A training program for elementary school teachers. Optometrist-teacher communications.

Communication between optometrists and teachers is critical to optometric involvement in interdisciplinary team approaches to learning disabilities. The classroom teacher may be a prime source of referrals to the general optometrist as well as the vision development specialist. Optometry's contribution to classroom learning cannot be fully realized without sound optometrist-teacher communication. The basic design of a training program to enhance optometrist-teacher communications is presented in this paper. The individual optometrist may modify and supplement the program to suit the special needs of the teachers involved.     

Congenital pit of the optic nerve

Congenital pit of the optic nerve is a rare condition which can lead to serous retinal detachment. A case history of a patient with a small pit of the optic nerve is presented and management by the optometrist is discussed.     

Tourette syndrome and the eye

BACKGROUND: Tourette syndrome is a stress-sensitive neurologic disorder characterized by involuntary vocal and motor tics. Both Tourette syndrome and the medical treatment for this condition can affect the eye. CASE REPORTS: Case 1: A 5-year-old boy was brought in to see the optometrist by his mother for excessive "flinching" of the eyes. The flinching was actually excessive blinking and, after consulting with the patient's pediatrician and a neurologist, Tourette syndrome was diagnosed. Case 2: An adult male patient complained that, on occasion, he would forcibly blink out his soft contact lenses. He had previously received a diagnosis of Tourette syndrome, which is successfully managed with medication. CONCLUSION: Eye signs in Tourette syndrome include excessive blinking, squinting, eye rolling, exaggerated eye opening and closing, and problems with saccades. Because the eye can be involved in Tourette syndrome, the optometrist should be aware of the different manifestations of the condition, which often go unrecognized.     

PRACTISING OPTOMETRY IN THE UNITED KINGDOM

This paper is written for the Australian optometrist who may hope to practise optometry in the United Kingdom. It describes the statutory bodies which regulate and control the practice of optometry, the modes of general practice, orthoptic practice and contact lens fitting, and discusses in some detail the steps an Australian optometrist must take to be qualified legally to practise in the United Kingdom.     

Vicarious liability

"Vicarious liability" or "imputed negligence" is a doctrine that shifts legal responsibility from one individual to another so that, under the appropriate circumstances, an optometrist may be held responsible for the negligent conduct of agents, employees, partners, and others with whom the optometrist has created the necessary legal relationship. The application of vicarious liability to clinical practice is discussed, with emphasis upon relationships with other professionals, delegation of duties to employees, and referrals to other health care providers.     

三种双眼视功能障碍的鉴别诊断及处理方法

目前,集合不足、基本型外隐斜、假性集合不足三种双眼视功能障碍引发的视疲劳在视光学门诊中较为常见,由于这三种视功能障碍的症状和体征相似,视光师如果仅对单纯的某个指标进行分析往往会造成误诊,因此在对此类患者进行鉴别诊断时,需要对患者的远近眼位、调节反应、AC/A、正/负相对调节等各个体征进行综合分析以准确诊断和归类。根据诊断结果,提供合适的配镜处方、训练方法以及日常生活建议,才能最好地缓解视力疲劳,维持正常双眼视功能。     

THE MARTON LECTURE: OCULAR MANIFESTATIONS OF SYSTEMIC MEDICATION

The probability of ocular adverse reactions to systemic medication is low but when a reaction does occur it is often associated with one or more special factors relating to the condition being treated, to the patient, and to the nature of the drug itself. Nevertheless the role of the optometrist in the monitoring, detection and reporting of adverse reactions is important and is recognized by the College reporting scheme. A selection of the type of reactions that may be encountered in general optometric practice is reviewed. The reactions range from the relatively innocuous anticholinergic effects of the benzodiazepine tranquillizers to the more serious corneal, lens and retinal changes that may be associated with the corticosteroids, phenothiazines and chloroquine.     

Learning disabilities: the role of the developmental optometrist.

