Clinic: Example Exam Structures

Question 1

PC: Vicroads glasses, no dilation indicated, vision, no prior Rx knowledge (8)

Answer 1

Observe current glasses (quick vert? Make sure to know what type e.g. SV, BF, PALs. Actually check).
VA (habitual D + N) + CT
Screening: Confrontation (re driving), Motility, CT (if not done)
Anterior eye (check for opacities. Check pupil reactivity while in SL)
Posterior undilated (check post pole z UFE)
Retinoscopy
Refraction
IOP/Tono (quick glaucoma check)

Question 2

PC: GEE re DM checkup/review (8)

Answer 2

VA (D + N) + CT (very quick CT)
Anterior + Pupils (e.g. ensure no DM cataract, check for any opacities/ look to see if cornea clear)
Dilate
Refraction (quick check to see if roughly the same. 5 mins)
Screening (Confrontation)
Posterior DFE
CFP
OCT

NB: Anterior and refraction could be swapped around. However, if so, make sure to do pupils separately before dilation, rather than during SL. Also NB: VA may be slightly worse if you do after dilation, so keep that in mind. Can add +1.00 over finding as blur and work backwards to best VA with dilation. However, Final VA findings would be worse. NB: Refraction after drop would be more for patient who had good habitual VA initially (like 6/6). Whereas, if VA was a bit worse, then we could do refraction prior to dilation to try and push 6/6.

Question 3

How should VA and CT be combined?

Answer 3

DVA –> DCT (look at first letter of line above best) –> NVA –> NCT (look at letter above best paragraph).

Question 4

What should be done before you start any refraction?

Answer 4

A very quick PD

Question 5

PC: Full BV workup (11)

Answer 5

VA (D + N) + CT (D + N)
Refraction: incl blur function (trial frame preferred here. If phoropter, switch to trial frame after)
MEM RET
NPA/NPC
A+V facility
Near prentice
ACA
PRC/NRC (D+N) (D = distance prentice) (z prism bar)
NRA/PRA (phoropter with the ruler sticking out)
Binoc X-cyl (optional. Can do MEM RET instead)
MR/VG (optional)

*Do this z best corrected in trial frames (or specs if already best corrected). Measure PD for trial frames prior to MEM RET.

Question 6

How do you perform NRA/PRA

Answer 6

Start with NRA:

• Px phorop binoc near target (1 size above best)
• add +ve lens until px can’t make clear
• do same for -ve lenses (PRA)

Question 7

How to perform X-cyl?

Answer 7

+/- 0.50 lens (with -ve cyl axis oriented vertically)
Lag = horizontal lines clearer (closer to retina)
Lead = vertical lines clearer (closer to retina)

Question 8

When should you fo near VA generally?

Answer 8

After refraction (put near add in frame and adjust near add with flippers while they look at near chart)