The synaptophore is an orthoptic instrument used for both diagnostic and therapeutic purposes in optometry. It works using the haploscopic principle to divide visual space into two separate areas visible to only one eye each. Slides can be used for simultaneous perception, fusion, stereopsis, and other tests. Diagnostic uses include measuring deviations, retinal correspondence, and fusional reserves. Therapeutic uses treat suppression, amblyopia, and heterophorias. Proper adjustment and preliminary settings are required before administering tests to accurately diagnose and manage binocular vision anomalies.
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.
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.
magnification, It's definition, types, clinical uses, Uses in Optical instruments like microscopes, telescopes, Uses in Optical instruments like direct Ophthalmoscopes, indirect ophthalmoscopes and slit lamps, In low vision
Contact lens for congenital aphakia and other eye conditions for infants and toddlers. The slide presentation encompasses indications for CL fitting in paediatric, contact lens options, fitting techniques, challenges and contact lens as myopia control.
magnification, It's definition, types, clinical uses, Uses in Optical instruments like microscopes, telescopes, Uses in Optical instruments like direct Ophthalmoscopes, indirect ophthalmoscopes and slit lamps, In low vision
Contact lens for congenital aphakia and other eye conditions for infants and toddlers. The slide presentation encompasses indications for CL fitting in paediatric, contact lens options, fitting techniques, challenges and contact lens as myopia control.
For generations, the Synoptophore has been THE standard instrument of choice for the busy Orthoptic clinic. It is ideal for the assessment and treatment of ocular motility disorders by reliably performing the most comprehensive binocular vision assessment available today.
The term ‘‘aniseikonia” comes from the Greek words ‘‘an” (not) ‘‘is” (equal) & ‘‘eikon” (icon or image) so aniseikonia is a binocular condition in which the apparent sizes of the images seen with the two eyes are unequal.
Whenever refractive ametropias in the two eyes of a person are different (i.e., when there is an anisometropia), the corrected retinal images of the two eyes, and consequently the two visual images, differ in size.
This condition has been termed aniseikonia
Optical aniseikonia
Retinal aniseikonia
Cortical aniseikonia
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.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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.
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
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
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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. Synaptophore(amblyoscope)
It is an basic orthoptic instrument used for diagnostic
as well as therapeutic purpose.
The word synaptophore derived from greek word.
Synaptophore
Sin with
Ops eye
Phore bearing
3. History
The oldest model is developed by Claud worth .
Mc. Maddox first develop slides used in early device.
4. Principle
Haploscopic principle
it is based on the principle of division of physical
space in to two separate area of visual space each of
which is visible to one eye only.
5. Parts
Two tubes for viewing picture
Lenses with in the eyes piece are +6.5 DS
Pairs of slides
Controls allow vertical separation of the target as well
cyclotorsional adjustment
Mirror in each tube to reflect the image of target through
the eye piece into corresponding eye.
Scales to measure the amount of deviation
Illumination system to increase or decrease the stimulus
luminance
6.
7. Slides
Simultaneous perception slides
Foveal
Macular
Para macular
Peripheral
Fusion slides
Steropsis slides
Special purpose slides
After image slides
Haidinger brushes
Slide with number or letters
12. Uses of synaptophore
The uses of synaptophore divided into two
Diagnostic uses
Therapeutic uses
13. Diagnostic uses
Estimation of grade of binocular single vision
Measurement of objective and subjective angle of deviation
Measurement of deviation in all cardinal direction of gaze
Measurement of inter pupillary distance
To investigate the state of retinal correspondence
Measurement of primary and secondary deviation
To estimate presence and type of suppression
Measurement of fusional vergance
measurement of angle kappa
Measurement of AC/A ratio
14. Therapeutic uses
It is used in treatment off
Supression
ARC
Amblyopia with Eccentric fixation
Accomodative esotropia
Heterophorias and intermittant heterophorias
15. Preliminary setting
1. The patient’s chair and the table should be
adjusted so that he is able to look through the
centre of the eye-pieces comfortably with his
head erect.
2. The chin and forehead rest should be adjusted to
suit the patient.
3. The patient’s interpupillary distance (I.P.D.)
must be measured and the instrument adjusted
so that the distance between eye-pieces is equal
to the interpupillary distance.
