Night time tint for Streff Syndrome Patient

[scograd]

I have a patient with a history of Streff Syndrome (teenage female, decreased VAs, constricted VFs, color defects). She's complaining about the distance vision and glare and photophobia at night. Manifest refraction yields same acuity as uncorrected Rx, and I'm hesitant to Rx anything at distance (VT dr rxed pl/+0.50 with improvement, although pt continues to have inconsistant acuities and refractions).

The patient is begging me for an Rx, and so I'd like to just Rx low power and maybe with a tint or AR. Can anyone help me out?

[ken_h_lin]

I have a patient with a history of Streff Syndrome (teenage female, decreased VAs, constricted VFs, color defects). She's complaining about the distance vision and glare and photophobia at night. Manifest refraction yields same acuity as uncorrected Rx, and I'm hesitant to Rx anything at distance (VT dr rxed pl/+0.50 with improvement, although pt continues to have inconsistant acuities and refractions).

The patient is begging me for an Rx, and so I'd like to just Rx low power and maybe with a tint or AR. Can anyone help me out?

Stay away from tinting for nightime vision, because little tint could reduce VA from 20/20 to 20/25 at night. AR coat is the option you need, try the Clear AR form Optima.

[DragonLensmanWV]

The problem lies with the photophobia at night. Normally you would not want a tint at all for night, as any tint will of course reduce the nightime VA.

You might try one of the very lightly tinted polarized lens in a nice brown color with AR front and back.
You must decide whether driving with a 35% tint at night would be too much lost, or just right for the photophobia.

Try to get a sample from KB Co.or whoever makes the lightest tinted polarized, and have her try walking around the darkened exam room with it held in front of her eye.

[fjpod]

First I would talk it over with the parents in private for their consent.

But in Streff's, isn't a placebo just as likely to help? Why not try something like standard A/R, perhaps one that is more noticeable, and see if it helps. She'll be safe at night, and think that the A/R is helping her.

[IndianaOD]

+0.50 DS OU with 0.5 PD BI OD/OS is all you should need if its true Streff's. Shouldn't need tint.

[Ory]

I would hope this is a silly question but has the patient been cyclopleged? And not just with the weaker stuff (i.e. mydriacyl)?

[coffee joe]

i wear a light amber at night for a sleep disorder and don't have any problems driving or anything. i'll even forget that i'm wearing a tint after i've had them on for a while. this would block the blue light that is probably the most aggravating part of the spectrum for her photophobia.

but really, for streff, is there much you can do? as i understand it, it has allot to do with emotional variables, so how can you offer a solution that assumes a constant physiological abnormality. i recomend a lens that gets more xanaxy with exposure to stress. or catnip tea.

[Chris Ryser]

Streff Syndrome- named after the optometrist who originally described it, Dr. John Streff. This functional vision loss is also known as Non-Malingering Syndrome. Signs include reduced visual acuity in both eyes at distance and near. The visual acuity at near is more reduced than the distance acuity. Frequently patients will have reduced stereopsis, large accommodative lag on dynamic retinoscopy, and a reduced visual field (tubular or spiral field). The syndrome is associated with a visual or emotional stress occurring in the child's life. It is more prominent in girls (ages 7-13) than boys. Treatment includes a low plus lens and/or vision therapy. This condition is sometimes incorrectly diagnosed by doctors as hysterical amblyopiaStreff Syndrome- named after the optometrist who originally described it, Dr. John Streff. This functional vision loss is also known as Non-Malingering Syndrome. Signs include reduced visual acuity in both eyes at distance and near. The visual acuity at near is more reduced than the distance acuity. Frequently patients will have reduced stereopsis, large accommodative lag on dynamic retinoscopy, and a reduced visual field (tubular or spiral field). The syndrome is associated with a visual or emotional stress occurring in the child's life. It is more prominent in girls (ages 7-13) than boys. Treatment includes a low plus lens and/or vision therapy. This condition is sometimes incorrectly diagnosed by doctors as hysterical amblyopia

[rbaker]

Is there any significance to the fact that Streff Syndrome is not mentioned to any great degree in medical literature?

[IndianaOD]

Is there any significance to the fact that Streff Syndrome is not mentioned to any great degree in medical literature?

Nope. As a residency trained pediatric OD I've seen it several times. Half the things that MDs do aren't in the scientific literature either.

Don't let that limit your options.

[fjpod]

Is there any significance to the fact that Streff Syndrome is not mentioned to any great degree in medical literature?

If you mean medical literature with a capital M, it's likely because MDs generally don't put much stock in things discovered or discussed by other professions. (a common thread in this forum??)

It's not a common condition, but I have seen it at least a dozen times during my 30 years of practice. It's not sight threatening. It's not life threatening so it doesn't get that much attention...except when you are the parent of one of these children.

[Andrew Weiss]

I'd expand on what DragonLensMan suggested. Perhaps have a small group of tint samples: the one Dragon suggested, a light yellow, and also a light UV-500/550 treatment (I'll use that with macular degeneration patients). I'd stay with tints which give the appearance of heightening contrast (yellow, orange) as a way partially to offset the VA loss due to the tint density. I'd suggest for the trial run in the darkened exam room that you patch one eye and make sure she holds the sample tinted lens within normal vertex distance. You might want to have the projector on to simulate the focused beam of light she'd encounter from a car headlight at night.

Since I'm not an OD, I won't make a suggestion about Rx other than to note IndianaOD's suggestion, and to ask you to consider whether any tinted lens should be combined with an Rx like that to maximize her VA.

And, of course, I agree with the recommendation of a high-quality AR treatment.