CACO Synthesis Sample Cases
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4 year old white female in daycare
Teacher reports that child's left eye occasionally turns in
Father has glaucoma; Maternal grandmother has ARMD and type II DM
Unaided VA: OD 6/12 OS 6/24 (patient uncooperative)
Cover tests: 7 esophoria at 6 m, 12 occasional left esotropia at 40 cm
Worth 4 dot test: fused response at distance, occasional suppression of OS at near
Amplitude of accommodation: patient not responsive
Retinoscopy: OD +1.50 6/9-1 OS +2.50-0.75X165 6/12-2 (reflex fluctuates)
Cover tests through best correction: 4 esophoria at 6 m
(prism bars, amplitude variable)
Phoria unmeasurable at 40 cm - patient not cooperating
Ocular health: fundus healthy OU;
Anterior segment: no abnormality OU Pupils equal, round and reactive to light ______________________________________________________________
1. Based on this information, what is the most likely diagnosis?
A. Convergence excess
C. Latent hyperopia
D. Left sixth nerve palsy
2. What additional test should you perform to confirm your diagnosis?
A. Stereoacuity testing
B. Cycloplegic refraction
C. Lancaster screen
D. VA with pinhole
3. What is the preferred mode of treatment for this patient?
A. Spectacle correction
B. Prism therapy
C. In-office vision training
4. What advice do you give to the patient's concerned parent?
A. Don't worry, she'll grow out of it.
B. Spectacles will help and we will reassess in 3 months.
C. Contact lenses will give her a better chance of natural vision.
D. We are going to refer to a specialist.