Stappenplan optometrie
LEERJAAR 1, 2 & 3
GOO-3.OZP-22
,Inhoud
Anamnese...............................................................................................................................................5
Algemene indruk.....................................................................................................................................6
CISS vragenlijst........................................................................................................................................7
Stereotest...............................................................................................................................................7
TNO.....................................................................................................................................................7
Randot / Titmus..................................................................................................................................8
Lang....................................................................................................................................................9
Lichtreflex.............................................................................................................................................11
Hoek Kappa.......................................................................................................................................12
Lichtreflex volgens Hirschberg..............................................................................................................13
Covertest..............................................................................................................................................14
Objectief.......................................................................................................................................14
Unilaterale CT...............................................................................................................................15
Alternerende CT............................................................................................................................15
Prismacovertest....................................................................................................................................17
Deviatie volgens Von Graefe.................................................................................................................20
AC/A relatie...........................................................................................................................................22
Maddoxglaasje met prisma’s................................................................................................................24
Maddoxschaal nabij met Maddoxglas...................................................................................................26
Maddox wing........................................................................................................................................27
Maddox Double Rod test......................................................................................................................29
4PT........................................................................................................................................................31
15PT & 15OPT.......................................................................................................................................33
Four dot test.........................................................................................................................................35
Monoculaire fixatie / Visuscopie...........................................................................................................37
Glaasjes van bagolini.............................................................................................................................39
Prismafussie / prismasuppressie met prismalatten (orthoptisch).........................................................41
Fusiebreedte met de foropter...............................................................................................................44
Compensatie volgens Sheard (berekening)...........................................................................................45
Compensatie volgens Percival (berekening)..........................................................................................46
Motiliteit screening / versies................................................................................................................47
Motiliteit met ACT................................................................................................................................49
Bielschowsky hoofdkantelingstest........................................................................................................52
Ducties..................................................................................................................................................53
Saccaden (oogsprongbewegingen).......................................................................................................54
Hess-schema.........................................................................................................................................55
1
,FD uitlijnprimsa (Mallett nabij).............................................................................................................58
FD POLA kruis met stip (projector veraf)...............................................................................................60
Fixatie Disparatie Curve (FDC)...............................................................................................................61
NPC / volgconvergentie.........................................................................................................................64
RAF Convergentie..................................................................................................................................66
Subjectieve AA-push up met fixatie latje..............................................................................................68
Objectieve AA‐push up met MEM........................................................................................................69
RAF Accommodatie...............................................................................................................................70
Dynamische skiascopie volgens de gemodificeerde NOTT methode....................................................71
Dynamische skiascopie volgens MEM...................................................................................................72
NRA & PRA (relatieve accommodatie)..................................................................................................73
Accommodatie flippers.........................................................................................................................74
Prisma flippers......................................................................................................................................76
Kleurenzien...........................................................................................................................................77
Ishihara.............................................................................................................................................77
Tritaanplaat.......................................................................................................................................78
Grove gezichtsveld bepaling (GGB).......................................................................................................79
Donders (GV)........................................................................................................................................81
Pupilreacties.........................................................................................................................................82
Spleetlamp routine...............................................................................................................................84
Indirecte verlichting..........................................................................................................................85
Specular reflection............................................................................................................................85
Retro illuminatie...............................................................................................................................86
BUT...................................................................................................................................................86
Ooglid omklappen.................................................................................................................................87
Conical Beam........................................................................................................................................88
von Herick.............................................................................................................................................89
