What are the tests for binocular vision?
During a Binocular Vision Assessment, the eye doctor evaluates both binocular vision functioning and visual perceptual skills:
Accommodation.
Convergence.
Depth perception (3D)
Fusion.
Ocular motility.
Ocular posture.
Presence of conditions that affect binocular vision functioning.
Spatial awareness / planning.
Keratometer is an ophthalmic instruments and has a very important role in optometry field specially for IOL power calculation, Contact lens fitting, to rule out corneal pathology and its progression ie Keratoconus, PMCD.
Magnification is a method of increasing the size of the image
so that enough of the retina is stimulated to send an impulse
through the optic nerve allowing an object to be perceived .
Keratometer is an ophthalmic instruments and has a very important role in optometry field specially for IOL power calculation, Contact lens fitting, to rule out corneal pathology and its progression ie Keratoconus, PMCD.
Magnification is a method of increasing the size of the image
so that enough of the retina is stimulated to send an impulse
through the optic nerve allowing an object to be perceived .
Gives a very brief review of how to evaluate a case of squint in day to day clinical practice. How to diagnose a basic abnormality of the movement of eye.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
3. Tests for BSV
Contents
Worth Four dot/light test
Bagolini glasses
4 Prsim diopter test
Lang two pencil test
Titmus Fly test
TNO test
After image test
4. Worth Four Lights
This is a dissociation test which can be used
with both distance & near fixation to
differentiate b/w BSV, ARC & suppression.
Results can only be interpreted if the presence
or absence of a manifest squint is known at
time of testing.
5.
6. Worth Four Lights
Apparatus:It consist of four circular lights
two green one red and one white which are
viewed through complementary red and
green goggles.
The red light is seen through the red filter
and the green lights through the green filter,
the white light is common to both eyes.
7. Worth Four Lights
Procedure:
A patient wears a red green goggles with the
red lens in front of the right eye , which filters
out all colors except red ,and a green lens in
front of the left eye, which filter out all colors
except green .
The patient then views a box with four lights,
one red, two green and one white.
8. Worth Four Lights
Results
If BSV is present all four lights are seen
If all four lights are seen in the presence of a
manifest strabismus, ARC
If two red lights are seen , left suppression is
present
If three green lights are seen, right suppression is
present
If two red and three green lights are seen, diplopia
is present
9. Worth Four Lights
If the red and green lights are seen
alternatively, alternating suppression is
present
If the patient sees 2 or 3 lights at 6m & 4
lights at 0.33m- the diagnosis is microtropia.
11. Bagolini Striated Glasses
This is the test for detecting BSV, ARC 0r
suppression.
The test can be used at 6m, 33cm or in any desired
gaze position,e.g. in up & down gaze in A-& V-
patterns.
The apparatus consists of a pair of Plano glasses,
marked with fine parallel striations at 45° on one
glass & 135° on the other. When a spot light is
viewed through the glasses each produces a line
image at 90°to the axis of the striation.
12.
13. Bagolini Striated Glasses
Procedure :
The two lenses are placed at 45°& 135°in front
of each eye & patient fixates a small light
source
Each eye perceives an oblique line of light,
perpendicular to that perceived by the fellow
eye
Dissimilar images are thus presented to each
eye under binocular viewing conditions.
14. Bagolini Striated Glasses
Results:
If the two streaks intersects at their centers in
the form of an oblique cross the patient has
straight eyes with BSV or squint with ARC
If the lines do not cross in center ,the patient
has squint with NRC and diplopia
If only one streak is seen ,there is no
simultaneous perception and suppression is
present
15. Bagolini Striated Glasses
If a small gap is seen in one of the streaks, a
central suppression scotoma (as found in
microtropia) is present but in practice this is
often difficult to demonstrate & the patient
describes a cross. This scotoma can be
confirmed with the 4Δtest
If only one line is seen, large regional
suppression is present.
17. 4Δ prism test
This test differentiates bifoveal fixation
(normal BSV) from a central suppression
scotoma
Method of use:
Place a prism base –out in front of one eye
whilst the patient fixate a near target, observe
the movements.
