civrc university of waterloo march 26, 2017...44 year old male diagnosed with cone dystrophy in 2008...

Dr. Ana M. JuricicLow Vision OptometristThe Clearview InstituteCIVRC – University of Waterloo– March 26, 2017

www.DrJuricic.com www.DrLowVision.com

67 year old woman Inferior decentered pupils with iris atrophy Microphthalmus OU IOL donesis OU Extensive choroidal colobomas OU 25 right XT


Already uses high powered microscopic +24 D reading glasses, wants to read better

Wants to see distance better, enjoys going to the movies and theatre-currently uses a 20 yrold 8X monocular hand held telescope

#1 GOAL : Very self conscious of the physical appearance of her eyes, wants to be able to minimize people noticing them


Manifest refraction:

OD +1.25/-0.50X125 = 20/200 EF

OS +1.25/-0.50X145 20/200-2 EF


2.2X bioptic = 20/80

Beecher 6X = 20/32-2

Beecher 7X (mounted on Eschenbac frame)= 20/32+

More comfortable


Goals – to see movies and theatre, currently using 8X hand held monocular

Already appreciates higher magnification 2.2X bioptic would be sufficient for watching

TV in living room, not as beneficial to see live theatre

Head borne devices would be more advantageous for longer viewing periods.



Prescribed 7X Beecher binocular mounted on an Eschenbach frame with adjustable nosepads


28 D lenticular microscopic glasses for near = read 0.5M

Custom tinted 35% rose brown lenses with a flash mirror coating


77 year old female with histoplasmosis and right cataract

Previously seen 3 yrs ago for a low vision assessment

Wants to see faces and TV better Travels to visit family Currently using a digital magnifier that is

quite helpful


Manifest refraction

OD +1.75/-1.25X046 20/125-2 1 BD

OS +2.00/-1.75X164 20/200-2

ADD +6.00 OD 1M OS 1.6M+

Appreciated CPF 511 immediately


Distance viewing aids:

2.2X sightscope – 20/63-2

2.2X instamount telescope 20/63- OD



2.2X instamount telescope OD (gave her more flexibility than having telescope mounted on frame

65 yr old female originally from Iran with advanced glaucoma that is stable

Xalatan qhs OU

Wants to see faces, TV and be able to sew

Glare is an issue


Manifest Refraction

OD -0.75/-1.00X137 20/125 ADD +4.50 1M

OS -2.75/-0.50X148 20/100+ ADD +4.50 0.8M 3BU

▪ Appreciated 3 BU apprec distance and near when looking binocularly

Ocular Examination:

Old lasik flap OU, P/C IOL OU with mild IOL donesis, c/d 0.95 OU, RPE changes with ERM R>L


Low Vision Devices:

Near: 20 D HH LED magnifier 0.5M, 24 D HH 0.4M

Digital magnifier: 0.32M (liked all modes)

Corning Lenses: apprec corning 450 the best

Distance viewing: 2.2X sightscope 20/40+2


44 year old male Diagnosed with cone dystrophy in 2008 Very photophobic – prefers wearing darkest

possible tinted glasses Wants to see better in distance and near Salesperson for automotive parts supplier

Needs to see sales orders, invoices, spreadsheets

LOVES to cycle and fix bicycles

Manifest Refraction:

OD -2.50/-2.00X081 20/125+

OS -2.25/-1.25X090 20/125+

+3.50 ADD OU – read 0.63 M- OD and 0.63M OS

NOTE: unaided read 0.8M

Corning lenses – no improvement

Preferred dark grey sunglass approx 85% tinted

Distance viewing aids:

2.2X bioptic over current rx = 20/50+

Ocutech 4X VES sport OS = 20/25-3

▪ (read 0.5M – at near with above)

Original eSight eyewear = 20/25+ distance and 0.5M at near

Important goals for patient:

See better distance and near –especially when at work

Something that can help with cycling

Needs to help with his photophobia

Ocutech 4X VES sport OS with polycarbonate transition

lenses in carrier extra polarizing slip in plus tinted grey lens cap for

telescope

82 yr old Eastern European lady with macular degeneration undergoing lucentisinjections every 6 weeks OS

Wants to be able to see faces and read again


Unaided acuities: OD 20/300 EF OS 20/300 EF Manifest Refraction:

OD +2.25 sphere 2 BI 20/200-2

OS +1.75 sphere 2 BI 20/125-

ADD +6.00 OD 2M OS 1.25 M

Ocular findings:

Nuclear sclerosis gr 3 with +2 cortical OU, c/d 0.35 OU, large geographic atrophy OU


Near : did best with 10 D prismatic 1M (with additional small dome read 0.8 M with increased fluency)



Distance 2.2X sightscope clip with current glasses = 20/80+

Her response: “Wow!”

62 year old man with cone dystrophy, works in IT

Very photophobic Currently wearing the original 6X top

mounted ocutech VES – 18 yrs old Wants improved vision and wants to see what

new devices are available (has many low vision aids he currently uses)


Unaided acuity: OD 20/160-2 OS 20/200-2 Manifest Refraction:

OD +2.00/-1.75X004 20/160 +20 D ADD 0.4M

OS +2.25/-1.50X002 20/200-2 +20D ADD 0.63M

Ocular Findings:

Trace corneal clouding OU, N/S gr 2.25 OU, c/d 0.5 OD, 0.6 OS, mottled macula with RPE changes OU


Patient’s current aids:

6X ocutech VES OD from 1998 20/32

16X22 monocular telescope purchased through ebay= 20/25

+16 D double loupe worn on top of +14 lenticular OD – 0.32M

Corning 450 bifocals


Low Vision assessment:

2.2X sightscope clipped to CPF 450 BF=20/80+2

2.2X instamount OD with CPF 450 BF= 20/80+

4X VES sport OD 20/40 (NOTE: do not have 6X VES sport as a demo at the office)

32 D unilens (ordered for another patient) = 0.32M

▪ (patient found slightly too close to read comfortably)


Final recommendations: 6X ocutech VES sport OD with transitions RX

with +20 D add

Ordered tinted sideshieds

2 grey slip behind filters

Dark filter cap for telescope


95 year old lady originally from Jamaica Had cataract surgery OS 8 weeks prior Used to LOVE to read – especially prayer

books and Bible Had 14 children!!


Unaided acuity: OD LP OS 20/160-

(note prior to cataract sx OS was also LP!)

Manifest Refraction:

OD no improvement

OS +0.50/-1.25X100 20/80 ADD +3.00 0.5M-

Ocular Findings:

Hypermature cataract with synechiae OD, P/C IOL OS, no posterior view OD, c/d 0.7 OS, RPE changes


Near viewing (unaided) 24 D HH LED 0.32M

Distance viewing:

2.2X bioptic unaided 20/40

2.2 x FDTS OS with RX = 20/32-


Great example that age should not be the factor determining cataract surgery

Went from Light Perception 3 months prior to seeing 20/32 in distance and 0.32M at near !!!

This lovely lady is now able to read and see the faces of all of her loved ones once again!


Sometimes the solutions may look different...

www.DrLowVision.com

“These glasses may not look pretty,but they are beautiful to me.”

Jane RussellLegendary ActressARMD patient

June 1921 – Feb 28, 2011

Treated by Dr. Shuldiner in October 2007

Thank you!


Email: [email protected] or [email protected]

mailto:[email protected]

civrc university of waterloo march 26, 2017...44 year old male diagnosed with cone dystrophy in 2008...

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