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Simple Myopia

Myopia is a refractive error whereby distant object appears blurred. Myopia is a common vision disorder and more often results in visual morbidity and elevate chances of contracting vision threating conditions such as detachment, retinal breaks, and glaucoma. Frequently, nearsightedness or myopia occurs when the retina receives light rays in front of it. Thus, those objects that are close are seen clearly, and the distant objects are perceived unclear. When a person is myopic the eyeball is too long or either the refractive power of the cornea and lens is too unlimited. Also, hyperglycemia in uncontrolled diabetic persons it causes lens swelling resulting into myopia. As a result, the correction is made with the use of contact lenses, corneal modification procedures or proper minus power (concave lens) that diverge light rays outward. Thus, by using this measures which aims at decreasing the corneal refractive power. Furthermore, in a condition where there is a temporary and intermittent shift in eye refraction toward myopia, the situation is improved with the performance of the vision therapy.

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Since this was a retrospective and following case study, the patient was assessed and reviewed. So, following the clinical evaluation and assessment, patient demographic data were collected, analyzed and consequently entered into a table. Also, visual characteristics and general systemic was included. Furthermore, a list of the patient details is provided in a table which is categorized into age, assessment date, medical history, medication history, social history, sex, weight, and allergies. 

The school hospital medical file of the patient revealed that the patient had psychosocial difficulties such as quick loss of temper, short attention span, reduced frustration span, the problem with impulse control and the poor frustration tolerance. Further, the patient history has shown that the student was quickly distracted during learning and more often presented with compensatory conducts where he perceived himself to be lesser to his peers. Also, the class teacher and the school nurse described the patient as a young man full of ambitions and characterized with much activity but with physical accidents and dangerous behaviors in school. However, to deal with this psychosocial problem, the patient was on the program of the child psychologist in an attempt to improve his impulsive mood, the self-esteem and drive off his negative attitude.

The first sign that the patient had juvenile myopia was the difficulty in seeing distant objects, such as the chalkboard. A chalkboard was placed at a distant with writings on it, and the child was requested to read, but it was a struggle for the patient and could not manage reading them. Similarly, the patient could not understand the road signs or images on a whiteboard or even screen and see people clearly at a distant place also was impossible for him. Also, the presence of insistent squinting or closing the eyes to see distant objects were observed. In this condition, the eyes were unable to move in a common direction whereby one eye looked forward to focussing on the object while the other one turned either outward, upward, inward or outwards. Lastly, having eyestrain and headaches when watching television is another symptom that the patient revealed. The patient watched the television for a few minutes and then started complaining of a headache and inability to see.

Patient Demographic Details

Age 14 years
Sex Male
Date of Assessment 4/10/2017
Weight 37 kgs
Medical History no H/O present
Social History Under Psychological Program
Medication History NIL
Allergies NIL

Table1.1:The above table represent the demographic details of a patient suffering from simple myopia.

Assessment

The patient's history cross-examination revealed the case was associated with the mild corneal clouding and a few instances of mild myopia (with a visual acuity of 0.6).in addition, examples of myopia that develop in childhood are referred as juvenile-onset myopia, and once it appears in children, it increases in the severity. Also, this has ascertained that the progression rate range from 0 to 1.5 D per year but the higher registered rate had ranged from 0.5-0.6D in every year. However, the progression of juvenile myopia commonly slows down in the last period of the teenage years.So, the development happens earlier for the girls than for boys. Similarly, the development of simple myopia can appear later in the adult life. Generally, at around the age of 20-40, the early adult myopia appears. Thus, the speed at which myopia develops in childhood is higher than the progression rate in the young adulthood. Hence, the myopic condition starts decreasing its severity at the age of 45 years. While the cause of simple myopia is still unclear both the environmental factors and the inheritance play a significant role in the etiology of simple myopic cases. Additionally, patients who have simple myopia have been at times associated with the type of the diet they take.

