1 / 27

Case Analysis I- Lecture 5

Liana Al-Labadi, O.D. Case Analysis I- Lecture 5. If you hear hoof beats, think horses—not zebras. Case 5: The Distance Blur. A 59yo PF, an established patient, c/o blur at distance & difficulty driving at night F requency: Constantly (all the time, everyday) O nset: During the past year

yamka
Download Presentation

Case Analysis I- Lecture 5

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Liana Al-Labadi, O.D. Case Analysis I- Lecture 5

  2. If you hear hoof beats, thinkhorses—not zebras

  3. Case 5: The Distance Blur • A 59yo PF, an established patient, c/o blur at distance & difficulty driving at night • Frequency: Constantly (all the time, everyday) • Onset: During the past year • Location: Both eyes • Duration: Notices it all the time • Associated Factors: • No other symptoms of near vision blur or headaches or glare • Relief: None • Severity: N/A

  4. DIFFERENTIAL DIAGNOSIS????

  5. Case 5: The Distance Blur • POH: • Negative for HA, DIPL, asthenopia, surgery, trauma, pain, F&F • Ophthalmic auras without migraines; No DR/Glc/AMD/Cat • Usually takes off specs to read • She reported previously blurry vision with uncontrolled HTN • Reported an episode of panic attack in the past while driving- could not focus properly • LEE: Last year by Dr. Curtis • FOH: Negative for AMD, DR, Glc, Cat • LPE: Last year by Dr. Nixon • PMH: (+) HTN- controlled with medsa; recently added changed meds (+)Anxiety- Have recently been increasing in frequency (+) Basal cell carcinoma on nose- diagnosed a year ago; treated • FMH: (+) HTN- parents; (+) DMII- father • MED: (+) Lotrel (+) Lorazepam • Allg: NKDA; No seasonal allergies • SH: Reading • Occupation: Clerk • No alcohol consumption & no smoking

  6. Entrance Testing????

  7. Case 5: The Distance Blur • Entrance Testing: • Lensometry: • OD: -1.50 -0.50x 010 • OS: -1.50 -0.50x 160 • DVA (c): 20/50 OD; 20/50 OS • NVA (s): 20/25 OU • Motility: S&F OD, OS • Confrontations: Full OD, OS • Pupils: 4mm/4mm RRL OD, OS; No APD

  8. Additional Testing????

  9. Case 5: The Distance Blur • Cover Test: • (D) : 2pd XP • (N): 4pd EP • Retinoscopy: • OD: -1.00 -1.25x 030 • OS: -1.50 -2.00x 156 • Manifest Refraction: • OD: -1.00 -1.00x 030 VA: 20/20 • OS: -1.00 -1.50x 160 VA: 20/20

  10. Case 5: The Distance Blur • Lensometry: • OD: -1.50 -0.50x 010 VA: 20/20 • OS: -1.50 -0.50x 160 VA: 20/20 • Manifest Refraction: • OD: -1.00 -1.00x 030 VA: 20/20 • OS: -1.00 -1.50x 160 VA: 20/20

  11. Additional Testing????

  12. Case 5: The Distance Blur • SLE: • L/L: Quiet OD, OS • Conj: No injections OD, OS • K: Clear OD, OS • Iris: Flat & brown OD, OS • AC: No cell & no flare/ D&Q OD, OS • Lens: Clear OD, OS (dilated) • IOP (TA): • 15mmHg OD; 15 mmHg OS @ 1:30pm • DFE: Unremarkable OD, OS

  13. FINAL DIAGNOSIS

  14. Case 5: The Distance Blur • Assessment: • Compound myopic astigmatism/ Presbyopia OU • Pt accepted new spec Rx with TF • Internal & external ocular health unremarkable OU • Plan: • Release final distance spec Rx • Pt prefers to take off specs to read • RTC in 1 year for CEE

  15. Case 5: The Distance Blur • 1 month later pt returns to clinic c/o: • Problems with new specs- cannot describe her problem exactly • Frequency: • Notices that when she is looking straight ahead, everything seems fine. As soon as she looks around or begins to walk, things feels disturbing • Onset: Ever since she got the new glasses • Location: Both eyes • Duration: As long as she wears the specs • Associated Factors: None • Relief: Feels better when takes specs off & wears old glasses; Could not wear specs for more than 15-20 minutes • Severity: N/A

  16. Entrance Testing????

  17. Case 5: The Distance Blur • Lensometry: • OD: -1.00 -1.00x 030 • OS: -1.00 -1.50x 160 • DVA (c): 20/20 OD; 20/20 OS • NVA (s): 20/20 OU • Motility: S&F OD, OS • Confrontations: Full OD, OS • Pupils: 4mm/4mm RRL OD, OS; No APD

  18. Additional Testing????

  19. Case 5: The Distance Blur • Cover Test: • No significant change • Manifest Refraction: • No significant change

  20. Other Considerations???

  21. Case 5: The Distance Blur • Change in frame size or shape • Not a factor; pt used the same frame she purchased previously • Base curves • PD • Lens material • Pantoscopic tilt • Glasses adjustment

  22. Other Considerations???

  23. Case 5: The Distance Blur • CASE HISTORY!!! • Patient has been an established patient for 7 years • The new prescription does not seem to be that different from LAST YEAR’S prescription • Patient sheepishly admits that she had been unable to wear last year’s specs because of similar difficulties

  24. Case 5: The Distance Blur • 2 years ago: • MR OD: -1.50 -0.50x 010 OS: -1.50 -0.50x 160 • 1 year ago: • MR OD: -1.00 -1.00x 020 OS: -1.25-1.00x 160 • This year: • MR OD: -1.00 -1.00x 030 OS: -1.00 -1.50x 160

  25. FINAL DIAGNOSIS

  26. Case 5: The Distance Blur • Assessment: • Compound myopic astigmatism/ Presbyopia OU • Difficulty adapting to increased astigmatic Rx • Plan: • Release final distance spec Rx • OD: -1.25-0.75x 020 • OS: -1.25-0.75x 160 • Pt education on adaptation period with new spec Rx • TF new spec Rx in office- pt accepted • RTC in 1 year for CEE or PRN

  27. Case 5: The Distance Blur • Clinical Tips: • Patients who don’t wear specs full time have more difficulty adapting to a change in prescription • A patient with low to moderate CHA may wear specs only when working on the computer • A patient with low to moderate CMA may use the prescription only for driving • For these patients each time they put on their specs, they have to make spatial adaptation to the cylindrical or axis change all over again • Reassure patients that they will adapt to the new Rx – usually works

More Related