Visit 2 notes
1.1.1: Obtains relevant history and information relating to general health, medication,
family history, work, lifestyle and personal requirements
DO + PR x 2
Full history taken, open and closed questions
For ocular surgery ask: which eye, when, how often etc.
For specific visual requirements for job/hobby: ask what for, what they need etc.
1.1.2 Elicits the detail and relevance of any significant symptoms
RP + PR
Hypermetropic myopic, astigmatic or presbyopic patient presenting with headache
Location: frontal/temporal/back of head
Onset: recent/longstanding
Frequency: how often
Type: dull, sharp
Self treatment: pain killers, sleep etc
Effect: on life
Associations: triggers or other symptoms
Main considerations:
Is this a visual problem? Uncorrected refractive error or change in rx, tends to be after visual
tasks
BV instability or decompensation?
Ocular pathology: swollen discs, may be associated with sickness etc.
Incorrect rx
Ill-fitting glasses
Migraines: tend to be unilateral and gradual onset over a few minutes, may have a trigger,
nausea, aura, missing VF
Tension HA: bilateral and frontal, dull ache
GCA: HA with tender scalp and jaw pain
Intracranial hypertension: dull HA, worse in AM, worse when coughing and moving
1.2.4 Explains to the patient the implications of their pathological or physiological eye
condition.
DO + RP
Gives factually relevant information in a clear and understandable way, avoiding jargon
and technical terms.
Uses appropriate supporting material, for example, diagrams or leaflets, and uses a range
of different explanations where required to avoid repetition.
Understands limitations of knowledge, referring the patient for advice where necessary
,For example if a px is referred by GP for headaches, but we see no ocular cause, they should
return to GP for further investigations
Keep things simple and give leaflets.
Myopia: myopia is also known as short sightedness, meaning we can see clearer up close
than far away, this occurs because the eye is longer than usual and the image is focused
Infront of the retina. It is treated with glasses.
Hyperopia: hyperopia is also known as long sightedness. Meaning we can see clearer in the
distance than we can up close, this occurs because the eye is too short so the image is
focused behind the retina. It is treated with glasses.
Astigmatism: astigmatism occurs due to the front surface of the eye called the cornea, or
the lens being an uneven shape, this means that instead of the light rays focusing at one
point they focus at 2 points instead. It is treated with glasses.
Cataract: cataracts are formed when the clear lens in your eye starts to become cloudy, it is
a gradual process and usually occurs as we get older. It may not greatly affect vision in the
earlier stages. The treatment or cataract is cataract surgery, if you get to a stage where your
vision is affecting your daily life, we can refer you to hospital for the surgery, it is usually
carried out at a day clinic under local anesthetic. Smoking and sunlight have been linked to
earlier formation of cataracts, so its recommended to use UV protection and stop smoking.
AMD: macular degeneration is a group of conditions that effects the macula, which is an
area at the back of the eye that is used for seeing fine details. There are 2 types: dry and
wet. The dry type is slowly progressing and occurs when deposits build up behind the
macula. The wet type occurs from abnormal blood vessels growing and leaking fluid behind
the eye, the wet type is associated with fast vision loss and straight lines may appear wavy
or you may notice a blank spot in your vision. There is no medical treatment for dry AMD,
but it can be linked to smoking, sunlight exposure and a poor diet. So it is recommended
that you use UV protection, stop smoking and incorporate leafy green vegetables into your
diet, there are also supplements that contain a formula which has been researched to slow
progression to more advanced types of AMD, for example macushield. If you have wet AMD,
you will be referred to the hospital eye service, a drug will be injected into the jelly like
substance in your eye which stops the growth of the abnormal vessels which are causing the
bleeding.
DR: diabetic retinopathy is a complication of diabetes where small blood vessels at the back
of the eye leak blood and fluid due to uncontrolled blood sugar levels. It usually doesn’t
show any symptoms or have an effect on vision in the early stages so it is important to keep
up to date with DRS and eye checks. If you have diabetic retinopathy, there is a laser
treatment which helps to stop the bleeds and fluid.
,Blepharitis: blepharitis is an inflammation of your eyelids, which causes crusting at the
eyelashes and can cause your eyes to feel itchy and irritated. It is a chronic condition that
needs to be well managed. We treat this by doing lid hygiene: warm compress, cleaning lids.
Dry eye: dry eye is a condition that causes changes to the tear film, your eyes may feel gritty
and irritated. It is a chronic condition that needs to be managed long term. We can give eye
lubricants to help with the symptoms.
2.1.1 Adheres to health and safety policies in the practice including the ability to
implement appropriate measures for infection control.
DO + Q
Proper disposal of eye drops and NaFl
Cleaning hands, trial frame and slit lamp
Tripping on slippery surface on rainy days – wet hazard sign should be put up
Good lighting at the repair/adjustment bay so staff can see properly. New staff should be
trained on how to use screwdrivers
Good lighting and illumination in the test room when a patient enters so that they can see
where they are going.
Know where the fire exits are, the fire escape routes and assembly area, where the
practice’s fire extinguishers are. Fire exits should not be obstructed and should be always
shut.