Since the patient had simple myopia, the case should, therefore, be examined annually. A consistent follow up at six-month intervals is appropriate for the teen since there weren't signs of high myopia progression rates. Also, the contact lens provided requires more regular follow-up for appraisal of lens fit and corneal physiology. Lastly, the parents were informed that simple myopia develops ever since its onset in childhood and state increases in severity to late teens. The parents were also told of the correction options available for their child, probable myopia controls and myopia reduction in their child. On issuing the patient with the spectacles, advice was done on the use of polycarbonate lenses for the eyes protection. Also, instructions were provided with regards to the times of wearing glasses or contact lenses. And finally, as the optometrist the patient and parent were educated about the importance of regular follow-ups care.

Diagnosis

The evaluation of the patient with simple myopia included the elements of comprehensive vision and the eye examination with particular emphasis on the following two areas(Hazarik & Addya, 2017, p. 66). It consists of the following, the patient history, and the ocular inspection. First, the patient history is the primary component of patient assessment that includes the review of the nature of the disease, the patient, ocular, general health history, visual, family and developmental history, medication allergies and use of the medication and both the vocational and avocational vision necessities(Ahmad, et al., 2017, p. 95). Thus, in simple myopia, the patient was checked for a particular typical symptom. The symptom was if the patient experienced near sightedness. Additionally, there was need to differentiate whether the nearsightedness is momentary or continuous. As a result, near vision was normal when the patient adjusted to close working distance to correspond with the linear reciprocal of the dioptric amount of the refractive error. Then, if there were symptoms other than distance blur, this could have suggested other coexisting condition.

Also, the ocular examination that characterized the measurement of both the near visual acuities and the unaided distance to the patient was equally done. Thus, due to the correlation of the unaided distance visual acuity with the degree of myopia, visual acuity provided the tool of assessing the internal uniformity of the refractive findings(Aller, 2014, p. 132). Therefore, the presence of reduced visual acuity was only a function of myopia and not any other ocular condition(Ahmad, et al., 2017, p. 101). Also, direct and indirect ophthalmoscopy and intraocular pressure was another critical evaluation for the patient. This testing indicated both the preventive review and retinal breaks and detachment in the patient.

Management/treatments and interventions

Optical correction through use of the spectacles or contact lenses offers clear distance vision. The patient was advised on the use of contact lenses this is because of the factors such as patient age, the motivation for wearing contact lenses, corneal functioning, and financial deliberations. This was based on the advantages of the contact lenses that outweighed those for the spectacles. Also, the following are the advantages of the contact lenses that surpass the use of glasses. First, contact lenses provide better cosmetic features making the eyes appear normal thus boosting the patient self-esteem, also contact lenses deliver larger retinal image and a better visual acuity as compared to the conventional method spectacles treatment.(Aller, 2014, p. 69) Also, the problem of the spectacles weight is absent in the contact lenses thus proving to be the best solution, particularly in the children. Contact lenses also reduce the problems of visual field restrictions which is more evident in the spectacles. Moreover, the use of contact lenses often minimizes the degree of myopia from succeeding to corneal flattening.

Also, the following considerations were suggested to the patient pertaining whether contact lenses were an excellent choice for the patient. The education delivered to the patient regarding the use of the contact lenses was based on the following; patient needs and expectations, observing to the contact lens guidelines for wear, cleaning and disinfecting and patience during the early modification period to contact lens wear (Chua & Wong, 2016, p.104). Furthermore, education on the contact lenses care was given. This training included the cleaning, disinfecting, and disuse of the homemade solutions when cleaning the lenses and finally, keeping off the no prescribed eye drops since they can interact with glasses, but instead in the case of change of prescribed brand of the solution, the patient was advised to seek help from an optometrist (Aller, 2014, p. 84-86).

Assessment of management/ treatment and intervention

The patient responded well once the contact lenses were applied, the initial assessment trials were repeated to ascertain the effectiveness of the contact lenses in the correcting the nearsightedness. The written board was placed at a distant point once again, and the patient was requested to read. Surprisingly, the patient was able to read the text written on the board. Similarly, on the television watching trial, the patient responded well and could not experience a headache as was noted earlier. Thus, the blurred vision was a past to the patient who from there henceforth lived the normal life just like the fellow students.

