 1856)


(Donders 1864)


Refractionrdquo

(Jackson 1895)



WHAT

DETERMINES

REFRACTION

11-2-2014 10

ORGANOGENESIS

FOXC1

PITX2 neural crest

LMX1B

FOXE3 lens

MAF


PAX6




Cornea

Lens

Axial length



Cornea

Lens

Axial length



Twin studies

Parental refraction

Ethnicity



Visual input


Accommodation

Daylight hours

Education

Geography


Outdoor activity

LBWIUGR

Maternal ageheight

Cigarettes

Height at adult age

13








Aug15(4)350-2

WHATrsquoS NORMAL



WHATrsquoS NORMAL



N=536

WHATrsquoS NORMAL



N=536

Who

What

Where

When

Why


THE 5 WrsquoS OF

REFRACTION

WHO IS GOING TO DO

IT


THE 5 WrsquoS

OF

REFRACTION

WHO IS GOING TO

HAVE IT DONE


THE 5 WrsquoS

OF

REFRACTION



wwwcommunityniorg

WHO IS GOING TO

HAVE IT DONE


THE 5 WrsquoS

OF

REFRACTION

And remember


were freerdquo

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF






WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION


wwweyeontechscom


wwwmedroundorg - $$

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Autorefractors

Retinomax

Plusoptix



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Retinomax



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Plusoptix

N=118 mean age 5







UZ-VUB

2013



PLUSOPTIX

RETINOMAX

AR amp

RETINOSCOPY



Average cyclo ARRM

+054




WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION


WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

REFRACTION

First visit

Check yearly


eyelid lesions

Decrease in VA



WHY


THE 5 WrsquoS

OF

REFRACTION







Guidelines

for

prescribing


A

TREATABLE

CONDITION

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

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myopia gt 200D

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Nanophthalmus

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Microphthalmia

XLRS

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High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

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vitreous lacunae


Baby +3 +3


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KEPLER EN DESCARTES





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(Hoyer 1836)





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(Donders 1864)


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11-2-2014 10

ORGANOGENESIS

FOXC1

PITX2 neural crest

LMX1B

FOXE3 lens

MAF


PAX6




Cornea

Lens

Axial length



Cornea

Lens

Axial length



Twin studies

Parental refraction

Ethnicity



Visual input


Accommodation

Daylight hours

Education

Geography


Outdoor activity

LBWIUGR

Maternal ageheight

Cigarettes

Height at adult age

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Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

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website


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astigmatism 200

myopia 200


myopia 300

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f ind the

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astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



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Postop +02 D (+- 08)



60 x

T-test p=000

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Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom





(Jaeger 1855)



(Hoyer 1836)





(Helmholtz 1856)


(Donders 1864)


Refractionrdquo

(Jackson 1895)



WHAT

DETERMINES

REFRACTION

11-2-2014 10

ORGANOGENESIS

FOXC1

PITX2 neural crest

LMX1B

FOXE3 lens

MAF


PAX6




Cornea

Lens

Axial length



Cornea

Lens

Axial length



Twin studies

Parental refraction

Ethnicity



Visual input


Accommodation

Daylight hours

Education

Geography


Outdoor activity

LBWIUGR

Maternal ageheight

Cigarettes

Height at adult age

13








Aug15(4)350-2

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WHATrsquoS NORMAL



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Who

What

Where

When

Why


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REFRACTION

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THE 5 WrsquoS

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WHO IS GOING TO

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wwwcommunityniorg

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wwweyeontechscom


wwwmedroundorg - $$

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Plusoptix



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UZ-VUB

2013



PLUSOPTIX

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Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

REFRACTION

First visit

Check yearly


eyelid lesions

Decrease in VA



WHY


THE 5 WrsquoS

OF

REFRACTION







Guidelines

for

prescribing


A

TREATABLE

CONDITION

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

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recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom




(Helmholtz 1856)


(Donders 1864)


Refractionrdquo

(Jackson 1895)



