QTing (F/10) came for eye examination, mother notices that one of her eyes is inattentive. Mother also reported that she tends to fall down or bangs into things since young and it gets better as she grows. Previously, she was prescribed patching therapy when she was 2years old & she had cycloplegia before. She has never worn any glasses yet.
Vision without glasses
R: 6/9
L: 6/9-
Examination shows:
R: +0.25 (6/9) PHNI N5@33cm
L: +0.25 (6/9-) PHNI N5@33cm
Other assessments show:
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 7 EP (yellow part)
Near: 7 EP (yellow part)
(normal value: 0-1 EP or 0-3 XP @Distance and 0-6 XP @Near)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards
Examination of Stereopsis/3D Vision (Random Dot 3S)
50″
(normal value: 12.5″)
There are 3things that are of concern to us:
- significant esophoria.. esotropia?
- optimal vision cannot be achieved and/or lazy eye/amblyopia?
- reduced stereopsis
We refer for cycloplegic refraction (to put eye drop to temporarily paralyse eye muscles to get the true eye power from eye specialist clinic/hospital only). After we paralyse eye muscles, we may elicit more hyperopic power/longsightedness/plus power and astigmatic power. Sometimes, hyperopic power does not show up during examination.. possibly due to tensed state in which the eyes are in. On top of the eye alignment/posture is being highly esophoric, the eyes may be stuck, unable to accept more hyperopic power in relaxing back the eye systems.
So, for QTing:
- cycloplegic refraction is the first step
- she will then wear glasses full time to correct refractive error/power.. allowing eyes to be at ease for 4-6weeks
- return for follow up
- to assess if her vision is improved to achieving 6/6 vision.. any lazy eye(amblyopia)?
- to assess her eye alignment/esophoric posture.. any squint eye(strabismus)?
QTing is 10yo.. we need to get it sorted out as soon as possible.. optimising her vision to 6/6 vision. If there is strabismus, both eyes are not seeing at the same place(hence reduced 3D vision), and the affected eye will not gain 6/6 vision.
The earlier the intervention/treatment/vision therapy, the better the chance in improving her vision.. especially of concern with strabismus.
* Lazy eye/amblyopia – need vision therapy,VT to improve her vision to 6/6 vision
* Squint eye/strabismus – need vision therapy,VT to improve her vision to 6/6 vision & to train the eye to align properly
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Wearing the optimum power usually is enough to put our eyes at ease for most of us.
Unless if there is underlying issues faced by our eyes, then we can detect & check – which can come in many different ways to tackle them.. such as vision therapy, specialty contact lens, specialty ophthalmic lens and etc.
We may ask a lot & you might be thinking.. “why you ask so many things one? Ci sin…. Gila….” Haha
Normally, we start navigating from your chief complaint. If glasses can settle all, that’s great!
But, sometimes, eyes are in need of some training(more love & care) to strengthen the eye systems like accommodation or vergence (after amblyopia & strabismus are all sorted out pheww).. in which you are required to do some vision therapy(VT) in order to improve the issue. Only by you doing it, will it be improved. Kalau sendiri tak buat VT, memang tak jadi kaodim.
For eg, Convergence Insufficiency(CI) is effectively addressed with vision therapy, as simple as doing pencil push up. Then we will see how it goes again in 4-6weeks. You need to commit & do the exercise, otherwise we can go no further together. Your slight blurry near vision still persists, and we also fail in improving your complaint. How sad! Nangis kita!
We do our best to let you know the things that we do. With that, we hope to foster better understanding between us which translates to better compliance & motivation. These are the things that cannot be seen, only you know it yourself and we know it after we check. It really delights us to see improvement in your VT.. some excitement that keeps us going.. otherwise being an optometrist is pretty boring huh? Manalah spark untuk kita terus kayuh ke depan
No doubt…. compliance & motivation are the big key factors in the success of VT. Most of our VT patients are children. We may ask your children to come back frequently, that is because we want to check & monitor.. allow them to see improvement in their effort too. Otherwise, they will be thinking.. you just ask me do do do only LOL
May the VT spirit be with us all.. as we strive to do better.
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QTing, aunty is so sorry.. I have not asked you regarding your experience with cycloplegia.. it may have caused some discomfort to you in the past.
Perhaps, we will prescribe a temporary pair of relax reading glasses for QTing to use whenever she sees near to help relax the eye systems.. to facilitate in accepting her refractive error/eye power. She has not come back.. we will reschedule her to come back soonest.
We will also attempt Mohindra retinoscopy to elicit her power.