The role of the optometrist in treating children experiencing learning disabilities embraces numerous areas beyond the customary optometric services. Etiological, diagnostic and therapeutic factors are discussed stressing visual functional disorders, perceptual-motor and developmental lags and cognitive style. Their effects on the learning disabled child are analyzed; and the rationale of optometric procedures frequently used in treating LD children is reviewed. The optometrist may also be helpful in counseling patients who have learning readiness problems, reading disorders, psychological difficulties and nutritional deficits.     

The special educator and the optometrist

This article is meant to give optometrists practical suggestions about how to better communicate their specialized knowledge to teachers. The optometrist has a wealth of information that can be not only useful to the teachers, but also extremely beneficial to the students. As team members, the optometrist and teacher share and exchange professional information. The teacher gains an understanding of how the student's vision loss affects learning while the optometrist gains an insight about the child's educational programming.     

The mentally handicapped patient: a perspective

The patient exhibiting decreased cognitive abilities (mental retardation) requires full scope optometric care, but may often receive little or no vision care whatsoever. This paper will provide the optometrist with a review of the history of exceptionality, Public Law 94-142, the educational classification of mental retardation, and various examination techniques appropriate for this population. The optometrist should contribute his/her knowledge and skill as a member of the patient's rehabilitation team and provide those services required by this unique population.     

Traumatic dislocation of the crystalline lens with delayed total retinal detachment

Traumatic dislocation of the crystalline lens usually presents as a visual disturbance that can often be corrected by nonsurgical means. However, this ocular condition is fraught with serious complications that can occur years later. The two most serious complications are glaucoma and retinal detachment. These complications can make treatment of patients with traumatic lens dislocation a dilemma for the optometrist and ophthalmologist alike.     

The rural optometrist: who and why?

A first step toward the goal of better optometric manpower distribution is the identification of variables associated with the optometrist's choice of practice location. This study focuses on the optometrist who chooses a rural practice location and on ways in which the rural optometrist differs from the non-rural optometrist. One hundred sixty optometrists practicing in rural locations in ten states answered questions about their background, mode of optometric practice, attitude toward the environment, interests, and personality traits. Rural optometrists were found to differ from other optometrists in their rural origin, their strong liking for the people and life style of the rural community, and their interest in outdoor pursuits. Community recognition as a health professional, rapid practice growth, professional independence, and the opportunity for community leadership were seen by the rural optometrist as major advantages of rural optometric practice.     

Systemic arterial blood pressure and its relevance to optometric practice.

The measurement of systemic blood pressure is a very significant detection test that can provide a great deal of information for the optometrist. The blood pressure readings can be critical in aiding the practitioner's evaluation of both the patient's visual health and related systemic condition and in indicating the possible need for referral. This paper presents a general survey of the benefits blood pressure measurements can provide in the optometric practice.     

SARS,avian flu,bioterror: infection control awareness for the optometrist

The outbreak of severe acute respiratory syndrome (SARS) in 2003 alerted the world to the new face of pandemic disease: highly contagious and fatal infections for which no vaccines are available and current drugs are largely ineffective. As a practitioner providing primary care, the optometrist must be familiar with new and evolving infections present in today’s society. Though they may be viewed as extreme events, scenarios such as the re‐emergence of SARS, the affliction posed by the H5N1 strain of avian influenza and the threat of a bioterrorist attack have all been described. In the event that such events occur, there is the potential for the spread of some highly virulent, transmissible disease. This paper highlights these public health threats and discusses several areas that the optometrist may want to consider regarding infection control in an era in which a highly transmissible disease is being spread from person to person.     

Optometric expert testimony: foundation for the horizontal gaze nystagmus test

The courts require that a foundation be laid for admission of the Horizontal Gaze Nystagmus Test into evidence. Some courts will not accept peace officers as experts, but will instead require that an optometrist provide the necessary foundation. The optometrist will be expected to establish the correlation between nystagmus and alcohol consumption, and to educate the court on the desirability of the test for use by the law enforcement community. The optometrist should prepare prior to trial to assist the prosecutor in achieving these goals.     

