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This 59-year-old woman presented as shown in the pictures above.  She gives a history of her eyes being straight as a child and young woman, but they began turning in gradually beginning eleven years before and now they seem to be “stuck”.  Her vision is also getting worse.  She is otherwise healthy and wears contract lenses.  As you look at this patient and listen to this brief history, you start to make a plan.

1.	Which of the following tests available to you in the clinic would give you the most insight into the diagnosis in the shortest amount of time?
	d -- a scan axial length measurement The simple test that you can do in the clinic first to give the best information in this case is measurement of the axial length with a scan.
2.	You ask the patient to remove her contact lenses and you do retinoscopy. You would expect to find:
	d -- high myopia Retinoscopy will be most likely to show high myopia.
3.	Which of the following tests would be most helpful for planning treatment?
	a -- coronal view with MRI Before planning treatment it would be very useful to see the results of a coronal MRI.

Sorry!  We are leaving you a bit “up in the air” on this case.  Do not worry.  There will be more on this patient.  Be sure and visit the QOW next week for more on this patient. EMH

This case was submitted by Dr. Petja Vassileva of Sophia, Bulgaria.