A female Chinese girl age 5 years old was came to Paediatrics clinic for fully eye check-up. She has no complaint of blurring of vision at distance and near and has no headache. But her mother claimed that she unable to get the most Visual Acuity according to her age during Eye test in her kindergarten school. Her mother had bring her to optical shop for refraction but had been refuse since she is very young girl. This patient had never wear glasses before, she was full term delivery baby and generally healthy, undergone ear operation before. Below are the full report of her eye examination.
Objective
VA | RE | LE | ||
Distance Unaided: 6/9¯³ Ph: 6/9¯³ | Distance Unaided: 6/18⁺¹ Ph: 6/9 | |||
Near: N6@25cm | Near: N6@25cm | |||
PD Distance: Near: | 27.0 mm | 27.0 mm | ||
25.5 mm | 25.0 mm | |||
Hirrschberg | Central & symmetry | |||
NPC | TTN, TTN, TTN | |||
OMT | SAFE | |||
Retinoscopy | -0.50 DS/ -0.75DC x180 | 6/9⁺¹ | -0.50 DS/ -0.50 DC x 180 | 6/9 |
Subjective Refraction | -0.25 DS/-0.50 DC x140 | 6/9⁺³ N5 | -0.50 DS/ -0.50 DC x 180 | 6/9 N5 |
Post Refraction (CT) Distance: Near: | Orthophoria Orthophoria | |||
Stereopsis | 50” of arc, Stereofly test | |||
Ophthalmoscope (visuoscope) | 0.5˚ superior nasal unsteady EF | Central fixation | ||
Neutral Density Filter VA ∞: | 0.6 log; 6/9¯³ | 0.9 log; 6/9¯³ | ||
Asessment / Diagnosis
1. Bilateral low compound myopic astig
2. BE amblyopia , RE with Eccentric Fixation (EF)
Plan / Management
1. Prescribe full correction for full time wearing
2. TCA 2/52 to ask level of comfort with RX and to check on EF, do visuoscope one more time
Group 1
Group 1
in this case when we can start to treat the amblyopic eye? how to manage bilateral amblyopia?
ReplyDeletewe need to treat this patient as early as possible. any delay, will cause poor prognosis.
ReplyDeletesince pt has uncorrected refractive error, we need to prescribe full correction for full time wearing as stated above. then, equalize the VA on both eyes.
perhaps, any G1 members can elaborate more =)
-Hidayah-
It's the only treatment given is full correction? How about RE with EF? Does the EF need to be treated first?
ReplyDelete1 more Q..it's possible to do patching? May be alternate patching?
ReplyDeletesalam, i would like to ask, when do we usually start the patching therapy for amblyopic patient?
ReplyDelete