A 20 year old Persian female came in for her first eye exam in the states last week and was complaining of blurred distance vision with her current pair of glasses as well as some itchy eyes for the past three months. She’s systemically healthy, isn’t taking any medications, and has no medical allergies.
All confrontation testing was normal.
Incoming VAs with glasses were:
OD: -3.00 -3.25 x 031 20/400, pinhole 20/40
OS: plano -2.50 141 20/40
Refraction results were:
OD: -6.00 -3.00 x 037 20/40
OS: -0.75 -3.50 x 150 20/40
Ocular health showed some trace papillae and otherwise myopic looking discs that were obliquely inserted, right>left.
For the ocular allergies, we recommended OTC allergy drops to be used as needed.
In terms of refractive error, this certainly looks like refractive amblyopia, which is what the student was leaning towards when she came in for the final consultation. However, what questions would you ask to help confirm this diagnosis or rule it out? What other testing could you do as well? Are there any other differentials for her decreased visual acuity given an unremarkable dilated ocular health exam?