The College of Optometrists

Hey jus a few q's

1) What theory did people actually revise i.e. parrot fashion notes for the 1st assessment?

2)In Motility do you do it with the trial frame on or with px's own spex or with nothing at all?

3) Would you do aided ct with current spex or do it with what you found at the end of the test i.e. with the 'new' Rx in the trial frame? Even if the Rx is not going to change that much from their current spex? iSN'T IT BETTER WITH THEIR CURRENT SPEX COS YOU CAN SEE MORE OF THE EYE?

4) When would you do Maddox Rod? Can you do it instead of the distance mallett unit? Why is it if there is no F.D on mallet unit there is always like triple with the Maddox Rod?

5) Is there anything pathological about a vertically oval disc?

6)Is the NRR where the vessels 'kink' out of the disc? It is always difficult to tell the ISNT rule..any tips?

7) In the exam do we make the patient px look in all directions when examining the vitreous too?

8) Does toxoplasmosis flare up later in life if the px contracted it when she was in the mothers womb?

9) im stressing any prescription pads available?

thanks!

Hi snaik

1) dunno - but it won't make any sense until you can work your study into your testing - make it come alive and meaningful

2) go to http://www.mrcophth.com/chua1.html for video's on motility. You do motility with nothing at all - you can use a pentorch. Watch for head tilting in vertical muscle problems.

3) Ct is done without spex on, with old spex - and new if you think it will show anything extra. I agree -you need to see the px eyes.

4) I would not personally use a maddox rod - but you could use it instead of a Mallett unit. A Rod would be handy if their vision was so poor they could not see the markers of the Mallett. Mallett unit finds fixation disparity - which is thought to be a measure of binocular stress. A Maddox Rod measures unassociated phorias - which is the resting posture of the eyes.

5) Nothing pathological in the disk shape -

A vertically oval cup - raises the risk of glaucoma - especially if its large cup. (note a rim width less than 10% of the disk diameter at that meridian is thought to increase risk.

6) for a good primer on disks look at the videos here: http://www.esg-egypt.org/Videos.html

Its the rim area and the cup shape which makes for glaucoma risks.

The best way to examine the optic disk is to use a volk 90 or 70 and a slitlamp. Use a 1mm round slit (use the slit aperture ring to find the 1mm hole). Px looks at your right ear for right eye and you will see the disk. Shape your slit to a little slit and measure the vertical height in terms of slit lengths.

Then measure the cup with the slit - same way. Then increase the light to high (if you keep it in the disk - the blind spot -it won't constrict the pupil) and change to round again and examine the disk margin all round. Use red free filter and examine the rim - checking for notching; pallor (grey in a green light); rim atrophy - a healthy rim is a pink hazy color as the neurones it hazy. In atrophy there is no haze - the rim is clear and pale.

Check for ppa - a healthy disk will not have a zone B ppa in most cases, but a zone A is fairly common.

Now draw it out and convert it to mm. you can email me for a scale to measure the disk. stevenmenyell@aol.com

If you don't use a Volk for disks - then use the macula stop on the direct - you can't examine a disk properly if the light is bigger that the disk - I think.

7) Yes - all around - it does not take a second and their eye movements will make the vitreous swirl to make it easier to see.

Practice practice - its not a big deal or takes too long.

8) Toxoplasmosis can flare up if the immune system is depressed as in pregnancy, AIDS, liver disease etc. THe immune system walls it in and then stops any activity.

9) Dunno - but I expect so.

- steve

I am not sure how much you want on disk analysis -but as I said the best way is to use a strong light using a one mm round aperture. Keep the light within the disk and on many people the pupil will dilate enough to get a bino view.

Healthy neural tissue on the disk is pink and translucent with vessels underneeth looking hazy.

Any rim die back from glaucoma makes the rim at that point clear so vessels underneeth are sharply defined. The rim looks clear (like water) without the haze of healthy neurons.

Double check it with a red free filter.

This is also true for the retinal nerve fibre layer - and it is best examined with a small round light going a bit at a time starting at the disk edge. Healthy tissue is pink, shiny and translucent. Unhealthy tissue is clear so you see the features underneeth, dark and patchy.

Check the peri peripheral atrophy and know the difference between zone alpha and beta (alpha is outer and often dark (from underlying RP) beta is near the disk and is often pathological - it is pale (from unhealthy neurons) and spreads from the disk edge at the points of rim damage. Zone beta is also in myopia and sometimes in age related atrophy. But, a partial zone beta near a rim change is pathogenic of glaucoma.

Again a small bright light is far better than a long dim slit -as it allows the pupil to open up, is less stressing for the px and gives you a great view.

If you practice this simple technique - disk analysis will be upto date and a breeze.

Remember, if you don't measure the disk and cup etc - then you are back to only guessing.

I hope that gives you some ideas to try

-steve