Transcript THEME 4: PERFORMANCE OF THE OPTOMETRIC EXAM a

COURSE SYLLABUS
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Psychology and visual health
Non-verbal communication
The visual exam
Performance of the optometric exam
Giving bad news
Difficult patients and managing complaints
THEME 4: PERFORMANCE OF THE OPTOMETRIC
EXAM
STRUCTURE OF THE THEME:
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Case history
Adaptation of the exam to the age of the patient
Children and adolescents
Adult population
The elderly
Poor vision
THEME 4: PERFORMANCE OF THE OPTOMETRIC
EXAM
1. ANAMNESIS
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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?”
THEME 4: PERFORMANCE OF THE OPTOMETRIC
EXAM
• 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
THEME 4: PERFORMANCE OF THE
OPTOMETRIC EXAM
2. Adaptation of the exam to the age of the
patient
•Young population
•Adult population
•The elderly
•Poor vision
THEME 4: PERFORMANCE OF THE OPTOMETRIC
EXAM
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
THEME 4: PERFORMANCE OF THE
OPTOMETRIC EXAM
3. Children and adolescents
a) Children to to 5-years-old
• TASKS:
– Learning to walk and talk
– Developing concepts
– Learning language to describe social and physical reality
• HANDICAPS TO THE DEVELOPMENT OF BLIND CHILDREN:
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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…
THEME 4: PERFORMANCE OF THE OPTOMETRIC
EXAM
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…
THEME 4: PERFORMANCE OF THE OPTOMETRIC
EXAM
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.
THEME 4: PERFORMANCE OF THE OPTOMETRIC
EXAM
b) Children over 8 and
adolescents
TASKS:
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Reading and writing
Calculations
Development of concepts for everyday life
Creating relationships “in twos”
Development of attitudes with respect to social groups and
institutions
THEME 4: PERFORMANCE OF THE OPTOMETRIC
EXAM
• 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
THEME 4: PERFORMANCE OF THE OPTOMETRIC
EXAM
4. Adult population
TASKS:
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Pairing up
Raising children
Managing a household
Building a career
Adjusting to physiological changes
implicit to midlife
THEME 4: PERFORMANCE OF THE OPTOMETRIC
EXAM
• 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
THEME 4: PERFORMANCE OF THE
OPTOMETRIC EXAM
• 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
THEME 4: PERFORMANCE OF THE OPTOMETRIC
EXAM
5. The elderly
TASKS:
• Adjusting to lessening physical
strength
• Adapting to retirement
• Reduced income
• In some cases, widowhood
THEME 4: PERFORMANCE OF THE OPTOMETRIC
EXAM
• 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!!
THEME 4: PERFORMANCE OF THE OPTOMETRIC
EXAM
MYTHS ABOUT THE ELDERLY
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 age
5. Almost all older people feel bad or ill most of the time
6. Physical strength tends to diminish with age
7. A least a tenth of elderly people live in institutions (residences,
hospitals, psychiatric wards)
8. Older drivers have fewer accidents than people younger than 65
9. Older workers generally cannot work with the same effectiveness
as younger workers.
THEME 4: PERFORMANCE OF THE OPTOMETRIC
EXAM
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 things
14. Older people tend to react more slowly than young people
15. In general, older people look similar
16. The majority of the elderly affirm that they do not get bored easily
17. The majority of the elderly are socially isolated
18. Older workers have fewer accidents than younger workers
THEME 4: PERFORMANCE OF THE OPTOMETRIC
EXAM
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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
THEME 4: PERFORMANCE OF THE OPTOMETRIC
EXAM
• 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
THEME 4: PERFORMANCE OF THE OPTOMETRIC
EXAM
6. Poor vision
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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
THEME 4: PERFORMANCE OF THE OPTOMETRIC
EXAM
• 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