Objective 1

Question 1

External forces may affect the accuracy of a prescription. When taking a case history, you must be aware of comments made by the patient, which should alert you to investigate further. These may include some of the following seemingly unrelated information, which may affect accuracy of prescriptions:

Answer 1

Lack of sleep
Just off a long work shift
Stress
Hormonal imbalance (birth control pills, pregnancy, hormone replacement therapy for menopausal symptoms, medications for prostate problems and/or prostate cancer, breast or other hormonal influenced cancers)
Blood pressure (high or low)
Hypoglycemia/hyperglycemia
Any systemic disease
Sudden growth spurts in adolescence

Question 2

More obvious causes that may affect accuracy of prescriptions: 4

Answer 2

Keratoconus
Eye trauma
Glaucoma
Diabetes and/or other systemic diseases

Question 3

Family history regarding ocular disorders: 5

Answer 3

Glaucoma
Cataract
Strabismus
Amblyopia
Blindness

Question 4

An optician should be familiar with the symptoms of the following eight types of headache:

Answer 4

Ocular or eyestrain headaches
Migraine headaches
Hypertension headaches (caused by high blood pressure)
Temporal arteritis
Muscular contraction headaches
Cluster headaches
Sinus headaches
Neuralgia headaches (trigeminal facial nerve)

Question 5

These typically occur in specific visual situations such as reading, computer work or close paper work. They are of medium intensity, feel dull and are usually located near or around the eyes. Most of the time they are equally intense on each side of the head.

Answer 5

Ocular or Eyestrain Headaches

Question 6

Sharper and typically one-sided. Often they are accompanied by striking visual disturbances. Patients sometimes describe seeing large areas of twinkling, flashing or shimmering lights. These are known as auras. They may also describe areas of vision that are blanked-out on one side of the visual field in one or both eyes. Some people experience nausea, but no visual disturbances.

Answer 6

Migraines

Question 7

Typically intense, strike early in the morning upon awakening and disappear as they day progresses. This is the opposite sequence of an eyestrain headache, which occurs as the eyes are used during the course of the day.

Answer 7

High Blood Pressure Headaches

Question 8

This condition almost exclusively occurs in people over age 50 and affects about 1 out of 1,000 people. Typically the large arteries to the head are affected, and usually there is sudden onset of a severe headache. Loss of appetite, tenderness of the scalp as well as a general feeling of malaise also occurs. The patient may complain of transient loss of vision in one or both eyes known as amaurosis fugax. Diplopia may also be present.

Answer 8

Temporal Arteritis

Question 9

The patient complains of the feeling of a steel band around the head, which can be worse in the forehead. The location of pain is similar to that described in the eyestrain headache. Stiffness of the neck can also accompany this type of headache.

Answer 9

Tension or Muscular Contraction Headaches

Question 10

One-sided, they produce severe, driving pain, which strikes quickly. They most commonly affect middle-aged men, often at night while the patient is lying down. Sometimes they are accompanied by tearing in the eye on the affected side, along with nasal congestion. The patient may report that getting up and walking around relieves the headache.

Answer 10

Cluster Headaches

Question 11

These headaches are caused by infection in the sinus cavities and are usually located in the forehead or cheekbone area. Pain is greater when the patient bends down. Sinus headaches are especially recognizable when the patient also reports postnasal drip, low-grade fever, and loss of sense of smell.

Answer 11

Sinus Headaches

Question 12

a headache that is piercing and knife-like. The pain has a sudden onset in the facial region. Also known as the tic douloureux, it is caused by inflammation of one or more divisions of the trigeminal nerve in the face or head. The pain can be set off by touching a specific area of the face while bathing, shaving or brushing the teeth.

Answer 12

Trigeminal Neuralgia

Question 13

External Eye Symptoms
As well as reporting problems associated with their vision, patients may have additional complaints related to their eyes. It is important that as a refractionist you become familiar with the following symptoms and understand their possible implications. List A-K

Answer 13

A. Itching B. Burning C. Scaliness of Lids or Lashes D. Injection or Redness E. Discharges F. Foreign Body Sensation G. Pain H. Sensitivity to Light I. Excessive Lacrimation J. Dryness K. Visual Disturbances