Melissa Valdellon

Patient case for September 1, 2023

So recently, we had a 29 year old Hispanic male come in for his comprehensive DM eye exam with a complaint of some mild distance blur in his current glasses. We’d last seen him in spring of 2020 and had found no complications.

Systemically, he was diagnosed with diabetes just 3 years ago and has a current HbA1C of 6.2. He has also been diagnosed with a heart murmur, mixed hyperlipidemia, fatty liver disease, acne, asthma, and major depressive disorder. He is taking an inhaler as needed, atorvastatin, benzoyl peroxide, flonase, sertraline.

His incoming VAs with his 1 year old glasses were:

OD: plano -3.25 x 180  20/30
OS: plano -3.00 x 180  20/30

Pupils, EOMs, confrontation fields are all full.

Refraction results were:

OD: -0.25 -3.75 x 180  20/25
OS: -0.25 -3.25 x 180  20/25

What’s your immediate thought on his visual acuities? It certainly looks amblyogenic, right? Except last year and the year before, he was able to read 20/20 in the right eye and 20/25+2 in the left eye.

What would cause a patient to lose 1-2 lines of acuity at this age, especially given his good diabetes control?

If I tell you that his dilated ocular health exam was all unremarkable, what would you do next? Are there extra tests to do? Referrals to make?

I’m looking forward to the discussion on this one.

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