Tonometrie...........................................................................................................................................92
Gonioscopie..........................................................................................................................................95
Direct oogspiegelen (DO)......................................................................................................................98
Volk (90D).............................................................................................................................................99
Classificatie Diabetes retinopathie..................................................................................................102
Classificatie hypertensive retinopathie...........................................................................................103
Classificatie arterio sclerose............................................................................................................103
BIO......................................................................................................................................................104
3- spiegel contactglas..........................................................................................................................105
Red cap test........................................................................................................................................107
Hertel / exopthalmometer..................................................................................................................108
2
,Bloeddruk...........................................................................................................................................110
Sinussen..............................................................................................................................................111
Lymfeklieren.......................................................................................................................................112
Ooglidfuncties.....................................................................................................................................113
Cogans Lid twitch................................................................................................................................115
Amsler.................................................................................................................................................116
Visus op afstand..................................................................................................................................117
Pinhole................................................................................................................................................123
Visus nabij...........................................................................................................................................124
Vistech................................................................................................................................................125
Pelli Robson........................................................................................................................................126
Pupildistantie (PD)..............................................................................................................................127
Brückner.............................................................................................................................................129
Topsterktemeter (niet-automatisch)...................................................................................................131
Skiascopie optometrisch (foropter)....................................................................................................132
Skiascopie orthoptisch........................................................................................................................134
Subjectieve monoculaire refractie met KC-methode..........................................................................136
Subjectieve Binoculaire refractie............................................................................................................1
Rood/groen balansproef.....................................................................................................................1
Polaroid regels....................................................................................................................................1
Fysiologisch septum............................................................................................................................2
Nabijrefractie..........................................................................................................................................3
Plusopbouw........................................................................................................................................3
Bi chromatische methode...................................................................................................................3
KC‐methode........................................................................................................................................3
Visuele training (VT)................................................................................................................................4
Fysiologische Diplopie.........................................................................................................................5
Pen tot neus (volgconvergentie).........................................................................................................6
Sprong convergentie...........................................................................................................................6
Stippellat / kralenkoord......................................................................................................................7
Convergentie en stereogramkaarten (met ruimtelijke fusie)..............................................................9
Convergentie en stereogram transparanten (met filters)..................................................................10
Staaflezen, trombone, accommodatie flipper...................................................................................11
Losse prisma’s / prisma flippers........................................................................................................12
Prismabril (stappen)..............................................................................................................................13
Leesondersteuning / studiebril (stappen).............................................................................................15
Gezichtsveld onderzoek........................................................................................................................16
Print out gezichtsveld onderzoek......................................................................................................16
3
,Zone 1...............................................................................................................................................17
..........................................................................................................................................................24
Zone 7 Glaucoma Hemifield Test (GHT)............................................................................................24
4
, Anamnese
De anamnese bestaat uit de volgende onderdelen:
Personalia
o Naam
o Geboorte datum en geboorteplaats
o Sexe
o Afkomst
o Adres, postcode en woonplaats
o Telefoonnummer
De hoofdklacht of reden van bezoek
Oogheelkundige klachten
o Asthenopie, hoofdpijn (hp), vermoeide ogen, taaginstellende focus, zware oogleden
vallen, branderige/ jeukende/ tranenede ogen (T/B/J), droge ogen, dubbelbeelden,
flitsen en floaters (F/F).
Visuele en oculaire voorgeschiedenis
o Bril / contactlenzen
o Eerdere oogheelkundige behandelingen
OK, amblyopiebehandeling, oefeningen, resultaat
o Aandoeningen
Strabismus (strab), amblyopie (ambly), hoge +/-, glaucoom (glau), ablatio, OK
o Laatste oogheelkundige onderzoek
Medische voorgeschiedenis
o Systemische aandoeningen
o Harts en vaatziekte (HVT), hypertensie (HT), hoge cholesterol, schildklier aandoening,
MS, Diabetes mellitus (DM), reuma (RA), infectieziekte, ademhalingsproblemen.
o Trauma of niet aangeboren hersenletsel (NAH)
o Geboorte en zwangerschap
o Bekend bij andere arts/specialist
o Laatste medisch onderzoek
Allergieën en medicatie
Familiaire voorgeschiedenis
o Strabismus (strab), amblyopie (ambly), hoge +/-, glaucoom (glau), ablatio, OK
o Harts en vaatziekte (HVT), hypertensie (HT), hoge cholesterol, schildklier aandoening,
MS, Diabetes mellitus (DM), reuma (RA), infectieziekte, ademhalingsproblemen.
Hobby’s / beroep
Het is belangrijk om iedere klacht verder uit te vragen. Dit kan aan de hand van DR. FALLOPPE
D Duration Duur
R Relief Wat vermindert klacht
F Frequency Frequentie / hoe vaak
A Associated Geassocieerde klachten
L Location Locatie
L Laterality Welk oog / welke kant
O Onset Wanneer ontstaan / verloop
P Pain Pijn. Zeurderig, stekend etc.