The Practice should ensure that fire alarms, smoke detectors, fire-fighting equipment,
emergency lighting be maintained and tested regularly.
Deliveries should be unpacked and stored away from the shop floor, and not obstruct
stairways or exits. These can be hazardous.
Know where the first-aid kit is, and who your first aiders are.
Reusable tonometry probes should be properly disinfected.
2.1.3 Shows respect for all patients.
DO + RA
In all cases the trainee should:
• involve patients in their decisions and advice e.g. if someone does not wish to be referred
for their cataracts as has no issues with it.
• gain consent VCG - for using their record for your assessments or for referral, use of
dilating agents
• ensure the patient is comfortable – on chinrest during SLE, inform patient that you will
dim the lights during retinoscopy etc.
• show interest, courtesy and respect
• be aware of how the patient is reacting to them
• show respect for the patient’s personal space
, 3.1.2 Uses a slit lamp to examine the external eye and related structures.
DO + PR
Px where van Herrick grade 3 or less
Starts from external to internal. Low magnification to high magnification.
Upper and lower eyelids -> eyelashes -> bulbar & tarsal conjunctiva -> limbus -> cornea ->
van herick -> iris -> lens -> vitreous -> volk (optic disc – nasal retina – macula – temporal
retina – superior right and superior left, inferior right and inferior left)
Reasons for VH grade 3 or less:
Cataracts: as it becomes more dense the iris pushes forward, narrowing the angle,
may cause Phacomorphic glaucoma
Plateau iris: abnormality that means iris is inserted anteriorly, narrowing the angle.
Hyperopes are more likely to have narrow angles
Ethnicity: Asian or African descent likely to have narrow angles.
Stress can induce an attack of CAG
Medications like anticholinergics
Pupil block
Angle closure glaucoma
Why check angles?
Before dilation to ensure angles won’t close.
3.1.3 Examines the fundi using both direct and indirect techniques.
DO + 2 X PR
px where direct has been indicated: wheelchair, cant reach slit lamp
px where indirect has been indicated
detects significant lesions: location and size, if seen previously is it the same?
For direct image is the right way up
Volk is laterally inverted
3.1.7 Assesses the tear film.
DO + PR
Patient where a tear film assessment is indicated and has been carried out; DRY EYE
SYMPTOMS
Non-invasive tear break up time (NITBUT) – the use of keratometer, tear scope,
pachymetry, count how long it takes for the regularity of the mires to distort or break up.
Minimal lighting, less likely to induce reflex tearing
Only assess 3mm of central cornea
Large variability between different instruments, hence the method used to assess
quality of tear film (TF) should be recorded to reduce this error
1.1.1: Obtains relevant history and information relating to general health, medication,
family history, work, lifestyle and personal requirements
DO + PR x 2
Full history taken, open and closed questions
For ocular surgery ask: which eye, when, how often etc.
For specific visual requirements for job/hobby: ask what for, what they need etc.
1.1.2 Elicits the detail and relevance of any significant symptoms
RP + PR
Hypermetropic myopic, astigmatic or presbyopic patient presenting with headache
Location: frontal/temporal/back of head
Onset: recent/longstanding
Frequency: how often
Type: dull, sharp
Self treatment: pain killers, sleep etc
Effect: on life
Associations: triggers or other symptoms
Main considerations:
Is this a visual problem? Uncorrected refractive error or change in rx, tends to be after visual
tasks
BV instability or decompensation?
Ocular pathology: swollen discs, may be associated with sickness etc.
Incorrect rx
Ill-fitting glasses
Migraines: tend to be unilateral and gradual onset over a few minutes, may have a trigger,
nausea, aura, missing VF
Tension HA: bilateral and frontal, dull ache
GCA: HA with tender scalp and jaw pain
Intracranial hypertension: dull HA, worse in AM, worse when coughing and moving
1.2.4 Explains to the patient the implications of their pathological or physiological eye
condition.
DO + RP
Gives factually relevant information in a clear and understandable way, avoiding jargon
and technical terms.
Uses appropriate supporting material, for example, diagrams or leaflets, and uses a range
of different explanations where required to avoid repetition.
Understands limitations of knowledge, referring the patient for advice where necessary
,For example if a px is referred by GP for headaches, but we see no ocular cause, they should
return to GP for further investigations
Keep things simple and give leaflets.
Myopia: myopia is also known as short sightedness, meaning we can see clearer up close
than far away, this occurs because the eye is longer than usual and the image is focused
Infront of the retina. It is treated with glasses.
Hyperopia: hyperopia is also known as long sightedness. Meaning we can see clearer in the
distance than we can up close, this occurs because the eye is too short so the image is
focused behind the retina. It is treated with glasses.
Astigmatism: astigmatism occurs due to the front surface of the eye called the cornea, or
the lens being an uneven shape, this means that instead of the light rays focusing at one
point they focus at 2 points instead. It is treated with glasses.
Cataract: cataracts are formed when the clear lens in your eye starts to become cloudy, it is
a gradual process and usually occurs as we get older. It may not greatly affect vision in the
earlier stages. The treatment or cataract is cataract surgery, if you get to a stage where your
vision is affecting your daily life, we can refer you to hospital for the surgery, it is usually
carried out at a day clinic under local anesthetic. Smoking and sunlight have been linked to
earlier formation of cataracts, so its recommended to use UV protection and stop smoking.
