RGP cases seen within the National District Hospital 2014 Lauren Coetzee OSSA Congress Drakensberg T: +27(0)51 401 9111 | [email protected] | www.ufs.ac.za Background Universitas Annexe Academic clinic 1/3 patients in 2013 were RGP. Average number of visits is 4. Service 4 provinces & Lesotho for RGPs in the low income sector. Patients come from 300km away. Started Clinic on 22 January; Wednesday afternoon, students divided into 2 groups: 13 clinics sessions each 8 Keratoconics have had appointments; 4 aphakes (2 school going); 2 prosthetic Px, progressive myopic (-24.00) Case 1 Px O Px O 26 year old male from Hartswater 2011 diagnosed with keratoconus Mother has keratoconus Px diagnosed in 2012 with glaucoma, and uses medication, is under control Can feel vision deteriorating Wants to renew drivers licence He drove off the farm gate Px O Lenses 2011 OD K5 6.9 BC / 9.5mm TD/ -6.00 OS T S/C 7.9 BC/ 9.4mm TD/ -2.50 Was told by a practitioner in Kimberley to discontinue use; reason unknown- most likely due to poor fit Rx 2011 -8.75/ -2.25 x 25 -10.75 / -3.00 x 35 Patient did not receive spectacles, VA’s not given Px O SL revealed grade 1 blepharitis, education was given on lid hygiene Ophthalmoscopy showed 0.6 C/D (OU) Unaided VA OD FC @1m OS 6/60 Refraction -13.50/ -2.25 x 15 -11.50/ -1.00 x 50 PH no improvement (6/7.5) (6/15) Px O Px O insisted he does not want to wear RGP lenses; this patient was educated on his condition, and piggy backing was decided upon His main motivation was for comfort Two weekly lenses instead on dailies were fitted, due to cost 8.4 BC -0.50 D Px O Topography OD: 6.84/6.49 2.8 D corneal astigmatism 0.97 e Best AA was 57% OS: 7.39/6.46 5.3 D corneal astigmatism 0.90 e Best AA was 53% Topography after SCL OD: 6.93/6.54 2.9 D 0.87 e AA 32% OS: 7.48/6.8 4.5 D 0.80 e AA 48% Px O 11 lenses were fitted to OD 10 had central bubbles Accepted fit was 6.6 BC 1.0e 10.5 mm TD -2.50 DS VA 6/6 Unfortunately there were no photos of the fit taken, we had 8 mini power failures and digital photos were sub standard Px O 2 Lenses were fitted to OS First lens had central bearing and peripheral bubble superior temporally Accepted lens was 7.1 BC 1.0e -5.25 DS VA 6/7.5 OU VA 6/6 +3 Patient was satisfied with his vision Px O The patient was quoted for both lenses, and the patient has paid for them. A purchase order has been received and the lenses have been ordered On average turn around time for patients from date of payment to receiving lenses is 4 weeks. Case 2 Px D Px D 23 year old male from Bloemfontein, student Diagnosed in 2012 with Keratoconus Our diagnosis was changed after seeing him On waiting list for corneal graft Patient has apical scarring on OS, visible without aid of a SL No surgeries Only medication for allergies Px D Rx OD +2.75 -0.75 X 180 6/15 OS no reflex SL showed mucus strands and blepharitis grade 1 OU, education was given on hygiene Ophthalmoscopy showed a tessellated fundus Px D Topography revealed negative e values in OU, OD: showed the kissing doves pattern DDx Pellucid Marginal Degeneration 8D corneal astigmatism Low minus e values: periphery is steeper than centre cornea Px D 8 lenses were fitted to OD 7 had large central bubbles Final fit was 7.00 BC, 1.1 e -6.25 DS VA 6/6 This lens was low riding but did not cross the limbus PMD often have a lower fit, as lens ‘sits’ on steepest area of the cornea 2 lenses were fitted to OD Accepted lens was 6.0 BC 1.0e -16.50 DS VA 6/20 Pooling along vertical meridian and good edge lift Px D Px D received his lenses and is happy with his vision, he obtains (after settling) 6/5 OU. He wears his lenses 6 days a week and is currently building his wearing time, now at 6 hours a day. He states they are better than his spectacles No photos taken Case 3 Px K Px K 28 year old female from Segopi Township Currently wearing spectacles (2012), and CC is poor distance and near vision Sinusitis and dry eyes, medicated Rx spectacles -3.00/ -1.50 x 90 -5.00 /-1.25 x 105 VA 6/20 VA 6/30 New refraction shows no change in 3.00 jumps, will re-refract on next visit Motivation of patient poor Px K SL showed grade 1 hyperaemia Ophthalmoscopy within normal limits Topography OD: 6.72/5.56 10.5 D corneal astigmatism 1.15 e OS: 6.54/5.78 6.8 D corneal astigmatism 1.31 e Px K OD has had 10 lenses fitted Accepted fit was 6.4 BC 1.2e 10.5mm TD -10.00 DS VA 6/9 OS has been fitted with 6.2 BC 1.8e, however has a small inferio-central bubble and obtains 6/12. On her next visit OS will continue to be fitted Thank You Dankie T: +27(0)51 401 9111 | [email protected] | www.ufs.ac.za
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