The document discusses various methods of dynamic retinoscopy that have been developed over time to objectively measure the accommodative response and lag of accommodation. Some of the key methods mentioned include Cross method, Sheard's method, Tait's method, Monocular Estimate method, Nott dynamic retinoscopy, Bell retinoscopy, and stress point retinoscopy. The document also discusses the typical lag of accommodation values found in studies and how lags can indicate problems with accommodation.
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Retinoscopy and Objective Refraction and Subjective Refraction in spherical ametropia and astigmatism
Retinoscopy (Principle & Techniques of Retinoscopy) and objective refraction, Subjective Refracition
Best presentation about retinoscopy and objective refraction techniques, and basis of subjective refraction. If you want to master the technique of retinoscopy, this presentation can be your guidance and partner in your journey to retinoscopy, objective refraction and subjective refraction.
Presentation Layout:
Retinoscope, types of retinoscope and uses of retinoscope
-Introduction to retinoscopy and objective refraction
-Retinoscopy
- In spherical ametropia
- In astigmatism
- Others: strabismus, amblyopia, pediatric pt.,
cycloplegic refraction
-Static and Dynamic Retinoscopy
-Problems seeing reflex during retinoscopy
-Errors in retinoscopy
Objective of retinoscopy and objective refraction
-To locate the far point of the eye conjugate to the retina
- Myopia or hyperopia
-Bring far point to the infinity by using appropriate lenses
- Determines amount of ametropia by retinoscopy and objective refraction
References:
-Clinical Procedures in Optometry by Eskridge, Amos and Bartlett ,
-Primary Care Optometry by Grosvenor T.,
-Borish’s Clinical Refraction by Benjamin W. J.,
-Theory And Practice Of Optics And Refraction by AK Khurana
-Retinoscopy-Student Manual by ICEE Refractive Error Training Package (2009)
-Clinical Optics and Refraction By Andrew Keirl, Caroline Christie
-Clinical Refraction Guide - A Kumar Bhootra
-Clinical Procedures in Primary Eye Care by David B. Elliott
-Internet
Follow me to get in touch with optometric and ophthalmic updates.
DIRECT DOWNLOAD LINK ❤❤https://healthkura.com/retinoscopy/❤❤
Dear viewers Check Out my other piece of works at ❤❤❤ https://healthkura.com ❤❤❤
Retinoscopy and Objective Refraction and Subjective Refraction in spherical ametropia and astigmatism
Retinoscopy (Principle & Techniques of Retinoscopy) and objective refraction, Subjective Refracition
Best presentation about retinoscopy and objective refraction techniques, and basis of subjective refraction. If you want to master the technique of retinoscopy, this presentation can be your guidance and partner in your journey to retinoscopy, objective refraction and subjective refraction.
Presentation Layout:
Retinoscope, types of retinoscope and uses of retinoscope
-Introduction to retinoscopy and objective refraction
-Retinoscopy
- In spherical ametropia
- In astigmatism
- Others: strabismus, amblyopia, pediatric pt.,
cycloplegic refraction
-Static and Dynamic Retinoscopy
-Problems seeing reflex during retinoscopy
-Errors in retinoscopy
Objective of retinoscopy and objective refraction
-To locate the far point of the eye conjugate to the retina
- Myopia or hyperopia
-Bring far point to the infinity by using appropriate lenses
- Determines amount of ametropia by retinoscopy and objective refraction
References:
-Clinical Procedures in Optometry by Eskridge, Amos and Bartlett ,
-Primary Care Optometry by Grosvenor T.,
-Borish’s Clinical Refraction by Benjamin W. J.,
-Theory And Practice Of Optics And Refraction by AK Khurana
-Retinoscopy-Student Manual by ICEE Refractive Error Training Package (2009)
-Clinical Optics and Refraction By Andrew Keirl, Caroline Christie
-Clinical Refraction Guide - A Kumar Bhootra
-Clinical Procedures in Primary Eye Care by David B. Elliott
-Internet
Follow me to get in touch with optometric and ophthalmic updates.