Now repeat the test with the base-out prism in
front of the other eye & observe the movement,
in order to confirm the findings.
18.
19. 4Δ prism test
Results :
1. In the presence of bifoveal fixation: the eye
behind the prism make an inward movement
to regain foveal fixation
The other eye will make a conjugate outward
movement (Herings’law) resulting in
diplopia,which stimulates convergence to
regain fusion.
20. 4Δ prism test
2. In left microtropia with CSS:
The patient fixates a distance target with
eyes open and a 4Δ prism is placed base out
in front of the left eye with suspected
central suppression scotoma scotoma.
The image is moved temporally in the left
eye but falls within the CSS & no
movement of either eye observed.
21. 4Δ prism test
The prism is then moved to the right eye
which adducts to maintain fixation : the left
eye similarly moves to the left (Herring's),
but the second image falls within the CSS
and no refixation movement is seen.
23. Tests for stereopsis
Qualitative test:
Lang two pencil test;
This is a rudimentary test for the presence of
stereopsis which compares the patient’s responses
with both eyes open & with one eye covered, both in
manifest strabismus to assess if abnormal BSV is
present & in apparently straight eyes when it can
confirm the presence of BSV.
It is a very simple test requiring only two pencils & a
cover.
24.
25. Lang two pencil test
Method of use:
The patient is given a pencil to hold vertically & is
asked to place this on top of the examiner’s
vertically held pencil, thus using horizontal
disparity detectors to locate the correct position.
The test is then repeated with one eye occluded
(the deviating or amblyopic eye if present).
26. Lang two pencil test
The subject is not given too long to perform
the test so that he does not use any monocular
or motion clues to depth.
The test is repeated several times & the
responses compared.
27. Lang two pencil test
Results :
If accuracy in locating the examiner’s pencil is
repeatedly better with both eyes open then stereopsis
is present thus confirming normal or abnormal BSV
If the response is comparable with both eyes open &
with the squinting eye covered, the squinting eye is
suppressed & BSV is absent.
28. Lang two pencil test
A person with suppression may perform this
test in both monocular & binocular
conditions.
A person with ARC passes this test only
under binocular condition.
29. Tests for stereopsis
Quantitative tests:
TNO test:
The TNO random dot test consists of seven
plates of randomly distributed paired red &
green dots which are viewed with
complementary red & green goggles.
30.
31. TNO test
Within each plate the dots of one color
forming the target shape are displaced
horizontally in relation to their paired dots of
other color so that they have a different retinal
disparity from those outside the target.
32. TNO test
Some control shapes are visible even without red -
green spectacles,while the test targets are only
visible to an individual with stereopsis , while
wearing red-green spectacles.
The first plate contains two butterflies,the second
plate contains four circles,& the third five different
shapes; each plate has at least one image which can
be appreciated monocularly.
There is a suppression test plate with three circles.
33. TNO test
The first three plates are used to establish the
presence of stereoscopic vision & subsequent
plates to quantify it.
Because there is no monocular clues , the
TNO test provides a true positive
measurement of stereopsis than the Titmus
test, but can give the false negative errors
when fusion is poor.
34. TNO test
The disparities measured range from 480 to
15 seconds of arc tested at 40cm.
Most children are able to do this test from the
age of about 4 years.
Method of use:
The red-green spectacles are worn & the
apparatus is held at 40cm perpendicular to the
patient.
35. TNO test
The screening plates subtending 980 seconds of arc
are shown first, & if these are successfully
completed the graded plates from 480 to 15 seconds
of arc are presented until the patient is unable to
locate the three-dimensional shape correctly.
If the screening plates are not appreciated the
response can be checked with the suppression plate,
which consists of three circles, the middle one being
common to both eyes.
36. Frisby
The Frisby stereo test consists of three
transparent plastic plates of varying thickness.
On the surface of each plate are printed four
squares of small randomly distributed shapes.
One of the squares contains a hidden circle,in
which the random shapes are printed on the
reverse of the plate.
The patient is required to identify this hidden
circle.
37.
38. Frisby
The test does not require special spectacles because
the disparity is created by the thickness of the plate
& can be varied by increasing or decreasing the
working distance ,which needs to be accurately
measured.
