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strabismus Accurate correction of the anisometropia is an essential part of amblyopia and strabismus management
Introduction
Refraction should be assessed objectively Refraction should be assessed with and without cycloplegia in order to determine the accommodative component Subjective refraction is used to verify the findings of objective refraction and to find the best possible optical correction for distance and near vision in terms both of vision and comfort
Introduction
First assess the correction for each eye which gives the best visual acuity, then test the patient binocularly, noting: The presence of diplopia
Due to aniseikonia Due to manifest strabismus
The binocular visual acuity for near and distance The patients binocular functions
Introduction
Anisometropia should be fully corrected in young children in order to prevent or treat anisometropic amblyopia Older children and adults may be unable to tolerate a full correction binocularly and the optical correction of the more ametropic may need to be reduced, even if optimum visual acuity is not achieved
Introduction
Large anisometropia may need correction with contact lenses, which should be considered if: Insuperable aniseikonia is present Binocular vision can be restored Binocular visual acuity can be improved
Introduction
Patients with anisometropia may have microtropia with: Foveal suppression scotoma Amblyopia Eccentric fixation on the border of the scotoma Peripheral binocular single vision with
Cycloplegic refraction
defective stereopsis
8 PD esophoria for near, 8 PD for distance 15 PD test: positive Peripheral fusion in free space of 15 Synoptophore: obj/subj: +4 peripheral fusion of 10 central fusion of 7 Stereopsis: Titmus 60, Lang pos !!!!! R/ Soft contact lens LE: +5,00 (-2,25 x 90)
4 PD test: positive 6 PD esophoria for near Synoptophore: obj/subj: -2 peripheral/central fusion of 10 Fusion: 30cm: 18^BT till 14^BN 6m: 10^BT till 8^BN Stereopsis: Titmus 120, Lang pos !!!!!
Cycloplegic refraction:
LE normal No aniseikonia
R/ Glasses: +4,50 BE
Refraction without cycloplegia: RE: +8,00 LE: +3,00 Refraction under cycloplegia: RE: +8,50 LE: +6,00
Optimal correction
PS: RE: myopic aspect CT: no strabismus Stereopsis: negative R/ Glasses: -10,00 (2,75 x 10) plano Full time occlusion LE
RE: -10,00 (-2,75 x 10) LE: +0,50 (-0,25 x 45) LE: normal
R/ RE: Cl 10,00
C-2 x 20
5^ b 135
Automatic refraction:
glasses 2
R/ Glasses:
R/ Glasses:
R/ Glasses:
No more headaches, reads better VA RE: 1.0 cc VA LE: 1.0 sc 8 PD esophoria for near Stereopsis: 60
Conclusion
Check refraction with and without cycloplegia
Accommodation difference
Conclusion
Check peripheral and central fusion
Suppression scotoma present?
Check stereopsis Amblyopia risk from 1D difference in hypermetropia Check microtropia (4^prism test/Gracis biprism)