What is pseudomyopia? Avoiding overcorrection in children

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什么是pseudomyopia，它发生频率？我们怎样才能避免年轻近视过度腐蚀？近视已经定义为折射状态等于，或比-0.50d更低当眼睛住宿放松时.1但是，当容纳系统没有放松时，也可以称为容纳痉挛或假瘤症的瞬时近视，使患者错误地似乎需要更多减去透镜校正力。

This issue may be quite common in our young population: theAnyang童年眼睛研究调查了4500多名学龄儿童的各种因素。Pseudomyopia被定义为在Cycloptgia之前的斜纹膜半球运动术前往的近视，并且在睫状症后少于-0.50d：在迅速下降折射上的emmetropic。减去两者给出了假瘤症的量，并通过自动反射进行措施。2

Almost one-quarter of 6-year-olds were pseudomyopic and 19% of 13-year-olds were pseudomyopic.

这younger children showed mean pseudomyopia of 1.13D and for older children it was 0.38D. Among these children, 1 in 6 were wearing spectacles - which they obviously didn't need. There was not enough statistical power to test if wearing unneeded glasses sped up eventual myopia progression.

这re was no link found between pseudomyopia and time spent on near work or time spent outdoors. After one year, 16% of these 6-year-olds and 11% of the 13-year-olds had become myopic, but this progression was not any faster than in the true myopes.

Concerningly, this study found that 50% of the younger children and 13% of the older children wearing spectacles for myopia were overcorrected by at least 0.50D.只有大约三分之一的人在眼镜上穿着准确的矫正，而10％的年轻人和50％的年龄越来越多被腐败。

Relaxing accommodation: accurate refractions matter

Anyang童年眼睛研究调查了'127光学商店'，并报告说，72％的人没有使用任何方法在折射期间放宽住宿。在四分之一二次使用的雾化方法中，只有3％的术语常规使用近视儿童的第一折射。

Retinoscopy is ideal

Retinoscopy with fogging is an ideal refraction technique as it allows for both an accurate refraction and evaluation of the subsequent binocular vision response. Retinoscopy is the best screening tool for detecting amblyogenic risk and detecting refraction when done by an optometrist or ophthalmologist3,4.并列于Optometry Australia’s paediatric eye care reference guideas the primary refraction technique for children up to age 7, and in theAmerican Optometric Association’s Clinical Practice Guideline on Pediatric Eye and Vision Examination作为学校老年儿童的首选技术。这American Academy of Ophthalmology Pediatric Preferred Practice Guideline on Pediatric Eye Evaluationsagrees, stating that "Patients should undergo cycloplegic refraction to determine refraction with retinoscopy, followed by subjective refinement when possible."

在视网膜镜检查期间雾化未经测试的眼睛收益率导致儿童肿瘤会计结果的0.3D。5雾化量似乎没有影响结果，从+ 1d到+ 5d产生类似的结果。6

儿童，确保足够的加良好住宿是关键。考虑到+2.00'雾化测试'成功检测5-11岁儿童的远视，7这似乎是雾化儿童视网膜镜的合理数量。

When undertaking retinoscopy, fogging the non-tested eye by around +2.00 should be sufficient to achieve a refraction outcome in children within 0.25D of the cycloplegic result.

读An Ode to My Retinoscope对于许多更多的方式，视网膜检查镜可以帮助童年折射到角蛋白酶筛查以隐形眼镜练习。

Cycloplegia is gold standard

A cycloplegic refraction is the hallmark of refractive accuracy and the gold standard for research studies; but theIMI.临床管理指南8don’t necessitate cycloplegic refraction at each examination of a myopic child. Rather they suggest using cycloplegia when indicated, which may vary depending on the practitioner, country, availability and the presentation of the patient. If used, the recommended dosage for cycloplegic refraction is two drops of 1% cyclopentolate or tropicamide given 5 minutes apart. Cycloplegic refraction should be performed 30 to 45 minutes after the first drop is instilled. Read more about this, including clinical presentations where cycloplegia is necessary, inHow to Achieve Accurate Refractions for Children.

Refraction checks to avoid overcorrection

  1. Check presenting acuity against the refractive change.可疑在使用儿童当前校正中测量的无辅助和/或敏感性与折射上发现的变化不符。一行字母应等同于约0.25d。在儿童中，6 / 9.5或20/32的敏锐截止值具有高特异性和灵敏度，用于检测至少-1.00D近视。9
  2. Try the monocular +1.00 blur check.测量新的最佳矫正单眼敏锐度，然后用另一只眼睛遮挡+1.00到一只眼睛。患者应该模糊到6/9到6/12（20/30到20/40）。如果没有发生这种情况，请继续加入更多加号，直到患者的敏锐度模糊到预期水平。然后减少0.25D步骤的电力，鼓励您的患者继续阅读较小的线路，并“赚取额外减去”，直到视力进一步改善。10Some children may be less tolerant of blur and deteriorate from normal acuity to less than 6/12 or 20/40 with the monocular +1.00 - this is just variation and doesn't mean more minus is needed.
  3. 考虑到呢?lation to axial length.虽然不是完美的相关性，但轴向进展的0.4mm等于1.00D左右。11为了避免过度矫正，如果轴向长度仅显示最小的变化，则可疑，较大的屈光变化。
  4. 双目平衡技术。Requiring equal acuity in both eyes, the techniques of alternate occlusion, prism dissociated blur balance, prism dissociated duochrome or Humphriss Immediate Contrast method all show similar accuracy.12Watch Dr Kate Gifford explain an adapted alternate occlusion techniquehere.

进一步阅读假瘤症并避免儿童过度腐败

看看近视镜头的两个小时，强烈实用的在线课程Mastering Refraction for Kids. Upskill with interactive text, downloads, animation and video demonstrations, prescribing advice, test-your-knowledge challenges and more. This course will increase your knowledge, clinical skills and confidence in refraction techniques and prescribing decisions for children of all ages and refractions - not just myopes!Click the link要了解更多并免费尝试前几课。

Cassandra Haines BIO image 2019_white background

About Cassandra

Cassandra Hainesis a clinical optometrist, researcher and writer with a background in policy and advocacy from Adelaide, Australia. She has a keen interest in children's vision and myopia control.

This educational content is brought to you thanks to unrestricted educational grant from

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