Lab 1: Case History & Refractive Status

Questions and Answers

What should be assessed to help establish the diagnosis for a patient with an eye condition?

The patient's case history (correct)

The history of any recent medications

The patient's social history

The patient's understanding of their condition

Which of the following factors should be included when determining the severity of a patient's symptoms?

The presence of family history

The patient's age

A scale from 1-10 (correct)

Emotional state of the patient

In the assessment of eye turn, which aspect is NOT relevant?

The timing of the symptoms

Awareness of the eye turn

The patient's occupation (correct)

The direction of the eye turn

What is essential to determine the goals of the patient/parent during an examination?

The main concern expressed by the patient/parent Signup and view all the answers

What type of diplopia should be clarified when assessing a patient with double vision?

Monocular vs binocular true diplopia Signup and view all the answers

When inquiring about eye turn symptoms, which question addresses how often these occur?

When is the eye turn/diplopia present? Signup and view all the answers

Which aspect should NOT be focused on when discussing possible referrals for a patient?

Patient's coping mechanisms Signup and view all the answers

What is the importance of knowing the relief factors for a patient’s symptoms?

To guide treatment plans effectively Signup and view all the answers

What could indicate a potential improvement in the eye turn or diplopia symptoms?

Compliance with prescribed wearing schedule of glasses Signup and view all the answers

What factor about the patient's medical history could influence the eye turn or diplopia?

Prenatal exposure to teratogenic substances Signup and view all the answers

How might a patient be able to temporarily alleviate symptoms of diplopia?

Turning or tilting their head Signup and view all the answers

What aspect of health might be assessed regarding the onset of diplopia symptoms?

Age of the patient at first symptom notice Signup and view all the answers

Which of the following is an important aspect of evaluating the change in eye turn symptoms over time?

Whether the symptoms have become less frequent Signup and view all the answers

What does the APGAR score evaluate shortly after birth?

Newborn's physical appearance and vital signs Signup and view all the answers

What is a possible outcome of inadequate compliance with patching treatment for diplopia?

Increased likelihood of needing corrective surgery later Signup and view all the answers

Which of the following evaluations is crucial for understanding the condition of diplopia?

Reviewing the history of past childhood illnesses Signup and view all the answers

What should be considered a diagnostic indicator during the gross observation of a patient?

Head circumference Signup and view all the answers

Which piece of equipment is specifically used for conducting a cover test?

Occluder/Patch Signup and view all the answers

When assessing refractive status, what technique involves determining visual acuity under specific conditions?

Pinhole visual acuity Signup and view all the answers

Which observation would NOT typically fall under cosmetic indicators?

Head position Signup and view all the answers

What is the purpose of conducting a case history in the patient assessment process?

To gather comprehensive information about the patient's health Signup and view all the answers

Which component is particularly important in the assessment of head position during gross observation?

Tilt or turn of the head Signup and view all the answers

Which diagnostics procedure is used for assessing a child's near vision?

Mohindra Near Retinoscopy Signup and view all the answers

What aspect of a patient’s posture would NOT be recorded during gross observation?

Eyewear prescription Signup and view all the answers

What is the primary purpose of using a projected target, cartoon, or video during retinoscopy for patients with strabismic deviations?

To facilitate on-axis scoping using the phoropter Signup and view all the answers

What is the recommended method for scoping on axis using the phoropter for strabismic patients?

By holding prism in front of the fixating eye by the amount of deviation Signup and view all the answers

What is the primary goal of assessing refractive status in patients with strabismic deviations?

To determine the correct lens prescription Signup and view all the answers

What type of retinoscopy is typically used for patients with strabismic deviations?

Cycloplegic retinoscopy Signup and view all the answers

What is the purpose of using a lens rack during retinoscopy?

To adjust the phoropter for on-axis scoping Signup and view all the answers

What is the primary benefit of using a projected target during retinoscopy for patients with strabismic deviations?

Improved patient cooperation Signup and view all the answers

What is the primary purpose of the near retinoscopy method?

To estimate refractive errors, especially in young strabismic children Signup and view all the answers

What is the correct way to calculate the net findings in near retinoscopy?

By adding -1.25 algebraically to the sphere power only Signup and view all the answers

What is the recommended method for assessing refractive status in patients with strabismic deviations?

Retinoscopy with a projected target Signup and view all the answers

What is the recommended distance between the examiner and the patient during near retinoscopy?

50cm Signup and view all the answers

What is the primary limitation of using a phoropter for on-axis scoping in patients with strabismic deviations?

Difficulty in adjusting for on-axis scoping Signup and view all the answers

What is the purpose of turning off all room lights during near retinoscopy?

To make the retinoscope light the only source of light in the room Signup and view all the answers

What is the recommended action if the patient has reduced acuity through best correction?

Perform a pinhole visual acuity test Signup and view all the answers

What is the difference between Mohindra and MEM?

Mohindra tests refraction, while MEM tests accommodation Signup and view all the answers

What is the purpose of occluding one eye during near retinoscopy?

To neutralize the primary meridians of the un-occluded eye Signup and view all the answers

What is the recommended way to attract the attention of a young patient during near retinoscopy?

By calling their name or making sounds Signup and view all the answers

Study Notes

Gross Observation

Diagnosis begins with observing the patient's gait, head/body posture, and eye movements in the reception area and exam room.
Monitor for diagnostic and cosmetic indicators, including:
- Head position: tilt, turn, chin lift, or depression
- Body stature: asymmetries in lid, pupil, orbit
- Mobility: head circumference, width of bridge of nose, width of face, interpupillary distance
Record observations for diagnostic and cosmetic indicators.

Case History

Probe areas in the case history to establish diagnosis, develop prognosis, and prepare for patient/parent conference.
Areas to probe include:
- Chief complaint: why the patient is there, main concern
- Symptoms: eye turn, double vision, diplopia, asthenopia, failed screening, second opinion
- Modifying factors: what helps improve symptoms
- Severity: scale from 1-10
- Context: affecting when, associated signs
Onset: time and type, age, by whom, patient medical history
Patient medical history: general health status, past childhood illnesses, hospitalizations, prenatal, perinatal, postnatal
Patient eye history: dates of previous evaluations and/or treatment, compliance with suggested wearing schedule
Family eye/medical history: specific eye/medical problems, eye turns, lazy eye, binocular vision or learning related problems

Assessing Refractive Status

Retinoscopy: static or cycloplegic, for patients with strabismic deviations
Materials: retinoscope, lens racks, patch
Procedure:
1. No phoropter
2. Turn off all room lights and close door
3. Sit directly in front of patient at ~ 50cm
4. Occlude one eye with patch
5. Direct patient to look at retinoscope light
6. Using lens bars, neutralize primary meridians of un-occluded eye
Clinical pearls:
- Perform near retinoscopy on partner
- If patient has reduced acuity through best correction, perform pinhole visual acuity
- Don't confuse Mohindra with MEM (MEM tests accommodation)
- Turn off all lights to attract young patient's attention to retinoscope light

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Description

This lab session focuses on practical procedures for assessing refractive status and conducting case histories. Participants will learn how to perform gross observations, identify diagnostic and cosmetic indicators, and utilize essential equipment such as diagnostic kits. Join us to enhance your skills in ocular evaluation.