Diagnosis and Management of Special Populations Part II 2010

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Diagnosis and Management of Special Populations presents the latest in the assessment and treatment of those with physical, cognitive, and behavioral abnormalities. Up to date information concerning …

Diagnosis and Management of Special Populations presents the latest in the assessment and treatment of those with physical, cognitive, and behavioral abnormalities. Up to date information concerning the etiology, prevalence/incidence and physical/cognitive findings of individuals with developmental disabilities (Cerebral palsy, Down syndrome, Fragile X syndrome, autism, acquired/traumatic brain injury) will be discussed. New diagnostic and treatment techniques are reviewed. The eye care practitioner will be able to confidently provide eye and vision care for those with disability at the end of this presentation.

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  • 1. Diagnosis and Management of Special Populations Part II 2010
  • 2. Dominick M. Maino, O.D., M.Ed., F.A.A.O ., F.C.O.V.D.-A. Professor, Pediatrics/Binocular Vision Service Illinois College of Optometry Illinois Eye Institute 3241 S. Michigan Ave. Chicago, Il. 60616 312-949-7280 (Voice) 312-949-7358 (fax) [email_address] MainosMemos.blogspot.com www.ico.edu nw.optometry.net
  • 3. Diagnosis
    • Assessment Techniques for Special Populations
    Use everything you know, be creative, and trust your objective evaluation skills!
  • 4. Diagnosis
    • Preparing for the examination
      • greet patient by name
      • position yourself at patient’s eye level
      • be on schedule
      • consider patient’s wishes about family/friends in exam room
      • direct initial comments to patient
      • treat patient as a person first, then as an individual with a disability
  • 5. Diagnosis
    • Preparing for the examination
      • speak clearly
      • listen carefully
      • use short command sentences
        • “ look here”
        • “ do this”
        • “ watch my light”
  • 6. Treat the patient the way you would want to be treated!
  • 7. Remember the 10 Commandments
    • 1.) Speak directly to the person rather than thru a companion or sign language interpreter.
    • 2.)Always offer to shake hands when introduced.
    • 3.)Always identify yourself and others who are with you when meeting someone who is blind.
    • 4 .) If you offer assistance wait until the offer is accepted, then listen and wait for instructions.
    • 5.) Treat adults as adults.
    • 6.) Do not lean against or hand on someone's wheelchair or cart.
  • 8. Remember the 10 Commandments
    • 7.) Listen attentively when talking to people who have difficulty speaking and wait for them to finish.
    • 8.) Place yourself at eye level when talking to someone in a wheelchair.
    • 9.) Tap a person who is deaf on the shoulder or wave your hand to get their attention .
    • 10.) Relax. Don’t be embarrassed if you use common expressions that seems torelate to a person’s disability.
    The Ten Commandments of Communicating with People With Disabilities
  • 9. Case History
  • 10. Case History
    • Demographic Information
    • Medical history including their disability
      • typically taking many medications
    • Visual history
    • Educational history
    • Rehabilitation history
    • Vocational history
    • Recreational history
  • 11. Visual Acuity
    • Use highest level possible
    • binocular before monocular testing
    • adaptive positioning
    • use assistants, friends, family members
    • limited window of opportunity
