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Summary Laymans BV/RX/Other conditions

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Summary of 35 pages for the course Optometry OSCE at Aston (for OSCE help)

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Risk of amblyopia

Introduction
Address RFV
Good News
Condition: with the drops that I used to relax the eye muscles and find the true prescription, I'm
finding that _ is long-sighted/ short-sighted/ astigmatism. Do you know what that is? It is when…
can cause eye turn in (eye tries to overfocus to overcome rx and turns in), eyestrain, headaches,
rubbing the eyes, poor vision
Reason: FH (if someone wears glasses), shape of the eye
Management/prognosis: important to wear glasses FT as your child is within what we call as the
critical period where the brain is constantly making connections to help us see and this happens from
birth up until 8 years of age. Any problems within this plastic period such as eye turns, uneven
prescriptions and cataracts can result in a lazy eye that can be permanent for life as the eye will not
be able to receive clear visual information and so falls behind on development becoming weaker.
Am I making sense so far?
But it's good that you have brought him in today because we can reverse this as your child is still
within the critical period so vision can still be improved and we hope that with glasses both eyes will
be able to work together equally and the eyes are able to male connections with the brain and we will
continue to monitor x and see x in ~3 months.

Additional qus:
●​ What will happen if he doesn't wear the glasses?
Connections between the brain and eye won't be able to be made and the brain will learn to ignore
the image from the weaker eye and favour the stronger eye leading to a permanent eye turn and lazy
eye that can impact the child in the future socially and affect their learning.
●​ Will he/she need glasses for the rest of the life?
it's hard to tell as of yet but most of the time the vision improves and as a child's eye is constantly
developing, some children can grow out of a prescription but depends on how high the prescription is
to begin with
●​ What will happen if the glasses don't improve vision?
Now that is not something to be worried about at this point. Most of the time we can use glasses if a
child's vision is reduced to help this normal visual development but sometimes it may not work as well
as we hope which is why we have been monitoring _ for a couple of months. Another option that we
can do which has a high success rate as well is to refer _ routinely to an eye muscle specialist called
an Orthoptist to begin something called patching. Have you heard of that before? It is when the
stronger eye is patched with a sticker for a couple of hours a day in order to force the weaker eye to
work and then the child is monitored to see if there is any improvement




Child first ST, you find a squint, explain to parent why they need glasses and
when to wear them



-​ C: After examining the eyes today, I would like to discuss with you some of
my findings. I can see that your child has a turn in their eye which we call a
squint. For some kids, the turn can stay constant but for others it can come
and go. This can make the eyes become lazy because it is not centred and so

, it won't be able to receive the correct visual information and therefore that eye
will fall behind on development and not be able to see as well.
-​ R: this can happen if there is a big difference between the prescription in each
eye or if there is someone in the family with the condition.
-​ M: The good news is however that your child is within what we call as the
critical period where the brain is constantly making connections to help us see
and this happens from birth up until 8 years of age. Therefore there is still time
to stop the eye with the turn to become permanently lazy usually by wearing
glasses full-time. This will help both eyes work together equally as they will be
receiving clear images and therefore allow connections to be made between
the eyes and brain. We will be monitoring his turn by seeing


18-month old baby has first eye test, you find +2.00. explain to mum why she
does not need specs. Mum is confused because she thinks +2.00 is a high
prescription worthy of glasses
-​ when a baby is born, their eyes are constantly developing and it takes a few
years for their eyes to reach normal adult levels of vision
Before their vision reaches adult vision, babies are long-sighted before they
grow out of it and so have a prescription however, it is not needed for us to
prescribe the prescription as this is the normal for the baby so a +2.00
prescription is the type of prescription we would expect to find from a baby of
your child’s age
-​ If we found a prescription that was above or more than what we would expect
of them, that’s when we would prescribe glasses, otherwise, we need to let
their eyes and visual system develop, without interrupting it with unnecessary
glasses

,☆☆ J&J- ESOTROPIA

Six-year-old Dominic has been seen at the hospital eye service and given a
prescription for bifocal glasses. His parents are concerned about the fact that
the hospital has told them he needs bifocals. They were given very little
explanation at the hospital and so have to come to see you to get the
spectacles dispensed and to see if you can help them understand why bifocals
are necessary.

Rx:
RE +2.50/-0.50 x 180 6/6 ADD: +1.50 N5
LE +3.50/-0.25 x 170 6/7.5 ADD +1.50 N5

Hello, my name is khawlah. I'll be your pre reg optometrist and I'll be dispensing
Dominic today. Before we take any measurements, I'll explain to you why Dominic
has been prescribed bifocals.
Firstly, do you know why Dominic is under the HES?
-So first of all I can see from his prescription that he is quite long-sighted. Do you
know what this is? This is when you are able to see things far away better than
things close up and can be due to the eye shape being smaller. I'm seeing that the
prescription for far away gives Dominic good vision in BEs although the RE is the
stronger eye. Based on what you have mentioned, the eye turn, Dominic has been
given a separate prescription for close-up and this is because when we are young,
we have lots of ability to accommodate which means changing our focusing power
and when we look at things close-up our eyes naturally turn inwards, however in
Dominic's case he is over focusing whilst looking at things close-up and causing his
eyes to turn inwards. The purpose of this prescription is to relax the eye muscles to
stop his eyes from turning inwards.
All of this combined will prevent Dominic from getting headaches, eyestrain and give
him the best possible vision.
I know that you may have seen bifocals only work by adults but rest assured we can
also give it to children
It's really important for him to wear the glasses full time or how the hospital have
recommended in order to control the eye turn otherwise it can become permanent
and lead to a lazy eye because the eyes wont be centred and receive correct visual
information so the eye becomes behind on development and the stronger eye takes
over

Will Dominic find it hard to adapt?
Children tend to adapt to bifocals very quickly, and in lots of cases, even quicker
than adults

Will he have bifocals for life?

, So as he is under the hospital, the hospital will continue to monitor him, if they see
an improvement then they are likely to reduce the reading prescription step by step.
They may also start on eye exercises which are successful as well.




0.3= 6/12 every 0.0=6/6

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