P Prescription Medicatie: dosis, dosering, etc
E Excerbating factors Waardoor neemt de klacht toe
5
LEERJAAR 1, 2 & 3
GOO-3.OZP-22
,Inhoud
Anamnese...............................................................................................................................................5
Algemene indruk.....................................................................................................................................6
CISS vragenlijst........................................................................................................................................7
Stereotest...............................................................................................................................................7
TNO.....................................................................................................................................................7
Randot / Titmus..................................................................................................................................8
Lang....................................................................................................................................................9
Lichtreflex.............................................................................................................................................11
Hoek Kappa.......................................................................................................................................12
Lichtreflex volgens Hirschberg..............................................................................................................13
Covertest..............................................................................................................................................14
Objectief.......................................................................................................................................14
Unilaterale CT...............................................................................................................................15
Alternerende CT............................................................................................................................15
Prismacovertest....................................................................................................................................17
Deviatie volgens Von Graefe.................................................................................................................20
AC/A relatie...........................................................................................................................................22
Maddoxglaasje met prisma’s................................................................................................................24
Maddoxschaal nabij met Maddoxglas...................................................................................................26
Maddox wing........................................................................................................................................27
Maddox Double Rod test......................................................................................................................29
4PT........................................................................................................................................................31
15PT & 15OPT.......................................................................................................................................33
Four dot test.........................................................................................................................................35
Monoculaire fixatie / Visuscopie...........................................................................................................37
Glaasjes van bagolini.............................................................................................................................39
Prismafussie / prismasuppressie met prismalatten (orthoptisch).........................................................41
Fusiebreedte met de foropter...............................................................................................................44
Compensatie volgens Sheard (berekening)...........................................................................................45
Compensatie volgens Percival (berekening)..........................................................................................46
Motiliteit screening / versies................................................................................................................47
Motiliteit met ACT................................................................................................................................49
Bielschowsky hoofdkantelingstest........................................................................................................52
Ducties..................................................................................................................................................53
Saccaden (oogsprongbewegingen).......................................................................................................54
Hess-schema.........................................................................................................................................55
1
,FD uitlijnprimsa (Mallett nabij).............................................................................................................58
FD POLA kruis met stip (projector veraf)...............................................................................................60
Fixatie Disparatie Curve (FDC)...............................................................................................................61
NPC / volgconvergentie.........................................................................................................................64
RAF Convergentie..................................................................................................................................66
Subjectieve AA-push up met fixatie latje..............................................................................................68
Objectieve AA‐push up met MEM........................................................................................................69
RAF Accommodatie...............................................................................................................................70
Dynamische skiascopie volgens de gemodificeerde NOTT methode....................................................71
Dynamische skiascopie volgens MEM...................................................................................................72
NRA & PRA (relatieve accommodatie)..................................................................................................73
Accommodatie flippers.........................................................................................................................74
Prisma flippers......................................................................................................................................76
Kleurenzien...........................................................................................................................................77
Ishihara.............................................................................................................................................77
Tritaanplaat.......................................................................................................................................78
Grove gezichtsveld bepaling (GGB).......................................................................................................79
Donders (GV)........................................................................................................................................81
Pupilreacties.........................................................................................................................................82
Spleetlamp routine...............................................................................................................................84
Indirecte verlichting..........................................................................................................................85
Specular reflection............................................................................................................................85
Retro illuminatie...............................................................................................................................86
BUT...................................................................................................................................................86
Ooglid omklappen.................................................................................................................................87
Conical Beam........................................................................................................................................88
von Herick.............................................................................................................................................89
