3. 3
Initial consultation - an overview
1. Presenting complaint – what problems do they want addressed?
2. Visual tasks/goals – how do they use their eyes?
3. Past ocular history – may impact your management/treatment
4. Family ocular history – may have an increased risk of some eye
Pupil reactions
conditions
Anterior segment health Posterior segment health Intraocular pressure
Eye movements Focussing
5. Medications and allergies – both of which can affect the eyes
Vision
–1. – CASE CONSULTATION
– OCULAR HEALTH
2. – PRELIMINARYHISTORY
3. 4. VISION & FOCUSSING
5. 5
Eye health - retinal photos
Macula Optic nerve
Normal retinal appearance You guessed it…. not normal….
Toxoplasmosis
6. 6
Results of the initial consultation
Glasses? Contact lenses? Secondary consultation?
Referral to GP? Referral to ophthalmologist? Referral to allied health?
16. 16
Children
Some childhood eye problems are, erm…. very subtle…..
Headaches during a 3D movie? More clumsy than your average kid?
Didn’t see what all the fuss was about? Hand-eye coordination?
Some eye problems are, erm…. obvious
…..and you only have until 8 years of age to get it sorted…..
17. 17
Teens and young adults
Blurred
vision?
Reading
too close?
Squinting?
Frontal headaches?
18. 18
40 to 45 years of age
I can still read….
I just need to hold it back further……
19. 19
Older adults
THE BIG THREE
Cataracts – surgery required – generally around 75-85 years of age in
Brisbane population
Macular degeneration – loss of detailed central vision, two forms
called wet and dry, wet is treatable with injections
Glaucoma – due to an increase in the intra-ocular pressure,
asymptomatic in the early stages, generally simple to manage with eye
drops if diagnosed early, blinding if left untreated, if presenting with noticed
vision loss – generally a raging glaucoma
20. 20
Any time
Refer ASAP for these symptoms Scary possible cause
Flashes of light – like lightening bolts Retinal detachment (RD)
Recent onset of spots in the vision – especially red Retinal detachment
Double vision – seeing two of things – esp recent onset Brain tumour, myasthenia gravis
Blacked out central vision Macular degeneration
Known to cause eye problems What can happen
Oral/injected steroids (and less commonly inhaled) Glaucoma, cataracts
Parkinson’s Disease Double vision
Marfan’s Syndrome Turned eyes, focus problems, RD
Diabetes and high blood pressure (esp uncontrolled) Retinal blood vessel haemorrhages
Stroke Peripheral vision - driving
21. 21
PART FOUR
Areas of specialization in optometry
22. 22
Areas of specialisation in optometry
Behavioural Contact lenses Research
With ophthalmologists Low vision Therapeutics
23. 23
My area of specialization
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25. 25
1. A six year old child has a focusing problem in one
eye. This could go undetected because:
a. The child never covers one eye to check if each eye has good
vision.
b. Their parent doesn’t take them in for an eye test because the
child doesn’t complain.
c. The child is labelled ‘uncoordinated’ and no further investigations
are done.
d. The child mentions they have a headache at the cinema when
watching a 3D movie and the parent puts it down to the lollies!!
e. All of the above.
26. 26
2. A person presenting to an optometrist has an eye
condition. What are the chances that it is (firstly)
asymptomatic and (secondly) treatable?
a. 30% asymptomatic and 75% treatable.
b. 40% asymptomatic and 30% treatable.
c. 10% asymptomatic and 30% treatable.
d. 40% asymptomatic and 75% treatable.
e. 75% asymptomatic and 40% treatable.
27. 27
3. A patient you are treating happens to mention that
they have blurred vision. Possible causes could be:
a. Undiagnosed diabetes
b. Cataracts
c. A focusing problem such as
shortsightedness, longsightedness or astigmatism.
d. A pituitary tumour
e. All of the above….. plus many more!!
Editor's Notes
There are some symptoms that we need to check out ASAP. Mainly flashes of light like lightening bolts going off in the vision, a recent onset of new spots like a little mosquito floating around – especially if they are pink or red. Recent onset of double vision – seeing two of things when there should just be one.
