A man, 35 yrs of age complains of poor near vision Distant vision is normal. Retinoscopy at 1 meter shows + 2 D spherical lens. He has:
**Core Concept**
The patient's symptoms of poor near vision with normal distant vision suggest a refractive error that affects near vision. The retinoscopy result of +2 D spherical lens indicates that the patient has a hyperopic (farsighted) refractive error at near distance.
**Why the Correct Answer is Right**
The patient's symptoms are consistent with a presbyopic condition, where the age-related loss of accommodation (the ability of the eye to focus on near objects) results in hyperopia at near distance. The +2 D spherical lens is a correction for hyperopia, which is a common condition in individuals over 40 years old. However, this patient is only 35 years old, so we must consider other options.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because myopia (nearsightedness) is typically associated with difficulty seeing distant objects, not near objects.
**Option B:** This option is incorrect because astigmatism is a refractive error that affects both near and distant vision, and does not typically present with normal distant vision and poor near vision.
**Option C:** This option is incorrect because anisometropia is a condition where the refractive error differs between the two eyes, and does not explain the patient's symptoms.
**Clinical Pearl / High-Yield Fact**
Presbyopia typically begins around the age of 40, but can occur earlier in individuals who have had cataract surgery or have other eye conditions. This patient's presbyopia is likely due to an earlier onset of age-related accommodation loss.
**Correct Answer:** D. Presbyopia