The disparities measured range from 600 to 15
seconds of arc.
Is is important not to allow the subject to tilt the
plate or move their head during testing as this gives
monocular clues.
39. Lang stereo test
This test combines panography with random dots.
The targets are fine vertical section that are seen
alternatively by each eye as they are viewed through
the built in cylindrical lens elements,& does not
require special spectacles.
Displacement of the random dots creates the
disparity.
40. Lang stereo test
The test comes in two versions: Lang I,with a
disparity range of 12oo-550 seconds of arc;& Lang
II, with a disparity range of 600-200 seconds of arc.
Method of use:
The card is held at normal reading distance & the
child is asked to name or point to the pictures.on the
Lang II test a star can be seen monocularly.
41.
42. Lang stereo test
The examiner can also observe the child’s eye
movements from picture to picture on the
card. However ,the card must be held exactly
parallel to the plane of the face for the effect
to be seen.
43. Wirt or Titmus test
Three dimensional Polaroid vectograph consisting of
two plates in the form of a booklet viewed through
Polaroid spectacles.
On the right is a large fly & on the left is a set of
circles & animals, one of which is disparate in each
set.
The image seen by one eye is polarized at 90° to that
seen by the other eye when viewed through the
polarized spectacles.
45. Wirt or Titmus test
The test gives monocular clues, especially
when viewing the first three sets of circles,
when it is easy to see monocularly that one
circle is displaced & therefore different from
the others.
The test is performed at a distance of 40cm.
46. Wirt or Titmus test
If only gross stereopsis is demonstrated the
apparatus should be turned through 90°, when
there is no depth effect, or one eye occluded
& the response compared.
47. Wirt or Titmus test
1. Fly is test of gross stereopsis (3000 seconds of arc),
& is especially useful for young children.
The fly should appear to stand out from the page &
the child is encouraged to pick up the tip of one of its
wings b/w finger & thumb.
In the absence of gross stereopsis the fly will appear
as an ordinary flat photograph.
48. Wirt or Titmus test
If the book is inverted,the targets will appear
to be behind the plane of the page.
If the patient states that the fly’s wings are
still ‘popping out’,then they are not
appreciating true stereoscopic vision.
49. Wirt or Titmus test
2. Circles comprise of a graded series which
tests fine depth perception.
Each of the nine squares contains four circles.
One of the circles in each square has a degree
of disparity & will appear forward of the
plane of reference in the presence of normal
stereopsis.
50. Wirt or Titmus test
The disparity measured range from 800 to 40
seconds of arc.
If the patient perceives the circle to be shifted to the
side , then they are not appreciating stereoscopic
vision, but are using monocular clues instead.
The animals are similar to the circles test but consist
of three rows of five animals each, one of which will
appear forward of the plane of reference.
The degree of disparity ranges from 400 to 100
seconds of arc.
51. After-image test
Hand held apparatus:
The apparatus consists of a linear light with a
central black band within a circular
background mounted on a flash apparatus.
The line can be presented horizontally or
vertically.
52. After-image test
Method of use:
The patient must have steady foveal fixation.
The deviating eye is covered & the line is
presented horizontally at a distance of
approximately 50cm.
The apparatus is flashed while the patient
fixates the black band.
53. After-image test
The fixating eye is then covered & the process is
then repeated with the line presented vertically.
A vertical line is more likely to fall outside the
suppression scotoma.
The patient looks at a blank wall in normal
illumination and should see two negative linear after
images each with a central gap corresponding to the
fixation and therefore representing the visual
direction of the fovea.
54. After-image test
He is asked to draw or describe the position of
the lines.
blinking may aid appreciation of the images.
Alternatively the position of positive after-
images can be assessed in a dark room.
55. After-image test
Results
A symmetrical cross with coincident gaps indicates
normal retinal correspondence
Displacement of the lines indicates abnormal retinal
correspondence the separation between the gaps is
determined by the size of the angle of anomaly there
will be crossed projection in esotropia
If eccentric fixation is present the results will need to be
assessed accordingly a symmetrical cross would then
indicate ARC.