    • randomize optotypes, use reinforcers
    • test=game, be creative
  • 12. Visual Acuity
    • Snellen
    • Broken Wheel
    • HOTV
    • Lea Symbols
    • Teller Acuity Cards
    • OKN
    E F P T O Z H O V T
  • 13. Visual Acuity
    • Snellen
    • Broken Wheel
    • HOTV
    • Lea Symbols
    • Teller Acuity Cards
    • OKN
  • 14. Visual Acuity
    • Snellen
    • Broken Wheel
    • HOTV
    • Lea Symbols
    • Teller Acuity Cards
    • OKN
  • 15. Visual Acuity
    • Snellen
    • Broken Wheel
    • HOTV
    • Lea Symbols
    • Teller Acuity Cards
    • OKN
  • 16. Visual Acuity
    • Snellen
    • Broken Wheel
    • HOTV
    • Lea Symbols
    • Teller Acuity Cards
    • OKN
  • 17. Visual Acuity
    • Snellen
    • Broken Wheel
    • HOTV
    • Lea Symbols
    • Teller Acuity Cards
    • OKN
  • 18. Visual Acuity
    • Snellen
    • Broken Wheel
    • HOTV
    • Lea Symbols
    • Teller Acuity Cards
    • OKN
    • Cardiff Cards
    Drs. Hannu Laukkanen, Jennifer Valente-Caywood, Jeremy Nett http://opt.pacificu.edu/ce/catalog/14041-GO/14041-GO.html preferential looking cards that use form discrimination with vanishing optotypes
  • 19. Visual Acuity
  • 20. Refractive Error
    • Mohindra Dynamic Retinoscopy
      • lens bars, 50 cm working distance
      • dark, pt looks at light
      • neutralize primary meridians
      • write in spherocyindrical form
      • add a (-) minus 1.25 to the sphere
  • 21. Refractive Error
    • Cycloplegic spray
      • Spray on closed lids, have pt blink, wipe off excess (.5% Cyclo, .5% Myd, 2.5% Phenyl)
    O’Brien Pharmacy 5453 W 61st Place Mission, Kansas 66205 913-322-0001 (phone) 913-322-0002 (fax) 800-627-4360 (toll-free) http://www.obrienrx.com/ [email_address]
  • 22. Refractive Error
    • Keratometry
      • hand held electronic devices (Nidek)
      • Placido’s disk
      • Keratoscope
  • 23. Binocular Vision Assessment
    • Observation
    • Cover Test
    • Bruckner
    • Angle Kappa
    • Hirschberg
    • Krimsky
  • 24. Binocular Vision Assessment
    • Cover Test: Unilateral/Alternate
    • Bruckner: Two Eyes Needed
      • Whiter/Brighter Reflex
    • Angle Kappa
      • Monocular Fixation
      • C, S, OD/OS
    • Hirschberg: Two Eyes Needed
    • Krimsky: Neutralize Hirschberg with
    • Prism
  • 25. Binocular Vision Assessment
    • Lang stereotest
    • Random Dot E
    • Worth 4 Dot
    • MEM Nearpoint
    • Retinoscopy
    • NPC
    • Accommodative Facility
    • Saccades/Pursuits
  • 26. Binocular Vision Assessment
    • Lang stereotest
    • Random Dot E
    • Worth 4 Dot
    • MEM Nearpoint
    • Retinoscopy
    • NPC
    • Accommodative Facility
    • Saccades/Pursuits
  • 27. Binocular Vision Assessment
    • Lang stereotest
    • Random Dot E
    • Worth 4 Dot
    • MEM Nearpoint Retinoscopy
    • NPC
    • Accommodative Facility
    • Saccades/Pursuits
    http://opt.pacificu.edu/ce/catalog/14041-GO/14041-GO.html
  • 28. Binocular Vision Assessment
    • Lang stereotest
    • Random Dot E
    • Worth 4 Dot
    • MEM Nearpoint
    • Retinoscopy
    • NPC (use red lens)
    • Accommodative Facility
    • Saccades/Pursuits
  • 29. Binocular Vision Assessment
    • NPC (use red lens)
    • Yi Pang, Helen Gabriel, Kelly A. Frantz and Faheemah Saeed. Accommodative Facility Saccades/Pursuits A prospective study of different test targets for the near point of convergence. Ophthal. Physiol. Opt. 2010 30: 298–303
    • NPC with RL is a more sensitive method to identify abnormal findings and assist in diagnosing CI compared to using AT or TR. We recommend that NPC with RL be routinely used to evaluate patients suspected of having CI.
