Need help with a patient!

[shindog1961]

63 yo male was seen 10/09 with refraction of +.5-.5X110 OD, +.5 DS OS normal anterior seg, IOP fundus, trace nsc/psc. Takes Amlodipine and Simvistatin. Uses +2.50 readers and +1.50 VDT Rx.

Comes back 3/10 complaining that one eye sees close and one eye sees far. New refraction -2.25-0.25X130 and +1.00. Normal anterior seg, IOP and fundus. No changes in cataracts. PCP has adjusted the dosage on Amlodipine, but no other health changes. Saw PCP the day before and given a clean bill of health and told he should get his eyes rechecked.

Any thoughts?

[bigeyejim]

Comes back 3/10 complaining that one eye sees close and one eye sees far. New refraction -2.25-0.25X130 and +1.00. Normal anterior seg, IOP and fundus. No changes in cataracts. PCP has adjusted the dosage on Amlodipine, but no other health changes. Saw PCP the day before and given a clean bill of health and told he should get his eyes rechecked.

Any thoughts?

Wow, built in Monovision! Cool.

Makes it harder when he was given a clean bill of health from PCP. Rules out Quick onset diabetes. Was Amlodipine increased or decreased? With all else being equal, that would be a first glance.

Otherwise, its off to Neuro!

[IcyTrax]

No changes in cataracts. PCP has adjusted the dosage on Amlodipine, but no other health changes. Saw PCP the day before and given a clean bill of health and told he should get his eyes rechecked.

Any thoughts?

Did this patient experience any migraines prior to the adjustment in Amlodipine? Any past history with Stroke, TIA or did he ever feel like he was going to have a Stroke around the time they put him on Amlodipine? Is he taking Amlodipine specifically for HBP? Like "shindog1961" pointed out, was it an increase or decrease -- and by how much? My guess is that it was increased...but still. More info please!! :)

[npdr]

1. If unilateral, it is not systemic.
2. Nuclear sclerosis

[shindog1961]

He isn't too happy about the monovision though. The Amlodipine was increased about 1 month ago.

Wow, built in Monovision! Cool.

Makes it harder when he was given a clean bill of health from PCP. Rules out Quick onset diabetes. Was Amlodipine increased or decreased? With all else being equal, that would be a first glance.

Otherwise, its off to Neuro!

[shindog1961]

MI 18 months ago. Amlodipine increased about 1 or 2 months ago. He didn't report anything unusual when they put him on the med. What are you thinking?

[drk]

1. If unilateral, it is not systemic.
2. Nuclear sclerosis

Listen ^^^

[IcyTrax]

MI 18 months ago. Amlodipine increased about 1 or 2 months ago. He didn't report anything unusual when they put him on the med. What are you thinking?

If a Px is placed on Amlodipine, it acts as a CCB effectively reducing TPR and BP. If a Px has HBP, and complains of migraines (more likely headaches) just after being put on Amlodipine, there is a chance that that the Px suffers from Basilar Artery Migraines --> classic double vision symptoms (not a very common find, but the problem pops up every now and then). A small to moderate bump in dosage would clear up the problem, but it usually takes time to notice the change.

If none of this applies to the Px's history, or is too far fetched based on the information you have about the Px, I'd go with something more "up front" such as nuclear sclerosis like "npdr" indicated.

[shindog1961]

Do you think that would cause the change in refraction?

[bigeyejim]

On any given drug's side (serious) effects, "vision changes" can occur. Had a patient who was a -1.50 in each eye jump to -2.50 in OD and -1.75 OS after starting on Lithium. Three months later, back to the original refraction. It isn't too far fetched. Otherwise, the votes are for nuclear sclerosis!

[Richard Hom]

bigeyejim,

Would a systemic effect be bilateral rather than unilateral?