WHAT

DETERMINES

REFRACTION

11-2-2014 10

ORGANOGENESIS

FOXC1

PITX2 neural crest

LMX1B

FOXE3 lens

MAF


PAX6




Cornea

Lens

Axial length



Cornea

Lens

Axial length



Twin studies

Parental refraction

Ethnicity



Visual input


Accommodation

Daylight hours

Education

Geography


Outdoor activity

LBWIUGR

Maternal ageheight

Cigarettes

Height at adult age

13








Aug15(4)350-2

WHATrsquoS NORMAL



WHATrsquoS NORMAL



N=536

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N=536

Who

What

Where

When

Why


THE 5 WrsquoS OF

REFRACTION

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IT


THE 5 WrsquoS

OF

REFRACTION

WHO IS GOING TO

HAVE IT DONE


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OF

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wwwcommunityniorg

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were freerdquo

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wwweyeontechscom


wwwmedroundorg - $$

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Autorefractors

Retinomax

Plusoptix



WHAT ARE YOU GOING

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Retinomax



WHAT ARE YOU GOING

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Plusoptix

N=118 mean age 5







UZ-VUB

2013



PLUSOPTIX

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Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

REFRACTION

First visit

Check yearly


eyelid lesions

Decrease in VA



WHY


THE 5 WrsquoS

OF

REFRACTION







Guidelines

for

prescribing


A

TREATABLE

CONDITION

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom


WHAT

DETERMINES

REFRACTION

11-2-2014 10

ORGANOGENESIS

FOXC1

PITX2 neural crest

LMX1B

FOXE3 lens

MAF


PAX6




Cornea

Lens

Axial length



Cornea

Lens

Axial length



Twin studies

Parental refraction

Ethnicity



Visual input


Accommodation

Daylight hours

Education

Geography


Outdoor activity

LBWIUGR

Maternal ageheight

Cigarettes

Height at adult age

13








Aug15(4)350-2

WHATrsquoS NORMAL



WHATrsquoS NORMAL



N=536

WHATrsquoS NORMAL



N=536

Who

What

Where

When

Why


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REFRACTION

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THE 5 WrsquoS

OF

REFRACTION

WHO IS GOING TO

HAVE IT DONE


THE 5 WrsquoS

OF

REFRACTION



wwwcommunityniorg

WHO IS GOING TO

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THE 5 WrsquoS

OF

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were freerdquo

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OF

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WHAT ARE YOU GOING

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TO DO


THE 5 WrsquoS

OF

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wwweyeontechscom


wwwmedroundorg - $$

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TO DO


THE 5 WrsquoS

OF

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Autorefractors

Retinomax

Plusoptix



WHAT ARE YOU GOING

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OF

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Retinomax



WHAT ARE YOU GOING

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THE 5 WrsquoS

OF

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Plusoptix

N=118 mean age 5







UZ-VUB

2013



PLUSOPTIX

RETINOMAX

AR amp

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Average cyclo ARRM

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Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

