Transcript Advanced Basic Procedure - American Optometric Association

Advanced Basic Procedure
Handheld Autorefractor
• Welch-Allyn SureSight
• Retinomax
• SureSight
– Important points
• make sure it is in the correct mode for “child” or
“adult”
• Move the unit to lefft eye after to right eye
measurements
• Remind the patient to look at the red light
• If confidence number is less than 6, retest eye
• Reprint if black boxes are on the printout.
• You can test a max of 3 times for each eye
• Retinomax
– Important points:
• Dimming lights may help obtain adequate confidence
numbers
• If the confidence level is less than 8, retest eye
• A confidence level of “E” is not a valid reading
• It may help to put your thumb on pt forehead and place
the forehead rest on your thumb instead of directly
above the pt brow.
• See handout for specific instuctions and
recording.
Drop Instillation
Tono-pen
• In the ER, or with patients who are difficult to
examine, we can check pressure using a
handheld electronic Tono-pen.
• Prepare patient by instilling a drop of topical anesthetic onto
the eye
• Position patient in front of a fixation target
• Hold the tono-pen like you would a pencil
• Brace the heel of your hand on the patient’s cheek for stability
while hold the unit perpendicular to and within ½ inch of the
patient’s cornea
• Depress operator button once
• Within 15 sec, Touch the unit to the cornea lightly and briefly,
then withdraw. Repeat several times
• A chirp will sound and IOP measurement will sound
• After four valid reading are obtained, a final beep will sound
and the average will appear
http://youtu.be/bdVOItixpvo?t=37s
• Calibration
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[CAL] followed by row of dashes [----]
Point the tip straight down towards the floor
Hit operator’s button two times quickly
Wait 15 sec for the beep and the display {UP}
Then flip so the tip is directed to the ceiling
Display [Good] or [Bad]
• http://www.youtube.com/watch?v=AWamV6
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Extraocular muscles(EOM)
• Check EOM in six positions of gaze: right,
upper right, upper left, left, lower left, lower
right. One eye muscle is the prime mover in
each position of gaze.
• Right gaze is mainly moved by the right lateral rectus
muscle and the left medial rectus muscle.
• Upper right gaze is by the right superior rectus and left
inferior oblique.
• Upper left gaze is by the left superior rectus and right
inferior oblique.
• Left gaze is by the left lateral rectus and right medial
rectus.
• Left lower gaze is by the left inferior rectus and right
superior oblique.
• Right lower gaze is by the right inferior rectus and left
superior oblique.
• Check EOM motility by asking examinee to
watch your light while keeping the head still,
move your finger across in “H” pattern, at a
distance about 10-14 inches away from the
examinee.
• http://youtu.be/vd7OOJ7c1q4
Confrontation Fields
Confrontation Fields
• Test peripheral vision
– Sit about 3 ft directly in front the patient.
– Ask patient to cover one eye while you close the
opposite eye
– Present varied number of fingers in each four
quadrants while patient fixates on your nose
Pupils
• To examine the pupils, the level of the ambient
light should be reduced and, to relax
accommodation, the patient should be directed
to look at a distant object. Using a penlight
directed from below, just barely illuminating the
pupils, one inspects for symmetry in pupillary
size. The patient continues to view a distant
object, and each pupil is tested separately for
constriction in response to bright light. Also,
check the pupils with near-vision, as they should
constrict with accommodation.
• The penlight is then quickly moved from one
pupil to the other, shining light directly into each
eye (the "swinging penlight test" to elicit afferent
pupillary defect) In this test, one is specifically
looking for a pupil that dilates as the light is first
directed toward it, demonstrating greater
consensual than direct response. The afferent
pupillary defect is also known as a Marcus Gunn
pupil.
• http://youtu.be/HSYo7LhfV3A
• If any discrepancy of more than 1 mm in
pupillary size is found, the pupils are
measured in both bright and reduced ambient
light. Differences in pupillary size (aniso-coria)
tend to be physiologic and not pathologic if
such differences are only 1 to 2 mm and
remain the same in differing levels of ambient
light.