it all begins with - american optometric convention/2017...wrap cuff and secure, center arrows...

Download It all begins with - American Optometric Convention/2017...Wrap cuff and secure, center arrows marked on cuff over brachial artery Locate pulse with stethoscope on brachial artery

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    It all begins with CASE HISTORY This is one of the most important procedures in any eye examination. You become the detective Ask open ended questions Let the patient tell you their story Chief Complaint Why are you here? Tell me about your eyes and your vision? Document is patients exact words Location specifically where the problem occurs Frequency how often as this occurred Onset when does the problem typically first occur Progression how the problem begins, unfolds, resolves Duration how long the problem typically lasts Aggravating or alleviating factor what makes it worse or better Any associated symptoms or attributions what causes it Last eye Examination When By Whom Prescription history Ocular Health (i.e. cataracts, glaucoma, macular degeneration) Self Family History General Health (i.e. hypertension, diabetes) Self Family History Medication What (including over-the-counters and supplements) Allergies Medication Environmental (seasonal) Occupation/Hobbies

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    BLOOD PRESSURE It is the pressure caused by the blood pushing against the inside walls of the arteries as it flows through the body. Systolic Pressure First and largest number The force exerted against the arterial walls during the heart beat Diastolic Pressure Second and smaller number The force on the arterial walls when the heart is a rest Sphygmomanometer Aneroid Uses a pressure gauge and indicator on a dial Mercury Uses mercury to measure pressure How to: Determine the proper cuff size Patient should be seated, relaxes, with arm slightly flexed and supported at heart level,

    palm up Expose upper arm and place cuff1 inch above brachial artery pulse (inner crease of arm) Wrap cuff and secure, center arrows marked on cuff over brachial artery Locate pulse with stethoscope on brachial artery Close valve of pressure bulb Inflate cuff to 30mm Hg above patients normal systolic level (no more than 200mm Hg) Slowly release the valve about 2 0 3 mm Hg/second Note measurement level at which first clear sound of two consecutive beats are heard Continue deflating cuff gradual Note measurement level at which the sound disappears Wait 30 seconds if repeating Pulse Lay index and middle fingers on inner side of patients wrist Count beats for 15 seconds Multiply by 4 = beats per minute

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    VISION ACUITY Chart should be well-illuminated Room light may vary according to practitioner philosophy Important that all personnel use same conditions Recommended sequence Distance without RX OD OS OU Distance with RX OD OS OU Near without RX OD OS OU Near with RX OD OS OU

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    PUPILLARY DISTANCE Distance PD Rest millimeter ruler on bridge of nose Close your right eye and have patient look into your open left eye Align the zero with the temporal edge of patients right pupil Open your right eye and close your left eye Instruct patient to look into your open right eye Take reading from millimeter rule that is directly in line with nasal edge of patients left

    pupil Verify that ruler has not moved Near PD Instruct patient to look at your open left eye Align zero of ruler to temporal edge of patients right pupil Look to the patients left eye Take measurement that intersects with nasal edge of patients left pupil Or use Pupillometer EYE DOMINANCY Also called eye preference Have patient form a triangle with their hands, overlapping thumbs as the base or use a card with a hole in the center Stretch to full arms length Ask patient to focus on an object or an isolated letter on the acuity chart Observe which eye they focus with This is their dominate eye To verify, have them close that eye and report what they see

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    STEREOPSIS Is the ability to see or appreciate depth using both eyes

    Types of Booklets used: Titmus Stereo Fly Randot Stereo Reindeer Performed with patients best correction in good illumination With cross polarized filters at near distance (16 inches) Measures gross stereopsis, intermediate stereopsis or fine stereopsis Measured in seconds of arc The smaller the number the finer the stereopsis Example: Gross = 3,000 seconds of arc Intermediate = 400, 200, 100 seconds of arc Fine = 40 seconds of arc

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    NEAR POINT OF ACCOMMODATION and CONVERGENCE Accommodation defined as focusing ability of the eyes Convergence act of the eyes turning inward toward the nose NPA is to evaluate the ability of the eyes to focus at near NPC is to measure the ability of the two eyes to work together To perform: Patient wears near spectacle prescription Use a target, such as a penlight. Hold at midline Bring target toward the patients nose

