The College of Optometrists

Hi,I have a few questions,any response would be extremely appreciated.

By what mechanism does diabetes cause III and VI nerve palsies? :-S

In pxs with reduced AoA and slow accomodation,what is the advisable treatment? Is it to practice focusing on a stimulating target as it is brought closer to the face?

Also, I recently had a px suffering from a condition called 'Lupus' which she told me 'affects all the organs in the body' and 'the body's immune system attacks itself'. I've never heard of this disease and was wondering if it has any effect on the eyes? The px had no visual probs and the eyes were healthy, but she had only recently been diagnosed with the disease. Thanx!!

1) palsies are due to diabetic neuropathy which is caused by damage to the micro vascular supply to the nerve.

2)Slow AoA - depending on age and we are not discussing presbyopia here.

Most optoms would offer reading glasses, I think. Some cases subside spontaneously. I not heard of any particular exercises that exercise accomodation.

Lupus is an auto immune disease where the immune system attacks and can damage organs of the body. It can cause episcleritis and iris as well as uveitis. The biggest ocular problem can be dry eye. It can cause skin rashes, hair loss, sensitivity to the cold, pleuracy etc. It is controlled by immune supressing medicines as and when the symptoms flare up. It can be progressive.

Aren't the muscles in the eye like any other muscle in that, the more they are exercised, the better their performance? I'm not sure if this is a silly question...

no its not silly - but no - the extra ocular muscles are vastly over strong for the job they do - so exercising them would not make a measurable difference.

Don't flipper lenses increase accommodative ability?

Flippers are used to train the accom of the eyes - yup! They also train the efficiency of the bino system at near and are used in orthopics for this.

So yep - maybe I am wrong there and you could design such an exercise for poor accomodation. Mind-you I have never personally heard of these working and I think many optoms would think about offering weak plus glasses which also help. So thats why I discounted suggesting exercises.

Hey -good luck on your exams. Any more thing you want to discuss? steve

Stephen. I asked at the college if I had to perform perimetry during the refraction exam. The answer I got was 'I would not be penalised' As an examiner would you happily accept me writing down perimetry in the additional test section? Any tips for the exams? Thank you.

Perimetry is not compulsory - but I personally think its a useful test abd I would do it. So far, by waving a small target about in perimetry has picked up one brain cancer in a kid, two other brain cancers in adults, many field reductions, typically quadrananopias due to retinal branch oclusions and other vascular problems. So I think to do it is worthwhile. The problem with auto field plotters is that they only do the central 25 degrees - and I have met many people with good central fields and problems with their peripheral fields.

Besides, I would tell the examiner, you need a wide (100 degrees h x 20 v)defined visual field to drive - if you have not checked it - then how do you know they are legal to drive?

So I use a small target with the cover test (after distance ct) for near then move into motility - ending with convergence. Then they look at my shirt top button and to a quick perimetry on each eye.

Takes no time at all.

In the exams you got to show a smooth, logical aproach - so plan ahead before you start. When I first see the px -I plan how to approach the test then, what to do and why. So in an oldie - I will get out the Amsler automatically. Try to alot set times to do various tests - and then move on - if you are getting confused with the cross cyl results (for eg) - drop it and go to the other eye. Thats to stop you spending too much time on one thing -and then winding up with time pressure at the end.

Be well up on the common stuff - diabetes, hypertension, AMD and be able to talk about the conditions and have care plans ready (ie: for amd - daily self testing with amsler and informing px how to handle and monocular distortions). Don't forget your squints - and be prepared for one in yr cover test. Know how to check the muscle palsies and don't forget that a squint op. of years before can change make a funny incom. looking squint as people get old.

Don't give an Rx that can't be dispensed - so don't give vari's to a monocular px and don't give highly anisometropic Rx's - unless you need to and then don't forget the spex will have to be slabbed of.

You've got to show you're safe - so don't forget advice on adapting to the new Rx and safety glasses where appropriate. Go to this site - and ask other preregers their experience: http://theoptom.com/viewforum.php?f=5

In all - try to enjoy it. The questions are not too bad and the px is trying to help.

=hope it helps - any more questions -please ask steve