Case History in Ocular Assessment

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Questions and Answers

What is the value subtracted from the sphere gross value for adults during the measurement process?

0.50D

1.00D

1.25D (correct)

1.50D

Which age group has its sphere value modified by subtracting 1.00D?

Children over 2 years (correct)

Children over 5 years

Children aged 2 to 3 years

Children under 1 year

What factors can influence the modification of net sphere value according to age?

Type of lens used

Environmental light conditions

Patient's emotional state

Type of refractive error (correct)

For children under 2 years, how much is subtracted from the sphere?

0.75D Signup and view all the answers

What is the assumption made regarding tonic accommodation for adults during the measurement?

0.75D Signup and view all the answers

What working distance is assumed in the measurement for adults?

50cm Signup and view all the answers

What is one of the primary reasons for probing the areas in the case history?

To establish goals for the patient Signup and view all the answers

Which of the following would be considered when assessing the severity of a complaint?

The duration of the complaint Signup and view all the answers

What aspect does NOT directly aid in the diagnosis process?

Understanding the patient's occupation Signup and view all the answers

How is the relief from symptoms assessed in the case history?

By identifying modifying factors Signup and view all the answers

When considering diplopia in a patient, which factor is crucial for establishing the type?

The direction of the diplopic images Signup and view all the answers

What is an essential question to ask regarding the onset of symptoms?

How long has it been since symptoms first appeared? Signup and view all the answers

Which symptom is least likely to be related to eye turn?

Color blindness Signup and view all the answers

What type of diplopia is described when there is confusion of images in both eyes?

Binocular true diplopia Signup and view all the answers

Which of the following questions would NOT help determine aggravating factors during case history?

Do you have a pet at home? Signup and view all the answers

What type of prism should be used for a patient with left esotropia before the right eye while scoping?

30 BO prism Signup and view all the answers

For a 30 prism left eye exotropia, which prism should be used during retinoscopy?

30 BI over the right eye Signup and view all the answers

When dealing with vertical deviations, what should be applied before the fixating eye?

Neutralizing prism Signup and view all the answers

In cases where horizontal deviations exceed 15 PD, what is the best practice for retinoscopy?

Perform out of the phoropter and align with the turned eye Signup and view all the answers

What method is suggested for recording gross findings in near retinoscopy?

By marking on the optical cross Signup and view all the answers

Which prism should be used in retinoscopy for a patient with 15 right hypertropia while scoping the right eye?

15 BD prism Signup and view all the answers

What is recommended for patients who are young or have special needs during the retinoscopy process?

Perform retinoscopy out of the phoropter Signup and view all the answers

What adjustments should be made to align Purkinje images when retinoscopy is performed?

Align oneself with the turned eye and adjust accordingly Signup and view all the answers

For patients with esotropia during distant target fixation, what type of prism is suggested for the left eye correction?

Base-out prism Signup and view all the answers

How should gross findings be handled immediately after performing Mohindra retinoscopy?

Record them on the optical cross promptly Signup and view all the answers

How might symptoms of eye turn or diplopia vary in relation to time of day?

Symptoms may increase at specific times, like evening. Signup and view all the answers

Which factor could lead to the onset of eye turn or diplopia?

An underlying neurological condition. Signup and view all the answers

What is a possible change in the symptoms of eye turn or diplopia over time?

They can vary in both frequency and severity. Signup and view all the answers

Which of the following is least likely to be a contributor to eye turn or diplopia symptoms?

Usage of prescribed eyeglasses. Signup and view all the answers

How can patients potentially alleviate their eye turn or diplopia symptoms?

By turning or tilting their heads. Signup and view all the answers

What aspect of medical history is crucial to understanding eye conditions?

Other childhood ailments or hospitalizations. Signup and view all the answers

Which of the following factors is the least relevant when assessing the severity of eye turn?

The patient's comfort level at rest. Signup and view all the answers

What maternal factor is critical in the prenatal period related to eye conditions in a child?

Maternal health and nutrition. Signup and view all the answers

Which of the following is considered a recommended practice in managing pupil eye conditions?

