The College of Optometrists

Hi, was just wondering if someone could answer a few questions for me, got my finals in a week!

1. Is it correct that anisometropic amblyopia can be treated at any age? 2. When doing binocular balancing, can you add negative lenses? 3. Should you do reading add monocularly first and then binocularly? i.e to check px has been balanced correctly-

I'v read this in books but it seems to conflict with what I have originally learnt.

Also 4. When assessing tear film, is there anything else we need to check apart from tear prism and TBUT? 5. Do we have to do confrontation? Have heard conflicting views. 6. Can we take a Wratten filter into the ODA station test for a possible CL complication station? 7. Do we have do carry out Maddox rod and Maddox wing tests in the routine? Is cover test and FD measurement enough?

Soz, so many questions, thanx!!

Hi Aahmad

good luck for the finals!

1- yes -Prof. Bruce said in a lecture recently that you can treat refractive and anisometropic at any age. Full rx and see it slowly get better. However, strabismic amblyopia is very stuck after the early years, usually thought to be under nine.

2- Yes you can add negative lenses - negative lenses have a reputation of causing accomodation that they don't truely deserve. Half a dioptre minus is not going to cause some terrible problem and a quarter dioptre is going to do even less. For bin balancing you try to get equally clear images that give similar accom relaxation to each eye.

3- Yes again, do reading add monocularly for the reason you give. Its a valuable last minute check for balancing (and also will detect monocular accomodadtion problems)

4) I don't think so - but you could check for bulbar conjuctival folds common in dry eye, fl. staining especially smile staining. Check for blepharitis - everyone with dry eye will have some degree of blepharitis. (check for that by - eyelid margin smoothness, lashes missing or irregular (maderosis) - lid inflamation. Confrontation is not compulsory - but I really can't see how you can advise anyone about legal standards for driving if you don't do it. (100 degrees horizontal and 30 degrees vertical is legal limit I believe). I personally do it on everyone including kids -I had a kid once with a cerebral tumour and the only sign was the fields. I use a simple target - stick with a small dot which I use for motility and convergence and then I do a quick confronation with it as well , before moving on. For kids I use a stick with a toy duck on the end.

I think you can take a wratten filter into the exam - if you mention to the examiner that you use it to enhance your view - I can't see a problem.

Most people use cover test - and FD only (if you do it at distance - don't forget to do it a near as well)( doing one without the other is not good practice!).

Good luck - steve

hiya

just wondering a random question that in strabismic amblyopes say they can see fine 6/5 in the right eye with a +1.00ds but the other eye after ret and subjective u get +6.00 and this only brings their vision up from 6/60 to 6/24 why is it that most ppl give a balance lens? is it cosmesis? coz wouldn't the px prefer seeing at least a bit better with the poor eye even if it is a few lines???

many thanks

Thanx a lot, Steve, really helped.

Sorry snaik - I have been doing the messenger help for people. It has gone well and really helps.

Yes you are right - putting in a balance lens can be a cop out. You have to discuss with the px if cosmesis is all they want - or if they want better vision in the poorer eye. Then you drop the rx in the poorer eye until it just blurs, and leave it like that. Then open the better eye and do a bin balance (with a powerful lens in the good eye to blur it) and to try to reduce the (poor eye) power a little more.

Well done to think like this!!