A 22-year-old black female presented complaining of blurry vision in both eyes while driving. The problem was worse at night. She explained that she had noticed this problem for the last five years but that it did not bother her enough to check it out. She also mentioned that during her last eye exam, the doctor told her that her right eye was not correctable to 20/20.
She had no previous history of injury, surgery or eye turn. Her systemic history was unremarkable, and she denied taking medications.
Her best-corrected acuity was 20/30 O.D. and 20/20 O.S. at distance and near. There was no improvement upon pinhole. Her external examination found reduced stereopsis (80 seconds of arc at 16 inches) with no global stereopsis and intermittent suppression. Cover testing found no tropia and <5 prism diopters of exophoria. Visual fields, color vision and pupils were normal, with no afferent defect.
Retinoscopy revealed 0.75 0.75 x 120 for 20/50 O.D. and 0.25D sphere for 20/20 O.S. Subjective refraction revealed 3.75 100 x 120 for 20/30 O.D. and 0.50D sphere for 20/20 O.S. Keratometry measured 44.00D O.U. with good quality of the mires. Autorefraction uncovered 3.75D O.D. and 0.25D O.S.
Biomicroscopy found normal anterior segment structures. IOP measured 20mm Hg O.U.
The photographs demonstrate the pertinent fundus findings. There was no peripheral pathology O.U.
Does this case require any additional tests? What is your diagnosis? How would you manage this patient? What is the likely prognosis?
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Thanks to Kevin Brown, O.D., for contributing this case.