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Ophthalmology
Continuing Education
Continuing Education
ACMSS CONTINUING SCRIBE EDUCATION
© 2016 ACMSS. All Rights Reserved.
The Eye Examination
© 2016 ACMSS. All Rights Reserved.
Basic Steps of the Eye
Examination – UPDATED
Examination – UPDATED
• General physical examination should include:
– Vsual acutiy
– Pupillary reaction
– Extraocular movement
– Direct ophthalmoscope
– Dilated exam (in case of visual loss or retinal pathology)
– Pupillary reaction
– Extraocular movement
– Direct ophthalmoscope
– Dilated exam (in case of visual loss or retinal pathology)
© 2016 ACMSS. All Rights Reserved.
Basic Steps of the Eye
Examination II – UPDATED
Examination II – UPDATED
• General physical examination should include:
• Distance or Near
• Distance visual acuity at age 3
• Distance or Near
• Distance visual acuity at age 3
– early detection of amblyopia
© 2016 ACMSS. All Rights Reserved.
Basic Steps of the Eye
Examination
Examination
• General physical examination should include:
– Vsual acutiy
– Pupillary reaction
– Extraocular movement
– Direct ophthalmoscope
– Dilated exam (in case of visual loss or retinal pathology)
– Pupillary reaction
– Extraocular movement
– Direct ophthalmoscope
– Dilated exam (in case of visual loss or retinal pathology)
• Distance or Near
• Distance visual acuity at age 3
– early detection of amblyopia
© 2016 ACMSS. All Rights Reserved.
What is 20/20 (6/6) vision?
© 2016 ACMSS. All Rights Reserved.
Distance Visual Acuity Testing
• VA – Visual acuity
• OD – Ocular Dexter (right eye)
• OS – Ocular Sinister (left eye)
• OU – Oculus Uterque (both eyes)
• OD – Ocular Dexter (right eye)
• OS – Ocular Sinister (left eye)
• OU – Oculus Uterque (both eyes)
• Reporting Visual Acuity (e.g. 20/20)
– Distance between the patient and the eye chart
– Distance at which the letter can be read by a person with normal acuity
© 2016 ACMSS. All Rights Reserved.
Distance Visual Acuity (VA) Testing
• Place patient at 20 ft from the Snellen chart
• OD then OS (right then left eye)
• VA is line in which > 1/2 letters are read
• Pinhole if < 20/20
• OD then OS (right then left eye)
• VA is line in which > 1/2 letters are read
• Pinhole if < 20/20
© 2016 ACMSS. All Rights Reserved.
Near Visual Acuity Testing
• Indicated when
– Patient complains about near vision
– Distance testing difficult/impossible
– Distance testing difficult/impossible
© 2016 ACMSS. All Rights Reserved.
Pupillary Examination
• Direct penlight into eye wile patient looking at something in the distance
• Terms
– Direct: Constriction of the ipsilateral (same side) eye
– Consensual: Constriction of the contralateral (opposite side) eye
– Consensual: Constriction of the contralateral (opposite side) eye
© 2016 ACMSS. All Rights Reserved.
Direct Ophthalmoscopy
• Tropicamide or phenylephrine for dilation
– unless shallow anterior chamber
– unless under neurological evaluation
– unless under neurological evaluation
• Use your own OD to examine OD
– Same for OS
© 2016 ACMSS. All Rights Reserved.
Intraocular Pressure Measurement:
Important for Cataract Diagnosis
Important for Cataract Diagnosis
• Normal Range: 10 – 22 mmHg
© 2016 ACMSS. All Rights Reserved.
Summary of Steps in Eye Exam
• Visual Acuity
• Pupillary examination
• Visual fields by confrontation
• Extraocular movements
• Inspection of
• Pupillary examination
• Visual fields by confrontation
• Extraocular movements
• Inspection of
– Lid and surrounding tissue
– Conjunctiva and sclera
– Cornea and iris
– Conjunctiva and sclera
– Cornea and iris
• Tonometry
• Fundus examination
• Fundus examination
– Disc
– Macula
– Vessels
– Macula
– Vessels
© 2016 ACMSS. All Rights Reserved.
Chronic Vision Loss
© 2016 ACMSS. All Rights Reserved.
Basics of Chronic Vision Loss
• 1994: 38 million blind people (age > 60 years) worldwide
• 1997: Leading causes of blindness in people over 50 years of age in the West:
• 1997: Leading causes of blindness in people over 50 years of age in the West:
1) Macular Degeneration
2) Cataract
3) Glaucoma
4) Diabetic Retinopathy
2) Cataract
3) Glaucoma
4) Diabetic Retinopathy
© 2016 ACMSS. All Rights Reserved.
Glaucoma — Updated
• Treatment Options:
– Medical:
– Drops to decrease aqueous secretion or increase aqueous outflow
– Systemic medications (PO or IV) – useful in small percentage of population
– Systemic medications (PO or IV) – useful in small percentage of population
– Laser:
– Iridotomy – for narrow angle
– Trabeculoplasty – for open angle
– Trabeculoplasty – for open angle
– Surgical:
– Filtration Surgery (e.g. Trabeculectomy)
– Tube shunt
– Microinvasive glaucoma surgery (MIGS)
– Value? surgery
– Tube shunt
– Microinvasive glaucoma surgery (MIGS)
– Value? surgery
© 2016 ACMSS. All Rights Reserved.
Glaucoma
• Treatment Options:
– Medical:
– Drops to decrease aqueous secretion or increase aqueous outflow
– Systemic medications (PO or IV)
– Systemic medications (PO or IV)
– Laser:
– Iridotomy
– Iridoplasty
– Trabeculoplasty
– Iridoplasty
– Trabeculoplasty
– Surgical:
– Filtration Surgery (e.g. Trabeculectomy)
– Tube shunt
– Tube shunt
© 2016 ACMSS. All Rights Reserved.