History Taking:
- Came to have follow up to monitor the stability of refractive error, VA and the compliance of alternate patching therapy.
- Mother claimed that the patient have good vision at near and distance when focus.
On previous visit, patient had been prescribed:
- Unaided alternate patching ½ hour per eye in 1 month with intense near tasks.
- No prescription given yet, need to monitor the stability.
Previous visit findings (9/2/2011):
| | RE | LE |
| Vision (Lea Symbol @3m) | 6/15 | 6/15 |
| BE: 6/9.5 | ||
| Vision(Lea Symbol @40cm) | 6/9.5 | 6/7.5 |
| Retinoscopy | +2.00DS/-1.50DCX10 (6/12-2) | +2.00DS/-2.00DCX10 ( 6/12-1) |
| VA (Lea Symbol @40cm) | BE: 6/12 | |
| Hirschberg test | LE 45⁰ XT | |
| PCT | Distance: 30 ∆ AXT Near: 50 ∆ AXT | |
| Stereopsis (Frisby test) | 215 sec of arc | |
Today’s findings (9/3/2011):
| | RE | LE |
| Vision (Lea Symbol @3m) | 6/9.5-2 | 6/7.5- |
| Vision(Lea Symbol @40cm) | 6/6-2 | 6/9.5 (pt tired) |
| Retinoscopy | +2.00DS/-1.25DCX10 | +2.25DS/-1.75DCX10 |
| VA (Lea Symbol @3m) | 6/9.5 | 6/9.5 |
| VA (Lea Symbol @40cm) | 6/12 | 6/19 (pt tired – lack of attention) |
| Diagnosis | ?? | |
| Management | ?? | |
1. What is the diagnosis of this patient? (clue: remember back the classification of exotropia)
2. What is the management for this patient? Why?
Happy discussing =)
Prepared by Group 3 [Hidayah_Ayu_CheNur_Noely]
selamat berdiskusi kawan2 ;;)
ReplyDeleteEVERYONE PLEASE GET INVOLVE YA!
ReplyDeleteCome on guys...
ReplyDeleteFor your information, please refer total deviation on last visit, since patient came to monitor the stability of refractive error, VA and the compliance of alternate patching therapy.
ReplyDeleteI noticed that the deviation increases than first visit. Or did it not?
ReplyDeletePatient has Basic Alternating Exotropia
But the vision improves than before from the patching exercise.
The refractive error is stabalize though vision does not improves with the correction.
Patient need to continue patching to ensure vision is being balance and good. Since with orthoptics theraphy, the deviation cannot improve and is larger than 25prism diopter. Patient is suitable for option of surgical correction. This may need to be done ASAP since we want to conserve the vision.
Roger and Out...=D
@siti zahirahare you sure about the diagnosis?
ReplyDeletefor treatment, please remember what is the suitable VA according to the age. What the most important before giving any therapy to the paediatric patient? remember, what we need to consider..
salam..
ReplyDeletei think the Dx is alternating Exotropia convergence weakness type since the deviation is larger at near as compared to distance.
based on the age, she supposedly can read up to 6/6. the alternating patching was very helpful for her since it did improve her VA up to 6/7.5. thus, i think continue the alternating patching could possibly increase her VA up to 6/6.
however, the large deviation (>25prism D)can only be corrected with surgical option at this age.
I think the diagnosis would be amblyopia secondary to strabismus (alternating XT, CI type).
ReplyDeleteHow come there's no value on the PCT for the 2nd visit?
Patching seems to have improved the pt's VA. However, VA is still not 6/6. The best mx would be to monitor pt's condition in another 1-2 months time to see any improvement in VA. If by that time VA reaches 6/6, I think we could continue with strabismus mx after ruling out any accommodative factors.
@Nurul Atikah
ReplyDeleteat the age of 4 years old. patient must obtain VA of 6/6 already. Any refractive error at this age must be corrected. But then, some alteration on the possible component of refractive error is necessary.
I prefer to prescribe this gurl with plus correction. It's ok?
DX: alternating Near XT
ReplyDeleteDo we need to prescribe RX? When is the nest TCA? what examination need to be done? is patching still needed?
yes we need to prescribe RX but we can do it in bifocal. the nearest TCA will be after 3 months and patching is needed until we get the best VA and before the emmetropization end.
ReplyDelete@nurlizzz
ReplyDeleteactually i've posted my comment last 2 weeks about the managaments case for thi. Tak perasan plak dia x kuar.The Mx should be:
yes, the Dx is alternating near XT.
No Rx prescription is needed for the time being. we have to ask pt to come again in 6 months to look at the stability of the refractve error, the deviation. no pathing is necessary since the VA 6/9 or greater is no longer considered as amblyopia.
on the next visit we must considered to prescribe pt with spectacle if the Rx is stable.
@azuwanmusa
ReplyDelete*VA 6/9 or better
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