16.
17. Estimation of grade of binocular single vision
Simultanous perception
First grade of bsv
Tested using two dissimilar picture such as an object and a
surround E.g.: cage and lion
Patient is asked to put the lion in cage by moving the arm
of synaptophore
Ideally the foveal picture must be used. But the target size
should be appropriate to the patient visual acuity
Slide size Angle subtended
Foveal 1 degree
Macular 1 to 3 degree
Para macular 3 to 5 degree
Peripheral > 5 degree
18. Recording
If the patient is able to see both the pictures at a time then
S.M.P. is present and recorded as S.M.P. at zero degree or at
a particular angle.
19. Fusion
Tested using similar but incomplete picture eg: two
rabbit one lacking tail and one lacking bunch of
flowers. If fusion is present one rabbit complete with
tail and flower will be seen.
Sensory fusion:
One tube is locked and patient is asked to create a
composite image and the position of sensory fusion was
achieved is read off the scale.
Motor fusion:
Lock the Colum at their real corrected angle then to
measure negative fusion adduction knob adjusted and
for positive fusion abduction knob is adjusted. Then
note the value when the image split into two.
21. Stereopsis
Tested using two pictures of same object which have
been taken from slightly different angle
if the images are fused and is seen three diamensioly
stereopsis present
22. Measurement of IPD
The patient should be seated at the
Synoptophore
inter-pupillary distance (IPD) should be
adjusted so the lines on the eyepiece
line-up with the corneal reflections
23. Measurement of objective angle of deviation
Patient seated in front of synaptophore and IPD should be adjusted.
Smaller picture should be placed in front of RE and larger picture
placed in front of LE. An alternate cover test is performed by
alternatively switching off the light illuminating the slides.
Then according to the directions of eye movement the tube before
the non fixing eye is adjust until no movement is seen. Then the
measurement is recorded from scale. If the eyes moves out to take
fixation left arm moved in and vise versa
This can be repeated for vertical deviations.
24. Measurement of subjective angle of deviation’
Patient seated in front of synaptophore and IPD should be adjusted
Smaller picture should be placed in front of RE and larger picture
placed in front of LE
Ask the patient to pull or push the handle controlling the non fixing
eye’s tube until the two images are super imposed.
In the presence of suppression patient fail to superimpose two
images. In this case a larger target should be introduce. If the patient
fail to superimpose in peripheral slide the patient has no BSV
25. Measurement of The Angle of Deviation For Near by The
Synoptophore:
Minus 3.00D spheres can be inserted in the lens holders
situated in front of the eyepiece lenses. The patient has to
exert 3.00D of accommodation in order to get a clear image of
the slides
In doing so , each eye exerts 3Δ of convergence for each
dioptre of accommodation-in other words, 9Δ of convergence
in one eye or 18Δ of convergence
recording the angle of deviation, we must keep this in mind and
either subtract 18Δ from or add 18Δ to the major amblyoscope
readings)
Eg:20 prisam bsae out the devation will be 20-18 = 2 prisam base out
20 prisam base in the deveation will be 20+18=38 base in
26. Recording
SMP using macular slide
Angle of deviation for distance
Fixing RE
Objective deviation: 0 degree
Subjective deviation: 0 degree
Angle of deviation for near
Fixing RE
Objective deviation: 0 degree
Subjective deviation: 0 degree
27. Measurement of cyclodeviation with Maddox slide
Maddox slides (white binding) can aid the assessment of 9 positions
of gaze. Horizontal and vertical deviations are assessed in the
normal way.
However, with the cross before the fixing eye the examiner may
rotate the torsion control until the patient is satisfied that it
superimposes in the centre of the green surround and all lines
should run parallel.
28. Measurement of cyclodeviation with sp slides
Use SP slides and put lion in front of RE and cage in front of LE
The patient is asked to look at each one in turn and asked whether
cage appear level.
