1 Diagnosis and Management: P ti t ith S ilN d Patients with Special Needs Dominick M. Maino, O.D., M.Ed., F.A.A.O. Professor, Pediatrics/Binocular Vision Service Illinois College of Optometry Illinois Eye Institute 3241 S. Michigan Ave. Chicago, Il. 60616 312-949-7280 (Voice) 312-949-7358 (fax) [email protected]www.ico.edu nw.optometry.net Diagnosis Assessment Techniques for Special Populations Use everything you know, be creative, and trust your objective evaluation skills! Diagnosis • Preparing for the examination • greet patient by name • position yourself at patient’s eye level • be on schedule be on schedule • consider patient’s wishes about family/friends in exam room • direct initial comments to patient • treat patient as a person first, then as an individual with a disability Diagnosis • Preparing for the examination • speak clearly • listen carefully • use short command sentences • “look here” • “look here” • “do this” • “watch my light” Treat the patient the way you would want to be treated!
Presentation given at the Vision's Impact on Learning Conference 9-11
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Diagnosis and Management:P ti t ith S i l N dPatients with Special Needs
Dominick M. Maino, O.D., M.Ed., F.A.A.O.
Professor, Pediatrics/Binocular Vision Service
Illinois College of OptometryIllinois Eye Institute
preferential looking cards that use form discrimination with vanishing optotypes
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Visual Acuity Refractive Error
Mohindra Dynamic Retinoscopy
•lens bars, 50 cm working distance, g•dark, pt looks at light•neutralize primary meridians•write in spherocyindrical form•add a (-) minus 1.25 to the sphere
Refractive Error
• Cycloplegic/Mydriatic spray
• Spray on closed lids, have pt blink wipe off have pt blink, wipe off excess (.5% Cyclo, .5% Myd, 2.5% Phenyl)
Refractive Error
• Keratometry• hand held electronic devices (Nidek)• Placido’s disk• keratoscope
•Hand held devices•Slit lamp•Keeler/Tonopen/•Perkins•Perkins•BIO/MIO/direct
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Ocular Health
•Hand held devices•Slit lamp•Tonopen/PerkinsTonopen/Perkins•BIO/MIO/direct
Tangential Penlight Angle Estimation
• Penlight at temporal aspect of cornea
• Angle between 20-35 degrees to the facial planethe facial plane
• Maximum brightness
• Open angle = nasal illumination at least 75% as bright as temporal illumination
Special Testing
• VEP, ERG, EOG
• Sweep VEP
• Ultrasound (A/B scan)
• TOVA• TOVA
• Visagraph
Special Testing
• VEP, ERG, EOG
• Sweep VEP
• Ultrasound (A/B scan)
• TOVA
Ultrasound, B-Scan
CPT 76512 (contact B-scan);
IndicationsExamination of the posterior
• TOVA
• Visagraphportion of the eye when direct view is precluded by media opacities. Evaluation of intraocular or orbital masses.
For more info:
http://www.healthgate.co.uk/dp/dph.0253.shtml
Special Testing
• VEP, ERG, EOG
• Sweep VEP
• Ultrasound (A/B scan)
• TOVA
The Test of Variables of Attention (T.O.V.A.®),
a 21.6 minute computerized continuous performance test used by professionals in the diagnosis and monitoring
of treatment of attention deficit disorder (ADD)/attention deficit hyperactivity • TOVA
• Visagraph
( ) yp ydisorder (ADHD) in children and adults. The standardized test is well normed and extremely helpful in predicting responsiveness to treatment modality.
More info at: http://www.tova.net/
Special Testing
• VEP, ERG, EOG
• Sweep VEP
• Ultrasound (A/B scan)
• TOVA• TOVA
• Visagraph
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Assessment
• Working with incomplete or “fuzzy” clinical data
• “Get over it!”
• Seek helpSeek help• Dr. Dominick Maino• 312-949-7282• [email protected]