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MANAGEMENT APPROACH OF LOW VISION IN RETINITIS PIGMENTOSA: WHAT SHOULD WE DO? Poster Presentation - Case Report - Resident Novi Auliya Dewi; Ani Ismail; Eva Kumalasari
Majalah Oftalmologi Indonesia Vol 49 No S2 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/fq3vna15

Introduction : Retinitis pigmentosa is a chronic and progressive disease throughout patient’s life. Management low vision in retinitis pigmentosa patients are to maximize their remaining vision and provision of visual aids, it can be financial dan social burden. Case Illustration : A 56-year-old man came with blurred vision in his both eyes for 12 years. The patient had cataract surgeries and IOLs implantation in 2022. Ophthalmologic examination revealed the right eye was 4/40 and the left eye was 3/60. Funduscopic examination revealed the bone spicule appearance, blood vessel attenuation, and waxy disc pallor in both eyes. Contrast sensitivity test decreased and Farnsworth hue test showed mild to severe. Humphrey visual field examination showed peripheral visual field defect, therefore patient diagnosed with low vision caused by retinitis pigmentosa with bilateral pseudophakia and his Low Vision Quality of Life was intermediate. Discussion : Treatment includes pharmacological treatment with supplementation, optical or non-optical treatment, and rehabilitation. Spectacles clarified distant and near vision with Best Corrected Visual Acuity 6/30 with photochromic lenses, for adapting the light and gave addition lens +5.00 in both eyes. Rehabilitation enhances his head tracking, scanning, and habitual spotting skills. Lighting and typoscope would help his daily reading activities as well. Conclusion : Low vision requires several management approach, patient with visual impairment can get low vision aids to optimize his visual function based on his needs. Managing low vision in patient with visual impairment has to be considered from multiple aspects.

Low Vision Management in Chronic Glaucoma: Poster Presentation - Case Report - Resident Muhammad Fahmi; Ani Ismail; Eva Kumalasari
Majalah Oftalmologi Indonesia Vol 49 No S2 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/c6kpx754

Introduction : Glaucoma is a group of progressive optic neuropathy corresponding to peripheral vision loss, causing severe visual impairment to blindness. Low vision is a person who has the best visual acuity in the best eye of 6/18 to light perception or with a visual field of <10 degrees from the fixation point, after medical, surgical, and/or optical intervention. Low vision will affect every aspect of patient’s life, hence precise management of low vision is important. Case Illustration : RY, a woman, 64 years old, works as a housewife. Complained of blurred vision slowly since 3 years ago, especially when reading. The patient then went for treatment to get glasses and was said to have glaucoma. Glaucoma surgery was performed on both patient's eyes and cataract surgery on the right eye. Now the patient’s visual acuity is 6/21 with peripheral vision loss on the right eye and NLP on the left eye. Discussion : The patient was diagnosed with Low Vision et causa Glaucoma. Treatment includes pharmacological treatment, optical and non-optical treatment to carry out daily activities so that the patient remains independent. Education must be explained to patients that there is no therapy to eliminate visual field disturbances but that the use of the remaining visual fields can be maximized. Conclusion : The goal of low vision management in this patient is to maximize central vision and provide visual aids to maximize the patient’s quality of life.

Epiblepharon Induced Anisometropic Amblyopia : Should We Treat or Observe? Poster Presentation - Case Report - Resident Syena Damara Riza Gustam; Ani Ismail
Majalah Oftalmologi Indonesia Vol 49 No S2 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/whd7dw39

Introduction : Previous study reported that epiblepharon strongly associated with astigmatism. Uncorrected refractive errors are considered the most common cause of amblyopia. Amblyopia by pure anisometropia is the one with the best prognosis recovery of visual acuity. Case Illustration : A children, 9 years old complained of eye discomfort, watery eyes and difficulties in recognizing distant object. After clinical examination and investigations, the patient had visual acuity 5/60 for right eye and 6/18 for left eye was identified as epiblepharon in both eyes with corneal erosion in right eye. The patient underwent repair epiblepharon surgery for right eye and topical antibiotics for corneal erosion. At 2 months after surgery, corneal erosion completely resolved. Best corrected visual acuity 6/21 with spectacle lens S - 1.00 C - 3.00 X 180o positive crowding phenomenon, and 6/6 for left eye with S – 1.00 C - 1.00 X 180o. Topography examination show with-the-rule astigmatism. At 2 month follow up after correction, visual acuity reached 6/6 for both eyes. Discussion : Epiblepharon induced astigmatism by mechanical force of the eyelid that influences corneal contour. Long term epithelial erosion also contribute to triggers corneal curvature remodelling and induced with-the-rules astigmatism. Diopter differences for astigmatism more than 2.00 D leads to anisometropic amblyopia. Conclusion : Adequate correction after surgery is proven to recover visual acuity in amblyopia patient caused by epiblepharon

