Welcome to question of the day #307

Eyetools question of the day #307

I examined an 11-year-old boy in my community eye care practice last week. He had 6/24 in his right eye and 6/5 in his left. He had moderate astigmatic hyperopia in his right eye and plano in his left. I prescribed glasses but was unsure. Will his right visual acuity improve?

I saw a similar patient last week. His mother was short-sighted and wanted an examination because her son had never had an eye examination before. Neither the mother of the boy had any visual concerns. His educational development was slower than expected for his age, his general health was good, no medication, and his uncle had been diagnosed with hydrocephalus at a young age. The boy did not have any headaches.

His vision with both eyes together was 6/5. So far so good but when I covered his left eye much to my and his mother’s surprise he couldn’t get better than 6/24. With his left, he was 6/5. His mother felt bad for not spotting his eye problem. But I reassured her that it is difficult to spot poor vision in one eye when the other eye sees very well. For near he could read N12 with his right and N5 with his left.

His eyes were straight on distance and near cover test, and his colour vision was normal as was his fundoscopy. He could manage the Titmus fly but none of the Wirt circles or animals.

On retinoscopy, I found right +2.00/+1.00 x 95 and left plano. This amount of hyperopic astigmatism aligned well with the reduced right vision. The boy had anisometropic amblyopia.

I advised glasses for all school work, gaming, TV watching, and homework but not for sports and rough and tumble activities.

I advised a review for three months’ time to check that his right visual acuity is moving toward 6/6. It might never get to 6/5 but I expect it to reach at least 6/9 within three months and eventually 6/6 if his glasses-wearing compliance is good.