10 eye exam tricks by Akbar Rashid Qadri is a short PDF book for eye examiner to carryout eye exam in an easy way for differential diagnosis.

1. 10 Eye Exam
Tricks
For Problematic Patients like Malingering Patients, child and
Mentally Retard Patients
Muhammad Akbar Rashid
(Vision Science / Optometry)
akbaroptometrist@gmail.com

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10 Eye Exam Tricks.
Preface:
Every Eye professional should know how to handle problematic
patients. Otherwise it will be time consuming for him or her without
getting best results. That’s why I am going to write this to solve
problems facing to check tricky eye patients. I will try my best to explain
things in short and effective way. This material is related to my
experience.
Inside Look:
*Simple and Easy Language
*Step by Step writing
*Images and Concept Building Material
*Based on Practical Work
Muhammad Akbar Rashid
akbaroptometrist@gmail.com

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10 Eye Exam Tricks
No.1 “The Handoff Reading Material”
In case of malingering patient: Handoff some piece of reading
material immediately and ask him to grab it and read. If patient
Grab it from your hand and start reading. Than we can guess he
/ she can see things.
Or
You can do same thing with the shake hand, Hey! How are you?
If patient shake hand with you, then we can guess he / she can
see things.
Remember:
1. Hand him / her something in very short time.
2. Don’t touch the hands of patient “first” to shake hand

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No.2 “Pupil Changes”
Put some light on the pupil of the patient. Pupil will show some
reactions / constrict.
“It is impossible that eye have good vision and pupil of eye
don’t show any reaction by putting light on it”

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No.3 “Flicking Fingers”
Flick your fingers near the eye of the patient. If Patient blink in
response of flick. It means patient have vision in his / her eyes.
We can do flicking by high intensity light.

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No.4 “Plano Lens”
Place Plano (0.00D) lens in front of the eyes and ask to the
Patient, now can you see better or not. If patient say, yes I can
see better. It means patient is lying.
We can do this test by placing same power plus and minus
lenses in front of eye. Resultant will be 0.00 D.
i.e.
If we use +4.00 D and -4.00 D
Resultant: +4.00 -4.00 = 0.00 D (Plano Lens)

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No.5 “Eye Popping”
Popping:
This test is mostly used in children. Not useful for malingers.
This is done with room light ON and OFF. In case of eye popping
child have good vision.
Light OFF: === Eye popping takes place
Light ON: === Eyes return to its original position
Pupil Reactions:
Bright Light: Pupil Constrict
Dim Light : Pupil Dilates

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No.6 “Finger Touch Test”
Ask your patient hey beautiful/ handsome touch your first
finger of your both hands at arm length.
If patient touch his/her fingers properly. It means patient have
good vision.
If patient can’t do this. It means patient have some vision
problems.

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No.7 “Pinhole Test”
Place pinhole in front of the eye with the help of trial frame.
You can use pinhole monocular or binocular.
Turn the room lights off. Hold near VA chart at patient habitual
distance. Use torch light to illuminate the spot area. And ask
the patient that you can see or read anything or not??

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No.8 “Optokinetic /OKN Drum”
OKN Drum mostly used for pediatric eye exam. It has black and
white strips. Hold OKN drum in front of the patient. Spin it in
front of the patient. Patient eyes will follow the Black strips. It is
almost impossible that eyes having vision and don’t follow the
black strips. We will get jerky eye response like nystagmus. This
response is known as optokinetic response.

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No.9 “OKN Flag”
OKN Flag has same strips like OKN drum. This has same working
principle like OKN Drum.
Flag Movement:
 Right
 Left
 UP
 Down
Patient eyes will follow the Flag movement.
(Available in red-white or black-white color)

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No.10 “Rotating Spherical Lens”
In case of malingering patients, place sphere lens of any power
in front of the eye, and ask patient now it’s better or not.
Now rotate sphere lens 30 to 40 degree. Again ask patient this
position is better or previous one was better.
(We know that sphere has equal power in all portions of lens)
 If patient say better or verse. It means patient is lying
 If patient say same as previous. It means patient is not
lying

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“I am doing smart work instead of hard
work. Smart work is my passion”
(Muhammad Akbar Rashid)
About Author:
Muhammad Akbar Rashid
Vision Science 4th
year student at “Pakistan Institute of
Rehabilitation sciences (PIRS), ISRA University Islamabad Campus,
Pakistan”
Belongs to: D.G. Khan, Punjab Pakistan
Contact: akbaroptometrist@gmail.com