Those of you who are optometrists reading this will recall your student days when a clinical instructor presented a topic by saying: “I just had a case like this come in to my office yesterday …” Well as coincidence would have it (as David Cook might add, or not …) I had a 5 year-old in the office this afternoon who exemplified the two most recent blog topics, hyperopia/literacy and ADHD. A little background first, and you can cobble together the essentials from three key passages I’ve extracted from the referring OT’s nine page report:
Some key findings (all unaided):
VA: OD = 20/40- and OS = 20/40- at distance and near
Randot Forms: Correct >/= 250 seconds of arc
Keystone Visual Skills: Distance fusion with esophoria/ Near diplopia high esophoria
Cheiroscopic Tracing significant eso shift
Manifest Open View Autorefractor Distance and Near:
Closed View Autorefractor 1% Cyclpentolate after 15 minutes:
Best Visual Acuities With Tentative Rx:
Manifest (“Dry”) OD: +1.75-1.00 cx 180 = 20/30- and OS: +1.25-1.00 cx 180 = 20/30-
Cycloplegic (“Wet”) OD and OS +2.50 – 1.50 cx 180 = 20/25-
One more tidbit. Brayden has an older brother who has accommodative esotropia. The same pediatric ophthalmologist who Rxed glasses for his brother (single vision) saw Brayden 5 months ago, and said that everything was fine, and no Rx or other intervention was necessary at that time.
What’s your call?