Blurred vision in a 6-year-old patient: clinical evaluation and initial management

Clinical situation 

• A 6-year-old girl was referred for consultation due to blurred vision.
• No previous history
• Both parents have myopia:
  • Mother: -4.00 D OU
  • Father: -5.50 D OU

Examination

Visual Acuity is:

• OR: 60/200
• OS: 40/200 

Autorefractometer indicates: 

• OR: -3.25 (-0,25 @ 100°)
• OS: -3.50 (-0.50 @ 85°)

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What would you prescribe? 

Full correction after cycloplegic refraction 

Optical correction for children always requires refraction under cycloplegia.  
Full correction should be prescribed to prevent myopia progression. 

Cycloplegic refraction results:

• OR: -2.25 (-0,25 @ 100°)
• OS: -2.50 (-0.50 @ 85°) 

Full correction is therefore prescribed. 

Would you prescribe a control myopia system? 

Yes

• Prescription of a myopia control system is needed, as the child is young and already has established myopia.
• Both parents are myopic, resulting in a high risk for the child. 

What myopia control system would you prescribe? 

Defocus spectacle lenses 
Atropine low-dose

Both systems may be prescribed. However, the solution should be discussed with the parents and the child to ensure compliance with the system. 

Defocus contact lenses and orthokeratology are indicated for older children or adolescents.