REFRACTION

First visit

Check yearly


eyelid lesions

Decrease in VA



WHY


THE 5 WrsquoS

OF

REFRACTION







Guidelines

for

prescribing


A

TREATABLE

CONDITION

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

11-2-2014 10

ORGANOGENESIS

FOXC1

PITX2 neural crest

LMX1B

FOXE3 lens

MAF


PAX6




Cornea

Lens

Axial length



Cornea

Lens

Axial length



Twin studies

Parental refraction

Ethnicity



Visual input


Accommodation

Daylight hours

Education

Geography


Outdoor activity

LBWIUGR

Maternal ageheight

Cigarettes

Height at adult age

13








Aug15(4)350-2

WHATrsquoS NORMAL



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N=536

WHATrsquoS NORMAL



N=536

Who

What

Where

When

Why


THE 5 WrsquoS OF

REFRACTION

WHO IS GOING TO DO

IT


THE 5 WrsquoS

OF

REFRACTION

WHO IS GOING TO

HAVE IT DONE


THE 5 WrsquoS

OF

REFRACTION



wwwcommunityniorg

WHO IS GOING TO

HAVE IT DONE


THE 5 WrsquoS

OF

REFRACTION

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were freerdquo

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION



WHAT ARE YOU GOING

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THE 5 WrsquoS

OF






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TO DO


THE 5 WrsquoS

OF

REFRACTION


wwweyeontechscom


wwwmedroundorg - $$

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TO DO


THE 5 WrsquoS

OF

REFRACTION

Autorefractors

Retinomax

Plusoptix



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Retinomax



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Plusoptix

N=118 mean age 5







UZ-VUB

2013



PLUSOPTIX

RETINOMAX

AR amp

RETINOSCOPY



Average cyclo ARRM

+054




WHAT ARE YOU GOING

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THE 5 WrsquoS

OF

REFRACTION



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION


WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

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Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

REFRACTION

First visit

Check yearly


eyelid lesions

Decrease in VA



WHY


THE 5 WrsquoS

OF

REFRACTION







Guidelines

for

prescribing


A

TREATABLE

CONDITION

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom



Cornea

Lens

Axial length



Cornea

Lens

Axial length



Twin studies

Parental refraction

Ethnicity



Visual input


Accommodation

Daylight hours

Education

Geography


Outdoor activity

LBWIUGR

Maternal ageheight

Cigarettes

Height at adult age

13








Aug15(4)350-2

WHATrsquoS NORMAL



WHATrsquoS NORMAL



N=536

WHATrsquoS NORMAL



N=536

Who

What

Where

When

Why


THE 5 WrsquoS OF

REFRACTION

WHO IS GOING TO DO

IT


THE 5 WrsquoS

OF

REFRACTION

WHO IS GOING TO

HAVE IT DONE


THE 5 WrsquoS

OF

REFRACTION



wwwcommunityniorg

WHO IS GOING TO

HAVE IT DONE


THE 5 WrsquoS

OF

REFRACTION

And remember


were freerdquo

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF






WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION


wwweyeontechscom


wwwmedroundorg - $$

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Autorefractors

Retinomax

Plusoptix



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Retinomax



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Plusoptix

N=118 mean age 5







UZ-VUB

2013



PLUSOPTIX

RETINOMAX

AR amp

RETINOSCOPY



Average cyclo ARRM

+054




WHAT ARE YOU GOING

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THE 5 WrsquoS

OF

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WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION


WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

REFRACTION

First visit

Check yearly


eyelid lesions

Decrease in VA



WHY


THE 5 WrsquoS

OF

REFRACTION







Guidelines

for

prescribing


A

TREATABLE

CONDITION

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom



Cornea

Lens

Axial length



Twin studies

Parental refraction

Ethnicity



Visual input


Accommodation

Daylight hours

Education

Geography


Outdoor activity

LBWIUGR

Maternal ageheight

Cigarettes

Height at adult age

13








Aug15(4)350-2

WHATrsquoS NORMAL



WHATrsquoS NORMAL



N=536

WHATrsquoS NORMAL



N=536

Who

What

Where

When

Why


THE 5 WrsquoS OF

REFRACTION

WHO IS GOING TO DO

IT


THE 5 WrsquoS

OF

REFRACTION

WHO IS GOING TO

HAVE IT DONE


THE 5 WrsquoS

OF

REFRACTION



wwwcommunityniorg

WHO IS GOING TO

HAVE IT DONE


THE 5 WrsquoS

OF

REFRACTION

And remember


were freerdquo

WHAT ARE YOU GOING

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THE 5 WrsquoS

OF

REFRACTION



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF






WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION


wwweyeontechscom


wwwmedroundorg - $$

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Autorefractors

Retinomax

Plusoptix



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Retinomax



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Plusoptix

N=118 mean age 5







UZ-VUB

2013



PLUSOPTIX

RETINOMAX

AR amp

RETINOSCOPY



Average cyclo ARRM

+054




WHAT ARE YOU GOING

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THE 5 WrsquoS

OF

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WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

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WHAT ARE YOU GOING

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THE 5 WrsquoS

OF

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Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

