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Case study 2

Take home message:
Be determined to get the most out of life, whatever cards you are dealt.
A team approach by a prosthetist, optometrist, and ophthalmologist will always deliver the best outcome for patients.

Glossary of terms:

Microphthalmia : Abnormally small eye.
Coloboma : A gap or split in structures that make up the eye.
Lower lid laxity : A drooping lower lid.
Scrimshaw : Etching on bone or ivory adopted by whalemen in the early 1800s.

Background:
At 23 years of age Rochelle Byers has learnt to count her blessings. She has 20% vision in one eye and loving and supportive parents who have encouraged her fierce independence and are now counted among her best friends.
Rochelle was born with a microthalmic right eye and a left eye with choroidal coloboma. Her right eye was blind but her left eye enabled her to see enough (20% vision) to learn to read and write etc. as she grew up. School was a nightmare for Rochelle and she was teased constantly because of her poor looks. She stood up to it however and when she went to Homai College for the blind as a teenager, she adjusted well and enjoyed the years she had there.

Rochelle works as a librarian and like many young woman, loves music, drinking with friends, and reading. She is also artistic and takes after her mother who is a noted scrimshaw artist. Rochelle’s main passion however, is international travel – no doubt fostered by the early trips she had to the Pacific Islands and Australia with her parents. She has had several trips abroad on her own in the last few years and has recently come back from a 6 week tour of Europe with Con Tiki Tours.

Review of existing prosthesis:
When Rochelle presented in October 2008 her prosthesis was too small and was gazing downward. Her lower lid had become lax, possibly due to the long term effect of wearing a poor fitting prosthesis. Indeed, Keith Pine had made this prosthesis when Rochelle was only 3 years old and because it was so comfortable to wear, it had not occurred to
Rochelle or to her family that all artificial eyes need to be replaced from time to time to keep up with growth and the
aging of the socket. Rochelle’s left sighted eye was checked at the same time by David Haydon, Optometrist *

Treatment:
Keith Pine custom fitted a new prosthesis to Rochelle’s right socket and David Haydon provided an opaque, blue tinted soft contact lens for the left eye. The result was dramatic (see photos) but Rochelle’s appearance can be further
improved if she is able to have surgery to correct her right lower lid laxity. She has been referred to Dr David Dalziel *
who will make a decision about this. Rochelle and her family are delighted with the result so far. Rochelle says she feels much more comfortable around people now that she looks more normal. Look out world – this charming and forthright young lady is on the move like never before. Go for it Rochelle.

* David Haydon, Principal Optometrist at Haydon Optometrists, Takapuna.
* Dr David Dalziel, ophthalmologist at the Eye Centre Primecare, Kensington Hospital, Whangarei

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