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Thread: Better visual acuity at night?

  1. #1
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    Better visual acuity at night?

    A patient came in today saying his visual acuity is far better at night than in the day with his new specs. He is 56 years of age and has had a balance lens all his life
    R: BAL
    L: +2.50 / -0.50 x 80
    Near ADD: +1.75 R/L

    Dist vas:
    R: HM
    L: 6/6 -2

    Near vas:
    R: N/A
    L: N5

    Currently wearing:
    R: +2.50 (recommended sph by optom) Single vision 1.6 MAR
    L: +2.50 / -0.50 x 80 Varifocal Grey reactions 1.67 MAR
    Near ADD: +1.75 R/L

    Any ideas as Im stuck on this

  2. #2
    Master OptiBoarder OptiBoard Silver Supporter rdcoach5's Avatar
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    central cataract maybe ? Try putting -0.25 trial lens in front of glasses . It will probably clear up his day vision

  3. #3
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    He has been seen by 2 different optoms and been rechecked 3 times in total and there’s no sign of any cataract. The first time he got tested with us, we found +3.50DS for his left eye. He came back a month later saying vision is no good and he preferred +3.00DS. Another month went by and he came back saying vision is STILL not clear so we tested him again and +2.50DS is what he preferred. I saw him today with the specs made to the rx above and he still saying vision is not clear. I put his rx in a trial frame and lowered both eyes to +2.00DS but kept the cyl the same and he said it’s a lot better. I feel like I’m going round in circles and stuck on what to do if this doesn’t work!!

  4. #4
    My Brain Hurts jpways's Avatar
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    Is the patient diabetic? That would be my first guess for that large of a variation in prescriptions.

    As for the patient liking their eyeglasses more at night would be that everyone is (generally, if a patient has a fixed pupil this will not hold) more myopic at night then in the day because of the difference in pupil size. The only solution I could think of to diagnose this would be to refract the patient in a brightly (as opposed to the normally dimly) lit room.

  5. #5
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    No, not diabetic. I’m looking at the fundus now and he has some pigmentation at the macular on his left eye which I can confirm (after speaking with a colleague) is not macular degeneration. We’ve already tested him 3 times but if we end up retesting him, I may ask the optom to try that out!

    It’s just so strange as when he recently came in I put the +2.50 rx in a trial frame and took him outside in the daylight and he preferred the +2.00 rx for bright conditions but when we can inside into the slightly dimmer light he preferred the +2.50.. very odd.

  6. #6
    What's up? drk's Avatar
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    Ideopathic central serous retinochoriodopathy is a rule out.

  7. #7
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    Yeah I gathered that but had to consider all points!

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