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Abstract: A 4-year-old girl with poor visual acuity was admitted to kindergarten for a physical examination, so she went to our hospital and was found to be hyperopic in both eyes. After informing her parents, she was given glasses to correct her visual acuity and combined with amblyopia training. 3 months later, the child’s corrected visual acuity and naked eye visual acuity improved and no further decrease in visual acuity occurred.
Basic information】Female, 4 years old
Disease Type】Farsightedness with astigmatism and amblyopia
Hospital】The First Affiliated Hospital of Zhengzhou University
Date of Consultation】May 2021
Treatment Plan】Dilated eye examinations (atropine sulfate eye gel) + prescription lenses + amblyopia training
Treatment Period】Outpatient optometry and prescription, review after 3 months
Effectiveness】Improved corrected visual acuity and naked eye vision
I. Initial consultation
The child was 4 years old and was found to have substandard visual acuity in both eyes during a physical examination in kindergarten. Physical examination: both eyes were correctly positioned, and there were no obvious abnormalities in eye movements. He had 0.3 visual acuity in the right eye and 0.3 in the left eye, no obvious abnormalities in the anterior segment and fundus of both eyes, IOP 13 mmHg in the right eye and 12 mmHg in the left eye. compound tropicamide dilated pupillometry: +3.00DS/-2.50DC×160=0.5 in the right eye and +3.00DS/-2.00DC×180=0.5 in the left eye, no obvious abnormalities in the anterior segment and fundus of both eyes. The initial diagnosis was hyperopia with astigmatism and amblyopia.
II. Treatment history
The diagnosis of hyperopia, astigmatism, and amblyopia was clear based on the child’s visual acuity and optometry results, as well as the anatomical structure of the eye. In order to ensure the accuracy of the refractive correction, the child was given atropine sulfate ophthalmic gel to fully dilate the pupil, and the eye was rechecked after 5 days of medication. 5 days later, atropine sulfate ophthalmic gel was used to dilate the pupil, and the right eye +5.00DS/-2.75DC×160=0.5, the left eye + The child was given a prescription of +1.25DS/+2.75DC×70 for the right eye and +1.25DS/+2.25DC×90 for the left eye. combined amblyopia training was recommended twice a day and was reviewed in 3 months.
III. Treatment effect
Three months after the first visit, the child’s eye position was corrected, and he usually asked to wear glasses on his own initiative, cooperated well and insisted on training. After another 3-month review, the corrected visual acuity of both eyes was 0.8+ in the right eye and 0.8+ in the left eye, and the corrected visual acuity improved. Atropine sulfate ophthalmic gel dilated optometry: +4.00DS/-2.25DC×160=0.8+ in the right eye and +4.00DS/-2.25DC×178=0.8 in the left eye, with improved naked eye vision. It is recommended to insist on review every six months.
IV. Notes
It is very gratifying that the child can discover the vision loss at an early stage and give timely correction. It is necessary for the family to remind and help the child to develop the habit of wearing glasses throughout the day, once the habit is developed, the child will actively look for glasses to wear after the vision improvement by wearing glasses, thus forming a virtuous cycle, which is conducive to the correction of hyperopia and the treatment of amblyopia. In addition, in the process of vision improvement, due to the recovery of adjustment, the child may appear to be orthotropic when wearing glasses, and appear to have internal strabismus when removing the glasses, this situation is normal, with the gradual reduction of the farsightedness, most of them will gradually ease, do not worry too much.
V. Personal insight
The child in this case was not very old at the time of consultation and was very malleable, but the degree of refractive error was deep, so it is necessary to be patient with the prescription and try to develop the child’s visual acuity and visual function to the maximum. Most farsightedness will gradually decrease with age, and most astigmatism is innate and generally does not change much throughout life. Early refractive correction is very important for the treatment of amblyopia and must be taken seriously by the child and parents.