Saturday, August 14, 2010


7 years old/Male/Malay


- Diagnosed with autism since 2 years old.
- Pt is undergoing psychotherapy and is showing good progression. Pt

   also attend speech therapy.

- Father complained that child frequently look too close at near object

   since he was 2-3 years old.

- Father complained that child frequently rubbed BE.

- Eye become red especially when he's in a bad mood.

- Frequently bumped on things when walking and tend to fall down often

   since 2 years old.

- Delay development in reading, spelling, writing & calculation.

- General development history:

    1. Language - Has improved and can count simple number.

    2. Social- Not very good and prefer to be alone.

- General health & ocular history:
   1. Birth history: normal delivery.

   2. Often get high fever since 2007.

   3. Tonsilitis- On Loratadine medication and under ENT observation.

   4. Constipation problem: on medication

    * Loratadine- anti-inflammatory drug.

- Family history:

   1. The only one in family who's autistic.

   2. Unremarkable diseases in family.



RE: Low hyperopic astig (WTR)

LE: Low simple astig (WTR)


  1. What is the suitable management for this case?

    "Selamat Menyambut Bulan Ramadan" :)

  2. additional info:

    we did try measuring his vision with LEA symbol but fail because pt cant understand the instruction given. Since Cardiff visual acuity is not available during hat time, test using small beads were done.
    This patient is able to take small beads.

    kawan2 in group 1 & 2 pls participate in this discussion yer..

    Q: what is the suitable MX for this case :)

    -salam ramadhan from G3 nad G4-

  3. hi..
    i think he should be monitored first to ensure the refractive error is stable after 3 times of TCA before prescription can be given. plz enlighten me if i'm wrong...

  4. Good, so you think a prescription is necessary for this case. Since the patient is autistic do you think a spectacle is the best solution to correct his refractive error if necessary?

  5. first and foremost, monitor ensure the refractive error is stable.
    then, if stabled and he loves to wear glasses.better give him spectacles. if not, he should be given contact lens. that's my opinion.

  6. salam
    i agree with ela...we should monitor the refractor error of this patient..see the progression of the difference in the power. as from the result, he is antimetropia. but, as the power is considered normal for his age,besides emmetropization process is still going on,monitoring is very important.
    monitor the progression of the cylinder power.

    besides vision, there is no other abnormalities remarkable for this patient, thus, annual TCA will do.

    i think the best optical correction for this type patient is contact lens...

    one more thing, motivation from the family is very important for this patient and don't let the patient to be alone.
    environment influences the growth of a child.

  7. regarding this case, i think its better to wait for his RX stable first. Then, can give the prescription. Since the patient is reported always bump on things, so should be tested on stereopsis status of the patient. Of course, with corrected eye.

  8. since the pt is 7-year-old autistic boy with poor speech and social skill, it is hard to get respond from pt.

    so, it is better ask the pt to come again (TCA) when the patient is more matured, more develop in speech and social skill, let's say 3 years later when he is 10 years old..thus, TCA annually is good enough to monitor this pt.

    hopefully time by time, he can manage to respond and cooperate with the examintion.

    interesting experience with autistic children! =)

  9. as for this kid, no immediate management is done since based on his age, his vision is normal. thus, RX is not required for this patient.

    patient is advised to come again once he is able to understand instruction. our concern for next visit is of kos his vision as well as his visual skill.

    my other frens in G3 n G4, anything else to add??

    to Rohaila, Hanan and Aida..tq for ur coopertion :)

  10. let us do a visit to autism center...

    so, we can learn more on this kind of patient, we need more cases, to build experiences

    Group 4, prepare proposal! (i'm from group 4 as well. haha)

  11. Interesting case....

    I'm abit concern with his condition of always bumping into objects and tend to look very near....

    I agree that his RA needs to be monitored before any prescription is done. There is also the fact that the real visual status cannot be achieved since good response cannot be acquired.

    With his current symptom. He doesn't show any indication of latent hyperope i suppose? Does he qualify as a candidate for cyclo refraction?

  12. i don't think we can do anything with this patient as we can't prescribe him with RX as he is so active and i don't think he will be able to wear the glasses properly...
    i think we should monitor him first until he big enough (10-12 years old) so that he can be compliance with the test perform and also the result will be more reliable...

    base on ret & autoref the power is not high only mild hyperope with astig..beside his age is only 7 years old and still in emmetropization process...

  13. zahirah, this patient didn't respond well in most tests. no, it is definately not a latert hyperope.

    It's common in autistic patient to be hyperopic astigmatism. only the degree will detemine whether prescription of correction is necessary or not. everyone is agreed for no vision correction is necessary.

    oN next visit, we must have teller acuity card to check his vision right?



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