NOA 2023: Insights and lessons from a pediatric patient case

Rhea Magee, OD, participated in the Resident Grand Rounds session at the National Optometric Association 2023 Convention in Fort Lauderdale, Florida, alongside aymond Farmer, OD, and Stephen Murray, OD. Magee outlines a case of a child presenting pediatric posterior polymorphous dystrophy and the journey she took to diagnose, research, and communicate the patient's care needs to the parents.

Video transcript

Editor's note: This transcript has been lightly edited for clarity.

Rhea Magee, OD
Hi, I'm Dr. Rhea Magee. I'm a pediatric optometrist, and I work at Clarkson Eyecare Kids in Frisco, Texas.

So my presentation provides an overview of pediatric posterior polymorphous dystrophy [PPMD], and I discussed the diagnosis, how to rule out differential diagnoses, management, and treatment in pediatric patients. And then I also touch upon Alport syndrome, which is a systemic condition in which PPMD, it can be an ocular finding.

This patient was actually one of my favorite patients of my residency. I met him in October of 2021, and at the time, he was four years old. So he came in for a 3-month followup to monitor his and anisomyopic refractive error. And previously he was an established patient due to the fact that he had amblyopia in his right eye, so he did go through amblyopia therapy to equalize the vision between both eyes. At that followup, however, in his glasses, his vision was reduced in the right eye at 20/50 versus 20/20 In the left eye. And retinoscopy was performed to check for any changes that were needed to his refractive error. And it showed an abnormal corneal pattern through the retinoscope, so that prompted a thorough corneal evaluation behind the slit lamp.

And with that, UAB where I did my residency, it's a great school and that has a wide range of clinics to offer. So he was seen in the pediatric clinic at that visit, and then a couple of days later, he was also seen in the pediatric neurology clinic due to the fact that this was a new finding that was never seen before. And so that was when I met him at his peds neurology followup.

And so the refraction that was repeated, it showed that he did have an increase in his myopia and astigmatism, but then we were seeing some horizontal folds in Descemet's membrane and the endothelium of his cornea. So he was diagnosed with PPMD, or posterior polymorphous dystrophy.

And so I had the pleasure of managing his, you know, ocular care throughout my residency, placing him again on amblyopia therapy, and just trying to improve the vision and make sure that his corneal presentation was not progressing.

Definitely for one, in our pediatric patients, sometimes we might think they're a child; odds are things are normal, but it is very important as part of their comprehensive health to always perform a thorough corneal evaluation and slit lamp examination in general.
And then with that, two, retinoscopy, we often think of as a tool to assess refractive error, but it was the tool that prompted us to do the corneal examination.

Lastly, I spoke before about how PPMD is an ocular finding in Alport Syndrome. And the reason I came to know that was by doing self-research. So in general, continuing education we have to do for licensure, but doing your own research to make sure that you know if any ocular findings are connected to any systemic conditions is very important. Because as eye care providers, we have the beautiful job of managing a patient's vision and their ocular health, but we also can play a role in making sure that they have any additional testing, anything extra that they need to make sure that their systemic health is where it should be.

Whenever you do have pediatric patients where you have to inform parents of any abnormal findings, oftentimes, parents are some of the strongest people. They can have a stoic affect, but internally they might be panicking. So it is really awesome that we can play a role in the parents' wellbeing as well as the patients'. So just trying to work with them; if you can, show them what you're seeing.

For my specific case, I allowed the mother to use the retinoscope to look at the differences between his corneas, so at the end of the day, she may not have remembered that he has PPMD, but she does understand why he needs to be followed and the importance of having an eye care provider.