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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

Case Analysis i

Liana Al-Labadi, O.D.

case 1 the dissatisfied presbyope
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
case 1 the dissatisfied presbyope1
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)

case 1 the dissatisfied presbyope2
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)
case 1 the dissatisfied presbyope3
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)
case 1 the dissatisfied presbyope4
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.

case 2 blurry vision eval
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

case 2 blurry vision eval1
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

case 2 blurry vision eval2
Case 2- Blurry Vision eval

http://www.revoptom.com/email/ogs_0606v2.htm

case 2 blurry vision eval3
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

case 2 2 week f u
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

case 2 blurry vision eval4
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