    (the eyes will turn in trying to maintain single image) Instruct patient to tell you when the target becomes blurry (This point is called breaking fusion) Stop and ask patient if they can clear the image When patient can no longer clear , measure distance from target to bridge of nose This is blur point or Near Point of Accommodation Continue moving target toward nose Ask patient to try to maintain a single image Monitor patient eyes Watch for an eye to turn out When patient reports target doubles or you see one eye lose fixation This is the break point or Near Point of Convergence Record to nose for NPC Place target on nose Slowly move along midline Ask patient to report when target becomes single again This is recovery point Measure distance from bridge of nose Data is recorded as blur, break and recovery points in cm

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    Cover/Uncover Test

    Unilateral Cover Test Evaluates the alignment of the eyes Determines frequency (constant or intermittent) Unilateral or alternating

    How is it done? Patient wears correction Watching a single letter of acuity chart Cover right eye for 2 3 seconds Watch for movement of left eye Repeat several times Now move to left eye and repeat Also watch for movement of covered eye as removing occluder If no movement

    o No tropia is present Ortho

    If movement o If right eye moves when left eye is covered

    Right tropia o If left eye moves when right eye is covered

    Left tropia o If both eyes move when the other is covered

    Alternating tropia

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    Alternating Cover Test Determines the direction and magnitude of the tropia or phoria

    Eso Exo Hyper Hypo

    How is it done?

    Patient instructed to look at letter on acuity chart Cover patients right eye Hold it for 1 second Move to left eye Observe right eye Hold for 1 second Move to right eye Observe left eye

    If no movement

    Patient is orthophoric

    If eye moves in to pick up fixation as uncovered Habitual position is out Patient is exophoric

    If eye moves out to pick up fixation as uncovered Habitual position is in Patient is esophoric

    If there is no movement detected on unilateral cover test but movement is noted on alternating cover test

    THEN. Phoria is present

    If movement is noted in both tests

    THEN Tropia is present

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    EXTRAOCULAR MUSCLE TESTING Broad H Pursuits Movements of eyes as they follow a moving target Saccades Jumping movements from one target to another To Perform: Face the patient, with room and target well-illuminated Patient removes eyewear Hold target approximately 40 cm directly in front of patient Instruct patient to follow the target with eyes not moving their head Starting a midline, move target horizontal to the right approximately 12 inches Then up, then down, then back to midline Move target across midline to patients left approximately 12 inches Then up, then down, then back to midline Record as smooth and full or jerky or incomplete Use two testing targets Present targets approximately 40 cm in front of patient

    and approximately 30 cm apart horizontally Ask patient to look from one to the other Repeat sequence in vertical meridians and in both directions of an X pattern Record the accuracy of eye movements,

    whether eyes are able to locate and fixate or overshoot or undershoot

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    COLOR TESTING Color Vision Classifications Trichromatism normal color vision Uses three primary colors (red, green and blue) Protanolalous Red weakness Deuteranomalous Green weakness Dichromat Uses two primary colors Protanope Red deficiency Deuteranope Green deficiency Tritanope Blue-Yellow deficiency Monochromat Sees everything as the same color Also known as achromatism Pseudoisochormatic Plates Most commonly performed With correction Evaluated with lighting daylight from the northern sky Reading distance (30 inches or 75cm Give a limited amount to time for viewing Farnsworth D-15 Patient is asked to arrange the discs in color sequence

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    KERATOMETRY A measurement of the corneal curvature Cornea supplies approximately 2/3 of the refracting power of the eye (43.00D) To Perform: Clean and adjust keratometer eyepiece for clarity Seat patient comfortably; head should be firmly against headrest, chin in chinrest Occlude eye not being tested Release locking knob located on left side and swing instrument in front of eye to be tested Instrument can be raised or lowered until pin at side of lamp house is aligned with patients outer canthus Patient can see an image of their own eye Adjust instrument until white circle is reflected off cornea Using focusing knob directly below eyepiece, focus circles until they are sharp and clear Circles should be aligned so the black cross is in center of lower right circle Once mires are


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