August 15, 2024
By Dr. Maryam Jabbar, Lecturer, Optometry Department, The University of Faisalabad
Dr. Jabbar worked closely with her patient to give her the proper diagnosis and treatment plan.
Subjective
A 21-year-old South Asian female reports that she experienced intermittent blurring in her distance vision for the previous two months. She emphasizes that at times of extreme stress, especially in the lead-up to exams or important academic deadlines, the blurriness usually gets worse. In addition, the patient occasionally gets headaches, feels fatigued in the eyes, and has episodes of eye strain, particularly after using a digital screen or reading for extended periods of time. She denies having any prior eye injuries or required corrective glasses/contact lenses in previous years. Notably, the patient has a history of anxiety that is currently being treated without medication with cognitive-behavioral therapy (CBT).
Objective
Visual Acuity:
Distance VA (Uncorrected): OD 6/18, OS 6/18P
Near VA: N6 in both eyes
Cycloplegic Refraction:
OD +0.75D
OS +0.75D
Manifest Refraction:
OD -1.25D
OS -1.25 D
Slit-Lamp Examination:
Within normal limits
Amplitude of Accommodation:
OD 12 D
OS 12 D
External and Internal Eye Health Examination:
Unremarkable
Assessment
The patient has symptoms that are consistent with pseudomyopia, and there is a positive link between her visual problems and periods when she gets stressed out. In this instance, anxiety-induced accommodative spasm and excessive near work are likely to aggravate pseudomyopia. This diagnosis has been confirmed by the patient’s intermittent blurred vision, her history of anxiety, and related symptoms like headaches and eye strain. The notable difference between the cycloplegic and manifest refractions, which indicates an accommodating spasm, confirms the diagnosis of pseudomyopia.
Plan
I recommended the patient make the changes to her daily life that included lifestyle modifications and anxiety management.
Lifestyle Modifications:
- When taking regular breaks, practice the 20-20-20 rule, which states that you should look at anything 20 feet away for at least 20 seconds every 20 minutes and spend at least two hours per day outdoors. This activity helps relieve eye strain and prevents accommodative spasm.
- Minimize Screen Time: Use digital devices for shorter periods of time to avoid eye strain. Avoid greater than 30 minutes of continuous near work without taking a visual break. Ensure that reading and digital device usage is performed at a distance of at least 12 inches (30 cm).
- Outdoor Activities: Increase your outside activities to benefit from the natural light and distance concentrating that promotes eye relaxation.
- Balanced Lifestyle: Develop a healthy way of living that incorporates regular exercise, a well-balanced diet, and enough sleep. These aspects all have the potential to decrease anxiety and enhance overall health.
Anxiety Management: I engaged in collaboration with the patient’s therapist to integrate anxiety-reducing strategies into her vision treatment strategy. The guided imagery approach is quite effective. I suggested using breathing and mindfulness techniques to help further reduce anxiety and stress. I also suggested that the patient engage in relaxing, stress-relieving activities such as yoga or meditation.
Education
In addition, I also provided education to the patient to better explain her condition and what she can do to ensure symptoms are under control.
- I advised the patient that stress and extended near work might cause pseudomyopia, a condition that sometimes causes blurry vision caused by an accommodating spasm. I clarified the difference between pseudomyopia, a functional problem associated with muscle spasm, and actual myopia, a structural disorder requiring corrective spectacles.
- I highlighted the connection between visual symptoms and anxiety, in addition to emphasizing the need for stress management in slowing the advancement of pseudomyopia. To demonstrate the need of integrating psychological and visual medical treatments, I explained how CBT approaches can be utilized to effectively manage visual symptoms.
- I provided the patient lifestyle advice, such as scheduling frequent breaks from long work hours and spending more time outdoors. I described how these modifications can improve eye health and lessen the chance of a recurrence of accommodative spasm. Furthermore, I encouraged the patient to lead a balanced lifestyle that includes consistent exercise, a healthy diet, and enough sleep — all of which can enhance general well-being and minimize anxiety.
Discussion
Ultimately, I had to address both the psychological and visual aspects of the patient’s pseudomyopia to minimize her symptoms and enhance her general quality of life. I emphasized how crucial it is to schedule follow-up visits so that we can keep track of her progress and modify the treatment plan as necessary. These sessions are essential to ensure that therapy is meeting the patient’s needs.
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Dr. Maryam Jabbar has been serving as a Lecturer in the Optometry Department at The University of Faisalabad since 2021. She holds a Doctor of Optometry degree from the same university, earned in 2021, and she has recently completed her MPhil in Optometry. She has published 15 original research papers, 11 of which are recognized by the Higher Education Commission (HEC) in the Y category journals. Dr. Jabbar has presented her research at 12 conferences, and she was awarded a Gold Medal for Best Presenter at the 1st International Conference of Rehabilitation and Allied Health Sciences (RASCON-2022). Currently, Dr. Jabbar is working on several projects, including the “MuSAFAR Tech Cane” for blind people, “Tea Tree Tonic” for managing blepharitis, and “JZ Optics” for frame selection. |
