Background:
This is a case of a growing child with progressive myopia and with the focus on appropriate myopia control.
A 12-year-old Asian girl who immigrated to USA 2 years ago from Hong Kong with her family, presented for eye exam for new glasses prescription who was accompanied by her father.
According to father, she wore Orthokeratology lenses while in Hongkong but later discontinued due to cost issues and the issue with the care regimen of the contact lenses. She was then given a pair of bifocal glasses which she wore until 2 weeks ago until she broke the glasses. Per father last eye exam was 2 years ago in Hong Kong, no past records were available.
First presentation:
Right eye, vision 20/20 with -8.50DS
Left eye, vision 20/20 with -9.00DS
Patient was prescribed with above glasses, along with +2.00DS add as a progressive addition lens (PALs). The patient and the father were not interested in the OrthoK lenses due to the cost and the care regimen, also were not interested in the BF glasses due to cosmesis/look of the glasses.
Second presentation (6 months f/up:
Right eye, vision 20/20 with -9.00DS
Left eye, vision 20/20 with -9.00DS
Upon examination, it was found that the frame was not fitting well on her face. Patient was prescribed new glasses Rx with +2.00 add for PALs but special note was made to make sure the good fitting frame is selected appropriate for her.
Third presentation: she was followed up again in 6 months:
Right eye, vision 20/20 with -9.00DS
Left eye, vision 20/20 with -9.00DS
Apparently, the progressive glasses were fitting well, and the myopia did not increase.
Fourth follow up in another 6 months again:
Right eye, vision 20/20 with -9.25DS
Left eye, vision 20/20 with -9.25DS
No change in Rx was recommended and she was asked to continue same glasses for until next follow up in 6 months.
Points to be noted on the case record:
Myopia control: the method used was PALs (other methods like corneal lenses like Orthokeratology and contact lenses were not preferred by patient and the family)
Bifocal glasses: Again, patient had tried and did not like due to the line/look of the glasses as the child is in school.
-explore many ideas based upon research articles, with references for the use of PALs for the myopia control
-based on the vision and refractive error above from visit 1 to 4, find out or relate the Axial length measurement as well
-discuss why PALs are important for myopia control especially in children and how this controls the myopia growth
-discuss about consequences of myopia, especially high myopia in school children and chances of failing in school and the certain profession
-also discuss the possibility of family history, environmental factors for myopia-in this case can make up child’s hobby as computer games, arts etc. and less focused on outdoor activities for the increase in myopia
-present a table to show refractive error from visit 1 to 4, include corresponding axial length for each visit (you can estimate)
-also give a plan for, how will you plan this patients’ future care and visit and what changes will you make
-you can add more or modify this information based on the information you obtain, reference is critical.
