Geriatric optometry OCULAR HEALTH EXAMINATION.pdf

OCULAR HEALTH EXAMINATION A thorough inspection of the external and internal aspects of the eyes with appropriate instrumentation is especially important in older patients. Statistically they are much more likely to have significant ocular and general health diseases and disorders. The inspection...

OCULAR HEALTH EXAMINATION A thorough inspection of the external and internal aspects of the eyes with appropriate instrumentation is especially important in older patients. Statistically they are much more likely to have significant ocular and general health diseases and disorders. The inspection of the interior of the eye can be more difficult than in younger patients because of small pupils and lack of media clarity. Unless contraindicated, the pupils should be dilated to enable the examination. However, postponing the instillation of the mydriatic and the full ocular inspection until after the visual abilities have been tested is beneficial. When ophthalmoscopy remains difficult, easier observation is possible by using small-diameter ophthalmoscope systems and perhaps reducing the illumination level. Slit lamp examination of the eyelids, conjunctiva, cornea, anterior chamber, iris, and lens requires more attention in older patients because of the relatively high prevalence of aging changes affecting these tissues. Tonometry should be performed routinely on older patients because of the higher incidence of raised intraocular pressure and glaucoma. During the examination of the eyes, the practitioner should explain what is being done. Older patients are almost invariably aware of cataract, glaucoma, and macular degeneration, and they should be reminded that these and other ocular diseases are being given close attention. They should be fully and clearly advised of the state of their own ocular health. This is part of the clinician’s basic responsibility and also reinforces the message that regular eye examinations are important to older individuals. The details of discussion about ocular disease will vary according to the patient, the examiner, and their previous interactions. Even though the examiner can grow tired of giving essentially the same routine explanations to patient after patient, this responsibility should not be neglected or conveniently curtailed.