A 65 year old man presents to his optometrist in Kerry complaining of reduced visual acuity. The optometrist checks his aided visual acuity and finds that with the glasses he prescribed 2 years ago the man can now only see 6/12 best corrected where previously he could see 6/6.

A)    Have you been to one of the multiples for refractive surgery?

B)     Is the family history of eye disease?

C)    Do you have glaucoma?

B is a good question to ask it is general and enables the patient to contribute meaningfully if they have valuable knowledge about any family eye condition

Refraction demonstrates a marked increase of 4 dioptres of against the rule astigmatism in both eyes.

Management- usually these function well with glasses – if gets very thin can perforate from mild trauma

May require a lamellar tectonic graft or even a penetrating graft- it is always better if possible to avoid penetrating grafts.