Comments for CLEARVIEW Training

Comment on Photophobic or Over Sensitive? by Shagufta Khan

Shagufta Khan — Sun, 11 Mar 2012 17:38:01 +0000

Hi Peter,
It seems like you have already done all the test any other optometrist would also do in your situation. The only other investigation is visual fields ( full field test).
I have encountered similar patients with these symptoms before and learnt (working with a consultant ophthalmologist) that a thorough investigation on migraines and family history of migraine should be noted. There ar some forms of optical migraine that can cause photophobia as its only symptom. As we all know some migraines can last for days to even months and can be very distressing for the patient. I advise after all tests being negative to refer them to a neurologist with ophthalmic interest. Also a follow up in 6months would not only benefit your patient but also aid your learning as to get feedback from the further investigations.
Good luck and keep us all posted!
Shagufta

Comment on Ask the Examiner: the OSCE’s by Jane

Jane — Sun, 19 Feb 2012 22:12:21 +0000

The ‘O’ in OSCE’s stand for Objective… and that’s’ what they are supposed to be. Bit tricky if you have examiners conducting vivas etc. So what has been devised is a system whereby the examiner has minimal interaction with the candidate, to maintain consistency between examiners and between stations. The why’s and wherefore’s are too many to go into here and this is not the most appropriate forum either. But there you go – as examiners we must try to remain objective, neutral and mark each candidate according to the same hymn sheet. Thus, the examiner will not ask you questions, like in a standard Viva examination.

When you address patients , use patient language but when addressing the examiner when you are explaining, for example, your referral criteria, use clinical terminology.

All the very best of luck! Manchester? See you there

Comment on Ask the Examiner: the OSCE’s by hassan

hassan — Fri, 17 Feb 2012 12:03:14 +0000

hi
having sat my osce exams in january i was stunned by the lack of questions/response from the examiners, my question here is, when communicating to the examiner alone do we still use laymans terms? or correct terminology?
many thanks

Comment on Ask the Examiner: Non EEA by Jane

Jane — Mon, 13 Feb 2012 17:20:55 +0000

You need to differentiate between acquired and congenital first.

Congenital Anomalies – Dichromats and anomalous trichromats

These are inherited. Think about r/g defects in boys but the important thing here is to consider the line of inheritance. Ask patietns who has had a colour vision defect in the family and establish where they are in the family tree. Don’t assume that its just boys you need to test – I had two sisters recently, both with congenital colour vision defects. A first for me, after 20+ years of practicing, and quite possibly the last too.

Dont forget the monochromats. Inheritance is not the same as it is for the dichromats / anomalous trichromats.

Some would argue that doing a CV test on all children as a baseline is good practice but there you need to consider what it is you are establishing and why.

Acquired.

Anything retinal goes here. There are a host of retinal and neurological conditions, drug toxicities etc that can affect colour vision. Many of the defect are reversible and also think of associated vf defects and reduced va. Test monocularly but be careful of the test you need – it needs to be more sensitive and specific than the Ishihara for example as many acquired defects are blue/yellow in origin.

I think it is time to dust an old Colour Vision lecture and upload the notes for you to look through. On its way, just give me a day or so to find it.

Comment on Ask the Examiner: Non EEA by Jan

Jan — Fri, 10 Feb 2012 20:48:47 +0000

What should prompt you to do a colour vision test other than on young boys? With what symptoms or conditions mentioned is this a necessary or helpful test to do?

Comment on Ask the Examiner: Non EEA by Jane

Jane — Thu, 09 Feb 2012 10:18:11 +0000

Recommended reading for BV:
Bruce Evans: Pickwell’s Binocular Vision Anomalies, and Eye Essentials (for a quicker read, although currently out of print – there may be a few second hand ones).

Have just launched a new bookshopswap service – lets see how that goes

Comment on Ask the Examiner: Non EEA by Simon

Simon — Thu, 09 Feb 2012 10:12:25 +0000

My experience is that manipulating the prescription more than +/-0.50DS is likely to give rise to blur or asthenopia. If you can’t align the markers with such small tweaks in the Rx, then move on to prisms. If they have their full cyclo Rx, then that would suggest that the DV will certainly be blurred if you increase their plus. Not sure what you mean in your last line re: children and symptoms. Young children tend not to report symptoms, and equally, their responses on something like a Mallet unit can be questionable too, so in any case it is not something that requires treatment in the early years.

Comment on Ask the Examiner: Non EEA by Jane

Jane — Wed, 08 Feb 2012 22:05:56 +0000

Hi Jan – thanks for the question. I have forwarded it on to the examiners. Which books / resources are you using to study? One of my questions to you would be what type of phoria you are investigating. Am assuming horizontal. Think about each type Convergence weakness, divergence excess etc. Remember Fixation Disparity is measuring the associated phoria too. Will get back soon.

Comment on Ask the Examiner: Non EEA by JAN CROOKS

JAN CROOKS — Tue, 07 Feb 2012 10:20:51 +0000

I am trying top understand when I would do refractive modification to manage symptomatic phorias, I have read about adding spheres to eliminate any movement of the lines when doing fixation disparity. Would you add spheres then initially, plus if sop and minus if xop instead of adding prisms initially if it was a young person, if they are symptomatic even if you have given the full eg cyclo prescription as children are unlikely to be symptomatic in the first place?

Comment on Do as I say, not as I do. by Jane

Jane — Wed, 01 Feb 2012 12:32:42 +0000

My last eye exam was Monday. Excepts it was a quick refraction done by a colleague in between CL patients. Excellent refraction but it made me think that I have not had my fundus checked for about 7 years.. You got any slots free this afternoon?!?