course syllabus

COURSE SYLLABUS

1. Psychology and visual health2. Non-verbal communication3. The visual exam4. Performance of the optometric exam5. Giving bad news6. Difficult patients and managing complaints

THEME 4: PERFORMANCE OF THE OPTOMETRIC EXAM

STRUCTURE OF THE THEME:

1. Case history2. Adaptation of the exam to the age of the patient3. Children and adolescents4. Adult population5. The elderly6. Poor vision


1. ANAMNESIS

• Two professionals do case histoies of the same patient and extract different information

• Good rapport• Good form, it is not necessary to follow “to

the letter”• Flow of information in two senses:

– Begin with open questions:Which is better? “What is the reason for

your visit?” or “Do you have some specific reason for coming in to visit today?”


• Adapt the order of the questions to the openess of the patient– Do not “fire questions” at the patient from

the very start– Patient’s concerns

• Does the patient remain silent or find it difficut to talk about the subject?

– Do not ask closed or administrative questions– Respect silence and use non-verbal

communication– Uncomfortable?

• Return to the questions• Suggest our perception of what is

happening• Do not insist

2. Adaptation of the exam to the age of the patient

•Young population•Adult population•The elderly•Poor vision



DEVELOPMENT PSYCHOLOGY• Importance of family and social

environment• Evaluation of development studying

tasks that each individual is capable of completing

• Tasks successfully completed: increase motivation

• Failure in the task: feeling of frustration

3. Children and adolescents

• TASKS:– Learning to walk and talk– Developing concepts – Learning language to describe social and physical reality

• HANDICAPS TO THE DEVELOPMENT OF BLIND CHILDREN:– Floppy hands– Difficulty grabbing objects– They walk at a later age– No touch+hearing integration with the vision– Less expressive– Difficulty learning through observation:

how to eat alone, maintain posture…


a) Children to to 5-years-old


BABY:– Determine the date and time of the visit with a parent– Do the exam after the baby has eaten and is wearing

clean diapers– Do not cooperate: be present in an observing capacity

12 MONTHS:– Easy execution test FRISBY

• With gaurantee after 2-years-old• Reinforcement: baby rattle, lights…


CHILDREN’S FEARS:

• 7 to 9 months: the are scared in the presence of strangers

• Fear of unexpected changes

• Fear of new experiences. Oclusion is nearly impossible between 1 and 2-years-old.

• Rejection of test glasses.


b) Children over 8 and adolescents

TASKS:• Reading and writing• Calculations• Development of concepts for everyday life• Creating relationships “in twos”• Development of attitudes with respect to social groups and

institutions


• Active cooperation: clear explanations TO THE CHILD• 4 years: knows that he/she is ill from external clues• 8 years: can describe the illness in terms of what happens or

is happening• Avoiding metaphors• Possibility for rejection of glasses

PREVENT ANXIETY:– Fear because of the association of ideas– Create an attractive atmosphere– Blame– Simple explanations– Do not wear a white robe– DIRECT ATTENTION TO THE CHILD AND NOT THE PARENTS– Do not lie: cycloplegics burn!!!– They do not understand jokes


4. Adult population

TASKS:

• Pairing up• Raising children• Managing a household• Building a career• Adjusting to physiological

changes implicit to midlife


• MEN: little contact with health services

• TOYS

• WRITTEN PLANNING OF VISITS

• DETERMINING NEEDS– Vision: close up– Vision: far away– Color vision– Ocular protection

• AVOID ECONOMIC IMPLICATIONS IN THE QUESTIONS

• PHYSICAL SYMPTOMS OF AGING: farsightedness


• A visual exam can provoke anxiety

• Unexpected or disagreeable news

• FEARS: image, deteriorated vision, general health problem…

• Allow catharsis and the freeing of emotions

• Do not minimize problems if they are serious

• Calm unfounded fears• Make the patient aware of

dangerous situations


5. The elderly

TASKS:• Adjusting to lessening

physical strength• Adapting to retirement• Reduced income• In some cases, widowhood


• 2020: 15% of the population > 65 años

• Women: 2/3 of the elderly population. Nearly half are widows

• Social isolation due to a precarious economic situation, bad health, or lack of transport

THESE DEMOGRAPHIC CHANGES WILL AFFECT THE VISUAL ATTENTION!!


1. The majority of people over 65 are senile (deficient memory, disorientation, dementia)

2. The five senses (sight, hearing, taste, smell, and touch) tend to weaken with age

3. The majority of elderly do not have the interest nor the capacity to maintain sexual relationships

4. The vital capacity of the lungs diminishes with age5. Almost all older people feel bad or ill most of the time6. Physical strength tends to diminish with age7. A least a tenth of elderly people live in institutions

(residences, hospitals, psychiatric wards)8. Older drivers have fewer accidents than people younger

than 659. Older workers generally cannot work with the same

effectiveness as younger workers.

MYTHS ABOUT THE ELDERLY


10. Almost ¾ of elderly people are healthy enough to participate in normal activities

11. The majority of older people are incapable or adapting to changes

12. Generally, elderly people find it more difficult to learn new things

13. It is very difficult for an older person to learn new things14. Older people tend to react more slowly than young people15. In general, older people look similar16. The majority of the elderly affirm that they do not get bored

easily17. The majority of the elderly are socially isolated18. Older workers have fewer accidents than younger workers


• Worried about their sight• Health (and not age!): principal cause of daily decline• Dependence, perceived support, perceived health• ↓ Visual acuity, contrasts and field of vision: falls,

mobility, independence• Questionaire NEI-VFQ


• Slow and prudent in their judgements• Medications• Preferably, they live at home. Visual attention

to the domicile?• Lots of patience!! • Diminished memory• Great variability in the state of health• Do not shout to be heard


6. Poor vision

• Depression or mourning? A feeling of dysfunction• Sudden losses of vision: depression in 5-15% of

cases• Frustration → regression• Reconstruction of their abilities. Something to do! • Artesanal, therapeutic actions


• Blind: solitary, destitute, dependent, depressed...• Be careful with certain behavior in front of blind

people!• Attention to people who still haven’t lost all of their

vision

course syllabus

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