The College of Optometrists

Hi, I had a 5yr old px recently who came in for his first eye examination. Vision was 6/7.5 R+L with BSV distance and near. When I cyclo-ed him, I got about +6.00DS subjectively right and left,with VA 6/7.5 R+L.Px is coming back for a post-cyclo refraction. How should I go about prescribing this px? Thanx

I'm not sure you can do a reliable subjective following cycloplegia but assuming you mean objectively you got +6.00 R & L I'd make sure your supervisor had double checked this as it seems a large Rx for such a small loss of VA.

If you are sure you have two choices you can either issue the full Rx and review in six weeks or issue a partial Rx and review, subsequently increasing the Rx if the patient is coping well.

Actually there is a third option which is to issue no Rx at all but I doubt most of us would be happy with that as +6.00 is a large hypermetropic Rx for someone of 5.

To give him +6.00 from nothing would cause disorientation and he would report blurring. So the findings would have to be reduced to be workable.

Actually, The only points in giving him specs are (1) give him comfortable binocular vision (2) give him comfortable and clear vision. This would minimise the risk of him developing poor convergence, developing a accom related bino problem and eye strain. As he is at school - specs would be important.

So, you can use a cover test and increase the Rx until you see slight exo, or ortho at distance and near AND he reports good vision. An impirical way would be to start with half and then modify slightly for clarity and if that feels 'good'. As a pure guess - i would start at +2.50 R & L.

Was there any family history of squint or hyperopia?

Either way, you would need to have an early recheck to review how he is getting on. It maybe better for him to start wearing the specs for near. The danger here is that he won't wear the glasses much, =hope it gives you some ideas - steve

Thanx!!