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Edit Comment Close Premium member Presentation Transcript Ocular examination procedure &Office Instrumentation : Ocular examination procedure &Office Instrumentation Section Objectives : Section Objectives Recognize and describe the purpose of ophthalmic instruments commonly found in the office of an eye care practitioner Describes the clinical procedure of contact lens fitting Contact Lens Fitting &Office Instrumentation : Contact Lens Fitting &Office Instrumentation The eye care professional utilize a variety of instruments to assess visual acuity and ocular health The goal of fitting contact lens is to satisfy patient’s needs on visual, cosmetic & health requirement. In-Office Instrumentation : In-Office Instrumentation Discussion of instruments are grouped in four categories: Basic eye exam Contact lens exam Evaluating spectacles and contact lenses Ophthalmic research Eye examination & CL Fitting Procedure : Basic Eye Exam History taking Refraction Slit Lamp Examination Ophthalmoscopy Contact Lens Exam Keratometry Trial Fitting Over-refraction Lens Delivery Education on contact lens wear Aftercare visit Eye examination & CL Fitting Procedure Basic Eye Exam : Basic Eye Exam History taking Visual acuity measurement with Snellen Chart Objective refraction with Autorefractor / Retinoscope Subjective refraction with Phoropter or Trial Frame External eye examination with Slit Lamp Internal eye examination with Opthalmoscope History Taking : Reason for contact lens Understands patient expectation & motivation Contact lens history General health condition Ocular health condition Any medication taken Occupational, recreational, environmental factors History Taking Clinician’s Abbreviations : Clinician’s Abbreviations In US: O.D. (ocular dextrus): viewing with right eye only O.S. (oculus sinister): viewing with left eye only O.U. (oculus uterque): viewing with both eyes In UK: it is just known as plain R.E. (Right Eye): viewing with right eye only L.E. (Left Eye): viewing with left eye only BVA (Binocular): viewing with both eyes Visual Acuity: Snellen Chart : Visual Acuity: Snellen Chart Measure of the eye’s ability to detect or resolve detail Measured with Snellen chart by reading letters at specific distance Visual acuity is expressed as a fraction 20/20 (US) or 6/6 (UK) 20/20 means patient can read the 20/20 line on chart at a distance of 20 feet 6/6 means patient can read the 6/6 line at a distance of 6 meters 60 36 24 18 12 9 6 5 4.5 4 3 Objective Refraction: Retinoscope : Objective Refraction: Retinoscope Objective refraction – measures refractive status of the eye independent of patient responses Observes reflection of light from retina using retinoscope Objective Refraction: Autorefractor : Objective Refraction: Autorefractor Evaluates patient’s refractive error by electronically assessing reflection of light from retina Results are estimates and require refinement with phoropter Subjective Refraction: Trial Frame : Subjective Refraction: Trial Frame A variety of trial lenses and other optical devices can be put into trial frame for assessing patient’s vision Provides subjective assessment of patient’s refractive status Subjective Refraction: Phoropter : Subjective Refraction: Phoropter Phoropter contains a variety of lenses and other optical devices for assessing patient’s vision Provides subjective assessment of patient’s refractive status External Eye Examination: Slit Lamp : External Eye Examination: Slit Lamp Slit lamp is a biomicroscope with special lighting system for the observation of structures of the anterior eye Also evaluates fitting of contact lenses on the eye External Eye Examination: Slit Lamp : External Eye Examination: Slit Lamp Internal Eye Examnination: Ophthalmoscope : Internal Eye Examnination: Ophthalmoscope Ophthalmoscope is a special optical device with lighting system for the observation of inside of the eye Evaluates internal structures of the eye Ophthalmoscope : Direct Ophthalmoscopy Ophthalmoscope Examination of the retina : Examination of the retina Direct ophthalmoscopy No pupil dilation Magnified view Cannot examine the periphery of the retina More useful in examination of the macular & Optic nerve head Indirect Ophthalmoscopy Pupil dilation required No / low magnification Give a wider view of the retina (up to Ora Serrata) Provide a stereoscopic (3D) image Use in thorough exam of the retina (retinal degeneration or detachment) Instruments in a CL Exam : Instruments in a CL Exam Central corneal curvature measured with Keratometer Central/ peripheral corneal curvature measured with Autokeratometer Whole corneal curvature measured with Corneal Topography Corneal Curvature: Keratometry : Corneal Curvature: Keratometry An optical device that measures corneal curvature by measuring the image size from reflection of cornea Measures radius of curvature over central three millimeters of cornea Corneal Curvature: Autokeratometer : Corneal Curvature: Autokeratometer Provides option to measure central & peripheral corneal curvature Provides corneal measurement automatically Corneal Topography : Provides information about corneal shape over most corneal surface Orbscan also provides topographic data on corneal thickness Most useful for: refractive surgery corneal problems, e.g. Keratoconus RGP fitting, e.g. Ortho-K Corneal Topography Trial Fit : Discussion on the choices of CL Initial selection for trial fit Hydrogel Disposable PRP Lens RGP Determines on-eye lens performance and allows patients to experience contact lens wear Trial Fit Trial Fit : Select lens parameters according to manufacturer’s recommendation Check lens fitting after 5-15 minutes of initial adaptation Good fitting for soft contact lens: Comfortable Central position & full corneal coverage Adequate movement Accurate & stable orientation for torics Trial Fit Over-refraction : Fine adjustment on final prescription Patient experiences the visual quality of contact lenses Over-refraction Lens Delivery : Education on lens care & lens handling Reassures normal adaptation symptoms e.g. mild redness, dryness, lens awareness Recommend wearing time, build up gradually from 4 hours Recommend replacement schedule, 1 year for traditional SCL, 1 year for RGP, manufacturer’s recommendation for PRD Lens Delivery Slide 27: Patient daily self test: see good look good feel good Whenever experience warning signs, patient should remove lenses and seek for professional opinion Patient Education Aftercare Visit : Critical for continued success of contact lens wear 1st week, 1st month, 3rd month, every 6-month Follow up on Wearing condition Visual acuity Lens fitting Lens condition Lens care condition Eye health condition Aftercare Visit Thank You : Thank You You do not have the permission to view this presentation. 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