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Visual and/or ocular problems: the importance of multidisciplinarity
WHO: “The process by which a group of workers from health related occupations with different educational backgrounds are able to collaborate in providing preventive, curative, rehabilitative and other health-related services.”
Professionals
• Optician-optometrist
• Ophthalmologist• General practitioner• Specialist• Psychologist• Speech pathologist
• Occupational therapist
• Physiotherapist• (CLS) • Osteopath • Homeopath• Others
Competences:
• Expert• Communicator• Teamplayer• Care provider• Longlife learning
Expert
• Aware of his professional expertise• Aware of his boundaries • Aware of the expertise from others • Seeks and reads relevant information
on a regular base
Communicator
• Develops an ethical and “therapeutic” relation (based on trust) with the patient/client and with colleagues from other disciplines
• Gives and analyzes relevant information and shares this with colleagues
• Communicates and clarifies (patients/clients + colleagues)
• Communication is oral and written
Teamplayer
• Collaborates with other team members avoiding conflicts and optimizing care
• Places the patient/client in the central of the treatment plan
Care provider
• Takes individual questions and needs into account (patients/clients/other team members)
• Contribues to continuous improvement of general and specific health problems
Longlife learning
• Maintains and continuously improves multidisciplinary activities
• Evaluates constantly and critically the obtained results and uses these results in team
• Stimulates this attitude in encouraging others • Contributes to continuous improvement of
care
Types of problems:
• Physical• Physiological• Psychological• Pathological• Personal• Other
Multidisciplinarity implies:
• Exchange of information• Exchange of ideas• Exchange of recommandations
• Common vision/mission • Adequate treatment plan
Multidisciplinarity
Refer/send
Recieve
Both
Optician-optometrist
• Optician• Optometrist• Behavioural optometrist• Contact lens specialist• Low vision specialist
Optician refers
• Optometrist• Behavioural optometrist• Contact lens specialist• Low vision specialist • Ophthalmologist• General practitioner
Optician refers
• Physical problem: no ears: refer to contact lens fitting
• Physical problem: insufficient convergence: refer to the behavioural optometrist
• Pathological problem: red eyes: refer to the ophthalmologist
Optometrist refers
• Optician• Behavioural optometrist• Contact lens specialist• Low vision specialist • Ophthalmologist• General practitioner
Optometrist refers
• Physiological problem: photophobia refer to the ophthalmologist
• Physical problem: torticolis (spasmodic) refer to the behavioural optometrist
• Pathological problem: exophthalmia (unilateral) refer to the ophthalmologist
Behavioural optometrist refers
• Ophthalmologist• Speech pathologist • Psychologist• Physiotherapist • Optician • Contact lens specialist
Behavioural optometrist
• Hysterical amblyopia: – Simulated amblyopia – Real amblyopia (hysterical) – Streff Syndrome
• Dyslexia and dyscalculia
• Reading problems
Behavioural optometrist
Hysterical amblyopia: • Monocular loss of vision • Accommodation spasm • Changing pupil • Nervousness
Prescribe “Relaxing” convex lenses Refer to the psychologist, the neurologist
Behavioural optometrist
Streff Syndrome: • Loss of vision to 4/10• Eyestrain • Headache • Lack of concentration
Prescribe “Relaxing” convex lenses Refer to the psychologist, the neurologist, the general practitioner (hormonal)
Behavioural optometrist
• Dyslexia and dyscalculia: Refer to the speech
pathologist, the psychologist
• Reading problems: Refer to the speech
pathologist, the psychologist
Contact lens specialist refers
• Behavioural optometrist• Low vision specialist• Ophthalmologist• General practitioner • Others • Optician
Contact lens specialist refers to
The ophthalmologist and/or the general practitioner
• Keratoconus • Refractive surgery • Trauma • Pathologies (Blepharitis, allergies, herpes,
pterygium, ...)
Low vision specialist refers
• Behavioural optometrist • Occupational therapist • Psychologist• Ophthalmologist• General practitioner • Optician
Low Vision specialist refers to
The psychologist
Different stages:• Denial • Anger • Sadness and depression • Acceptance
Low Vision specialist refers to
The occupational therapist
Using magnifying devices: • Monoculars • Reading magnifiers
Getting around: • Using a white cane
Multidisciplinarity implies:
• Exchange of information• Exchange of ideas • Exchange of recommandations
• A good structure of the file!!!• A good structure of the protocol!!!
The protocol of the behavioural optometrist contains:
As much information as possible:
– Data from the patient/client – Refraction– Tests performed – Proposed solutions (glasses, training exercises ...) – Results– Practical information for teachers – ...
Creating a good file
• To record the acts of the optometrist
• The patient has right to inspection
• The optometrist should be able to demonstrate his recommandations afterwards
Creating a good file
• Medical data may not be communicated to third parties unless the patient requests it in writing
• Save the file no longer than 10 years after the last visit of the patient (some countries)
A good file contains:
• Personal data of the patient • Ophthalmic diagnosis• Inventory of existing devices (as complete
as possible)• Anamnesis: extensive questioning – How is the patient’s participation? – What activities are limited?
• Inventory of activities
Activities list with ICIDH categories
1. See and recognize2. Learn, apply knowledge and tasks3. Communicate4. Moving activities5. Move (from one place to another)
Activities list with ICIDH categories
6. Activities of daily living7. Household activities8. Interpersonal behavior9. Deal with special situations10. Use of visual and/or other
technology
A good file contains:
• Finding out the participation
• 1. In home care2. In mobility3. In exchanging information4. In social relationships5. In education, work, leisure and spirituality6. In civil and social life
Finding out the participation
The patient "chooses" its own category of participation based on what he considers important!
A good file contains:
• Evaluation of existing visual aids- Some activities require specific visual aids- Estimation of the "possible increase" of activity: often differs between the optometrist and the patient (much more positive than the reality)- Visual aids quickly reach their limits of potential
Evaluation of existing visual aids
Education: Advantages and disadvantages
– Understanding the benefits:
• Visualization of details• Enlarge
Evaluation of existing visual aids
Education: Advantages and disadvantages
– Understanding the disadvantages: • Physical boundaries (vision)• Practical limits (unaesthetic, heavy, ...)• Technical limits (diameter of a magnifier)• Others (rheumatism, spasms, emotional objections)
A good file contains:
• Observation of the patient– Independance in movement
(correlation peripheral vision)– Position of the head – Movement to observe something/somebody
A good file contains:
• Low vision examination– Screening– Objective refraction– Subjective refraction (trial frame)– Contrast sensitivity for near (newsprint)– Visual field– Selection of devices (visual aids)– Testing visual aids
Low vision examination
• General instructions (selecting and testing) visual aids – Magnifiers
• Hand-held• Stand magnifiers• Mounted in a frame
– Telescopic systems• Kepler• Galileï
– Electronic devices
Finding out the participation
For what purpose the patient is doing activities?
If the answer to this question is unknown, the recommended devices are probably not adequate but for a complete other purpose (other forms of participation) than actually needed.
Thank you !