Optometric Examination for Older Adults

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Questions and Answers

What are the three questions the optometrist should ask when considering a patient's needs?

What medications is the patient taking?

What is the real reason for the patient’s being here today? (correct)

What does this patient want? (correct)

What does this patient need? (correct)

The visual characteristics of older adults are the same as those of younger adults.

False

What change is mentioned that occurs to the visual system as it ages?

Loss of accommodation

Which of the following conditions are commonly noted in older patients?

All of the above Signup and view all the answers

The diversity of vision needs among older adults often requires practitioners to use more _______ and flexibility.

imagination Signup and view all the answers

What is typically identified as a main concern in the near vision of older patients?

Reading Signup and view all the answers

What is the primary goal of case history taking in optometry for older adults?

Understanding the patient’s problems and needs Signup and view all the answers

What is the significance of using low-powered lenses in trial lens mountings?

They are easier to insert and remove. Signup and view all the answers

What adjustment should be made to the refraction result when seeking clearest distance vision at a distance of 4 m?

Change by 0.25 D. Signup and view all the answers

How should the axis and power of the overcorrecting cylinder be treated when determining astigmatism?

They are ignored initially. Signup and view all the answers

What is the recommended approach when a practitioner begins overrefraction?

Use a strong minus lens in one hand and a plus lens in the other. Signup and view all the answers

What is measured after completing the overrefraction process?

The back vertex power of the lens combination. Signup and view all the answers

How should the steps of dioptric power adjustments be handled during overrefraction?

The initial steps should be significantly large. Signup and view all the answers

What is suggested regarding the use of handheld lenses during the overrefraction procedure?

Camp together lenses of equal and opposite power. Signup and view all the answers

What is a necessary action before performing an astigmatic refraction?

Completely ignore the astigmatic correction in the old glasses. Signup and view all the answers

What should a practitioner do to ensure accurate measurement of astigmatism?

Elicit strong rejections of alternative axis orientations. Signup and view all the answers

How might changing the observation distance influence acuity scores?

It can alter the nature of the task and the acuity results. Signup and view all the answers

What is the minimum acuity score consistent with a 20/200 measurement at a distance of 10 feet?

10/60 Signup and view all the answers

Which alternative optotypes are mentioned that do not require a patient's literacy level?

Landolt rings and Tumbling E Signup and view all the answers

What is a recommended procedure for measuring acuity in low vision patients?

Make the first measurement at standard illumination levels. Signup and view all the answers

What happens when illumination is altered during acuity testing?

Patients might notice a difference in their reading ability. Signup and view all the answers

What problem can arise with charts that do not follow a logarithmic size progression?

Scaling issues may lead to inaccurate acuity measurements. Signup and view all the answers

What aspect of the task may change when observation distance is shortened?

The relative spacing between optotypes might increase. Signup and view all the answers

What is a key advantage of using printed panel charts for visual acuity measurement?

They allow measurement of poorer acuities. Signup and view all the answers

What type of cross cylinder should ideally be available in a general optometric office?

±0.25 D and ±0.75 D cross cylinder Signup and view all the answers

What is an important consideration when using the Jackson cross-cylinder test?

Maintaining the spherical equivalence of test lens combinations. Signup and view all the answers

Which design aspect can significantly affect visual acuity scores?

The number of letters and spacing between them. Signup and view all the answers

When should practitioners use bracketing approaches in vision testing?

When the spherical power determination is complete. Signup and view all the answers

How should practitioners handle the recording of visual acuity for rows not fully read?

Give partial credit for partially read rows. Signup and view all the answers

What specific power of the cross cylinder is recommended for low vision patients?

±0.75 D cross cylinder Signup and view all the answers

Why is it important for practitioners to note the specific chart used in visual tests?

Different charts can yield different absolute scores. Signup and view all the answers

What does the Pelli-Robson chart primarily measure?

Contrast sensitivity Signup and view all the answers

What is a significant visual problem associated with aging that affects older patients?

Increased intraocular light scatter Signup and view all the answers

Which method involves measuring the time taken for visual acuity to return after a bright light exposure?

Glare recovery testing Signup and view all the answers

Which instrument is commonly used to perform tests of contrast sensitivity?

Pelli-Robson chart Signup and view all the answers

What visual assessment method identifies losses in dark adaptation and glare recovery?

Low-contrast letter charts Signup and view all the answers

Why are tests of disability glare useful in monitoring older patients?

They predict functional difficulties under glare conditions. Signup and view all the answers

What type of targets are used in one of the methods to measure contrast sensitivity?

Large letters or edge targets Signup and view all the answers

Which condition is likely to exacerbate light scatter in older patients?

Presence of cataract Signup and view all the answers

What advantages do automated visual field testing procedures provide?

They maintain consistent control of test stimuli. Signup and view all the answers

What is one potential issue with visual field measurement in low vision patients?