If the cage left hand side lower than right hand side
incyclophoria or tropia
If the cage right hand side lower than left hand side
excyclophoria or tropia
Incyclophoria corrected by rotating tortional screws towards the
patient
excyclophoria corrected by rotating tortional screws away from the
patient
29. Retinal correspondence using SP slides
Measure objective and subjective angle using synaptophore
Find out angle of anomaly
Objective angle – subjective angle= angle of anomaly
Objective angle =
subjective angle
Normal retinal
correspondence
Angle of anomaly =
objective angle(subjective
angle zero)
Harmonious ARC
Subjective angle<
objective angle
Unharmonious ARC
30. Recording
Fixing RE
Objective angle: 0 degree
Subjective angle: 0 degree
Angle of anomaly: zero
Retinal correspondence: normal
31. Measuring AC/A ratio
Gradient method is often used
Measure the deviation with accommodation and without
accomodation divided by change in accomodation gives AC/A ratio
AC/A =∆L - ∆O /D where ∆L – deviation with addl.lens ,∆O – original
deviation D – dioptric power of lens
Eg; :- ∆L - 6 ∆ eso ∆ o - 2 ∆ exo D – 2 D concave sphere
AC/A =6-(-2)/2
8/2 = 4 ∆/D
32. Determination of angle kappa
A special slide consist of row of number or letters used for this
Ask the patient to look at zero. If the corneal reflex is on nasal side
the angle is positive
And if the reflex is on temporal side the angle is negative
The patient is asked to turn the letter or number until the reflex is
centered. The deviation correspond to letter or number is recorded.
33. To estimate type and presence of suppression
The area of suppression initially mapped out by
recording the angle at which the image is suppressed.
By lowering the angle the illumination of fixating eye
until the SMP is achieved give a rough estimation of
type of suppression.
34. Position of gaze
In complex ocular motility cases,
all 9 cardinal positions of gaze
can be subjectively measured
along with unilateral ductions
with repeatable, standardised
conditions.
The subjective measurement can
be performed fixing either eye in
the primary position, when the
central lock is released on lateral
versions and using the elevation
and depression controls up to
+/- 30° vertically.
35. After image test
There are two slides available one with vertical slit and other with
horizontal slit
Then right fovea is stimulated by vertical sit for 20 sec then left fovea
is stimulated by horizontal slit for 20 sec
Ask the patient to draw position of after image
36.
37. Haidinger’s Brushes
Haidinger brushes correspond to macula.
It is used for :
To determine whether amblyopic patient fixate with
fovea or not.
Traing technique in amblyopia to improve fixation
41. Flashing:
This can be done with an automatic flashing
device or by manual control of the switches. The
tubes are set at the objective angle of deviation.
First one light and then the other is extinguished
at interval of a few seconds. This induces
alteration. The speed of alteration should be slow
at first but gradually increased.
42. CHASING TECHNIQUE
It is a subjective exercise using the smallest SMP slide
that the pt.can superimpose
The two arms of the synaptophore are loosened and the
pt.is asked to hold the tube in front of the suppressed
eye
Examiner moves the other tube in front the fixating eye
in a random position
Pt. is asked to chase it and superimpose the two pictures
by moving the other tube
As the pt.’s performance improves , smaller pictures are
used
43. MACULAR MASSAGE
This exercise stimulates retina of deviated eye
It is done by moving the visual target across the
suppression scotoma
CROSSING TECHNIQUE
Target is moved in front of suppressed eye from
periphery of field towards suppression scotoma
Target will disappear in suppression area & reappear on
the other side of scotoma
The movement is continued until this area has
decreased to such an extent that pt can perceive both
target & can superimpose the two object
44. Fusion exercises
Fusion exercises were given on major amblyoscope
with the fusion slides. Fusion range could be
increased by gradually converging both the tubes
of major amblyoscope till the fusion breaks.
Exercises were given daily or on alternate days for
10 to 15 minutes depending on the tolerance and
convenience of the patients.
45. Advantages
Accurate measurement is possible
Tube can be move separately
Large selection of suitable slides are available
The patient’s eye can be seen by the orthoptist and the
corneal reflections can be observed.
There can be rapid interchange from objective to subjective
conditions
46. Disadvantages
Poor fixation
Not useful in non cooprative child
Only corneal reflex is noted
Bulky instrument, difficult to transfer from one place
to other.
Though the slides are kept in optical infinity distance
but still it stimulates proximal accommodation of the
patient.
Needs expert orthoptist to handle the instrument
accurately.