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Clinical techniques and refraction

Clinical techniques and refraction

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Clinical techniques and refraction. Case History. Clinical thought. Case history. (1). Optometrical investigation. Tentative diagnosis. (2). Specific tests. (3)-(4). Treament plan. Definitive diagnosis. Analysis of information. (6). (7)-(8)-(9). (5). - PowerPoint PPT Presentation

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Clinical techniques and

refraction

Case History

Optometrical investigation

Optometrical investigation

Case history

Case history

Tentative diagnosis

Tentative diagnosis

Specific tests

Specific tests

Analysis of informatio

n

Analysis of informatio

n

Definitive diagnosis

Definitive diagnosis

Treament plan

Treament plan

(1)

(2)

(3)-(4)

(5) (6) (7)-(8)-(9)

Clinical thought

ObjectiveObjective

Extract information from the patient that will be useful in determining the specific tests that should be performed

during the visual investigation in order to, after their interpretation and analysis, arrive at a definitive

diagnosis and a treatment plan.

Extract information from the patient that will be useful in determining the specific tests that should be performed

during the visual investigation in order to, after their interpretation and analysis, arrive at a definitive

diagnosis and a treatment plan.

Objective of the clinical history

Important pointsImportant points

• The patient’s case history begins in the first few minutes of the visit but continues throughout the duration of the clinical examination

• When creating a case history, keep in mind the prevalence and incidence of visual conditions and ocular illnesses as well as their relation to age.

• It is important to establish an appropriate professional-patient relationship.

Reflections before beginning

Example of the question in the case history

Reflection before beginning

• Premature or hasty conclusion: a conclusion before obtaining all of the information necessary and stopping the investigation.

• Pseudodiagnosis or inadequate synthesis: all of the information is extracted but at the end there is no diagnosis.

• Lack of trust on the patient’s behalf• Letting oneself be guided by intuition, etc

Common errorsCommon errors

Most frequent errors

• Personal information• Main reason for the consultation (MC)• Personal history (PH)

– Ocular and general health history• Family history (FH)

– Ocular and general health history• Visual needs at work and other activities

Sections of the case historySections of the case history

Sections of the case history

Personal information

• First and last names• Date of the appointment• Date of birth and current age• Complete address and telephone number(s)• Sex/Race• Profession• Sent/recommended by• Observations

Personal informationPersonal information

Reason for the consultationReason for the consultation

Reason for the consultation (MC): the objective is to determine the possible

etiologies of the visual problem the person shows, depending on the symptoms that the

person manifests.

Main reason for the consultation

• Reasons for the consultation (MC):– Main reason for the consultation

• Open question“What is the reason for your visit?”,

“Why have you come to see us?”, “What’s wrong?”…

• Write it down in the patient’s words• Continue with more questions in order to get to the

main and any secondary symptoms: when, how, where, from distances, from near…

Reasons for the consultationReasons for the consultation

Reasons for the consultation

Examples of questions to center on the reasons for the consultation

Reasons for the consultation

• Blurry vision• Visual fatigue• External ocular discomfort• Headaches• Loss of vision• Other visual discomfort

Most frequent symptomsMost frequent symptoms

Most frequent symptoms

• Blurry vision (functional causes):– Ametropia/Presbyopia– Amblyopia– Accomodative

dysfunction– Binocular dysfunction– Simulation/ocular

hysteria

• Blurry vision (pathological causes):– Corneal/crystalline

alteration– Inflammation– Vitreous opacities– Macular problems– Problems with the optic

nerve

Most frequent symtoms

Most frequent symptoms

• Visual fatigue:– Ametropia/Presbyopia– Binocular dysfunction– Accomodative dysfunction– Anisometropia/aniseikonia– Inadequate optical correction– Inadequate environment

Most frequent symptoms

• Double vision (diplopia):– Ametropia– Binocular dysfunction– Monocular diplopia

• Loss of vision (of visual acuity):– Migraine– Optic neuritis – Occlusion of retinal vein

or artery– Temporary arthritis– Papilloedema

• Loss of vision (of field of vision):– Retinal lesions/loosening– Anomalies of the visual

pathway

Most frequent symptoms

Most frequent symptoms

• Discomfort related to the anterior segment of the eye– Excessive tearing– Reddening/Itchy eyes– Sensation of foreign body

Most frequent symptoms

• Headaches:– Ametropia/Presbyopia– Binocular dysfunction– Accomodative dysfunction– Vascular: migraine, tensional, etc.– Inflammatory, tumoral, etc.

Most frequent symptoms

• Headaches:– Ametropia/Presbyopia– Binocular dysfunction– Accomodative dysfunction– Vascular: migraine, tensional, etc.– Inflammatory, tumoral, etc.

Personal history

• Visual and ocular personal history– If he/she wears glasses and/or CL

• How long have you worn glasses? How long have you had this prescription? When was your last check-up? When or for what do you wear the glasses? Do they work well for you?

• Test the graduation to the frontal focometer and the centration distance, effects, material, color, design, etc.

– If he/she does not wear glasses• Have you ever worn glasses? When was your last

eye exam?

Personal historyPersonal history

• Visual and ocular personal history– Ocular traumas– Is the person using any drops or creams

for the eyes? Has he/she ever used any?– Past or present ocular illnesses– Ocular operations or operations in

surrounding areas

Personal historyPersonal history

Personal history

Personal history

• Personal history of general health– General health

• Current state of health? Any health problems like diabetes, hypertensión, etc.?

– Medication:• Is he/she taking any medication? Why? For

what? When? Since when? How much?• Has he/she taken any medication recently?• Are there any known allergies?

• Family history (FH)– Ocular history and general health

• Interrogation directed at conditions with a possible hereditary factor and that can affect the vision: glaucoma, diabetes, retinal detachment, severe loss of vision, ocular or arterial hypertension, etc.

Family history

• Visual needs– What do you do? Distance, lighting, size, etc.?– Any hobbies that require visual exertion?:

reading, painting, sewing, music, etc.

Visual needs

• Observations: any relevant TRAZO from external factors

Relevant observations

Case file

• Personal information• MC, PH, FH• Refractive section:

– PD– AV– Retinoscopy and

Subjective– Others

• Visual efficiency: – Binocularity– Accomodation– Ocular motility

Case file

• Personal information• MC, PH, FH• Refractive section:

– PD– AV– Retinoscopy and

Subjective– Others

• Visual efficiency: – Binocularity– Accomodation– Ocular motility

• Ocular health:– Anterior segment– Eye exam– Visual field– Pupillary function– Intraocular pressure

(IOP)

• Ex. complementary:– Color vision

• Diagnosis• Treatment plan

• Future visits

Associated practice

• Practice 1: Case history between fellow students in the group

• Practice 2: Case history of external patients

Work outside the classroom

• Creation of a list of questions to ask in distinct hypotheses:– 15-year-old that attends a revision due to

loss of far vision– 38-year-old adult that attends a revision

due to loss of near vision– 70-year-old elderly patient that attends a

revision for loss of vision

Bibliography