Accommodation/ Accommodation of Eye, Measurement of Accommodation of Eye (hea...Bikash Sapkota
CLICK HERE TO DOWNLOAD FULL PPT ❤❤ https://healthkura.com/measurement-of-accommodation-of-eye/ ❤❤
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Measurement of Accommodation of eye:
Amplitude, Facility,
Relative Accommodation, Fatigue, Lag,
Dynamic Retinoscopy
Presentation Layout:
-Introduction to accommodation of eye
-Mechanism
-Components
-Measurement of accommodation of eye
- Amplitude
- Facility
- Relative accommodation
- Lag
-Dynamic Retinoscopy
Accommodation
-dioptric adjustment of the crystalline lens of the eye
- to obtain clear vision for a given target of regard
-process by which the refractive power of eye is altered
- to ensure a clear retinal image
For further reading
-Clinical Procedures in Optometry by J.D. Bartlett, J.B. Eskridge, J.F. Amos
-Primary Care Optometry by Theodere Grosvenor
-Borish’s Clinical Refraction by W.J. Benjamin
-Clinical Procedures for Ocular examination by Carlson et al
-American Academy of Ophthalmology
-Optometric Clinical Practice Guideline by American Optometric Association
-Internet
Follow me to get in touch with optometric and ophthalmic updates
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 .
what is Duochrome Test, Why do we take Red and Green color only,
What is the Principal of Duochrome Test, Why Hyperopic Pt sees green better than red and vice versa
Presbyopia/ Methods of Presbyopic Addition Determination (healthkura.com)Bikash Sapkota
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Presbyopia and techniques of measurement
A fantastic presentation in the topic "Presbyopia and techniques of measurement"
A detailed information about presbyopia, techniques of presbyopic add determination and different correction methods.
Informative slide presentation on presbyopia for ophthalmology residents, ophthalmologists, optometrists, ophthalmic assistants, ophthalmic technicians, ophthalmic nurses, medical students, medical professors, teaching guides.
Presentation Contents:
--Introduction to presbyopia
-Types of presbyopia
-Risk factors
-Symptoms and signs
-Refractive error and presbyopia
-Methods of determining near add.
-Management of presbyopia
In a nutshell..
- The evaluation and management of presbyopia are important because significant functional deficits can occur when the condition is left untreated
- Undercorrected or uncorrected presbyopia can cause significant visual disability and have a negative impact on the pt.'s quality of life
- Finally, every tentative addition should be adjusted according to the particular needs of the patient
For Further Reading:
-Clinical Procedures in Optometry by J.D. Bartlett, J.B. Eskridge, J.F. Amos
-Primary Care Optometry by Theodere Grosvenor
-Borish’s Clinical Refraction by W.J. Benjamin
-Clinical Procedures for Ocular examination by Carlson et al
-American Academy of Ophthalmology
-Optometric Clinical Practice Guideline by American Optometric Association
-Internet
Follow me to get in touch with optometric and ophthalmic updates.
Accommodation/ Accommodation of Eye, Measurement of Accommodation of Eye (hea...Bikash Sapkota
CLICK HERE TO DOWNLOAD FULL PPT ❤❤ https://healthkura.com/measurement-of-accommodation-of-eye/ ❤❤
Dear viewers Check Out my other piece of works at ❤❤❤ https://healthkura.com ❤❤❤
Measurement of Accommodation of eye:
Amplitude, Facility,
Relative Accommodation, Fatigue, Lag,
Dynamic Retinoscopy
Presentation Layout:
-Introduction to accommodation of eye
-Mechanism
-Components
-Measurement of accommodation of eye
- Amplitude
- Facility
- Relative accommodation
- Lag
-Dynamic Retinoscopy
Accommodation
-dioptric adjustment of the crystalline lens of the eye
- to obtain clear vision for a given target of regard
-process by which the refractive power of eye is altered
- to ensure a clear retinal image
For further reading
-Clinical Procedures in Optometry by J.D. Bartlett, J.B. Eskridge, J.F. Amos
-Primary Care Optometry by Theodere Grosvenor
-Borish’s Clinical Refraction by W.J. Benjamin
-Clinical Procedures for Ocular examination by Carlson et al
-American Academy of Ophthalmology
-Optometric Clinical Practice Guideline by American Optometric Association
-Internet
Follow me to get in touch with optometric and ophthalmic updates
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 .
what is Duochrome Test, Why do we take Red and Green color only,
What is the Principal of Duochrome Test, Why Hyperopic Pt sees green better than red and vice versa
Presbyopia/ Methods of Presbyopic Addition Determination (healthkura.com)Bikash Sapkota
DIRECT DOWNLOAD LINK ❤❤https://healthkura.com/presbyopia-near-addition/❤❤
Dear viewers Check Out my other piece of works at ❤❤❤ https://healthkura.com ❤❤❤
Presbyopia and techniques of measurement
A fantastic presentation in the topic "Presbyopia and techniques of measurement"
A detailed information about presbyopia, techniques of presbyopic add determination and different correction methods.
