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Refracting Skills > Unit 2/3 > Flashcards

Unit 2/3 Flashcards

1
Q

Most common working distance for Ret

A

Arms length (2/3m or 66.7cm)

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2
Q

Three movements with retinoscope

A

-Against movement (minus lenses are added)
-With movement (plus lenses are added)
-The whole pupil glows (neutralised)

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3
Q

When you are working at 66cm what WD power would you add?

A

+1.50

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4
Q

When you are working at 50cm what WD would you add?

A

+2.00

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5
Q

3 phases of retinscope

A
  1. Initial lens selection
  2. Identification of the principal meridians
    3.Neutralisation of the refractive error along the two principal meridians
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6
Q

what does BVS stand for?

A

Best vision sphere

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7
Q

When neutraising the meridians

A
  1. Neutralise the more positive “MOST WITH” (or least negative/least against) meridian first
    -Use 0.50D intervals until the first meridian is neutralised
  2. Neutralise the remaining AGAINST movement with a concave cylinder lens - lines orientated in the directin of this meridian
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8
Q

Purpose of doing needs assesment

A
  1. Figure out why the px has come to office
  2. Develop a database of info (ocular and health)
  3. Develop rapport (relationship)
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9
Q

FOLDAARS

A

F- Frequency
O- Onset
L- Location
D- Description
A- Associated symptoms
A- Aggravating factors
R- Relief
S- Severity

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10
Q

What type of questions should you avoid with pxs?

A

Leading questions
ex. “Your eyes dont get fatigued , do they?”

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11
Q

When to inform patient expectations

A

Cataracts
Cataract surgery
Macular degeneration
Retinal disease
Corneal disease
Amblyopia
High rx errors

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12
Q

Manangment of px expectations can be broken down into 5 steps

A
  1. Communication
  2. Fidelity / Honesty
  3. Broker (negotiate)
  4. Consensus
  5. Documentation
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13
Q

Communication - px expectations

A

-Really listen to what patients are stating
-Listening to what the px wants is crucial, this is the foundation for making any other treatment recomendations

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14
Q

Fidelity - px expec

A

-pxs eyes may be limiting factors for their visual aspirations
-time should be spent explaining why a procedure or lens is not a good idea so that the px can fully appreciate their own reality

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15
Q

Broker - px exp

A

-Negotiate refractive distances and lens options to best accomodate pxs needs
-Pxs need to know where they gain and where they give up something

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16
Q

Consensus - px exp

A

Agreement about how to proceed
Explain the course of action to pxs and then have them repeat back in their own words

17
Q

Documentation - px exp

A

-brochures that lightlight risks and benefits should be the last thing pxs have in hand when they leave office

18
Q

when to refer (RX..)

A

When there is a large change in RX
-exceeding +/- 1.00 in the last 6 months
-exceeding
+/- 2.00 since the most recent RX

19
Q

When to refer (other parameteres)

A

Large changes in keratometry, IOP, VA and visiual field

20
Q

When to refer (va)

A

-best corrected visual acuituy will be less than 20/25 in either eye
-Not satisfied with the best corrected vision after 2 independed refraction have been conducted

21
Q

Would you refer a px if their best corrected visual acuity is OD: 20/30 and OS: 20/40 after your refraction?

A

Yes, it is less than 20/25

22
Q

Two types of dominance tests

A

Sighting dominance
Sensory dominance

23
Q

What is sighting dominance

A

Hole in the card, or hands form a triangle
-Test is carried out with the px fully corrected for distance

24
Q

Monovision eye dominancy

A

‘Near point add’ is provided in the non-dominant eye

25
Q

What is sensory dominance

A

“Fog method”
-Test is carried out with the px fully corrected for distance
-Px is asking to observe a distance target binoculary
-A +2.00 DS trial lens is held in front of each eye in turn
-Whatever eye the is more blurry with a +2.00 is your dominant eye

26
Q

Can you predict a reading add based on age?

A

Yes you can - age is relevant to presbyopia

27
Q

Can we predict changes in RX

A

Yes we can predict the amount of RX change by drop in VA
-ex. Degradatiom of 1 line of vision corresponds to approximately -0.25 but also depends on pupil size and blur tolerance

28
Q

If VA drops 4 lines how much RX change is there ?

A

-1.00 because each line is considered -0.25

29
Q

Objective refraction

A

Does not requrie pxs co-operation, will not need feedback from px

30
Q

When is objective refraction appropriate

A

-Noticeably significant VA change
-Language/verbal barriers
-Pediatrics

31
Q

Prescription benchmarking

A

More appropriate for cases where
-Minimal rx change is expected
-Benchmark vision is 20/20

32
Q

Would you refer if you find a shift of -1.50D when comparing pxs RX from 6 months ago?

A

Yes you would refer because it is exceeding +/- 1

Refracting Skills (7 decks)

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