A Low Vision Referral from Pediatric Opthalmology
By David Armstrong, OD with Richard J. Shuldiner, OD, FAAO, Chief Clinical Editor
I first saw Lauren a few weeks before her 17th birthday. Her low vision resulted from optic atrophy secondary to optic nerve glioma. Lauren’s pediatric ophthalmologist referred her to me hoping that I’d be able to prescribe low vision glasses that would help her see and function on a higher level.
Optic Atrophy can be caused by several different conditions. Whatever the cause, it can result in profound vision loss.
Lauren’s visual acuity with and/or without her glasses tested at OD: 20/500 OS: CF @ 1 ft. She also demonstrated nystagmus, which is common in people with optic nerve glioma.
Lauren is a Hyperopic Astigmatic with Rx of:
OD +5.50 -2.00 X 43
OS +5.00 -2.50 X 177
Lauren does not wear her glasses as they make no improvement in her vision.
The optic atrophy resulted from a slow-growing brain tumor called an optic nerve glioma. She was been born prematurely at 34 weeks and shortly thereafter was diagnosed with the glioma, located at the optic chiasm. An optic nerve glioma is a rare type of cancer which usually occurs in children. As the tumor enlarges the child’s vision worsens. Fortunately, optic nerve gliomas do not metastasize to other sites in the body. Treatment for the glioma consisted of chemotherapy when she was about 4 years old. In some cases, radiation is used in the treatment, but not in this particular case.
Lauren is being homeschooled and is very skilled at using her iPad as an assistive device. In addition to using a large font on the iPad, she often uses it to take a picture of something like labels or price tags. She then enlarges the picture on the screen in order to see it better. Lauren asked me for help seeing without the iPad.
After taking her acuity with and without glasses I directed Lauren to the hallway of my office. I asked her to observe a lighted EXIT sign about 30 feet from where she was standing. Lauren was barely able to see that there was something there. I demonstrated a pair of 4x binoculars, and she was able to read the sign. Lauren and her father were excited by this demonstration as it proved that magnification would help her see better.
I evaluated her distance vision with several different powers of bioptic telescopic glasses and prescribed 5 X VES Sport II bioptic glasses from Ocutech, Inc. The Sport is a monocular, focusable, Keplarian design bioptic. Lauren read 10/60 OD with the Sport.
I also evaluated Lauren’s near vision with telemicroscopic glasses, but they did not improve her ability to see the iPad.
I did show her how to connect the iPad to her TV so she can read from the large TV screen. That allowed her to use less magnification on the iPad resulting in more words on the screen for easier reading.
Occasionally, people see better with their final bioptic glasses than they did during the low vision evaluation. When Lauren returned to receive her Sport bioptic we were pleasantly surprised to find that with them her acuity was 20/60 OD. She was able to recognize faces at about 30 feet and read license plates from 20 feet. Lauren and her father were very pleased with the improvement that the bioptics made in her vision.
Lauren is a good example of a person with a very significant, life-long vision loss who is capable of improved vision by using low vision glasses. Her pediatric ophthalmologist recognized that a referral to a low vision optometrist could result in greater independence for this nice young lady.