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Case Analysis i

Case Analysis i. Liana Al-Labadi, O.D. Case 1- The Dissatisfied presbyope. 64yo PM returned 3 weeks after his most recent eye exam c/o poor vision for the computer screen with his new bifocal glasses F requency: How often does it occur? How long do the symptoms last?

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Case Analysis i

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  1. Case Analysis i Liana Al-Labadi, O.D.

  2. Case 1- The Dissatisfied presbyope • 64yo PM returned 3 weeks after his most recent eye exam c/o poor vision for the computer screen with his new bifocal glasses • Frequency: How often does it occur? How long do the symptoms last? • Onset: When did it begin? Sudden or gradual? • Location: Which eye? • Duration: How long has this been going on? • Associated Factors: Are there any other symptoms? Did you have the same problem with old glasses? • Relief: Does anything make the problem go away? • Severity: N/A

  3. Case 1- The Dissatisfied presbyope • Objective Tests? • Lensometry (old glasses): +2.00DS/+2.00 add OU • Lensometry (new glasses): +2.00DS/+2.50 add OU • DVA (c): 20/20 (6/6) OD, OS • NVA (c): 20/20 (6/6) OD, OS • Subjective refraction:+2.00DS OD, OS 20/20 (6/6) +2.50 Add @40cm (6/6)

  4. Case 1- The Dissatisfied presbyope • Assessment: • Hyperopia with presbyopia OU • Poor intermediate vision with current line-bifocals • Plan: • Patient education on presbyopia • Recommend patient obtain one of the following: • Trifocals • Occupational glasses • Or progressive lenses (PALs)

  5. Case 1- The Dissatisfied presbyope • What Rx would you write? • For a trifocal: • Rx with a typical intermediate power of one half the add • +2.00 DS/ +1.25 intermediate/ +2.50 add OD, OS • Educate patient about cosmetic issue s • For occupational bifocals: • +3.25 DS/+1.25 add OD, OS • Educate pt that Rx only for computer & near • For a PAL: • +2.00 DS/ +2.50 add OD, OS(1st time PAL)

  6. Case 1- The Dissatisfied presbyope • Clinical Pearls: • “Never prescribe without understanding the patient’s visual needs” • Always think of the effect of any new prescription on the patient’s needs • Case history is VERY IMPORTANT • Visual needs should be established during case history Werner, L.; Press, L. Clinical Pearls in Refractive Care. Woburn: Butterworth-Heinemann, 2002.

  7. Case 2- Blurry Vision eval • MED: • Combivent • Albuterol • Nifedipine • Lisinopril • 62 YO PF c/o blurry vision at near • POH: Unremarkable • PMH: • COPD, prostate cancer, hypertension, RA, CAD • FOH: Unremarkable • FMH: Family’s medical history • ALL: NKDA • HCTZ • Simvastatin • Sulfasalazine • Etodolac http://www.revoptom.com/email/ogs_0606v2.htm

  8. Case 2- Blurry Vision eval • Entrance Testing: • VA (s): 20/25 OD; 20/25 OS • BCVA: 20/20 OD, OS • Pupils: 3mm/3mm RRL OU; No APD • Conf (FDT N30 Screening): full OD, OS • IOP 26mmHg OS/26mmHg OS @ 8:30am • Pachymmetry: • 540 µm OD/ 535 µm OS • Gonioscopy: • Wide open angles OU http://www.revoptom.com/email/ogs_0606v2.htm

  9. Case 2- Blurry Vision eval http://www.revoptom.com/email/ogs_0606v2.htm

  10. Case 2- Blurry Vision eval • Plan: • Baseline OND photos today • RTC in 2 weeks for 24-2 • HVF & repeat IOP • Consult with internist regarding vascular status • Assessment: • Glaucoma suspect OU • 2˚ ocular HTN • Slightly thin pachs • Normal FDT screening • Blood vessel tortousity • R/O HTN retinopathy http://www.revoptom.com/email/ogs_0606v2.htm

  11. Case 2- 2 week F/U • IOP 24mmHg OD; 24mmHg OS @10am • HVF 24-2: WNL OD, OS • Uncontrolled BP 140/90-150/100 http://www.revoptom.com/email/ogs_0606v2.htm

  12. Case 2- Blurry Vision eval • Plan: • No treatment recommended. RTC in 6 months for DFE/OCT • Pt education on glaucoma • Pt education on risk of blindness • Pt education on the importance of F/U • Assessment: • Glaucoma suspect OU • 2˚ ocular HTN • Slightly thin pachs • Normal HVF 24-2 • STAR risk 14.9% http://www.revoptom.com/email/ogs_0606v2.htm

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