Sometimes you are just plain surprised at what you find in a seemingly routine infant vision examination. Take Allen here.
There was no family history of any remarkable eye or vision disorders in Allen's family. His parents had not noticed anything unusual, they brought their son in for a routine infant vision assessment because Allen's Grandma thought it would be important - and fun.
Allen had a normal developmental history, he bagan cross crawling at 9 months and walking at one year.
Allen presented in good, alert health. He maintained an interested fixation on the examiner.
Visual acuities were normal with fix and follow, no resistance to occlusion, and normal tracking of preferential looking paddles.
Eye movements were full in all directions of gaze. Eye alignment was normal at the initial visit.
Retinoscopy revealed OD +4.50 OS +5.50 non-cyclopleged and OD +5.50 OS +6.00 with 1% Tropicamide. Pre-cycloplegia Allen exhibited no change to against motion at any distance on nearpoint retinoscopy as a result of his high hyperopia.
Pupillary reaction, visual fields, and external eye health were all normal.
Dilated fundus exam revealed clear mediae, healthy optic nerves, clear maculae, and no peripheral reitnal disease.
This was a substantial hyperopic condition, but absence of eye turn or large esophoria, we set up an appointment to see Allen again in three month intervals.
His hyperopia did not change, the small anisometropia remained, an esophoria began to appear with slow recovery in the left eye. For six months we had the parents patch Allen's right eye for two hours every other day to address a potential amblyopia in the left eye.
At nine months, with more report of intermittent eye turn we prescribed eyeglasses for continuous wear: OD +3.00 OS +4.00.
His photo demonstrates good correction of his refractive error. The family reports no eye turn with his eyeglasses on. Allen is monitored closely for binocular vision status and will soon reach an age where a more accurate acuity and response to Randot Stereo Testing will provide us with our final piece of data to help guide us in Allen's treatment program.