    • http://www3.interscience.wiley.com/cgi-bin/fulltext/123341936/PDFSTART
  • 30. Binocular Vision Assessment
    • Lang stereotest
    • Random Dot E
    • Worth 4 Dot
    • MEM Nearpoint
    • Retinoscopy
    • NPC
    • Accommodative Facility
    • Saccades/Pursuits
  • 31. Binocular Vision Assessment
    • Lang stereotest
    • Random Dot E
    • Worth 4 Dot
    • MEM Nearpoint
    • Retinoscopy
    • NPC
    • Accommodative Facility
    • Saccades/Pursuits
  • 32. Ocular Health
    • Hand held devices
      • Slit lamp
      • Tonopen/Perkins
      • BIO/MIO/direct
  • 33. Ocular Health
    • Hand held devices
      • Slit lamp
      • Keeler/Tonopen/
      • Perkins
      • BIO/MIO/direct
  • 34. Ocular Health
    • Hand held devices
      • Slit lamp
      • Tonopen/Perkins
      • BIO/MIO/direct
  • 35. Tangential Penlight Angle Estimation
    • Penlight at temporal aspect of cornea
    • Angle between 20-35 degrees to the facial plane
    • Maximum brightness
    • Open angle = nasal illumination at least 75% as bright as temporal illumination
  • 36. Special Testing
    • VEP, ERG, EOG
    • Sweep VEP
    • Ultrasound (A/B scan)
    • TOVA
    • Ober II
  • 37. Special Testing
    • VEP, ERG, EOG
    • Sweep VEP
    • Ultrasound (A/B scan )
    • TOVA
    • Ober II
    Ultrasound, B-Scan CPT 76512 (contact B-scan); Indications Examination of the posterior portion of the eye when direct view is precluded by media opacities. Evaluation of intraocular or orbital masses. For more info: http://www.healthgate.co.uk/dp/dph.0253.shtml
  • 38. Special Testing
    • VEP, ERG, EOG
    • Sweep VEP
    • Ultrasound (A/B scan)
    • TOVA
    • Ober II
    The Test of Variables of Attention (T.O.V.A.®), a 21.6 minute computerized continuous performance test used by professionals in the diagnosis and monitoring of treatment of attention deficit disorder (ADD)/attention deficit hyperactivity disorder (ADHD) in children and adults. The standardized test is well normed and extremely helpful in predicting responsiveness to treatment modality. More info at: http://www.tova.net/
  • 39. Special Testing
    • VEP, ERG, EOG
    • Sweep VEP
    • Ultrasound (A/B scan)
    • TOVA
    • Ober II
  • 40. Assessment
    • Working with incomplete or “fuzzy” clinical data
    • “ Get over it!”
    • Seek help
      • Dr. Dominick Maino
      • 312-949-7282
      • [email_address]
  • 41. Treatment
    • Refractive
      • Patient’s cognitive level
      • Patient’s motor ability
      • Patient’s therapy goals
      • Patient’s vocational goals
      • Patient’s self abusive behaviors
      • Living conditions
      • Past success
  • 42. Treatment
    • When Do You Correct Refractive Error?
      • Myopia > 1.00D
      • Hyperopia > 2.00D
      • WR Astig > 2.00D
      • AR Astig > 1.00D
      • Oblique Astig > 1.00D
      • Anisometropia > 1.00D
  • 43. Treatment
    • Binocular Vision Dysfunction
      • Strabismus
        • Rx, VT, surgery
      • Amblyopia
        • Rx, VT
      • Accommodation dysfunction
        • Rx, VT
      • Oculomotor anomalies
        • Rx, VT
  • 44. Treatment
    • Ocular Health
        • Treat as you would any other patient. May even be more aggressive in your treatment
  • 45. Treatment
    • Ocular Health
      • anterior segment :
      • lids, lashes
        • conjunctiva, cornea
  • 46. Treatment
    • Lens
      • refer/treat optically
      • cataract
      • lenticonus
    • Fundus/Optic nerve
      • diagnose/refer
  • 47. Treatment
    • GLC
      • Treat/Refer
      • Many need surgical intervention
  • 48. Referral Resources
    • Developmental Disabilities Service
    • of the
    • Illinois Eye Institute
    • 3241 S. Michigan Ave.
    • Chicago, Il. 60616
    • 312-949-7280 (Pediatrics)
  • 49. Summary
    • All deserve optometric vision care
    • If all you do is take a detailed case history, it’s probably more than any have even attempted before
    • Do not underestimate the power of glasses
    • Be creative, use want you know, invent!
    • Treat (optically, functionally, medically) because we do it all!
  • 50. Questions? Contact:
    • Dominick M. Maino, OD, MEd, FAAO.FCOVD-A
    • Professor, Pediatric/Binocular Vision Service
    • Illinois Eye Institute Illinois College of Optometry
    • 3241 S. Michigan Ave. Chicago, Il. 60616
    • 312-949-7280 (phone) 312-949-7660 (fax)
    • [email_address]
    • www.ico.edu
    • www.nw.optometry.net
    • http://www.MainosMemos.blogspot.com