High astigmatism in pediatrics is one of the most common challenges optometrists face in the exam room. In this Case Reflection episode, Amrit walks through a case where she approached a young patient’s high astigmatism in a way that went beyond the standard playbook.
Instead of reaching straight for a full cycloplegic refraction and prescribing the high numbers, we undercorrected strategically and focused on the binocular vision issue driving the child’s visual symptoms. The result? The child’s acuity improved, their visual system developed more efficiently, and they didn’t have to rely on an unnecessarily high refractive error.
In this episode, we explore why high astigmatism often shows up in pediatric exams, talk about the limitations of relying only on cycloplegia, and share how functional prescribing and binocular vision treatment can transform outcomes.
If you’ve ever wondered how to manage high pediatric prescriptions in a way that supports long-term visual development rather than just clearing up the chart, this is an episode you don’t want to miss!
You can learn more from the following resources:

1. Lens Power in Action by Robert Kraskin


2. Optometric Management of Nearpoint Vision Disorders by Martin H. Birnbaum 


3. Pediatric Eye Care Masterclass course


4. OEPF Art & Science Course

The Four Eyes Podcast is brought to you by YoungOD Connect