Abstract:
Examination of the paediatric population can be challenging. It can also be extremely rewarding and can have a great impact on a child’s long term vision and visual outcome. This thesis presents three case studies/series that cover conditions frequently encountered that the clinician must be adept at managing using an evidence based approach. The topics covered in the case series are: amblyopia treatment, myopia control and vision therapy for intermittent exotropia. A short topic review exploring the diagnosis and management of nonorganic vision loss is also contained within this clinical portfolio as unexplained reduced vision is frequently encountered in paediatric practice. Amblyopia occurs when there is a disruption to the normal visual processing to one or both eyes, in the absence of organic abnormalities, resulting in sub-optimal vision. Anisometropia is the most common cause of amblyopia and this case series demonstrates the traditional therapies which include spectacle correction, patching and atropine penalisation. The results in this case series are comparable with the literature which shows both patching and the use of atropine are equally effective at improving visual acuity. This case of intermittent distance exotropia presented demonstrated successful treatment in a large angle deviation using an optometric approach of over-minused spectacles and vision therapy. This enabled the patient to regain binocularity negating the need for surgery, and overcoming the cosmetic concern. The increasing prevalence of myopia has contributed to recent interest in methods for preventing or controlling progression. The case series presented in this dissertation covers the treatment of myopia with Misight™ soft contact lenses and low dose Atropine. For those who are showing signs of definite progression, the use of myopia control techniques should be suggested as they are safe and effective. Finally, non-organic vision loss, a common childhood condition where there is no refractive or pathological cause for the vision loss, is reviewed. This condition is frequently associated with psychosocial distress and may be linked to an initial organic trigger such as a systemic or ocular condition. Treatment primarily consists of careful explanation of normal findings and reassurance.