Clinical Conundrum – what would you do?

As a locum I occasionally come across previous practitioner’€™s work which raises an eyebrow. However, I came across this young man recently:

Age 10, routine review, asymptomatic.

Previous practitioner reports: +0.50 R&L. No Rx given.

Today the findings were

RVA   6/5   +2.50 =  6/5
LVÂ   6/5   +2.50 =  6/5

I believe that the level of plus has been previously undetected rather than it appearing as €’brand new’€™ (the benefits of the often, sadly, underused retinoscope followed by binocular refraction to confirm my scepticism).  Stereopsis (TNO) 60″, cover test, fixation disparity etc – nothing remarkable.

Conclusion: No prescription given.  I left his parents with the understanding that if he develops any symptoms such as headaches or blurred vision, to return sooner, and that at some stage in the future, should the prescription remain, spectacles may be required.  Otherwise I left him alone.

So, first of all – who would have gone on to prescribe and why?
Who would leave him alone as I did?

And how was it missed in the first place!

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