Informative slide presentation on presbyopia for ophthalmology residents, ophthalmologists, optometrists, ophthalmic assistants, ophthalmic technicians, ophthalmic nurses, medical students, medical professors, teaching guides.
Presentation Contents:
--Introduction to presbyopia
-Types of presbyopia
-Risk factors
-Symptoms and signs
-Refractive error and presbyopia
-Methods of determining near add.
-Management of presbyopia
In a nutshell..
- The evaluation and management of presbyopia are important because significant functional deficits can occur when the condition is left untreated
- Undercorrected or uncorrected presbyopia can cause significant visual disability and have a negative impact on the pt.'s quality of life
- Finally, every tentative addition should be adjusted according to the particular needs of the patient
For Further Reading:
-Clinical Procedures in Optometry by J.D. Bartlett, J.B. Eskridge, J.F. Amos
-Primary Care Optometry by Theodere Grosvenor
-Borish’s Clinical Refraction by W.J. Benjamin
-Clinical Procedures for Ocular examination by Carlson et al
-American Academy of Ophthalmology
-Optometric Clinical Practice Guideline by American Optometric Association
-Internet
Follow me to get in touch with optometric and ophthalmic updates.
these slides explain the objective refraction in optometry , and describes its types and its measurement , and it gives you in details the types of Retinoscopy.
Techniques of refraction is the process of calculation of glass power.drbrijeshbhu
Refractive errors are most common cause of ocular morbidity. It affects all age groups, and ethnic profiles. There is no g nder discrimination. Most common symptoms are blur vission along with pain in eye ,headache and tiredness. Refraction is process of determination of eye and currect it with power glass power or contact lens power. It can subjective or objective.
Ocular Ultrasound is an ultrasound for eyes that uses high frequency sound waves to get detailed pictures of your eye and it's orbit. This procedure is usually done by Ophthalmologists.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. retinoscope is actually an outgrowth of
the ophthalmoscope
William Bowman(1861) noted the
changes in light and shadow that
occurred within the pupillary border
when he tilted his ophthalmoscope.
3. early 1900s, various investigators began
utilizing the retinoscope to determine
the amplitude or status of
accommodation in non-verbal patients -
term dynamic retinoscope emerged
Objective method of determining a
patient’s refractive error at nearpoint
4. A.J. Cross is credited with
introducing the basic theory
and method for dynamic
retinoscopy
Sheard, Nott, and Skeffington -
elaborated on the theory and
procedure
5. Goals
to determine accommodative Response
also helped determine the most
appropriate near prescription with
testing conditions
Reveals the degree to which
accommodation is fluctuating when
attending to a near target & if the eyes
are balanced equally at near
6. provide the information and insights
regarding the patient’s abilities and
level of visual processing at the
chosen distance
7. THE CROSS METHOD
Andrew J. Cross( 1920)
an alternative to cycloplegic refraction
Method of adding plus lens power to
obtain a reversal
8. Determining the correction in cases of
○Astigmatism
○Presbyopia
○Subnormal accommodation in
young patients
9. limitation
A measurement of negative relative
accommodation
Plus power recommended – patient
would not persist
10. SHEARDS’S METHOD
Charles Sheard (1920)
Introduced the concept of “ Lag
of accommodation”
add plus lens power until
neutrality occurred
11. TAIT’S METHOD
Tait(1953)
Working distance = 33cm
Fogging with a considerable amount
of plus lens power and then
approaches neutral by reducing the
plus lens power
12. Found an average of approximately
+1.50 D more than sheard system ,
thus total lag of accommodation =
+2.25 D
Close to +2.50D i.e Negative relative
accommodation.
13. LOW NEUTRAL AND HIGH NEUTRAL
METHODS
Sheard ( low neutral method)
The end point is the least plus power
required for a neutral reflex to be
observed.
Cross ( high neutral method)
Addition of plus power beyond neutrality
until a reversal occurs.
14. Monocular Estimate Method
(MEM) Retinoscopy
attributed to Dr. Harold Haynes at the
Pacific University College of Optometry
gives an estimated measure of the spatial
positioning of accommodation with
regard to convergence
cognitive demand is moderate
15. Materials
series of cards with a central
aperture mounted on a retinoscope
cards can have printed letters, or words,
or pictures that range in size from 20/160
(6/120) to 20/30 (6/9)
Arranged around the aperture
16.
