At the community clinics where I work, I often work with interesting and challenging patients – some more so than others. It’s always fun going over the details with my students and with colleagues, trying to figure out how we may approach this one patient differently or treat them the same. Here is one such case I’d like to share with you today:
The patient is a 46 year old Caucasian male coming in for his comprehensive eye exam who is complaining of near blur with his current reading glasses. He admits that he doesn’t wear his distance glasses often, and also reports blinking a lot at night.
Health-wise, he is being treated for hyperlipidemia for which he’s taking Lipitor and prediabetes, which is not being medically treated. He has no allergies.
Pupils are normal, confrontation field testing are full, and he is ortho in the distance.
Incoming vision:
OD: +1.00 -2.75 x 167 20/40
OS: +0.75 -0.75 x 108 20/20-2
Add: +1.25
Refraction:
OD: +1.00 -3.50 x 167 20/30
OS: +1.25 -0.75 x 018 20/20
For ocular health, Goldman tonometry is 11/11 mm Hg. Anterior segment shows mild staining inferior corneal staining OU. Posterior segment is generally unremarkable with C/D’s of 0.40round OU.
What’s the reason for this patient’s decreased vision in the right eye?
What additional testing could you do to rule in or out your differential diagnoses?
What are your optical recommendations for this individual?
If this patient gives you their DMV form to fill out, would you recommend that this patient be allowed to drive?
Post your thoughts in the comments below.