Topic:
Clinical Optometry Practice in Eye care
Discussion:
·
Introduction- an Optometrist is an eye care
professional who specializes in using refraction and other form of eye tests
within the scope of their practice to diagnose, treat & manage conditions
of the eye as a functional part of the human system.
·
Brief History- The profession Optometry became
popular in the early 19th century. Prior to this time, it was
unregulated and was made up of mainly opticians (one who fits glasses) for the
commercial purpose of providing spectacles for their clients. Today, the
profession has gradually evolved into a medical eye care provider. [In some
states in the USA, Optometrists are trained to perform laser surgeries and
other invasive procedures on the eyes.]
·
The Organogram of eye care- The eye care is a
sub-sector of the health care sector. There are three different types of care
in eye care sub-sector, viz primary, secondary and tertiary eye care.
Primary eye care
involves preventive eye care procedures like ocular hygiene, vision screening, education
etc.
Secondary eye care involves treating
eye conditions with glasses, drugs or surgery.
Tertiary eye care involves using low
vision aids to improve vision, post surgical care, glass prescription follow-up
for children below 9 years, managing chronic eye conditions e.g. glaucoma.
There are three different types
of eye care providers:
1) The optician (those who fix glasses prescribed by a
refractionist.),
2) The Optometrist (those who use refraction and other eye tests to
non-invasively diagnose and treat/manage/refer patients with eye medical
conditions.) and
3) The Ophthalmologist (Eye care specialists who use various invasive
procedures to manage eye medical conditions).
The
practice of Optometry- The practice of Optometry today has evolved
beyond managing ocular conditions with glasses alone into a medical eye care
profession as is been witnessed in our clinic. There are currently six
sub-units represented in Pan-OJ Clinic and Diagnostic Services Limited. The practice of optometry in the clinic been
able to touch various units in the clinic as highlighted by the following
illustrations:
a)
The drug dispensing/nurses unit-
*The nurses provide the optometrist with
auxiliary services in the form of taking Blood pressure(B.P.) , Visual acuity
(V.A.), dilating of the eyes with mydriatics etc
* They educate patients on how to
apply their eye drops/ointments.
* The nurses help patients in
making choices for frames in the clinic.
b)
The administrative unit- [The receptionist and the PRO]
* The Receptionist registers our
patients and directs them to the eye examination room.
* She informs the patients about their glasses
and ensures that the patients pay up before final dispensing of glasses and
drugs.
* She communicates follow-up
information to the patients.
* She assists the patients in
choosing their frames in absence of the nurses.
* Sorts out patient’s folders
when needed in the eye care unit.
* The public relation officer
(the P.R.O.) helps in creating eye care awareness and set seminars/workshops in
schools, hospitals, churches etc
* The PRO can assist patients in
choosing glasses.
The following three clinical co-managed cases highlight the
relationship between Optometry practice and general health care practice in
Pan-OJ Clinic and Diagnostic Services Limited.
Case
History (By the Head Laboratorist) 1:
Px, 29, A complained of
poor and deteriorating vision for the past 5 years especially on the right eye.
Her visual acuity
(V.A.) @ 6 meters was
RE: 6/4
LE: 1/60
Refraction was
RE: +0.50 DS (Dioptre Sphere) [6/4]
LE: +0.50 DS (Dioptre Sphere) [1/60]
Both eyes were dilated using Gutt: Mydriacyl 1% one drop every
5 minutes until maximum dilation was achieved.
Ocular fundus examination with the slit lamp and the
Ophthalmoscope revealed a macular scar on the Left eye and a coeco-central
choroido-retinal scar on the right eye. A laboratory test was requested to rule
out toxoplasma gondii as a causative agent.
A laboratory microbial analysis of the blood collected around
12.00 noon for ova/egg of Toxoplasma gondii was carried out which showed the
presence of the parasitic egg.
Case
History 2 (By Doctor Giwa):
Px B, 33, presents to the clinic
with a painful vesicobullous dermatitis on patient’s left side of the face. He
complained of photophobia, epiphora, chronic redness and loss of vision on the
ipsilateral eye. Patient has variously used over the counter eye drops without
much improvement.
His visual acuity @ 6 meters was
RE: 6/5
LE: LP
External examination revealed a
neovascularized cornea, corneal ulcer, anterior synechia and associated
blepheritis. There is no corneal sensitivity on the left eye. RVS test was requested and it came out
positive. Clinical observation of the red eye with the RVS result confirmed the
presence of Herpes Zoaster Ophthalmicus (HZO). He has since been co-managed
with a general practitioner. On his last visit, prognosis has improved
drastically.
His visual acuity on the Left eye
has improved to 6/60!
Case
history 3 (By Mr Moses):
Px C, 38, is a known chronic
hyperglycaemic patient who presented with sudden reduced vision even with her
habitual prescribed glasses. Her presenting visual acuity 6 meters [with her
glasses] was
RE: 6/18
LE: 6/12
Her visual acuity @25 cm was N8.
Refraction was
RE:-1.50-1.00 x 30 [6/9]
LE:-1.25-1.00 x 150 [6/9]
Add 2.25 [N5]
She was given the glasses. 3
months later she returned to the clinic with same complaint that her glasses do
not allow her see. Her presenting Fasting Blood Sugar (FBS) was 20 mmol/l. Her
visual acuity was
RE: 6/12
LE: 6/12
Refraction was:
RE: +1.00-1.00 x 30 [6/5]
LE: +1.25-1.00 x 150 [6/5]
Add 2.00 [N5]
She was given the new glasses but
was told to that her blood sugar level change will affect this new refractive
status. Last week, she reported back to the clinic with improved blood sugar
value of 9mmol/l. She cannot see with her last glass prescription. Her visual
acuity was
RE: Plano-0.75 x 30 [6/4]
LE: -0.25-0.75 x 150 [6/4]
Add 2.00 [N5].
This is a typical case of
fluctuating refractive errors in adults associated with DM. the new glasses has
since been given to her while a General practitioner manages her hyperglycemia.
In conclusion of our session, it
cannot be over-emphasised the role of clinical optometry in health care
practice. It is no longer the practice of lens prescription. It involves using
both topical and non-topical drug agents to treat/manage the condition of the
eyes.
Thank You.
Dr Victor Ezebuiroh Okwudiri (OD)
This test tells your eye doctor exactly what prescription you need in your glasses
ReplyDeleteor contact lenses. Normally, a value of 20/20 is considered to be optimum, or perfect
vision.