Routine Eye examination, Vision screening and saving the eye sight! Part 2

Optom
Most eye conditions are not emergency conditions and are often neglected, often times this becomes our worst undoing!Unlike conditions like hypertension, diabetes, Cardiovascular diseases, Accidents etc which often require an urgent need for medical attention; eye conditions that could lead to blindness don't often present with dramatically serious symptoms and hence it is not given much attention in relation to other health cases. But unfortunately, conditions that can cause blindness, eye diseases that are chronic and that has ability to reduce the patient to  visually challenged or visual handicap statue are capable of evading early dictation! Take for instance open angle Glaucoma or senile cataract! Do not forget too that conditions like Retinitis Pigmentosa etc are painless but sight threatening!
Routine eye examination involves  voluntary eye tests to ensure that there is no deviation in ocular anatomy and doing functional tests for the eyes to rule out any deviation in ocular physiology. Such tests like Visual Acuity, penlight examination of the pupils etc qualifies for functonal tests! In Routine eye examination, patient is not necessarily symptomatic. individuals are often enlightened and/or motivated to take care of his/her eyes! In routine examination, the following procedure of test batteries are performed! Patient is first required to complete a personal demographic data followed by question and answer session with the eye care specialist. In this process a case history file on the patient is developed and likely chief complaint (if there is any) is identified. The next step involves taking visual acuity @far and @ near followed by doing external examination either with a penlight, ophthalmoscope or with a slit lamp biomicroscope. The eyelid, the conjunctiva, the iris, the conjunctiva and pupillary reaction to light etc are checked and any loss of anatomic and/or physiologic integrity is noted. It is followed by doing an objective refraction either with a retinoscope or auto-refractors. There is need to do a subjective refraction, with or without significant change in visual acuity! The next step involves using the ophthalmoscope to view the posterior fundus of the eye. The aqueous humor, Optic nerve head, the retinal walls and vessels, the vitreous gel, the maculae area and the fovea centralis should be viewed and changes documented. I advocate for dilated fundus examination of atleast one eye except in situation where it could be contra-indicative, say, in closed angle glaucoma or patients with very narrow angle! In most cases, the batteries of tests could reveal subtle changes in the eyes that could be sight threatening! If needs be, I will also encourage further tests for differential diagnosis and confirmation of a particular pathology or defect! Such tests like Tangent screen tests, central visual field tests, intra ocular pressure checks, color vision tests, flouresin tests etc could come in handy to rule out disease conditions!
 On the other hand, Vision screening involves gross routine tests to rule out any visual anomaly. It is less complex than routine eye test and even much simpler than a thorough eye examination as performed in a clinic! You can screen for glaucoma in the adult population; you can screen for refractive error among school children; you can screen for hypertensive and/or diabetic retinopathy in patients having this chronic diseases! You can screen for cataract in the adult populations etc! It involves tests like visual acuity tests far and near. Confrontational tests. Shadow tests. Broad H tests etc It is usually carried out in public places but it is not unusual to have it in a clinic! Vision screening is very handy when parents are registering their children in school! it is very important when security men are conscripted or when a company is trying to employ new workers! Though some subtle changes in the eye might be missed, it is nontheless very necessary to identify sight threatening conditions in a group of people! In situation whereby the eyes are suspicious referal to appropiate eye care experts becomes important! A thorough eye examination would be carried out by the expert!
In Optometry practice both here in Nigeria and the world @ large, we are involved continously with patients and the public to nip eye disease condition in the bud! Being primary eye care providers, our practice requires us to encourage the general population to participate fully to screen, examine and/or thoroughly do eye tests to identify and manage eye conditions that might not necessarily be symptomatic but could be sight threatenig! I am encouraging colleagues and other eye care specialists to develop vision screening models, routine eye examination models and other specific examinations to alleviate the consequences of blindness! It is our ethical and moral responsibilities to ensure that blindness is avoided! Thank you.
Dr Ezebuiroh Victor Okwudiri.