University of Latvia
Department of Optometry and Vision Science RedZR011
Portfolio of Clinical Practice Clinical Practice in Optometry III
Student's name, surname, ID No. Taqwa Darwish (td24010)
Title of the detailed clinical case
Patient’s ID (AM2002)
Abstract
Keywords
Introduction
Clinical case report (subjective view on the problem)
Medical history/Anamnesis
A 22-year-old female medical student visited the University of Latvia Clinic for a
routine eye check-up with no specific complaints. She reported a daily screen time of 8
to 9 hours on her laptop and phone, with regular breaks, as part of her studies. Her
last eye examination was in August 2024, and she currently wears glasses. She has a
family history of congenital cataracts, affecting her father, sister, and herself and all of
them follow up once a year with opthalmologist. All family members wear glasses. She
has a known allergy to pollen but takes no medication and has no history of eye
surgeries, trauma, or general surgeries. She was born full-term with normal weight and
no complications.
Analysis of medical history
Formulation of clinical hypotheses
1. Refractive Status:
• Given that the patient wears glasses and has a family history of congenital
cataracts, visual acuity and refractive status should be evaluated .Screen time of 8–9
hours daily could contribute to digital eye strain, which may exacerbate symptoms of
under-correction or uncorrected refractive error.
• Questions related to refractive error are essential to assess her current
prescription and symptoms such as blurry vision, headaches, or eye strain.
2. Accommodative and/or Binocular Vision Disorders:
• Prolonged screen time increases the risk of accommodative fatigue,
convergence insufficiency, or related binocular vision issues.
• Specific questioning and tests (e.g., near point of convergence,
accommodative amplitude) should clarify whether her vision system adequately
handles prolonged near work.
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University of Latvia
Department of Optometry and Vision Science RedZR011
Portfolio of Clinical Practice Clinical Practice in Optometry III
3. Ocular Health:
• Her personal and family history of congenital cataracts may pose a risk for
visual complications or secondary ocular health conditions, such as early-onset lens
opacity or retinal issues.
• Screening for dry eye or allergic conjunctivitis is essential, as she has
pollen allergies, a common contributing factor to ocular discomfort.
Detailed description of the question groups
Questions Related to general history:
1. When did you last update your glasses prescription?
2. Do you experience any symptoms such as blurry vision, eye strain, or
headaches during screen use?
3. Are you comfortable with your current prescription?
Questions Related to Refractive Status
1. Have you noticed any difficulty seeing clearly at specific distances?
Questions Related to Accommodative and Binocular Vision Disorders
1. Do you experience double vision or difficulty focusing after prolonged near
work?
2. Do your eyes feel tired or strained after studying for long periods?
3. Have you noticed difficulty transitioning focus between near and far tasks?
Questions Related to Ocular Health
1. Have you noticed any redness, itching, or irritation in your eyes during
allergy seasons?
2. Have you had any recent changes in your vision or visual disturbances?
3. Have you ever experienced eye pain or light sensitivity?
Questions Related to Medical History
1. Are you currently taking any medications for your pollen allergy or other
conditions?
2. Do you have any history of systemic conditions like diabetes or
hypertension that could affect eye health.
Additional questions/question groups (after literature review)
No additional
Purpose of the visit and patient’s preferred solution
The patient’s purpose for the visit is a routine eye check-up to ensure her vision is
stable and her glasses prescription is accurate. She seeks confirmation of good ocular
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University of Latvia
Department of Optometry and Vision Science RedZR011
Portfolio of Clinical Practice Clinical Practice in Optometry III
health and advice on managing prolonged screen time effectively as a medical
student.
Analysis of the purpose of the visit and the patient’s preferred solution
The purpose of the visit is a routine eye check-up, as the patient has no specific
complaints and no pressing issues regarding her vision or ocular health. From her
perspective, she likely aims to ensure that her vision remains stable and her glasses
prescription is accurate, given her history of refractive error and congenital cataracts.
Additionally, as a medical student with prolonged screen time, she may want
reassurance that her current visual habits are not causing any long-term damage or
strain.
The patient’s preferred solution would likely involve confirmation that her eyes are
healthy, her current glasses are appropriate, and any potential issues related to her
screen time are addressed through practical recommendations, such as lifestyle
modifications or adjustments to her study environment.
Analysis of the purpose of the visit and the patient’s preferred solution
(after literature review)
No additions
Differential diagnoses and differential diagnostic
Uncorrected or Under-Corrected Ametropia (e.g., Myopia, Hyperopia, or
Astigmatism):The patient wears glasses, and her prescription might need adjustment
due to prolonged screen time. Family history of congenital cataracts could also
influence her refractive status.
Congenital Cataracts (Impact on Vision): A personal history of congenital cataracts
may affect her vision, depending on the type and the extent of the opacity and
whether it has been surgically managed or monitored previously.
