OSCE 3

Question 1

RGP script:

Answer 1

Hi I’m Dyllan, this test will assess that fit of your contact lens
* I’ll need to shine light through microscope and touch your face, cool?
Just going to clean the machine and my hands
Dynamic assessment first: diffuse lighting
* Coverage
* U/1mm from limbus
* Otherwise note TD size change
* Centration
* inferior is normal, not over limbus
* Pupil is covered
* Wettability
* Motion on blink (1x1)
* Score as: +2=2mm / -2=0.5mm
* Minimal lid interaction
* Lag and return time
* Lens position in 3 gazes (no limbus interaction)
Now static check: I’ll instill fluorescein on upper lid W/Wratten filter
* I’m manipulating your lids to center the lens
* Clear central, peripheral, edge zones
* Even BOZR, central trace fluorescein
* Edge clearance 0.5mm band

Question 2

RGP parameters:

Answer 2

8.10:8.30 / 8.50:8.80 / 10.05:9.80
8.10: BOZR
8.30: BOZD
8:50 intermediate zone radius
8:80: intermediate zone diameter
10:05: peripheral zone radius
9:80: total diameter
* Record just BOZR/TD/BVP (over-refraction)

Question 3

Near add script:

Answer 3

This test will check your near vision, I’ll need you to read and hold somethings, cool?
I’m adding your reading Rx to the phoropter and trial frame
Hold this card at your habitual distance
- I’ll measure it
Do you have other working needs closer/farther
- I’ll measure that
Placing the fused cross at your habitual distance, dimming lights, and using your distance Rx
- Using your reading PD’s, 0.5 setting, and relaxing your accommodation by 2D
Which set of lines looks clearer vertical or horizontal
- Vertical, I’ll decrease ADD until its horizontal
Using this tentative ADD in a trial frame, and brightening lights
- Hold reading card and focus on lowest line
- I’ll use -0.25 flippers, tell me if it feels better, worse, or the same
- Keeping the minus until reversal
Is this clear for your habitual and closer
- 2 lines above, clear for computer
I’ll note this as your final ADD

Question 3

Parameter changing for poor fit:

Answer 3

BOZR: Alignment/Too steep if center NaFl visible
BOZD: Pupil coverage
TD: Lens motion, not tucked under lid
Peripheral (BPR): Too flat if edge wide

Question 4

RGP parameter altering:

Answer 4

BOZD ^0.5mm: BOZR flatten by 0.05mm
- Flattening BOZR: 7.80 > 7.90
- BOZD ^0.5mm = TD ^0.5mm
BOZR flatten by 0.05: -0.25D change in tear lens
- BVP changes opposite to tear lens

Question 5

Normal BV values:

Answer 5

• Blur/Break/Recovery (+/-)
  BI: 12(5)/20(7)/12(5)
  BO: 15(6)/22(8)/13(5)
  BD: -/6(3)/3(3)
  BU: -/6(3)/3(3)
  AC/A: 3(2)

Question 5

BV script:

Answer 5

This test will check how your eyes work together, you’ll have to focus on targets and I may touch your face, cool?
First I’ll shine a light at your eyes and cover them, just looking at the light please
- tell me if you notice any pain
- Shining light from inferior around 8 gazes
- alternating cover
- Noting exo/eso at gaze and intensity
Next were looking at how your eyes relax
Using your near Rx in a trial frame
hold the howell card at half its length from you
- holding 6 BD prism lens over RE
Im doubling your vision, tell me where the top arrow points to and what colour
- Same again with 1 or 2 flippers to calculate AC/A
- Blue is exo
Next we’re checking how your eyes move together
hold this reading card/ruler and focus one line above threshold
- Ill change lens power in one eye tell me when it double and then when it blurs
- Repeating 4 times for each direction of doubling

Question 6

Muscle groups based on Px gaze:

Answer 6

Up-left: RIO, LSR
Left: RMR, LLR
Down-left: RSO, LIR
Down-right: RIR, LSO
Right: RLR, LMR
Up-right: RSR, LIO