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CASE OF THE MONTH

Patient Profile
Age

22 year old

Gender

Female

Last
Eye Exam

October 2019

Current
Rx

None

Medical
History

No Significant History

Chief
Complaint

Glasses Prescription

Uncorrected
Visual Distance

OD 20/100 OS 20/70

Exam Protocol

An auto-refraction was performed by the Visionix VX120. The Manifest refraction was performed by a remote COMT certified technician on the 2020NOW’s Eyelogic X2 Refraction System. Her refraction information is as follows: Autorefraction: OD: -4.75 -8.25 x018 OS: -0.75 -3.25 x141, Manifest Refraction: OD: -4.75 -8.25 x020 20/100 PH 20/40 OS: -0.75 -2.75 x130 20/40 PH NI. There was an immediate concern due to the lack of correction in vision. Upon further investigation, auto-keratometry from the Visionix VX120 was OD: 46.75@018/51.75@108 and OS: 45.50@163/48.50@073. The issue was further emphasized by the additional data provided by Visionix VX120 including topography (below), pachymetry 429um OD and 480um OS, and KPI (keratoconus prediction index) 100% OU. The rest of the examination results were unremarkable including. Color vision was WNL OU. Stereopsis was reduced, which is explained by the overall reduced acuity. Pupil measurements performed by the VX120 are considered inaccurate due the corneal abnormalities and in office were determined to be PERRLA. The anterior segment is evaluated using Eyefficient Firefly S390L digital slit lamp revealed unremarkable lids and lashes OU, normal conjunctiva, steep and thin beam during corneal evaluation OU, a deep and quiet anterior chamber, and clear lenses OU. The IOP taken by the Visionix VX120 is 13 OD and 12 OS. A visual field test was administered on the OCULUS Easyfield C but was unreliable due to poor acuity. The posterior segment was not evaluated during this visit.

Conclusion

The patient’s auto-refraction, manifest refraction, auto-keratometry, topography, and pachymetry all aligned to a clear diagnosis of Keratoconus or Keratoglobus. This is further supported by the alignment to the Visionix VX120 KPI of 100% chance of Keratoconus in this patient. The diagnosis was explained by a remote optometrist through face-to-face real time interaction with the patient and a referral for an evaluation for corneal cross linking and scleral lenses to prevent progression and maximize vision was explained and provided to the patient. Telehealth can play a vital role in making diagnoses of patient and directing them to the proper in-person specialists for appropriate treatments.

PHOTOS

EXAM EQUIPMENT
  • Centervue DRS
  • Oculus Easyfield C
  • Eyefficient Firefly S390L
  • 2020Now Eyelogic X2 Refraction System
  • Topcon CV.5000Phoropter
  • Visionix VX120

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