Optical training 12082_Healthcall_Training Doc_MASTER.indd 1-2
Promoting eye health and maximising independence for all Code of Practice for Domiciliary Eyecare September 2009 The Domiciliary Eyecare Committee is grateful for the comments of the UK Departments of Health on this Code • NHS eye examinations will be provided on request to those who cannot access community optical practices unaccompanied, as a result of mental or physical disability • NHS contractors will satisfy themselves that an NHS eye examination is clinically necessary and in the customer's best interests • Providers will respect the right of each customer to make their individual choice of provider of both services and appliances • Each customer will be treated as an individual and providers will not condone ‘group testing' of customers unless this is clinically feasible and by customer or carer choice • NHS eligibility for a domiciliary examination will be established and the reason noted on the record card, as will any eligibility for an optical voucher • Providers will make clear the likely cost of glasses in advance and the specific cost before placing an order • Providers will ensure that venues are suitable for testing and meet the requirements of NHS regulations • Customers will receive an eye examination in accordance with their individual needs and the duties of care and confidentiality of the optometrist* towards the customer • All NHS eye examinations will be provided in accordance with NHS regulations • Specialised portable equipment will be used to enable the optometrist* to deliver the best possible care to the customer • Where the environment or medical limitations of the customer make it impossible to include the full range of procedures, the reasons will be noted on the customer's record • Providers recognise that, when providing domiciliary services, they are acting in a privileged position of trust • Where appropriate, providers will follow the College of Optometrists' guidelines on treating customers with dementia or acquired cognitive impairment and similar ABDO guidelines on the challenges of dispensing to such customers • Providers will monitor and support clinical staff with regular clinical governance reviews 12082_Healthcall_Training Doc_MASTER.indd 3-4 Standards and probity • Glasses dispensed will be fitted individually to • Providers are committed to providing high Programme Information customers and any tolerance problems will be quality, personalised and professional eyecare and addressed by fully trained staff • Customers who are under 16 or blind or partially • All practitioners will carry identification and show An introduction to eyecare sighted will only be supplied with optical appliances it as appropriate and on request by, or under the supervision of, GOC registered staff • At the end of the appointment, customers will be given • Customers have a right to expect a high standard of the provider's contact details which may be in the form continuing care which ensures that any follow-up of a standard leaflet Welcome to Specsavers Healthcall's eyecare training care required or requested is provided efficiently • All eyecare will be provided in accordance with and professionally regulations and, in the case of NHS care, additionally programme. We hope you find it useful and enjoyable • Providers will advise the customer as to when their next in accordance with the provider's NHS contract and that together we can deliver quality eyecare for eye examination is due. They will not normally re-test • Providers will not offer or supply optical services before this unless the customer is experiencing specific including eye examination services, optometric older people and those with disabilities.
difficulties, which will be noted in the customer's record products or other inducements (including any services • Providers have an obligation to ensure that, when a or products), to third parties including the owners customer opts to be cared for by another provider, and staff of care homes, in order to gain or retain relevant information (e.g. lens prescription and date domiciliary business This programme aims to provide you with supportive and of last eye examination) is made available to the • This will not prevent legitimate advertising consistent enjoyable learning that will develop your awareness of: new provider with the consent of the customer or • The competitive market is recognised as a positive • How the eye works • Common conditions that can affect our eyes and how those conditions Providers will make clear in advance whether follow-up driver of quality and customer choice. Providers will not care will be provided free of charge (i.e. under the NHS therefore enter into ‘service level', ‘preferred provider' or at the provider's expense) or a cost to the customers or similar agreements with care homes or care home • How eye and vision problems can affect the lives of the people in your care chains or compete in other ways that are inappropriate • How, together with Specsavers Healthcall, care staff can provide support *or Ophthalmic Mediacal Practitioner (OMP) • Providers will apply a non-discrimination policy to the people in their care. towards customers in the supply of domiciliary services • Providers are committed to the highest standards of Programme summary Providers will ensure that personnel receive integrity and to employing rigorous audit processes to appropriate training in the specialist communication ensure eligibility for NHS funding skills necessary for domiciliary customers The programme comes in two parts: In accordance with the national timetable, all Each customer will be treated as an individual and domiciliary practitioners will be ISA registered communication will be with them throughout their • Providers will only claim higher rate domiciliary fees care unless this is inappropriate Your session will include the following topics: for more than two NHS customers resident at the same • When the customer is able to do so, their agreement a About eyes: how they work and what can go wrong establishment where such visits were reasonably made, will be sought before any aspect of their care is e.g. by request of a customer or carer exercising their discussed with relatives or carers. Where a customer is c Trying on simulation glasses choice of provider unable to consent, carers and relatives will be involved d How eye problems can affect health and well-being where appropriate 2. The candidate's pack In addition to issuing a lens prescription or a • Complaints about any aspect of provision should be statement that no correction or change is necessary, This is a self-study pack that will let you learn in your own time addressed to the provider in the first instance providers will leave further information with the and at your own pace. The pack includes learning materials and • If the complaint relates to an NHS eye examination customer (if relevant) or, with the customer's a self-assessment question and answer sheet to encourage you or the offer of inducements, the local Primary Care permission, with their carer or care home, to to think about and record what you have learnt. Organisation can be contacted summarise the outcomes of eye examination • If the complaint relates to glasses or contact lenses, the OCCS can be contacted: Optical Consumer Complaints Service (OCCS) P.O. Box 219, Petersfield GU32 9BY Tel: 0844 800 5071 Email: [email protected] • Complaints can also be raised in confidence with: Domiciliary Eyecare Committee, 199 Gloucester Terrace London W2 6LD Tel: 020 7298 5151 E-mail: [email protected] 12082_Healthcall_Training Doc_MASTER.indd 5-6 Evidence of training Although this is not an accredited course, some parts of it can provide useful supplementary evidence of knowledge that can count towards mandatory training requirements. The information can also contribute to a personal development plan. Skills for Care guidance states that: ‘all social care staff will need to maintain a record of their own training and achievements'. We therefore suggest that you use and retain the self-assessment question and answer sheets. If, or when, you are involved 4 The crystalline lens in any of the below programmes you can show this evidence of learning How our eyes work The crystalline lens is made up of several concentric to your assessor who can advise you how to use it. The eye can be likened to a camera. Light passes layers, rather like an onion. It is surrounded by a Depending on how the assessment question and answer sheets are through a lens at the front of the eye and is focused muscle, the ciliary muscle, which changes the lens completed, they may provide evidence towards the following, as well as on a light-sensitive area at the back. From there the shape and therefore its focus. When looking into the the Scottish Credit and Qualifications Framework and other qualifications: information travels to the brain, where it is turned distance the muscle should be relaxed and when we into pictures.
