Okay! its a new semester, with a new clinic rotation, and my first pt 8:30 on a hot Monday morning comes in...
48-yr old black female presents with a chief complaint of blurry vision @ distance and near. She reported that she experienced this ocular complaint before, but did not seek help or treatment in the last 20 yrs. (Thats right! She hasnt seen an eye doctor in T-W-E-N-T-Y yrs!!!). Her systemic history included hypertension and anemia, for which she is properly treated for.
Her best-corrected visual acuity measured 20/80 OD and 20/20 OS. External examination was normal, and there was no evidence of afferent pupillary defect. Biomicroscopy was unremarkable. Intraocular pressure measured at 20 mm Hg OU. Dilated funduscopy found quiet posterior poles with no peripheral pathology except for two retinal holes at the ora serrata OD (I KNOW, RIGHT? Can you believe I got out THAT far...Whoop! Whoop!=P)
Diagnosis and Management
The diagnosis in this case is refractive amblyopia, aka lazy eye, which is defined as poor vision due to lack of development of the visual system to the brain but the eye structure and function is normal. Treatment included prescribing the patient's refractive error. Since she hasnt worn glasses in over 20yrs and, therefore adapted to the poor vision in her right eye anyway, I cut the prescription of her right eye in half to minimize lense thickness. More importantly, I cut her Rx in half to prevent anisokonia, a difference of image size on the retina of each eye due to anisometropia, a difference of refractive error of two eyes, which would lead to more ocular complaints.
She was completely aware of her 'challenged' eye since she was a child but chose not to particatpate in patching therapy and chose not to ever wear glasses. And to make matters worse, annual eye exams were a foreign concept to her. A twenty yr grace period is waaaaaaay too long to wait before getting another eye exam. The lesson learned simply put...DON'T BE LAZY!
until next time...