Melissa Valdellon

Patient case for August 11, 2023

This week, we had a 54yo Filipino transgender female coming in for their first eye exam with us. They report distance blurred vision but no near problems, and they don’t have glasses.

Systemically, the patient has been diagnosed with DM2 and is s/p amputation of a toe on their left foot in July. They also have HTN, hypercholesterolemia, osteomyelitis, and history of a left sided stroke February of this year resulting in partial paresis on the right side and some residual speech difficulties. They have no medicinal allergies, and they report good compliance with medications: hydralazine, losartan, carvedilol, metformin, atorvastatin, aspirin, clopidogrel, glipizide, and insulin. Their last blood sugar was 120, but the latest HbA1c was 11.7 from February this year. They have an upcoming appointment with their PCP towards the end of this month and have been going through physical, occupational, and speech therapy since April.

Uncorrected visual acuity was OD 20/200, OS 20/125+1, with pinhole to 20/60, 20/50, respectively. Near VA was OD 0.4/1M, OS 0.4/0.63M.

Pupils, EOMs, and confrontation visual fields were full in both eyes.

The patient refracted to 20/40 OD with -2.75DS, OS 20/30 with -2.25 DS. There was no further improvement with pinhole.

Goldmann tonometry was 12/14 mm Hg. Anterior segment shows 1+ NS OU. Posterior segment was clear of any diabetic retinopathy or macular edema. There were no other remarkable ocular health findings.

What would you do in this case? The patient is certainly recovering from recent surgery still and still undergoing regular therapy for the sequelae of their stroke. Is there anything that could be contributing to this patient’s decreased visual acuity?

Would you prescribe glasses for this patient? How would you like to follow up with them?

Any other thoughts?

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