Tonometrie...........................................................................................................................................92
Gonioscopie..........................................................................................................................................95
Direct oogspiegelen (DO)......................................................................................................................98
Volk (90D).............................................................................................................................................99
Classificatie Diabetes retinopathie..................................................................................................102
Classificatie hypertensive retinopathie...........................................................................................103
Classificatie arterio sclerose............................................................................................................103
BIO......................................................................................................................................................104
3- spiegel contactglas..........................................................................................................................105
Red cap test........................................................................................................................................107
Hertel / exopthalmometer..................................................................................................................108
2
,Bloeddruk...........................................................................................................................................110
Sinussen..............................................................................................................................................111
Lymfeklieren.......................................................................................................................................112
Ooglidfuncties.....................................................................................................................................113
Cogans Lid twitch................................................................................................................................115
Amsler.................................................................................................................................................116
Visus op afstand..................................................................................................................................117
Pinhole................................................................................................................................................123
Visus nabij...........................................................................................................................................124
Vistech................................................................................................................................................125
Pelli Robson........................................................................................................................................126
Pupildistantie (PD)..............................................................................................................................127
Brückner.............................................................................................................................................129
Topsterktemeter (niet-automatisch)...................................................................................................131
Skiascopie optometrisch (foropter)....................................................................................................132
Skiascopie orthoptisch........................................................................................................................134
Subjectieve monoculaire refractie met KC-methode..........................................................................136
Subjectieve Binoculaire refractie............................................................................................................1
Rood/groen balansproef.....................................................................................................................1
Polaroid regels....................................................................................................................................1
Fysiologisch septum............................................................................................................................2
Nabijrefractie..........................................................................................................................................3
Plusopbouw........................................................................................................................................3
Bi chromatische methode...................................................................................................................3
KC‐methode........................................................................................................................................3
Visuele training (VT)................................................................................................................................4
Fysiologische Diplopie.........................................................................................................................5
Pen tot neus (volgconvergentie).........................................................................................................6
Sprong convergentie...........................................................................................................................6
Stippellat / kralenkoord......................................................................................................................7
Convergentie en stereogramkaarten (met ruimtelijke fusie)..............................................................9
Convergentie en stereogram transparanten (met filters)..................................................................10
Staaflezen, trombone, accommodatie flipper...................................................................................11
Losse prisma’s / prisma flippers........................................................................................................12
Prismabril (stappen)..............................................................................................................................13
Leesondersteuning / studiebril (stappen).............................................................................................15
Gezichtsveld onderzoek........................................................................................................................16
Print out gezichtsveld onderzoek......................................................................................................16
3
,Zone 1...............................................................................................................................................17
..........................................................................................................................................................24
Zone 7 Glaucoma Hemifield Test (GHT)............................................................................................24
4
, Anamnese
De anamnese bestaat uit de volgende onderdelen:
Personalia
o Naam
o Geboorte datum en geboorteplaats
o Sexe
o Afkomst
o Adres, postcode en woonplaats
o Telefoonnummer
De hoofdklacht of reden van bezoek
Oogheelkundige klachten
o Asthenopie, hoofdpijn (hp), vermoeide ogen, taaginstellende focus, zware oogleden
vallen, branderige/ jeukende/ tranenede ogen (T/B/J), droge ogen, dubbelbeelden,
flitsen en floaters (F/F).
Visuele en oculaire voorgeschiedenis
o Bril / contactlenzen
o Eerdere oogheelkundige behandelingen
OK, amblyopiebehandeling, oefeningen, resultaat
o Aandoeningen
Strabismus (strab), amblyopie (ambly), hoge +/-, glaucoom (glau), ablatio, OK
o Laatste oogheelkundige onderzoek
Medische voorgeschiedenis
o Systemische aandoeningen
o Harts en vaatziekte (HVT), hypertensie (HT), hoge cholesterol, schildklier aandoening,
MS, Diabetes mellitus (DM), reuma (RA), infectieziekte, ademhalingsproblemen.
o Trauma of niet aangeboren hersenletsel (NAH)
o Geboorte en zwangerschap
o Bekend bij andere arts/specialist
o Laatste medisch onderzoek
Allergieën en medicatie
Familiaire voorgeschiedenis
o Strabismus (strab), amblyopie (ambly), hoge +/-, glaucoom (glau), ablatio, OK
o Harts en vaatziekte (HVT), hypertensie (HT), hoge cholesterol, schildklier aandoening,
MS, Diabetes mellitus (DM), reuma (RA), infectieziekte, ademhalingsproblemen.
Hobby’s / beroep
Het is belangrijk om iedere klacht verder uit te vragen. Dit kan aan de hand van DR. FALLOPPE
D Duration Duur
R Relief Wat vermindert klacht
F Frequency Frequentie / hoe vaak
A Associated Geassocieerde klachten
L Location Locatie
L Laterality Welk oog / welke kant
O Onset Wanneer ontstaan / verloop
P Pain Pijn. Zeurderig, stekend etc.
P Prescription Medicatie: dosis, dosering, etc
E Excerbating factors Waardoor neemt de klacht toe
5