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Discussion

There are different types of contact lenses available and the type of lenses to be used depend much on the situation of the patient. Therefore, optometrist provides the platform on which the case will be corrected by assessing and diagnosing the patient. Moreover, there is two type of contact lenses, the soft contact lenses, and the gas permeable lenses(Kumaria & Lakshmi, 2016, p. 88). Gas permeable lenses are preferred over the soft contact lenses because they permit air to pass directly via the lens. Hence that the reason it is given gas permeable lenses. In addition to allowing more oxygen to reach the cornea, the gas permeable lenses provide clear vision and comfortability thus the study shown that fitting children with rigid gas permeable lenses are a more stable prescription than those in glasses. However, despite the superior benefits and success of the remedy that was provided to the patient a few improvement need to be done to enhance the workability of the gas permeable lenses. Thus, there should be a fitting lenses solution that is stronger to adhere the lenses to the cornea. This is because the lenses fitted were at time dislodged from the eye and just pushed off two sides. Moreover, the nurse was very crucial to the whole exercise and played a more significant role in providing nursing services to the patient, to begin with, removing of the lenses at night during the bedtime and also applying the appropriate solutions to the lenses in the morning hours. Consequently, it is essential for nurses to advance their care beyond maintenance application but preferably up to the providing treatment of such cases that do not need complex therapy of ophthalmic; this is because the school nurse was unable to offer treatment to the patient who required fewer skills to manage it.

Conclusion

Simple myopia is a condition that affect the refractive capability of the eyes. This refractive condition affects vision clarity, and also it limits occupational choices. Furthermore, persistent of the unmanaged case can result in high chances of acquiring vision threatening. Though, the most common symptoms of simple myopia include the reduced unaided distance visual acuity and blurred distance vision conditions. However, this situation is managed by the application of the minus power lenses. Moreover, this condition is more prevalent than the other types of myopia. Treatment for uncomplicated myopia usually is optical correction either by use of contact lenses or minus power spectacles lenses that restore distance visual acuity. Furthermore, other therapies include options such as myopia control that lowers the rate of myopia progression in patients.

Also, patient examination on the form of myopia which included a complete patient history, and also refraction measurement was done and finally the patient's ocular health.in addition, the patient was advised of the treatment availability and options present and even subsequent counseling done regarding the importance of follow-ups care.

Reference

  1. Ahmad, M.A., Yaseen, Z.A. and SHAKIR, N.F., 2017. Prevalence of refractive errors and other ocular disorders among students of the primary schools in urban of the Erbil city. Polytechnic Journal7(3).

  2. Aller, T.A., 2014. Clinical management of progressive myopia. Eye28(2), p.147.

  3. Chua, J. and Wong, T.Y., 2016. Myopia—The Silent Epidemic That Should Not Be Ignored. JAMA ophthalmology134(12), pp.1363-1364.

  4. Can, G.D. and Yulek, F., 2016. The Current Management Strategies for Myopia Control in Children: Mini Review. Adv Ophthalmol Vis Syst4(6), p.00133.

  5. Hazarika, H.N., Bhuyan, D., Hazarika, S.C. and Addya, S., 2017. Refractive errors in age group seven to fifteen years: North-east India scenario. International Journal of Community Medicine and Public Health4(6), pp.1928-1931.

  6. Kumari, V.K. and Lakshmi, M.S., 2016. Screening for simple myopia among high school children in Hyderabad city. J Evid Based Med3, pp.1097-101.

  7. Kumaraswamy, R., Sivakumar, N., Anandan, H. and Uddin, M.K.R., 2016. Refractive Errors of Patients between 20 and 40 Years and its Correlation with Axial Length. INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY3(11), pp.104-107.

  8. Loh, K.L., Lu, Q., Tan, D. and Chia, A., 2015. Risk factors for progressive myopia in the atropine therapy for myopia study. American journal of ophthalmology159(5), pp.945-949.

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