Accommodative Weakness or Fatigue: Daily screen time of 8–9 hours increases the
likelihood of accommodative fatigue, especially if her accommodation or vergence
system is not functioning optimally.
Binocular Vision Disorders :Prolonged near work can exacerbate issues related to
binocular vision, such as difficulty with convergence or maintaining near focus.
Dry Eye Syndrome: Long screen hours, combined with her known pollen allergy, may
lead to symptoms of ocular surface dryness or discomfort.
To confirm or exclude the possible diagnoses, a detailed examination plan will be
followed. First, the patient’s refractive status will be assessed. Visual acuity will be
measured at both distance and near, with and without her glasses, to determine if her
prescription is appropriate. Objective refraction using retinoscopy or an autorefractor
will provide a baseline measurement, followed by subjective refraction and binocular
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University of Latvia
Department of Optometry and Vision Science RedZR011
Portfolio of Clinical Practice Clinical Practice in Optometry III
balancing to finalize the correction. Corrected visual acuity at distance and near will
also be evaluated to ensure optimal clarity.
Next, accommodative function will be analyzed to check for weakness or fatigue,
especially given her prolonged screen time. Near visual acuity will be assessed with
and without correction, and tests such as accommodative amplitude (push-up or minus
lens method), NRA, PRA, and monocular and binocular accommodative facility will be
conducted.
To rule out binocular vision disorders, tests like the near point of convergence (NPC),
cover tests at distance and near, stereopsis assessments (e.g., Randot) will be
performed. These tests will confirm whether her binocular system can handle the
demands of prolonged near work.
Since dry eye syndrome is a possible concern due to her screen time and pollen
allergy, tear film stability and ocular surface health will be evaluated. This will include
tear break-up time (TBUT), and ocular surface staining with fluorescein or lissamine
green. The patient may also complete a dry eye questionnaire, such as the OSDI, to
assess the severity of any symptoms.
Lastly, her personal history of congenital cataracts necessitates a thorough
assessment of her ocular health. A slit lamp biomicroscopy will be performed to
examine the type and extent of the cataracts. Corrected and uncorrected visual acuity
at all distances will help determine their impact on her vision. Tonometry will measure
intraocular pressure to rule out secondary glaucoma, and a fundus examination will
evaluate the posterior segment to ensure no underlying complications.
Clinical case report (objective view on the problem)
Clinical findings
Previous OD:+1.00-0.50X178 OS: +1.00-0.50X13
correction(Lensometer)
VA with glasses @distance OD: 1.2 OS: 1.5
Retinoscopy OD: +1.50-0.50X170 OS: +1.50-0.50X10
Subjective refraction OD: +100-0.50X180 OS: +1.00-0.50X180
VA @ near OD: 1.0 OS: 1.0 OU:1.0
Cover test Distance: 1BO (EP)&less than 1BU OD
Near: 4BO (EP)& 1BU OD
Worth 4 dot test BSV @ Distance and near
Steropsis Distance: steropsis[osterberg]; Near:50 sec of arc
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University of Latvia
Department of Optometry and Vision Science RedZR011
Portfolio of Clinical Practice Clinical Practice in Optometry III
[Titmus]
Color vision Normal OU
Near point of 7cm/12 cm
convergence(NPC)
NRA/PRA +2.25 / -3.00
Accommodative facility Flipper +2.00/-2.00 Binocular 12cycle/min
Slit lamp examination Unremarkable OD and OS
Non-dilated fundus 0.3 C/D ratio, visible macular and foveal
examination reflex,bright round optic nerve head, sharp high
( indirect ophthalmoscope) contrast rims,smooth symmetrical branching pattern
of the blood vessels from the optic disc,smooth optic
disc borders, A/V ratio 2:3, reddish pinkish periphery
in all quarters both OD and OS
Van Herick Grade 4 OU
IOP by keeler OD: 16 mmHg OS: 14 mmHg @ 13:27
Ocular motility Symmetrical, smooth and accurate OU
Axial length OD: 0.24 C/D ratio
OS: 0.63 C/D ratio
Visual field monocular OD: within normal limits OS: within normal limits
( figure 3&4 by TOMY) ( autokinatic strategy)
Analysis of clinical findings
Analysis of clinical findings (after literature review)
Confirmed/rejected differential diagnoses
Diagnoses
Analysis of diagnoses
Analysis of diagnoses (after literature review)
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University of Latvia
Department of Optometry and Vision Science RedZR011
Portfolio of Clinical Practice Clinical Practice in Optometry III
Solution and follow-up (therapy/management plan)
Analysis of the solution and follow-up
Analysis of the solution and follow-up (after literature review)
Prognosis
Analysis of prognosis
Analysis of prognosis (after literature review and, if possible, after follow-up
visits)
Conclusion
Discussion and analysis
References