CAN RIGID GAS PERMEABLE (RGP) CONTACT LENS BE THE BEST OPTION FOR A KERATOCONUS PATIENT? Poster Presentation - Case Report - Resident DINA FATMA DWIMARTA; ANI ISMAIL; EVA KUMALASARI
Majalah Oftalmologi Indonesia Vol 49 No S2 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/nsh1nq94

Introduction : Keratoconus is a condition of cone-shaped cornea caused by stromal thinning. This disorder leads to visual disturbance due to irregular astigmatism, myopia, and corneal protrusion. A severe irregular astigmatism must be corrected by rigid gas permeable (RGP) contact lenses. Case Illustration : A 29 y.o female visited Ophthalmologist Clinic Subdivision of Refraction, Contact Lens, and Low Vision in RSKMM Provinsi Sumsel, complaining of discomfort while using her current glasses. Anamnesis, physical examination, and ophthalmologic examination were carried out. The patient then was maximally corrected of her refractive status, followed by contact lenses fitting and post- fitting evaluation. Discussion : Early ophthalmologic examination showed visual acuity of 6/60 ph 6/9 on both eyes. Corneal topography evaluation confirmed pattern of bilateral keratoconus, each 78% on right eye and 87% of left eye. Best-corrected visual acuity was 6/6 using S-3.50 C-7.00 180? (right eye) and S-4.00 C-6.00 170? (left eye). RGP fitting test was carried with trial lenses of S-4.00 D for both eyes with both base curve of 7.2 mm and diameter of 9.2 mm. Over-refraction showed result of S-3.50 D (right eye) and S-3.75 D (left eye) for both eyes to reach visual acuity of 6/6 and for patient to feel comfortable. Conclusion : While some period of adaptation was needed, severe keratoconus should be treated using RGP contact lenses to achieve a better prognosis. Accurate fitting test of RGP resulting in comfortable and satisfied outcome of patient.

LOW VISION IN RETINITIS PIGMENTOSA: HOW TO ENHANCE FUNCTIONAL VISION IN PSEUDOPHAKIC PATIENT: Poster Presentation - Case Report - Resident Siti Shalihah Ramadhani Novizar; Ani Ismail; Eva Kumalasari
Majalah Oftalmologi Indonesia Vol 49 No S2 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/rm213f77

Introduction : Retinitis Pigmentosa (RP) could lead to various visual impairments, including decreased visual acuity, poor dark adaptation, decreased contrast sensitivity, poor color vision, visual field constriction, leading to low vision (LV). LV in RP decreases patient’s quality of life (QoL) and Independence. We aim to report a successful case of LV management in a bilateral pseudophakic patient with RP. Case Illustration : A 33-year-old man came with progressively blurred vision in both eyes (BE) that worsen 6 months ago. Ophthalmologic examination revealed his uncorrected visual acuity for right eye (RE) and left Eye (LE) was 6/60 and 4/60. The patient had cataract surgeries and IOLs implantation on BE in 2021. Funduscopic examination revealed the bone spicule appearance, blood vessel attenuation, and waxy disc pallor on BE. Humphrey's examination showed a peripheral visual field defect. Decreased contrast sensitivity and poor color vision were also found. Discussion : The patient was managed by LV aids and rehabilitation. Spectacle clarified distant and near vision with best corrected visual acuity (BCVA) 6/21 and 0.8 M on BE, photochromic lenses aided in adapting to various lighting levels and as a UV protection, and the addition of illumination and color contrast enhancement improved vision in dim light. A convex mirror to be used as a field- enhancement spotting tool. Rehabilitation enhances his head tracking, scanning, and habitual spotting skills. Improvement of QoL has been recorded using LVQoL questionnaires. Conclusion : LV management are vary based on an individual’s level of functional vision and personal preferences. Optimal LV management could enhance patient QoL and Independence.

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