17. Procedure
instructed to keep the targets clear
sweeps the retinoscope beam
observes the motion of the retinoscopic
reflex
quickly interposes a trial lens at the
spectacle plane
18. Interpretation
“lag of accommodation” is the amount
of plus lens that neutralizes the reflex
has been found to accurately
measure the lag of accommodation
in an objective manner
19. limitation
Plus lenses – relaxation of
accommodation – accommodative
response measured by this value found
to be 10% less
No longer than one fifth of a second
22. Procedure
wears his compensating distance
lenses
Directed to read the letters
Performs retinoscopy by moving
farther from the plane of regard until
the motion is neutralized
23.
24. Interpretation
dioptric difference between these two
distances equals the lag of
accommodation
can be valuable in evaluating the
stability of the accommodative
response
25. Distance from the target to spectacle
plane = 40cm
Distance from retinoscope to
spectacle plane = 50 cm
Lag of accommodation
= 2.50D – 2.00D
= 0.50D
26. Bell Retinoscopy
Developed by Drs. W.R. Henry and
R.J. Appel
Evaluate the performance of the
accommodative system under moving
& real life conditions in free space
cognitive demand is low
27. Materials
Three dimensional viewing target
a small, highly reflective bell dangling
from String – replaced with a Wolff
Wand(½ inch diameter, metal ball
mounted on the end of a rod)
28. Procedure
wand is held by the
examiner
moved closer to and
farther from the patient
- slower than 2
inches/sec
29. retinoscope is positioned at a fixed
distance of 50 cm (20 inches)
patient fixates the target and the
examiner notes the direction of the
reflex
30. target is moved closer to the patient
there will be a point where the motion
changes from “with” to“against’’
Target is again moved away from patient
until with motion is observed
31. Interpretation
Distance between the retinoscope
and the target when the motion
change occurs is a physical measure
of the lag of accommodation
“with” to “against” motion is observed
at 35 – 42 cm (14 - 17 inches)
32. “against” to “with” at 37 - 45 cm. (15
-18inches)
accommodative flexibility can be
assessed by observing how quickly or
sluggishly the reflex changes
33. eye movement control can be assessed
by judging the extent to which the ball
can be fixated
NPC can be determined by the normal
means
34. eye-hand coordination can be evaluated
by asking the patient to touch the Wolff
Ball during the procedure
limitation
patient converges - scoping more off-
axis
35. Stress Point Retinoscopy
developed by Harmon and Kraskin
evaluate the response of the entire
organism to stress
in stress-point retnoscopy - looking at
the change in reflex quality
36. Cognitive demand is moderate to
high
reasoning behind stress-point
retinoscopy is that vision is intimately
related to the whole body and that a
physiological change in stress
occurring in the body can be
perceived through a change in the
retinal reflex
37. Three things occur when near-point
stress is experienced
Firstly - there is a change in the
individual's pulse
Secondly - there is an inner canthal
twitch and
lastly - change in the colour of the
retinal reflex is observed
38. Procedure
Wolff ball is moved closer to the patient
- looks at which distance the reflex
"pops"
initially brightened and then became dull
and finally brightened again - termed
"popping" of the reflex - about 4 inches
in front of the patient
39. distance is noted and then different
lenses are placed binocularly and the
procedure is repeated
ideal lens is the one which makes the
stress point as close to the subject as
possible
40. more desirable to have the stress-point
closer to the patient - they are not
working under physiological stress
For example; if the stress-point of a
subject is 40cm and they habitually read
at 30cm they would be under constant
near-point stress
41. plus lenses move the stress-point closer
to the subject and minus lenses move it
away
in children the stress-point should be
10cm closer to the subject than the
Harmon distance
42. In adults the stresspoint should be 20 to
22.5cm from the face
remote position of the stress point
indicates near point dysfunction
43. Book (Getman)
Retinoscopy
developed at the Gesell Institute of
Child Development at Yale University
developed to obtain information about
the visual processing of nonverbal
infants
cognitive demand is high
44. Procedure
patient is given reading material
Retinoscope is performed as the
subject reads aloud
information is gathered in real time
with a task that is close to their
normal work situation
45. Getman and Kephart described the
following response levels with this
technique
A. Free reading level: Desirable, reflex
