Although optometric programs have incorporated scleral lens (SL) education into their curricula, actual student experiences with SL fitting varies widely. This survey study describes the SL fitting and training experiences of graduating optometry students in US schools and colleges. Participants (323) were fourth-year students preparing to graduate in 2020 (19% response rate). Students appeared to have insufficient SL fitting practice, the median number of SL evaluations completed before graduation was 5 (range 0-110) and 63% reported less than 10 fits. Students with an interest in fitting SLs may wish to pursue additional training opportunities, such as residency, to acquire further experience before achieving sufficient proficiency with SLs.
Amblyopia is a common neurodevelopmental visual disorder for which there are well-established evidence-based treatment paradigms involving appropriate refractive correction followed by occlusion and/or atropine penalization. Nevertheless, evidence is limited for when to cease therapy, particularly for patients with poor compliance, if visual acuity (VA) plateaus at a sub-optimal level. This teaching case report illustrates the clinical dilemma of determining when to cease therapy in a child with residual amblyopia. Although the patient described in the case showed substantial initial VA improvements, amblyopia therapy was prolonged because of reluctance to cease when VA failed to improve beyond 0.4 logMAR. a of referred for and managed using appropriate refractive and lengthy and the plateaued at a This illustrates and for, residual in a for whom patching and prolonged despite We evaluate current evidence and discuss factors that Several risk factors for a poor prognosis were identified in our patient: delayed diagnosis and late onset of treatment, high refractive error, absent stereopsis at presentation and poor compliance. High hyperopia 40 and large degrees of anisometropia are strong risk factors for persistent amblyopia. Anisometropia can induce both defocus and aniseikonia, and spectacle correction can actually increase the image size difference between the eyes. Eyecare professionals rarely measure aniseikonia in clinical practice. However, aniseikonia may act as a to neural plasticity, restricting visual recovery and resulting in variable treatment outcomes likely through suppression of the amblyopic eye. 64,65 Anisometropic patients have greater suppression in glasses than in contact lenses due to a larger image size difference between the eyes with spectacle lenses. Fitting contact lenses or prescribing iseikonic lenses to minimize interocular retinal image size differences may be appropriate in cases where amblyopic eye VA is static despite good compliance with therapy.
Behind cataracts, glaucoma is the second leading cause of blindness worldwide. Patients with glaucoma are followed at regular intervals for testing to confirm stability of the disease; however, providers may need to divert from planned glaucoma testing when clinical findings suggest progression of comorbid ophthalmic conditions. This case report describes a patient presenting for a routine glaucoma follow-up appointment who was subsequently diagnosed with an acute choroidal neovascular membrane due to conversion from non-neovascular to neovascular age-related macular degeneration. The case highlights the management of normotensive glaucoma and both non-neovascular and neovascular macular degeneration.
