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Clinical Conundrums: Case history 6 The latent hypermetrope
As a locum I occasionally come across previous practitioner’s work which raises an eyebrow. However, I came across this young man recently:
Age 10, routine review, asymptomatic.
Previous practitioner reports: +0.50 R&L. No Rx given.Â
RVÂ Â 6/5 Â Â +1.50 =Â Â 6/5
LVÂ Â 6/5 Â Â +1.50 =Â Â 6/5Â
I believe that the level of plus has been previously undetected rather than it appearing as ‘brand new’ (the benefits of the often, sadly, underused retinoscope followed by binocular refraction to confirm my scepticism). Stereopsis (TNO) 60�, cover test, fixation disparity etc - nothing detected with or without the prescription. However, I felt that perhaps there should have been?
Conclusion: No prescription given. I left his parents with the understanding that if he develops any symptoms such as headaches or blurred vision, to return sooner than a year, and that at some stage in the future, should the prescription remain, spectacles may be required. Otherwise I left him alone.
So, first of all - who would have gone on to prescribe and why?
Who would leave him alone as I did?
And how was it missed in the first place?
Comments please?
Priya Morjaria // Oct 28, 2007 at 2:39 pm
I would agree with your management with leaving it alone and not prescribing. However, I would also monitor see him again in 6 months time.
I have recently also come across records when symptoms have been mentioned at previous sight tests and no note has been made. Parents show a concern and are back and you are then wondering what was done before and whether any necessary tests were carried out at the time.
My recent px was a 16 yr old who has been having regular sight tests and was advised he has a ‘colour vision problem’. Records show no results of any colour vision test being done. The px was here toget a form filled as he was getting a medical done to apply for the royal air force.
I feel that maybe sometimes Optoms are failing to record relevant information. Is it sheer ignorance or are we that rushed in a sight test?
Jane Macnaughton // Oct 29, 2007 at 4:31 am
Interesting notion - eye tests ‘rushed’? Now there’s a whole new can of worms!
On the subject if my young patient, yes, I think 6 months seems probably a better interval.
Priya Morjaria // Oct 29, 2007 at 1:36 pm
I would like to discuss this can of worms further.
This summer eye tests were highlighted in the media with the report from ‘Which?’, and I along with the majority of Optoms felt that the report was not dealt with appropriately and sweeping statements about eye tests were made.
However, I also feel that it probably made some Optoms sit up slightly and brush up on some tests that they were ‘opting’ not to do.
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