17. Second opinion

13 November 2020

When should you refer your patient?


Kirandeep Kaur, aged 57, comes to you for a second opinion having had her eyes examined at another local practice two weeks ago. She has recently moved to your area and was previously seen at a practice elsewhere in the country. You have not seen her before, but she was not happy with the quality of the sight test at the other local practice, feeling that it was ‘not thorough enough’. She is having no problems with her eyes and does not feel that her vision has got worse in the past few years. You find:

R+2.00/-2.00 x 75 VA 6/18 (no improvement with pinhole)
L +2.75/-1.50 x 90 VA 6/9 (no improvement with pinhole)

Reading add +2.50 gives N5 binoc.

Previous prescription was:

R +1.75/-1.75 x 75
L +1.00/-0.50 x 90

Kirandeep thinks that one eye has always been worse than the other, but cannot remember which one. She has a slight central corneal scar in her LE, which happened as a result of an injury in her twenties which causes her no problems. Ophthalmoscopy, visual field testing, Amsler and IOP are all normal. You phone the previous practice to ask what the VA was and they tell you she was seeing 6/6 in both eyes two weeks ago and there was no note of any corneal scar in either eye.

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