AMD: macular degeneration is a group of conditions that effects the macula, which is an
area at the back of the eye that is used for seeing fine details. There are 2 types: dry and
wet. The dry type is slowly progressing and occurs when deposits build up behind the
macula. The wet type occurs from abnormal blood vessels growing and leaking fluid behind
the eye, the wet type is associated with fast vision loss and straight lines may appear wavy
or you may notice a blank spot in your vision. There is no medical treatment for dry AMD,
but it can be linked to smoking, sunlight exposure and a poor diet. So it is recommended
that you use UV protection, stop smoking and incorporate leafy green vegetables into your
diet, there are also supplements that contain a formula which has been researched to slow
progression to more advanced types of AMD, for example macushield. If you have wet AMD,
you will be referred to the hospital eye service, a drug will be injected into the jelly like
substance in your eye which stops the growth of the abnormal vessels which are causing the
bleeding.
DR: diabetic retinopathy is a complication of diabetes where small blood vessels at the back
of the eye leak blood and fluid due to uncontrolled blood sugar levels. It usually doesn’t
show any symptoms or have an effect on vision in the early stages so it is important to keep
up to date with DRS and eye checks. If you have diabetic retinopathy, there is a laser
treatment which helps to stop the bleeds and fluid.
,Blepharitis: blepharitis is an inflammation of your eyelids, which causes crusting at the
eyelashes and can cause your eyes to feel itchy and irritated. It is a chronic condition that
needs to be well managed. We treat this by doing lid hygiene: warm compress, cleaning lids.
Dry eye: dry eye is a condition that causes changes to the tear film, your eyes may feel gritty
and irritated. It is a chronic condition that needs to be managed long term. We can give eye
lubricants to help with the symptoms.
2.1.1 Adheres to health and safety policies in the practice including the ability to
implement appropriate measures for infection control.
DO + Q
Proper disposal of eye drops and NaFl
Cleaning hands, trial frame and slit lamp
Tripping on slippery surface on rainy days – wet hazard sign should be put up
Good lighting at the repair/adjustment bay so staff can see properly. New staff should be
trained on how to use screwdrivers
Good lighting and illumination in the test room when a patient enters so that they can see
where they are going.
Know where the fire exits are, the fire escape routes and assembly area, where the
practice’s fire extinguishers are. Fire exits should not be obstructed and should be always
shut.
The Practice should ensure that fire alarms, smoke detectors, fire-fighting equipment,
emergency lighting be maintained and tested regularly.
Deliveries should be unpacked and stored away from the shop floor, and not obstruct
stairways or exits. These can be hazardous.
Know where the first-aid kit is, and who your first aiders are.
Reusable tonometry probes should be properly disinfected.
2.1.3 Shows respect for all patients.
DO + RA
In all cases the trainee should:
• involve patients in their decisions and advice e.g. if someone does not wish to be referred
for their cataracts as has no issues with it.
• gain consent VCG - for using their record for your assessments or for referral, use of
dilating agents
• ensure the patient is comfortable – on chinrest during SLE, inform patient that you will
dim the lights during retinoscopy etc.
• show interest, courtesy and respect
• be aware of how the patient is reacting to them
• show respect for the patient’s personal space
, 3.1.2 Uses a slit lamp to examine the external eye and related structures.
DO + PR
Px where van Herrick grade 3 or less
Starts from external to internal. Low magnification to high magnification.
Upper and lower eyelids -> eyelashes -> bulbar & tarsal conjunctiva -> limbus -> cornea ->
van herick -> iris -> lens -> vitreous -> volk (optic disc – nasal retina – macula – temporal
retina – superior right and superior left, inferior right and inferior left)
Reasons for VH grade 3 or less:
Cataracts: as it becomes more dense the iris pushes forward, narrowing the angle,
may cause Phacomorphic glaucoma
Plateau iris: abnormality that means iris is inserted anteriorly, narrowing the angle.
Hyperopes are more likely to have narrow angles
Ethnicity: Asian or African descent likely to have narrow angles.
Stress can induce an attack of CAG
Medications like anticholinergics
Pupil block
Angle closure glaucoma
Why check angles?
Before dilation to ensure angles won’t close.
3.1.3 Examines the fundi using both direct and indirect techniques.
DO + 2 X PR
px where direct has been indicated: wheelchair, cant reach slit lamp
px where indirect has been indicated
detects significant lesions: location and size, if seen previously is it the same?
For direct image is the right way up
Volk is laterally inverted
3.1.7 Assesses the tear film.
DO + PR
Patient where a tear film assessment is indicated and has been carried out; DRY EYE
SYMPTOMS
Non-invasive tear break up time (NITBUT) – the use of keratometer, tear scope,
pachymetry, count how long it takes for the regularity of the mires to distort or break up.
Minimal lighting, less likely to induce reflex tearing
Only assess 3mm of central cornea
Large variability between different instruments, hence the method used to assess
quality of tear film (TF) should be recorded to reduce this error