varies from neutral to with
B. Instructional level: more
demanding than the free reading
level, reflex is a varying fast against
motion
46. C. Frustration level: Even though
the subject is “focused” on the page
he is not Interpreting the information
properly
slow against motion
reflex color is bright and white when
the words are understood
47. reflex color is more pink and dims
slightly if the patient is struggling to
comprehend a word or passage
reflex color is dull and brick colored
when the patient has given up on
comprehending a word or reading
passage
48. Lag of accommodation
Accommodative lag =
accommodative demand ( +2.50D at
40 cm) – accommodative response
Lags are greater when closer test
distances are used
49. Lag of accommodation exhibits a
slow but progressive increase to adult
levels
Binocular accommodative system
normally respond with only +1.75D to
+2.00D of increased plus power
50. Lag of Accommodation
Normal Lag: +0.50 or +0.75 diopters
High Lag: +1.00 diopters or higher
Lead : +0.25 diopters or less
50
51. Mean lags of
accommodation
In various studies has varied from
about 0.25 to 0.75 D for the typical
test distance of 40cm
52. Rouse et al mean MEM lag of 0.34 D
Jackson and
Goss
Mean MEM lag of 0.23D
Tassinari Mean MEM lag of 0.35 D
Penisten et al a mean MEM lag of 0.77D
53. Average latency for an
accommodative response is
370msec
average total response time including
the latency and change in crystalline
lens power is about one second
54. mean difference between MEM and
Nott was 0.0002D (SD = 0.28)
Lags measured with Nott were lower
than the lags found with MEM in high
lag subjects
55. Lag > +0.75D/ High Lag
Inadequate accommodative response:-
as a result of :- near esophoria
poor negative vergences
accommodative insufficiency
uncorrected hyperopia
Patient is Overminused
56. Lag of accommodation <
+0.50D
Overaccommodating
As aresult of :- near exophoria
spasm of accommodation
Over Plus Correction
inadequate positive vergences
57. Pilar Cacho et al reported that the
Nott method was a more appropriate
technique to assess lags of
accommodation in young adults
because it is the method that least
contaminates the results
59. Accuracy of Dynamic
Retinoscopy
When compared with the near bichrome
test and the near cross cylinder test,
dynamic retinoscopy gave the best
agreement for the accommodative
response as measured with an infrared
autorefractor.
59
60.
61. Near retinoscopy and
dynamic retinoscopy
Mohindra retinoscopy
Fellow eye is patched
Performs at near on infants
Objective – measure refractive
condition at distance
Correction factor is subtracted from
the neutralizing lens
62. Radical retinoscopy and
dynamic retinoscopy
small pupil, cataract, or other media
opacity - observation of reflex is
difficult
moves closer to patient
WD – 20 cm
63.
64. References
Primary care of Optometry –
Theodore Grosvenor
Optometry – Mark and Nicola
Clinical refraction – Borish
Previous presentations
internet
Bell Retinoscopy
This technique was originally performed using a small bell suspended in front of the examiner&apos;s forehead. A one half inch steel ball attached to a thin metal rod has replaced the bell as a fixation target. The examiner performs retinoscopy at 50cm (20 inches). The patient is instructed to fixated on the target. The examiner slowly moves the ball toward the patient until neutral motion is observed. Typically neutrality will be observed when the ball is 15 to 16 inches from the patient. This yields a lag of 0.50 to 0.75D.
MEM Retinoscopy
A fixation target (letters on the retinoscope or card attached to the retinoscope) is placed at the patient&apos;s customary reading distance. The patient should be focused at the plane of the retinoscope. The examiner introduces lenses in front of the patient until neutrality is observed. The lenses are inserted and removed quickly, to avoid changing the patient&apos;s accommodative status.
Nott Retinoscopy
The patient fixates on the target at 40 cm. The examiner performs retinoscopy at a distance greater than the fixation distance and moves toward the patient until neutrality is observed. The dioptric equivalent of the linear distance between the target and neutrality is recorded and represents the lag of accommodation.
Interpreting Results
Normal Lag: +0.50 to +0.75D
High Lag: +1.00D or higher
Decreased Lag (Lead): +0.25D or less
High Lag
Accommodative Dysfunction
insufficiency
fatigue
paresis
infacility
Hyperopia or Latent Hyperopia
Vergence Dysfunction
esophoria and poor negative vergences
Patient is Overminused
Lead or Low Lag
Accommodative Dysfunction
spasm of accommodation
spasm of near reflex
Over Plus Correction
Vergence Dysfunction
exophoria and inadequate positive vergences