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myopia gt 200D

astigmatism gt 200D

myopia gt -300D


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K V is ion Res 2002422555 -9




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cont roversial


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Microphthalmia

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High myopia

CSNB

Congenital glaucoma

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FAS

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vitreous lacunae


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Parental refraction

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Visual input


Accommodation

Daylight hours

Education

Geography


Outdoor activity

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PLUSOPTIX

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Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

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WHY


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for

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PRESCRIBING

WHAT

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website


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astigmatism 200

myopia 200


myopia 300

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f ind the

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astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



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Postop +02 D (+- 08)



60 x

T-test p=000

WHY


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Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

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High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


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wwwcommunityniorg

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wwwmedroundorg - $$

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WHAT ARE YOU GOING

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N=118 mean age 5







UZ-VUB

2013



PLUSOPTIX

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Average cyclo ARRM

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Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

REFRACTION

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WHY


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for

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TREATABLE

CONDITION

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PRESCRIBING

WHAT

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website


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astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

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astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

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High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

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High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

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littlefoureyescom





Aug15(4)350-2

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What

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Why


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wwwcommunityniorg

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wwweyeontechscom


wwwmedroundorg - $$

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Retinomax

Plusoptix



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Retinomax



WHAT ARE YOU GOING

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N=118 mean age 5







UZ-VUB

2013



PLUSOPTIX

RETINOMAX

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Average cyclo ARRM

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Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

REFRACTION

First visit

Check yearly


eyelid lesions

Decrease in VA



WHY


THE 5 WrsquoS

OF

REFRACTION







Guidelines

for

prescribing


A

TREATABLE

CONDITION

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

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WHYhellip

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littlefoureyescom

WHATrsquoS NORMAL



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N=536

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What

Where

When

Why


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WHO IS GOING TO

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wwwcommunityniorg

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WHAT ARE YOU GOING

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wwweyeontechscom


wwwmedroundorg - $$

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Retinomax

Plusoptix



WHAT ARE YOU GOING

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Retinomax



WHAT ARE YOU GOING

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THE 5 WrsquoS

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Plusoptix

N=118 mean age 5







UZ-VUB

2013



PLUSOPTIX

RETINOMAX

AR amp

RETINOSCOPY



Average cyclo ARRM

+054




WHAT ARE YOU GOING

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OF

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TO DO


THE 5 WrsquoS

OF

REFRACTION


WHAT ARE YOU GOING

TO DO


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Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

REFRACTION

First visit

Check yearly


eyelid lesions

Decrease in VA



WHY


THE 5 WrsquoS

OF

REFRACTION







Guidelines

for

prescribing


A

TREATABLE

CONDITION

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

WHATrsquoS NORMAL



N=536

WHATrsquoS NORMAL



N=536

Who

What

Where

When

Why


THE 5 WrsquoS OF

REFRACTION

WHO IS GOING TO DO

IT


THE 5 WrsquoS

OF

REFRACTION

WHO IS GOING TO

HAVE IT DONE


THE 5 WrsquoS

OF

REFRACTION



wwwcommunityniorg

WHO IS GOING TO

HAVE IT DONE


THE 5 WrsquoS

OF

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were freerdquo

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WHAT ARE YOU GOING

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WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

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wwweyeontechscom


wwwmedroundorg - $$

WHAT ARE YOU GOING

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Retinomax

Plusoptix



WHAT ARE YOU GOING

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Retinomax



WHAT ARE YOU GOING

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Plusoptix

N=118 mean age 5







UZ-VUB

2013



PLUSOPTIX

RETINOMAX

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Average cyclo ARRM

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WHAT ARE YOU GOING

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THE 5 WrsquoS

OF

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WHAT ARE YOU GOING

TO DO


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OF

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Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

