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THE ALLIED NETWORKSUCCESS THROUGH COLLABORATION

Inaugural Conference 6th April 2013

Amanda Griffiths BAppSc(Optom)(First Class Honours)Optometrist

Founder www.myhealthcareer.com.au

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PART ONE

What does an optometrist do?

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Eye movements

Pupil reactions

Vision

Posterior segment healthAnterior segment health Intraocular pressure

Initial consultation - an overview

2. – PRELIMINARY CONSULTATION4. – OCULAR HEALTH3. – VISION & FOCUSSING

Focussing

1. – CASE HISTORY

1. Presenting complaint – what problems do they want addressed?

2. Visual tasks/goals – how do they use their eyes?

3. Past ocular history – may impact your management/treatment

4. Family ocular history – may have an increased risk of some eye conditions

5. Medications and allergies – both of which can affect the eyes

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Eye healthRetina

Lens

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Eye health - retinal photos

Normal retinal appearance You guessed it…. not normal….Toxoplasmosis

Optic nerveMacula

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Glasses? Contact lenses?

Referral to ophthalmologist?Referral to GP?

Secondary consultation?

Referral to allied health?

Results of the initial consultation

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PART TWOWho might an optometrist refer to?

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Hyperthyroidism

Eyelids uneven - upper lid retraction

Referral to GP - mainly for blood tests

Diabetes?

Recent onset of blurred distance vision

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Cataract surgery

Referral to an ophthalmologist

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Wet macular degeneration

Referral to an ophthalmologist

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Referral to an allied health practitioner

LOW VISION CLINICS

Social worker

Occupational therapist

Optometrist

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Referral to an allied health practitioner

Arthritis – OT, physio, ex phys

Diabetes – podiatrist, dietitian, ex phys

Stroke – physio, speech pathologist, social worker, psychologist, OT, dietitian

Cerebral palsy – OT, physio, psych, SW

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PART THREEWhy might you refer to an optometrist?

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Approximately 40%of eye diseases are

asymptomatic when the patient

presents for an eye test

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of vision loss is treatable

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Children

Some childhood eye problems are, erm…. very subtle…..

…..and you only have until 8 years of age to get it sorted…..

Headaches during a 3D movie?Didn’t see what all the fuss was about?

More clumsy than your average kid?Hand-eye coordination?

Some eye problems are, erm…. obvious

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Teens and young adults

Frontal headaches?

Blurredvision?

Squinting?

Readingtoo close?

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40 to 45 years of age

I can still read…. I just need to hold it back further……

Presbyopia often presents with denial

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Older adults

THE BIG THREE

Cataracts – surgery required – generally around 75-85 years of age in Brisbane population

Macular degeneration – loss of detailed central vision, two forms called wet and dry, wet is treatable with injections

Glaucoma – due to an increase in the intra-ocular pressure, asymptomatic in the early stages, generally simple to manage with eye drops if diagnosed early, blinding if left untreated, if presenting with noticed vision loss – generally a raging glaucoma

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Any time

Refer ASAP for these symptoms Scary possible causeFlashes of light – like lightening bolts Retinal detachment (RD)

Recent onset of spots in the vision – especially red Retinal detachment

Double vision – seeing two of things – esp recent onset Brain tumour, myasthenia gravis

Blacked out central vision Macular degeneration

Known to cause eye problems What can happenOral/injected steroids (and less commonly inhaled) Glaucoma, cataracts

Parkinson’s Disease Double vision

Marfan’s Syndrome Turned eyes, focus problems, RD

Diabetes and high blood pressure (esp uncontrolled) Retinal blood vessel haemorrhages

Stroke Peripheral vision - driving

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PART FOURAreas of specialization in optometry

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Areas of specialisation in optometry

Behavioural

Therapeutics

Research

With ophthalmologists

Contact lenses

Low vision

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My area of specialization

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PART FIVEMultiple choice questions

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1. A six year old child has a focusing problem in one eye. This could go undetected because:

a. The child never covers one eye to check if each eye has good vision.

b. Their parent doesn’t take them in for an eye test because the child doesn’t complain.

c. The child is labelled ‘uncoordinated’ and no further investigations are done.

d. The child mentions they have a headache at the cinema when watching a 3D movie and the parent puts it down to the lollies!!

e. All of the above.

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2. A person presenting to an optometrist has an eye condition. What are the chances that it is (firstly)

asymptomatic and (secondly) treatable?

a. 30% asymptomatic and 75% treatable.

b. 40% asymptomatic and 30% treatable.

c. 10% asymptomatic and 30% treatable.

d. 40% asymptomatic and 75% treatable.

e. 75% asymptomatic and 40% treatable.

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3. A patient you are treating happens to mention that they have blurred vision. Possible causes could be:

a. Undiagnosed diabetes

b. Cataracts

c. A focusing problem such as shortsightedness, longsightedness or astigmatism.

d. A pituitary tumour

e. All of the above….. plus many more!!