Amblyopia with Eccentric Fixation

New Case-5/C/F

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 2: CASE 1 (New case)

SUBJECTIVE

• 5/M/M 
• Patient was referred from Eye Specialist Clinic IIUM 
• Pt wear spectacle since 2 years old 
• Parent had noticed his eyes nystagmus since he is 2 years old 
• No hx of ocular trauma 
• Allergy to dust 
• Born as healthy and full term baby 
• Pt like to watch TV closely 
• No c/o headache

EXAMINATION RESULT

	RE	LE
VA aided @3m (Lea symbol) @40cm (Lea symbol)	6/30 6/24	6/30 6/24
Current Rx	-4.00DS/-1.00DCX180	-4.00DS/-1.00DCX10
Refraction	-6.00DS/-0.75DCX180 (6/15-2)	-6.00DS/-1.00DCX10 (6/15-2)
PCT without glasses : Distance Near PCT with glasses :  Distance Near	10˚pd BO 35˚pd BO 8˚pd BO 12˚pd BO
Stereopsis	Patient cannot appreciate
Hirschsberg	LE 15˚ temporally reflex at pupil margin

TENTATIVE DIAGNOSIS:

1.   Myopic amblyopia

     2.      Infantile ET 

     3.      Nystagmus blockage syndrome
 

MANAGEMENT:

•   Prescribe new glasses with full prescription

           RE: -6.00DS/-0.75DCX180 (6/15^-2)

           LE: -6.00DS/-1.00DCX10 (6/15^-2)

     # The glasses is prescribed to improve his vision since the finding reveal that new Rx can achieve 6/15^-2 which is better than his VA with current spectacle

      # This is also as a step to treat amblyopia

• TCA 1/12 to review his VA with prescribed glassses