REFRACTION

First visit

Check yearly


eyelid lesions

Decrease in VA



WHY


THE 5 WrsquoS

OF

REFRACTION







Guidelines

for

prescribing


A

TREATABLE

CONDITION

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

WHATrsquoS NORMAL



N=536

Who

What

Where

When

Why


THE 5 WrsquoS OF

REFRACTION

WHO IS GOING TO DO

IT


THE 5 WrsquoS

OF

REFRACTION

WHO IS GOING TO

HAVE IT DONE


THE 5 WrsquoS

OF

REFRACTION



wwwcommunityniorg

WHO IS GOING TO

HAVE IT DONE


THE 5 WrsquoS

OF

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were freerdquo

WHAT ARE YOU GOING

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OF

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WHAT ARE YOU GOING

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WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

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wwweyeontechscom


wwwmedroundorg - $$

WHAT ARE YOU GOING

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Autorefractors

Retinomax

Plusoptix



WHAT ARE YOU GOING

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Retinomax



WHAT ARE YOU GOING

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Plusoptix

N=118 mean age 5







UZ-VUB

2013



PLUSOPTIX

RETINOMAX

AR amp

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Average cyclo ARRM

+054




WHAT ARE YOU GOING

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OF

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WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

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WHAT ARE YOU GOING

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Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

REFRACTION

First visit

Check yearly


eyelid lesions

Decrease in VA



WHY


THE 5 WrsquoS

OF

REFRACTION







Guidelines

for

prescribing


A

TREATABLE

CONDITION

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

Who

What

Where

When

Why


THE 5 WrsquoS OF

REFRACTION

WHO IS GOING TO DO

IT


THE 5 WrsquoS

OF

REFRACTION

WHO IS GOING TO

HAVE IT DONE


THE 5 WrsquoS

OF

REFRACTION



wwwcommunityniorg

WHO IS GOING TO

HAVE IT DONE


THE 5 WrsquoS

OF

REFRACTION

And remember


were freerdquo

WHAT ARE YOU GOING

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OF

REFRACTION



WHAT ARE YOU GOING

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THE 5 WrsquoS

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WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

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wwweyeontechscom


wwwmedroundorg - $$

WHAT ARE YOU GOING

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Autorefractors

Retinomax

Plusoptix



WHAT ARE YOU GOING

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Retinomax



WHAT ARE YOU GOING

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Plusoptix

N=118 mean age 5







UZ-VUB

2013



PLUSOPTIX

RETINOMAX

AR amp

RETINOSCOPY



Average cyclo ARRM

+054




WHAT ARE YOU GOING

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THE 5 WrsquoS

OF

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WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

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WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

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Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

REFRACTION

First visit

Check yearly


eyelid lesions

Decrease in VA



WHY


THE 5 WrsquoS

OF

REFRACTION







Guidelines

for

prescribing


A

TREATABLE

CONDITION

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

WHO IS GOING TO DO

IT


THE 5 WrsquoS

OF

REFRACTION

WHO IS GOING TO

HAVE IT DONE


THE 5 WrsquoS

OF

REFRACTION



wwwcommunityniorg

WHO IS GOING TO

HAVE IT DONE


THE 5 WrsquoS

OF

REFRACTION

And remember


were freerdquo

WHAT ARE YOU GOING

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THE 5 WrsquoS

OF

REFRACTION



WHAT ARE YOU GOING

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THE 5 WrsquoS

OF






WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION


wwweyeontechscom


wwwmedroundorg - $$

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Autorefractors

Retinomax

Plusoptix



WHAT ARE YOU GOING

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THE 5 WrsquoS

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Retinomax



WHAT ARE YOU GOING

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THE 5 WrsquoS

OF

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Plusoptix

N=118 mean age 5







UZ-VUB

2013



PLUSOPTIX

RETINOMAX

AR amp

RETINOSCOPY



Average cyclo ARRM

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WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

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WHAT ARE YOU GOING

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THE 5 WrsquoS

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Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




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myopia gt 200D

astigmatism gt 200D

myopia gt -300D


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Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

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High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

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Gyrate Atrophy




vitreous lacunae


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littlefoureyescom

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Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

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THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

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eyelid lesions

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abounds


PRESCRIBING

WHAT

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WHAT


astigmatism 200

myopia 200


myopia 300

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f ind the

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astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