Regular eye evaluations and prescribed treatments. Signup and view all the answers

What aspect of infant health could impact the likelihood of future eye conditions?

APGAR score assessed immediately after birth. Signup and view all the answers

What is the primary purpose of using prism in retinoscopy for strabismic patients?

To align the optical axis with the fixating eye. Signup and view all the answers

Which of the following best describes a goal of vision therapy?

To address both short-term and long-term visual function issues. Signup and view all the answers

What might be a reason for assessing a child's developmental history in relation to their visual needs?

To establish a correlation between visual and motor skills. Signup and view all the answers

When evaluating a child's academic history, which factor is most important?

The match between grade level and age. Signup and view all the answers

Why is compliance with recommendations significant in therapy programs?

It directly impacts the success of therapy programs. Signup and view all the answers

In the context of eye surgeries, which factor is essential for evaluating success?

Both short-term and long-term results post-surgery. Signup and view all the answers

Which aspect is important when assessing allergies in relation to medications?

Environmental triggers that may compound the effects. Signup and view all the answers

What is a common reason for children to be included in special classes or tutoring?

To address specific learning challenges. Signup and view all the answers

What might be assessed regarding medications during a visual evaluation?

Any potential interactions between medications and visual therapy. Signup and view all the answers

What is a key consideration when determining a child’s visual needs in relation to their career aspirations?

Potential visual requirements for specific occupations. Signup and view all the answers

Study Notes

Case History

Establishing the diagnosis and prognosis is essential in evaluating patient complaints.
Frequency, duration, quality, location, and onset of symptoms are critical characteristics to document.
Chief complaints may include issues like diplopia, asthenopia, or failed screenings.
Assessing patient awareness of eye turns and potential double vision is vital, including identifying if it’s monocular or binocular.
Timing of symptoms—persistent or sporadic—can lead to insights about potential triggers and viewing conditions.
Understanding any modifying factors or actions the patient employs to alleviate symptoms offers additional context.

Onset and Patient Medical History

Important to note the onset of symptoms, including age of first notice and circumstances surrounding the event (e.g., injury or illness).
Changes over time regarding symptoms should be tracked, including any improvements or deteriorations in severity or frequency.
Review overall general health status, including historical illnesses and prenatal, perinatal, and postnatal factors.

Patient Eye History

Prior evaluations, treatments, and compliance with prescribed interventions (glasses, patching) must be recorded.
Success of treatments and any alternative therapies applied should be documented.
Assess vision therapy involvement, goals, length, and efficacy on both short and long-term outcomes.

Developmental and Academic History

Document milestones in motor and language development, alongside current academic standing.
Identify any learning difficulties or areas of academic struggle impacting the patient.

Family Eye/Medical History

Review family history for any eye conditions or related medical issues, such as binocular vision problems.
Understanding familial patterns can help inform diagnosis and treatment planning.

Goals of Patient/Parent

Clarify expectations for outcomes from evaluation or treatment, including functional, aesthetic, or other specific health objectives.

Assessing Refractive Status

Use of retinoscopy on strabismic patients involves specific techniques to capture accurate findings while engaging the patient's focus.
Horizontal deviations require specific prism applications (BI for exotropia, BO for esotropia).
Vertical deviations call for neutralizing prisms to ensure the fixating eye can properly view the distance target.

Clinical Pearls for Retinoscopy

For significant deviations (>15 PD), it may be more effective to perform exams out of phoropter for greater alignment with the patient's gaze.
Young or special needs patients may benefit from retinoscopy performed outside the phoropter for easier handling.

Near Retinoscopy

Record gross findings on the optical cross, adjusting values based on the patient’s age and expected levels of accommodation.
Understand subtractions for sphere gross values based on age to accurately assess refractive error.

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Description

This quiz focuses on the essential elements of establishing a case history for effective ocular assessments. It covers the diagnosis and prognosis related to patient symptoms, including key factors like onset and medical history. Understanding the nuances of symptoms such as diplopia and asthenopia is crucial for accurate patient evaluation.