The presence of a fixation point may lead to confusion. Signup and view all the answers

Why might a patient not recognize their central scotoma?

Because of the phenomenon of ‘filling in’. Signup and view all the answers

What should be considered when interpreting visual field results for patients with central scotomas?

The displacement of their preferred retinal locus. Signup and view all the answers

Which strategy can be employed for patients with central scotomas during testing?

Using a fixation cross centered on the viewing point. Signup and view all the answers

What can complicate the assessment of visual disturbances during the Amsler grid test?

The presence of a physiological blind spot. Signup and view all the answers

What is a common characteristic of patients with central scotomas that aids in visual attention?

They often develop a preferred retinal locus. Signup and view all the answers

Why are large or bright targets preferred in visual field testing?

They are easier for patients to see, increasing test reliability. Signup and view all the answers

Study Notes

Special Considerations in Older Adult Optometry

Older adults represent a unique demographic in optometry due to distinct visual characteristics and needs.
Unspoken agendas may exist for both patients and practitioners, necessitating thoughtful inquiry from the optometrist. Key questions to consider:
- What does the patient want?
- What does the optometrist believe the patient needs?
- What is the real reason for the patient's visit?

Aging and Visual Needs

Visual needs often shift due to retirement and lifestyle changes from aging or sensory limitations.
Common age-related changes in the visual system include:
- Loss of accommodation
- Reduced ocular media transmittance
- Pupillary miosis

Older adults are susceptible to various ocular pathologies, significantly impacting vision, such as:
- Maculopathy
- Cataracts
- Glaucoma
- Retinopathy

Case History and Patient Interaction

The case history should focus on identifying and fully understanding the patient’s primary visual problem.
Engage patients with curiosity to facilitate a comprehensive understanding of their visual needs.
Be sensitive to potential digressions in conversation, especially with patients who may feel lonely or have doubts regarding their self-worth.

Categories of Visual Needs

Examination and treatment should encompass diverse visual needs categorized into:
- Distance Vision: Assess adequacy for:
  - Recognizing faces
  - Watching television or movies
  - Reading signs
  - Mobility tasks like driving and navigating environments
- Near Vision: Reading is a primary concern, especially regarding the type of print and illumination conditions.

Flexibility in Examination and Treatment

The varying needs among older adults require practitioners to employ creative approaches in examinations and treatments.
Practitioners should be prepared to cover additional issues not initially raised once the patient has shared their main concerns.

Lens Measurements and Overrefraction

Low-powered lenses are easier to handle and often come in finer power increments.
Use trial lens clips for accurate astigmatism measurement at 4m or closer; a dioptric adjustment of 0.25 D is necessary for clarity.
Ignore previous astigmatic corrections when determining overrefraction; the process is treated as independent.
Initial overrefraction should involve large steps in dioptric power for easy clarity recognition.

Measurement Techniques

After overrefraction, measure back vertex power with a lensometer to determine total power necessary for correction.
Example: Patient wearing 0.00 DS −4.50 DC × 35 correction, overrefraction might be +0.75 DS −1.25 DC × 160.
Use handheld lenses for plano presentation; this approach facilitates recognizing refractive errors.

Visual Acuity Testing

Measurements should be recorded with partial credit for rows partially read (e.g., "20/20 −2").
Multiple chart types can influence visual acuity results; consistent documentation of chart type is essential.
Assess acuity using various distances while considering the appropriate illumination levels.

Astigmatism and Condition Monitoring

Utilize a Jackson cross cylinder for astigmatic determination; the test lens combination's spherical equivalence must be consistent.
Use large steps for power adjustments and strong rejections during axis determination to refine astigmatism measurements.
Displacement of central scotoma must be considered when evaluating visual field results.

Functional Evaluation and Visual Field Testing

Automated visual field testing offers reliable control but is less effective for mapping central scotomas.
Use large, visible targets to evaluate visual fields effectively in low vision patients, especially with central scotomas.
Scanning methods help identify preferred retinal locus (PRL) for patients with central vision loss.

Dark Adaptation and Contrast Sensitivity

Dark adaptation and glare tests evaluate the eye's response to different light levels, crucial for elderly patients.
Contrast sensitivity can be measured using the Pelli-Robson chart, aiding in assessing the patient's spatial frequency limits.
Glare tests are vital for monitoring cataract progression; increased intraocular light scatter is a common issue in aging patients.

Special Instruments and Additional Assessments

Employ specialized tests such as electroretinograms and fluorescein angiography for deeper diagnostic insights into vision issues.
Use low-contrast letter charts and dynamic contrast assessments to measure patients' abilities to detect objects under varied lighting conditions.

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Description

This quiz explores the key concepts and considerations involved in the optometric examination of older adults. It emphasizes the importance of addressing both spoken and unspoken needs of patients during the eye care process. Ideal for optometry students and professionals focusing on geriatric care.