Today’s patient is an 8 year old Middle Eastern girl coming in for her first eye exam in this clinic. She was referred over because she had failed a recent vision screening at her pediatrician’s. The patient is otherwise very healthy, has no allergies, and is not taking any medications.
Uncorrected, she is seeing 20/50, 20/30. All confrontation testing is otherwise normal, she is ortho on cover test, and ocular health is all normal with dilation.
Auto refraction results are:
OD: -0.75 -3.75 x 173 20/25-1
OS: -0.25 -2.75 x 180 20/25
Dry refraction results are:
OD: -0.50 -3.00 x 170 20/25
OS: -0.50 -2.00 x 010 20/25
Is it warranted to cyclo this patient?
For me, I was more concerned about getting her astigmatism correct and did not really anticipate getting more hyperopia out of her, so because of that, we just used 1% Tropicamide and 2.5% Phenylephrine.
Damp refraction results are:
OD: -0.50 -3.25 x 170 20/20-2
OS: -0.25 -2.75 x 180 20/25
What are you going to prescribe and what are you going to recommend in terms of wearing time and follow up? Look at the left eye in particular – what are your thoughts on only gaining one line of improvement after refraction?
In the middle of all the testing, she says she was prescribed glasses at the end of school last May but doesn’t like wearing her glasses so she never uses them. She did not bring the glasses with her to the exam.
Does this change your prescription and wearing recommendations? What would you say to the patient and the father present about her vision potential at 8 years old if she wears her glasses or not?
There’s no right or wrong here, obviously. I’m just curious for your thoughts.