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considered in



treatment fails



intraocular surgery


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60 x

T-test p=000

WHY


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High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

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High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

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littlefoureyescom

WHO IS GOING TO

HAVE IT DONE


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were freerdquo

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wwwmedroundorg - $$

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Retinomax

Plusoptix



WHAT ARE YOU GOING

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Retinomax



WHAT ARE YOU GOING

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N=118 mean age 5







UZ-VUB

2013



PLUSOPTIX

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Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

REFRACTION

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eyelid lesions

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WHY


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for

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TREATABLE

CONDITION

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abounds


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WHAT

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website


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astigmatism 200

myopia 200


myopia 300

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f ind the

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astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



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Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

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High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

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WHYhellip

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littlefoureyescom

WHAT ARE YOU GOING

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OF

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wwweyeontechscom


wwwmedroundorg - $$

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Retinomax

Plusoptix



WHAT ARE YOU GOING

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N=118 mean age 5







UZ-VUB

2013



PLUSOPTIX

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Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

REFRACTION

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eyelid lesions

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WHY


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for

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TREATABLE

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abounds


PRESCRIBING

WHAT

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recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF






WHAT ARE YOU GOING

TO DO


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OF

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wwweyeontechscom


wwwmedroundorg - $$

WHAT ARE YOU GOING

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Autorefractors

Retinomax

Plusoptix



WHAT ARE YOU GOING

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Retinomax



WHAT ARE YOU GOING

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Plusoptix

N=118 mean age 5







UZ-VUB

2013



PLUSOPTIX

RETINOMAX

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Average cyclo ARRM

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WHAT ARE YOU GOING

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WHAT ARE YOU GOING

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THE 5 WrsquoS

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Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

REFRACTION

First visit

Check yearly


eyelid lesions

Decrease in VA



WHY


THE 5 WrsquoS

OF

REFRACTION







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for

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A

TREATABLE

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abounds


PRESCRIBING

WHAT

RCOphth

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recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION


wwweyeontechscom


wwwmedroundorg - $$

WHAT ARE YOU GOING

TO DO


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OF

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Autorefractors

Retinomax

Plusoptix



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

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Retinomax



WHAT ARE YOU GOING

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Plusoptix

N=118 mean age 5







UZ-VUB

2013



PLUSOPTIX

RETINOMAX

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Average cyclo ARRM

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WHAT ARE YOU GOING

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Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

REFRACTION

First visit

Check yearly


eyelid lesions

Decrease in VA



WHY


THE 5 WrsquoS

OF

REFRACTION







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for

prescribing


A

TREATABLE

CONDITION

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Autorefractors

Retinomax

Plusoptix



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

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Retinomax



WHAT ARE YOU GOING

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THE 5 WrsquoS

OF

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Plusoptix

N=118 mean age 5







UZ-VUB

2013



PLUSOPTIX

RETINOMAX

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Average cyclo ARRM

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WHAT ARE YOU GOING

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WHAT ARE YOU GOING

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THE 5 WrsquoS

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WHAT ARE YOU GOING

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THE 5 WrsquoS

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Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

REFRACTION

First visit

Check yearly


eyelid lesions

Decrease in VA



WHY


THE 5 WrsquoS

OF

REFRACTION







Guidelines

for

prescribing


A

TREATABLE

CONDITION

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Retinomax



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

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Plusoptix

N=118 mean age 5







UZ-VUB

2013



PLUSOPTIX

RETINOMAX

AR amp

RETINOSCOPY



Average cyclo ARRM

+054




WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

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WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

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WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

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Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

REFRACTION

First visit

Check yearly


eyelid lesions

Decrease in VA



WHY


THE 5 WrsquoS

OF

REFRACTION







Guidelines

for

prescribing


A

TREATABLE

CONDITION

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Plusoptix

N=118 mean age 5







UZ-VUB

2013



PLUSOPTIX

RETINOMAX

AR amp

RETINOSCOPY



Average cyclo ARRM

+054




WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION


WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

REFRACTION

First visit

Check yearly


eyelid lesions

Decrease in VA



WHY


THE 5 WrsquoS

OF

REFRACTION







Guidelines

for

prescribing


A

TREATABLE

CONDITION

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

UZ-VUB

2013



PLUSOPTIX

RETINOMAX

AR amp

RETINOSCOPY



Average cyclo ARRM

+054




WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION


WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

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Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

