14. Parent fails to bring child in for cycloplegic refraction

A young patient's mother is insistent that he doesn't need spectacles but, in your opinion he should be wearing them. What should you do?

Scenario

Two weeks ago Sophie Edwards brought her four-year-old son Johnny for his first eye examination. He had just started pre-school, and the teacher noticed that he wasn’t concentrating as much as the other children and suggested that Sophie brought him to an optometrist. Sophie told you that she only brought him to you to keep the teacher happy, and she is sure that his eyes are fine. She really doesn’t want him to wear spectacles, as she doesn’t like the look of children in specs. She is also worried that wearing specs will make him stand out from the others at school. 

Johnny was not very communicative, but you estimated that his unaided vision was about R 6/24 and L 6/36. A brief cover test revealed no manifest squint and the ophthalmoscopy reflex appeared dull. He did not demonstrate any stereopsis on the Lang II or Titmus tests.

Retinoscopy showed:

R +6.00/-5.00 x 175
L +6.50/-6.00 x 10

(VA not possible as he was getting tired). 

You told Sophie that Johnny will need specs, will need to wear them all the time to improve his visual acuity, and if he does not have them his visual acuity may be reduced for the rest of his life. However, you need to get him back for a cycloplegic refraction to make sure you are giving him the best possible prescription. Sophie has since made two appointments for a cyclo refraction for Johnny, but has failed to turn up to either. 

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