Hyperopia/ADHD: You Make The Call

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:

Brayden Letter 1

Brayden Letter 2

Brayden Letter 3

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

Brayden KVS


Brayden Cheiro

Manifest Open View Autorefractor Distance and Near:

Brayden Open Auto Printouts

Closed View Autorefractor 1% Cyclpentolate after 15 minutes:

Bryaden Auto Cyclo PrintoutBest 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?


6 thoughts on “Hyperopia/ADHD: You Make The Call

  1. Len, of course my response is facetious in the most cynical way. What the child needs is an adequate Rx for full-time wear, and perhaps we can discuss what the Rx ought to be. Since this sort of Rx also wreaks havoc on accommodation and vergence, I would advise general VT to ensure these are normalised. These at the very least. As for drugs, I would recommend LSD to the other docs involved to keep them busy, and well away from cases like this.

  2. Back to the future with August. Just read the first post. Maybe I have ADHD. So now, how is he holding his pencil to track like that at 5 years old. They have from Bernell colored finger pencil holding guides. Now the young man needs to go back to basics, crawling, bear walking, marsden ball, I mean get on the floor and stay there till the gross motor improves. Just what the OT recommended. August

  3. I agree with you August, however I don’t feel we need to put a great emphasis on getting him on the floor when he was referred to me by an OT who specializes in SI and has already begun working with him “getting on the floor until gross motor improves”. There’s something to be said for collaboration …

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s