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CLINICAL ANALYSIS : An asset in management of Refractive Error World Congress on Refractive Error 14th-16th March 2007.

2/18/2012. 2. INTRODUCTION . The Art and science of Refraction and prescribing spectacle lenses had formed the cornerstone of the Optometric practice before the formal beginning of the profession during the late 19th century.In the 20th century, refraction of the eye and management of Refractive error has contributed to a higher quality of vision care.

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CLINICAL ANALYSIS : An asset in management of Refractive Error World Congress on Refractive Error 14th-16th March 2007.

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    1. 2/18/2012 1 CLINICAL ANALYSIS : An asset in management of Refractive Error World Congress on Refractive Error 14th-16th March 2007. Durban, SA DR NWAKUSO ARUOTU BSc, OD, FNOA, FNCO, FAAO. University of Port-Harcourt Teaching Hospital, Nigeria.

    2. 2/18/2012 2 INTRODUCTION The Art and science of Refraction and prescribing spectacle lenses had formed the cornerstone of the Optometric practice before the formal beginning of the profession during the late 19th century. In the 20th century, refraction of the eye and management of Refractive error has contributed to a higher quality of vision care

    3. 2/18/2012 3 INTRODUCTION Spectacle, Contact Lens, Lasik New spectacle design & material New contact lens design & material New diagnostic equipment & technique

    4. 2/18/2012 4 DEFINITIONS REFRACTIVE ERROR : Clinically, it is the variation from perfect coincidence of the principal focus of the eye with the Retina i.e. when accommodation is relaxed, parallel rays of light fail to converge to a sharp focus on the retina. Classified – Myopia, Hyperopia, Astigmatism. *Affects all ages, sex, race, ethnic groups and religions but with variable prevalence and distribution.

    5. 2/18/2012 5 DEFINITION CLINICAL ANALYSIS : It is the process of relating a patient’s symptoms to clinical signs towards the formulation of a diagnosis and treatment plan

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    8. 2/18/2012 8 AIMS AND OBJECTIVES Understand Subjective & Objective patient problem Factors that must be considered in developing a refractive treatment plan Rational for specific management approaches Clinical decision making process

    9. 2/18/2012 9 Today’s Situation Time management Equivalent dioptre sphere Full or under correction Rule of the thumb Signs and symptoms ?/?/?/??//??//???///????////?????

    10. 2/18/2012 10 CLINICAL ANALYSIS is similar to SCIENTIFIC METHOD SCIENTIFIC : Initiated by a research question i.e. hypothesis CLINICAL ANALYSIS: Initiated by a pre-diagnosis of the most likely cause of symptoms & signs presented by patient

    11. 2/18/2012 11 STEPS IN CA 1.Doctor considers some factors in the formulation of preliminary diagnosis -Relation among symptoms -Clinical signs -Diagnosis -epidemiology of eye in population

    12. 2/18/2012 12 STEPS IN CA 2. The doctor performs appropriate clinical test and procedures to obtain problem-related data. 3. Analyze clinical data to confirm pre-diagnosis; otherwise additional test procedure towards formulation of alternate diagnosis as scientific for hypothesis

    13. 2/18/2012 13 STEPS IN CA 4. Design a treatment plan if diagnosis is confirmed. -Tx options -Referral for further test or consultation -Patient education -Follow-up care

    14. 2/18/2012 14 IMPORTANT DECISION-MAKING QUESTIONS Chief complaint vs. RE Patient history vs. severity & type of RE Corrected & uncorrected VA vs. symptoms Consistence of RE measurement - Keratometry, Retinoscopy & subjective Will prescribing or changing SRx eliminate CC and will benefit be appreciated Symptoms from adaptation? Modify? Symptoms resulting from effects of accom or vergence? Lens design features - BC, seg ht, thickness? etc

    15. 2/18/2012 15 MANAGEMENT OF REs DIAGNOSIS OF RE IS RELATIVELY EASY BUT MANAGEMENT MAY NOT BE AS STRAIGHT FORWARD Correlation btwn symptoms and signs – High; eg, VA & Refraction result. However presence of RE does not justify SRx or CL Rx Each Px needs must be considered & evaluated on individual basis

    16. 2/18/2012 16 INDICATIONS FOR MANAGEMENT OF RE WITH SRx & or CL Improvement of VA Restoration of comfortable vision by eliminating symptoms of asthenopia Enhancement of vision efficiency Prevention or slowing progression of RE Protection & safety Special vocation or avocational needs Cosmesis Mechanical support

    17. 2/18/2012 17 FACTORS TO CONSIDER IN MANAGING RE WITH SPECTACLE/CL PATIENT’S AGE HISTORY OF SPEC WEAR VOCATION VISION REQD AVOCATION VISION REQD ABILITY TO ADAPT TO CHANGE TYPE OF RE SEVERITY OF RE POTENTIAL EFFECTS OF Rx ON ACCOMODATON & VERGENCE

    18. 2/18/2012 18 MILDER AND RUBBIN: 4 PRACTICAL PRINCIPLES OF PATIENT CARE Get the FACTS – obtain & evaluate Use Rule of the Thumb cautiously – its not absolute Do no harm Don’t Rock the boat - change for the sake of change is not necessary

    19. 2/18/2012 19 CASE STUDY 1 MYOPIA History:AG, 28yr, teacher CC- noticed slight blur at dist with current Rx Loves yard work & construction Clinical findings: VA: OD-20/20 @ dist & near with -1.25-0.50x175 OS-20/20 @ dist & near with -1.50-0.25x180 Cover T w/Rx OU-ortho Ret:OD -1.75-0.25x180 OS -1.50-0.50x180 SRx: OD -1.50-0.50x180=20/20+2 OS -1.50-0.50x180=20/20+1 photometry: dist near Phoria 1^xp 4^xp BI vergence x/9/4 14/22/10 BO vergence 12/22/7 17/28/9 NRA/PRA +2.25/-2.25

    20. 2/18/2012 20 CS MYOPIA Ocular health, tonometry, VF normal Assessment 1. Slight Increase in myopia, OS and astigmatism, OD 2. Phoria, vergence NRA/PRA normal (Morgan) Treatment Plan OU.-1.50-0.50x180, polycarbonate Px education- increased short-sightedness Discuss:

    21. 2/18/2012 21 CASE STUDY 2 HYPEROPIA CP, 40yr, fire-fighter CC- routine eye test Denied any symptoms while reading VA OD&OS -20/15@6m; 20/20@40cm Cover ortho@ 6m: 4^xp@40cm Stereo acuity@40cm:20sec Ret: OD&OS +0.50DS SRx:OD&OS +0.75DS Phoria 1^EP@6m; 2^XP@40cm NRA/PRA +175/-2.00 Trial framed - same VA with or without Rx

    22. 2/18/2012 22 HYPEROPIA Assessment Facultative hyperopia OU Normal binocular vision Treatment plan None at time Px education- RTC in 1-2 yrs if he experiences asthenopic symptoms during near work Discuss.

    23. 2/18/2012 23 SUMMARY ALTHOUGH MAJORITY OF THE PATIENTS WE SEE HAVE REFRACTIVE ERROR BUT NORMAL BINOCULAR VISION, HOWEVER CLINICAL ANALYSIS CAN BE AN ASSET IN MANAGING REFRACTIVE ERRORS THAT RESULT IN CLEARER, COMFORTABLE, ADAPTABLE AND MORE EFFICIENT VISION

    24. 2/18/2012 24 THANK YOU and God bless you all

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