REFRACTION

First visit

Check yearly


eyelid lesions

Decrease in VA



WHY


THE 5 WrsquoS

OF

REFRACTION







Guidelines

for

prescribing


A

TREATABLE

CONDITION

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION



WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION


WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

REFRACTION

Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

REFRACTION

First visit

Check yearly


eyelid lesions

Decrease in VA



WHY


THE 5 WrsquoS

OF

REFRACTION







Guidelines

for

prescribing


A

TREATABLE

CONDITION

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

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High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

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Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

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littlefoureyescom

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

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WHAT ARE YOU GOING

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THE 5 WrsquoS

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Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

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First visit

Check yearly


eyelid lesions

Decrease in VA



WHY


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A

TREATABLE

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Cont roversy

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WHAT

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PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

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f ind the

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astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







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Ver y

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Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

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High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

WHAT ARE YOU GOING

TO DO


THE 5 WrsquoS

OF

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Cycloplegia

atropine 1h 2w






to several authors




WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

REFRACTION

First visit

Check yearly


eyelid lesions

Decrease in VA



WHY


THE 5 WrsquoS

OF

REFRACTION







Guidelines

for

prescribing


A

TREATABLE

CONDITION

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

WHERE ARE YOU GOING

TO DO IT


THE 5 WrsquoS

OF

REFRACTION




WHEN


THE 5 WrsquoS

OF

REFRACTION

First visit

Check yearly


eyelid lesions

Decrease in VA



WHY


THE 5 WrsquoS

OF

REFRACTION







Guidelines

for

prescribing


A

TREATABLE

CONDITION

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

WHEN


THE 5 WrsquoS

OF

REFRACTION

First visit

Check yearly


eyelid lesions

Decrease in VA



WHY


THE 5 WrsquoS

OF

REFRACTION







Guidelines

for

prescribing


A

TREATABLE

CONDITION

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

WHY


THE 5 WrsquoS

OF

REFRACTION







Guidelines

for

prescribing


A

TREATABLE

CONDITION

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

Guidelines

for

prescribing


A

TREATABLE

CONDITION

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

Cont roversy

abounds


PRESCRIBING

WHAT

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

RCOphth

Not found

recent ly on

website


PRESCRIBING

WHAT


astigmatism 200

myopia 200


myopia 300

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

AAO

A gain hard to

f ind the

guidel ines


PRESCRIBING

WHAT



astigmatism gt 200D


myopia gt 200D

astigmatism gt 200D

myopia gt -300D


MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

MYOPIA







K V is ion Res 2002422555 -9




HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

HYPERMETROPIA










Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

Ver y

cont roversial


REFRACTIVE

SURGERY IN

CHILDREN


considered in



treatment fails



intraocular surgery


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom


eg



Preop -2275 to -100 D (-149 D N=11 18 eyes)



Postop +02 D (+- 08)



60 x

T-test p=000

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

WHY


THE 5 WrsquoS

OF

REFRACTION


High hypermetropia


Achromatopsia

Nanophthalmus

Cornea plana

Microphthalmia

XLRS

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

WHY


THE 5 WrsquoS

OF

REFRACTION


High myopia

CSNB

Congenital glaucoma

Megalocornea

FAS

Stickler

Stargardt

Gyrate Atrophy




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom




vitreous lacunae


Baby +3 +3


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom


SOhellip

Think refraction

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

WHYhellip

BECAUSE WE HAVE TO



littlefoureyescom

Documents

REFRACTION IN Anne Cees Houtman CHILDREN UZ …...retinoscopy -0.15 ± 1.31 Cycloplegic AR -0.12 ± 1.41 Int Ophthalmol. 2013 Oct 10. [Epub ahead of print]- abstract Comparison of