This is a ten year old boy who had surgery for a squint, (or turn in his eye,) at the age of four. As a result of the squint his left eye has never seen well, but he was able to read the top three letters on the chart. His right eye was normal, achieving 6/6- vision, (20/20-,) when he was last seen in April 2010. No retinal damage was apparent with the ophthalmoscope, (the hand held instrument that is standard for use in NHS and basic private examinations.) Although we have been seeing him regularly, his last Retinal Photographs were taken in 2006. No retinal damage was visible at that time as you can see from the picture on the right.
In November 2010 he attended early for an examination because his vision had been getting worse over the previous month or so. The vision in his right eye was now just the top three lines on the chart and with his left eye he was unable to see even the top letter. We took a Retinal Photograph of the right eye which can be seen on the right. If you look closely you can see a faint ‘Bull’s Eye’ shaped darker area in the middle, with more silvery striations, (lines,) around the shape in the middle. Moving on to the shadowgram you can see a very obvious circular shape in the middle. The bottom and right segments around that appear to be wrinkled. (The dark horizontal line across the whole scan is where he blinked when the scan was being taken.)
The ‘Thickness Map’ shows the red/white raised area and also more wrinkles. The layers are all much thicker than normal, (the pink figures shown on the ‘Thickness Measurements.’) Once we look at the B Scan images we can see fluid build up within the layers of the retina, (the dark spaces,) and also that the retina has become detached. (It should be touching the line at the bottom.)
It is likely that these changes have developed over a fairly long period of time, and there was probably some gradual fluid build-up in the layers of the retina before it started to detach. The boy will only have noticed that there was something wrong when it started to interfere with his central vision. If we had routine Retinal Photographs between 2006 and November 2010, (before any symptoms or signs had developed,) they may have suggested that changes were occurring, enabling us to refer sooner. If we had been able to carry out a Gold examination with OCT scans it is almost certain that we would have found more than enough irregularities to refer for urgent attention.
This boy was referred on an immediate basis. Initially, Both the right and left retinae detached. There was another detachment post initial treatment and he now has a permanent oil bubble in his left eye. He now suffers general poor vision which means he will never be able to drive.
This shows the importance of OCT scans at any age, even when there are no other signs or symptoms.