Case 1

Question 1

How do you properly control accommodation in ret?

Answer 1

make sure you blur the eye that you are not testing to the point you see an against movement, don’t just assume a WD lens is enough

Question 2

In case 1, how do we know the patient is myopic?

Answer 2

-they have reduced uncorrected DV
-young do should have good accommodation
-they have normal near vision

Question 3

In case 1, what is the most important information in the Hx?

Answer 3

-the RFV is reduced DV
-c/o of red eyes
-uses computer alot but has no issues
-is learning to drive soon

Question 4

in case 1, why is FH age-related ocular disease less relevant

Answer 4

as it depends on the disease

Question 5

in case 1, what are the unclear aspects about the Hx?

Answer 5

-dont know if the Px wore an eyepatch as a child - POH
-dont know if they ever used to wear glasses - POH
-wether they smoke as in wales if the patient is over 16 you have to ask
-if the red eye is actually due to swimming and not anything else

Question 6

why learn barrett’s method of ret?

Answer 6

-allows ret to be done in shorter rooms
-makes it easier to be done if the examiner is amblyopic

Question 7

what is one of the rare cases that monocular ret is used?

Answer 7

when the patient has a large angle strabismus

Question 8

what are the advantages of binocular refraction?

Answer 8

-accommodation is balanced so relaxed until subjective refraction
-it is quicker than monocular refraction
-don’t need to occlude so no latent nystagmus gets induced
-requires patients to make less decisions which patients appreciate

Question 9

what are the disadvantages of binocular refraction?

Answer 9

-it is difficult in patients with a highly dominant eye
-your starting point needs to be close to the final Rx

Question 10

who is binocular refraction good for?

Answer 10

patients with active accommodation

Question 11

who is binocular refraction not good for?

Answer 11

-patients without active accommodation (so >60s and pseudophakes)
-patients without binocular vision

Question 12

what should you be careful of when doing binocular refraction?

Answer 12

strong eye dominance

Question 13

what methods of binocular refraction are used?

Answer 13

-monocular fogging (method of choice)
-polaroid refraction procedure
-turville infinity balance

Question 14

what is the legal requirement for a Px to have after a sight test, which act are these specified in?

Answer 14

-confirm completion of sight test
-whether a referral to medical practitioner has been made and why if applicable
-patient’s spectacle prescription

Opticians Act 1989

Question 15

What should be included in the patient management plan?

Answer 15

-whether the patient is being referred to a different healthcare practitioner
-self management resources
-targeted health/ behaviour messages
-social prescribing referral if necessary
-minimum interval to next examination

Question 16

what could the differential diagnoses be to the fact the patient’s eyes were watering. red and sore after he said he went swimming?

Answer 16

-conjunctivitis (bacterial/ viral)
-acute allergy
-blepharitis
-dry eye
-sub tarsal foreign body
-uveitis
-trauma
-episcleritis
-MK
-HSK