CASE 4
Tom, a 5-year old boy, presented to an optometry practice for a routine sight test. When taking a history his mother reported that Tom had a congenital heart defect, but had experienced no eye problems. However, his visual acuity was recorded as 6/18 in his right eye and 6/6 in the left eye. Cycloplegic refraction revealed a refractive error of +6.00 DS in the right eye and +4.00 DS in the left. Fundus, media and ocular motility examinations were all unremarkable, but cover test without correction revealed a slight exophoria at both near and distance with good recovery. Bagolini lenses and visuoscope tests revealed central suppression in his right eye with parafoveal fixation. Stereoacuity was recorded as 240 seconds of arc, with normal fusional reserves. Full-time glasses wear for 16 weeks yielded no improvements, so part-time occlusion was prescribed for the next 16 weeks, with which the patient was compliant. His right eye VA recovered to 6/6 as a result, but his stereoacuity remained reduced.