208: Choroidal naevus

I have just examined a 50-year-old woman. She has no symptoms or signs and good vision in each eye. In her left eye, I...

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207: Retinal drusen

I have just examined a 76-year-old female patient. She had some drusen near the fovea in her right eye. Very subtle...

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203: How to pass exams

I’m starting a course as an eye specialist. It’s my first time at college and I’m worried that I won’t be able to cope...

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201: How to study.

I am studying for a qualification in eye care. I read all of the copies of slides the lecturers give me but nothing...

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193: I have just examined an eight-year-old girl. She complains of blurred vision when reading books and also when looking at the board at school. Her parents that her reading and writing skills are poorer than they expect from her advanced spoken language abilities. She is R 6/9, L 6/6, 6/6-2 with both eyes (BE) together. My refraction shows right plano/-0.50 x 45 and left plano/-0.25 x 135. This gives R 6/6, L 6/6/ and BE 6/6. Her parents asked whether glasses are necessary since she could see the same with BE with and without the refractive correction. What should I do?

Small amounts of uncorrected astigmatism especially when oblique can have marked effects on clarity at distance and...

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192: I have just examined a ten-year-old boy complaining of occasional headaches and eye ache when reading. His schoolwork is not going well and his reading ability is that of an 8-year old. He has a refractive error of +0.50 DS in each eye. His accommodative amplitude is 18 dioptres in each eye and 20 with both eyes together. Without refractive correction, he has a very small esophoria and with refractive correction, he is orthophoric at near. His parents are keen for him to have glasses. What should I do?

This is a difficult clinical dilemma. One that I faced a lot in clinical practice as I had a reputation for helping...

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189: I have just received a letter from a patient. He has asked me why I didn’t refer him at his last eye examination with me a year ago. He went to another eye specialist and has been diagnosed with primary open-angle glaucoma. He has been told that he has had glaucoma for around two years. I’ve looked in his clinical records and there is a copy of a referral letter but I can’t remember if I told him I was referring him as a glaucoma suspect. What should I do?

Two of my current medico-legal cases involve claims by patients that they weren’t told by their eye specialist that...

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188: One of my male patients has just presented complaining of no vision in his right eye. He noticed it about an hour ago when he woke up but is not sure if it has been there longer. This is the first time he has experienced this. He is 66 years old, overweight and is taking medicine for high blood pressure. His left visual acuity is ‘perception of light’. What is going on?

This sounds very much like a right central retinal vein occlusion. The most common cause is a blood clot, which...

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180: I’ve just started my first position as an eye specialist in an eye practice in a shopping mall. I saw a 20-year-old female with a long history of type 1 diabetes. She told me she has two reviews with her general practitioner per year and the last one was one month ago when her blood sugar levels were in the normal range. When I examined her retinas both had what looked like soft exudates. There was no one else in the practice to ask for advice. She is coming back next week for a review when a more experienced specialist will be in the practice. The image shows her right retina. The left was the same. What is going on?

I have looked at the image and to me, it looks the ‘soft exudates’ are actually a reflection of the light from your...

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176: Get some sleep

I work in a practice in a shopping mall. I start work at 9 am and work until 9 pm for six days a week and sometimes...

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