CA1

Case 1
History: 45-year-old Asian male. Smoker (4 cigs/day). Takes ibuprofen for sore joints PRN
(PRN means as needed). No known drug allergies (NKDA). Patient is an emmetrope and has
never had an eye exam. He does use readers to see small print.

Chief complaint: Patient notices decreased near vision, more in the right eye than the left.
Distance vision seems OK. Patient reports no itching, burning, tearing or other physical
symptoms.

Gross observation: Patient is in construction-worker overalls with some dust/dirt, but has a
clean face, clean hands, and a fresh haircut.

Exam findings:

DVAs: OD 20/20-; OS 20/20-

NVAs: OD 20/50; OS 20/50 NVAc: OD 20/40-; OS 20/25

Pupils: Perrla-mg CT: 2exop distance/ 2esop near

Motilities: Normal Fields: Normal

Refraction: (central shadow/dullness of reflex noted in retinoscopy OD)

OD +0.50 sphere 20/20- Add +1.25 Nr 20/40-
OS +0.50 sphere 20/20 Add +1.25 Nr 20/20

SLE:
Lids/Lashes: Normal OU
Cornea: OD clear; OS small sub-epithelial foreign body scar mid-periph at 4:00
Conj: Normal OU
A/C: Deep/Clear OU; IOP: 15mmHg OU
Iris: Normal OU
Lens: OD 2+ posterior capsular haze; OS smaller 1+ PSC haze
See Photo and retro-illumination photo

What is your diagnosis? Why is the reading effected but not the distance? What is the
treatment and prognosis? How do you educate the patient about his condition?