1.1.1 Obtains relevant history and information relating to general health, medication, family history, work, lifestyle and personal requirements.

Question 1

What to say in H&S

Answer 1

• Begin by saying, “Hi, I’m Shahzeb & I’m the pre reg optometrist who will be checking your eyes today”
• Open & closed questions
• Be prepared to do LOFTSEA!
  
  • Learn what to ask if vision is worse, if patient has headaches or dry eyes
  • E.g. Distance vision worse but NV OK
    
    • Is it worse in one or both eyes?
    • When did you first notice this change in your vision? Has it been quite a gradual change?
    • Has it become worse with your glasses on? Is it worse during any particular activity?
    • Anything done to make it better?
• Summarise at the end e.g. “So, the main reason for your visit is for a routine eye check, just to see if there’s any change in the Rx, your eyes are nice & healthy & if you require glasses at all. Is that correct? Perfect, so I’ll start having a look at your eyes now…”

Question 2

Task Analysis

Answer 2

• Task analysis lecture - Things to consider: Wd, How big the field is, Eye or head movement needed, Colour, Whether the task is moving, Lighting and contrast, Posture, Eye protection, Optical appliance like MAR or tint, Visual fields
• What type of glasses needed for squash, etc? Water sport, winter sport, swimming, golf?
  
  • Golf - amber tint or yellow tint best as the contrast of the ball against the sky is far greater
  • Polarising tint for water sport or fishing to help see through the water & reduce glare from its reflections
  • EN 174 (2001) - Ski goggles for downhill skiing
    Filtering lenses marked according to transmittance (S0 to S4) where higher number indicates lower transmittance. NO POLARISING FILTER OTHERWISE CANNOT SEE SNOW TROUGHS
  • BS 5883 (1996) -Surface swimming goggles
  • BS 7930 - Eye protectors for racket sports - practically mandatory for doubles squash and junior competitions. Certain impact resistance required & FOV
• Stitching - specific add
• If px does DIY for example or is a carpenter let’s say, ask if they wear safety spex and if they do, are they prescription? If plano needed e.g. wearing OTT of their spex, can buy from online or screwfix for example
• An employer pays for an eye exam for an employee. Should you send the test results to the employer?
  
  • Not without px consent!
• The patient brings a form for you to fill in with the results of the eye exam? Do you still need to record written consent?
  
  • Formal written consent is not required, as it is the patient themselves who will pass the information onto the employer

Question 3

In the case of a contract ST (if this is what you use for the PR):What is the act (in law)

Answer 3

• What is the act (in Law)?
  
  • Health & Safety Regulations 1992, Regulation 5
    Regulation 5 requires each employer to ensure that users employed by him are provided:
    (a) with initial eye and eyesight tests on request;
    (b) at regular intervals thereafter and with the consent of the users concerned, with subsequent eye and eyesight tests;
    (c) with additional eye and eyesight tests on request, where the users concerned are experiencing visual difficulties which might reasonably be considered to be caused by work on display screen equipment; and
    (d) with appropriate special corrective appliances, where normal corrective appliances cannot be used and any eye and eyesight tests carried out on the users concerned in accordance with regulation 5 show such provision to be necessary.

Question 4

From College Website:

When a patient who is an employee takes up their entitlement under the Regulations, perhaps as a result of visual problems when using a screen or computer, you should:

Answer 4

1. Carry out a full eye examination to determine the cause
2. Ask the patient to describe their workstation and its environment
3. Give appropriate advice, including ergonomic information, if appropriate. If patient complaining about strain during VDU use, may be how the keyboard, mouse, screen (should be eye level at slight tilt) or table is positioned. If patient complaining about screen themselves then may need to adjust screen flicker, brightness, contrast, text size. If the workplace size itself e.g. the size of the desk for docs & the VDU, the chair type & ability to adjust it. The environment matters in terms of heating, humidity, lighting, room to move chair, noise
4. Provide them with a prescription or written statement, as appropriate
5. Maintain confidentiality of clinical information at all times. Only provide clinical information to an employer if it is relevant to the employee’s DSE work and only if you have obtained the patient’s consent.

Question 5

You may also provide a report to the employee and their employer (with the employee’s consent). This should:

Answer 5

1. Clearly state whether or not the employee needs spectacles, specifically for their DSE work
2. Include any prescription for a corrective appliance for DSE work
3. Recommend when the employee should be re-examined, under the terms of the Regulations.
   - If spex bought not needed for VDU use, then px liable for its payment. Must be discussed between employee & employer beforehand
   - A bifocal or varifocal lens is referred to as special-corrective lenses. If these are actually needed for VDU whereby separate pairs might make work more difficult, then employer should give more money towards these spex
   
   • Optometrists should NOT always say that multifocal lenses are the perfect solution considering a varifocal will restrict some peripheral viewing, mean adjusting neck/head & possibly causing strain!
     - Cost for ST is reimbursed via Voucher or if px gives employer a Receipt
     - If patient is still having symptoms of eyestrain etc after been given spex, boss still has to pay for another ST & spex
   • Between you, employer & employee to make employee as comfortable as possible
     - Management - Give Add saying that this will help with eyestrain etc, Drops for dry eyes, 20-20-20 rule (eyestrain), etc
   • SVI, Enhanced reader, Office lens (restricted distance), Potentially good varifocal for intermediate

Question 6

Patient with Ocular surgery or Treatment Questions:

Answer 6

• Which eye?
• What for?
• When was the treatment?
• Where?
• Discharged?
• What did the doctors recommend?
• Any problems since? E.g. blur

EXAMPLE: RE cataract op on Oct 2021 done at HES, discharged, no other advice given, no problems since

Question 7

What can happen to eyes after cataract op?

Answer 7

Posterior capsular opacification is very common!

• Proliferation of lens epithelial cells that were stuck in the capsular bag after cataract taken out
  
  • Capsular bag - This term applies especially to the capsule after removal of its content by extracapsular cataract extraction or phacoemulsification
• Gradually reduced vision, glare and even monocular diplopia
• They look like pearls or big floaters on slit lamp
• Routinely referred for YAG laser treatment

Question 7

One Day post operatively patients may present with:

Answer 7

• Diplopia
• Corneal oedema
• Raised iop
• Anisekonia (if wrong lens power or deliberately correct high myopia)
• Wound leak
• Iris prolapse
• Vitreous prolapse
• Uveitis
• Vitreous Haemorrhage
• Hypopyon/endopthalmitis

Question 8

One week post operatievly patients may present with:

Answer 8

• Uveitis
• Endopthalmitis
• Glaucoma
• Corneal Oedema

Question 8

One to eight weeks post operatively patients may present with:

Answer 8

• Persistent uveitis
• Cystoid macular oedema
• Lens deposits
• Raised IOP
• Persistent corneal oedema
• Refractive suprise
• Astigmatism
• Capsular phimosis - this is fibrosis of the capsular bag which may decentre the IOL or narrow the anterior capsular aperture, comprising vision
• Retinal detachment or macular disciform
• Posterior capsular fibrosis