Legal issues in contact lens practice with special reference to the practice of orthokeratology

This report aims to encourage optometrists to reflect on the legal implications of clinical contact lens practice, with particular reference to the practice of orthokeratology (ortho-k), which has seen a recent revival of interest. A patient may claim compensation if an optometrist is negligent by breaching his duty to exercise reasonable care and skill in diagnosis, advice or treatment. However, the optometrist will only be liable for reasonably foreseeable harm to the patient, so practitioners need to be fully aware of the foreseeable risks. Failure to adequately inform the patient may lead to a claim for negligence, if disclosure of the risks would have influenced the patient's decision to undergo or forego the procedure. It is important that the professional bodies establish guidelines on acceptable practice, with particular emphasis on the provision of information to patients. Reasonable disclosure, use of appropriate information/consent forms, and proper documentation of cases, should all focus on the needs of, and benefits to, patients.     

The Prevalence of Pseudoexfoliation of the Lens Capsule in an Australian Sample and its Association with Glaucoma

Pseudoexfoliation of the lens capsule (PELC) was detected in 11 (1.1%) of 1000 consecutive patients of an optometrist in Australia. Four of the patients having PELC also had glaucoma. Evidence of PELC should be sought routinely during optometric examination in view of the frequent association of this condition with glaucoma.     

Migraine headaches: Diagnosis and management

BackgroundPatients often complain to their optometrist about their headaches, of which migraines are a common type. They may ask if their pain is from visual causes or whether the visual auras they experience are normal.MethodsThe literature on migraine is reviewed to provide the optometrist with current information to manage these patients.ResultsIncluded in the review are migraine epidemiology, pathophysiology, categorization, clinical presentation, diagnosis, and treatment.ConclusionOptometrists can help their migraine patients with a thorough examination, advice, proper referrals, and optical management when appropriate.     

Crouzon syndrome.

BACKGROUND: Crouzon syndrome is a rare genetic disorder characterized by distinctive malformations of the skull and facial region. Premature cranial suture closure is the most common skull abnormality. Optic disc edema and proptosis are among the most common ocular findings. CASE REPORT: We present a case of a 5-year-old girl with Crouzon syndrome displaying classic facial abnormalities along with proptosis and papilledema. The child's condition was improved dramatically after a monoblock advancement procedure. CONCLUSIONS: The differential diagnosis of the condition and treatment options are discussed. The referring optometrist can play an integral role in the multidisciplinary care the patients require.     

Optometrists'' examination and referral practices for patients presenting with flashes and floaters

INTRODUCTION: Patients experiencing flashes and floaters commonly present to their optometrist. Some of these patients may have significant pathology, yet there is a great deal of variability with regard to examination technique and referral practice. METHODS: A questionnaire survey was undertaken to determine the current management of patients presenting to their optometrist with flashes and floaters. All practising community optometrists within Southern Derbyshire received a questionnaire and 74 (56.9%) completed replies were received. RESULTS: Optometrists estimated that an average of 14 patients per month per optometrist presented with symptoms of flashes and/or floaters. Mydriasis was utilised routinely for examination in approximately half of the patients. Mean relative confidence was 2.0 at identifying a vitreous haemorrhage and 6.5 for vitreous pigment (complete confidence = 0, complete lack of confidence = 10). Eight percent of responders were unfamiliar with the clinical sign of vitreous pigment, and 17% identifying this sign did not refer all such patients to the hospital services. CONCLUSIONS: Patients presenting to their optometrists with flashes and/or floaters make up a sizeable part of the community optometrist's workload and the management of these patients is highly variable. A large proportion of these patients are examined without mydriasis, even in the presence of various risk factors for retinal detachment. There is a relative lack of confidence amongst optometrists with regards the detection of vitreous pigment and the prognostic implications of this finding. Educational measures such as study days may help the level of understanding and heighten the appreciation of the implications of flashes and floaters and the various clinical signs encountered.