look at something close to us, the muscle contracts, bending the lens into a steeper curve to bring closer Skills for Care Common Induction Standards The eye is made up of six main parts: objects into focus on the retina. The main chamber Standard 2.4 Producing a personal development plan of the eye is filled with a transparent jelly-like body Using learning opportunities and reflective called the vitreous humour. Unlike the aqueous practice to contribute to personal development The cornea is the clear window at the front of humour this is not a renewable substance and the eye, and it is this surface that bends or refracts Standard 7.1 Promote person centred values in everyday work tends to deteriorate with age. light to focus on the retina. The white of the eye is Standard 7.2 Working in a person centred way called the sclera and is the semi-rigid shell of the The retina is a complex structure of light receptors. eye. It is covered by a transparent membrane QCF Level 2 diploma in Health and Social Care (adults) for England The two types of receptors are rods and cones. called the conjunctiva. The rods are mainly located in the periphery of the Group B, Unit SS MU 2.1 Introductory awareness of sensory loss 2 The anterior chamber retina and are particularly sensitive to low levels of Group C, Unit HSC 2004 Contribute to monitoring the health of The anterior chamber contains a watery fluid light. The cones are packed more to the centre of individuals affected by health conditions called the aqueous humour, the pressure of which the retina and are responsible for our colour vision helps to maintain the shape of the cornea. This fluid and ability to resolve fine detail. When we look is constantly produced and drained away through We hope that you will find this training of real value and that it will help directly at an object it is focused on the area of the drainage channels, located near the junction of you identify the areas in which you can make a difference to the quality retina called the macula. This is the most sensitive the cornea and the sclera. of life of those in your care. part of the retina and is most receptive to colour and detail. We may feel that we see clearly and in full colour to the extremities of our field of view, but in The iris is a coloured muscular diaphragm which fact at these extremes we are seeing in monochrome varies the size of the pupil according to the light and with poor resolution: the brain makes us believe intensity. The pupil is simply a hole through which otherwise. It is only if there is damage to the macular light passes into the eye. The reaction of the iris area that we become aware of this fact. to light is used in many diagnostic tests. 6 The optic nerve The optic nerve carries the information gathered by the retina to the area of the brain responsible for sight, which is located at the base of the skull. Damage to the retina, optic nerve or this part of the brain will result in some loss of sight, depending on the extent of the injury.
12082_Healthcall_Training Doc_MASTER.indd 7-8 Cataracts Cataracts are the most common problem experienced effective and individuals may suffer no noticeable by older people, although in some cases they can be visual impairment. Patients with a close relative caused by injury in younger people. German measles who has glaucoma are at greater risk of contracting (Rubella) can cause babies to be born with cataracts. Most people do not understand what a cataract is and are fearful of the condition. It is often described as ‘a Age-related macular degeneration (AMD) film or skin that grows over the eye', but this is not the AMD is a condition that mainly affects older people. case. A cataract is simply a clouding of the crystalline AMD causes reduced central vision that gradually The detection and treatment of eye conditions lens inside the eye – the variable focus becomes worse, leaving the peripheral vision lens mentioned earlier. unaffected. Eventually it becomes impossible to read or Many people simply accept deteriorating vision as they grow older, recognise faces and many sufferers will be eligible to be but this does not have to be the case. Cataracts are treated with surgery. Many years ago registered partially sighted. There are two types of AMD: it used to be the case that cataracts had to be ‘ripe' wet and dry. There is no effective treatment for the more before they were operated on and, after the operation, common dry type although some studies have shown patients had to wear very thick lenses in their glasses. that certain dietary supplements may help to slow down Today, operations can be carried out as soon as the For older people good eyesight is essential for getting the most out of life. It can prevent the progression of the degeneration. The wet type can patient experiences difficulties, and with the latest feelings of loneliness or of being isolated from events around them and, of course, it means sometimes be helped if detected early enough. intraocular lens implants (replacing the crystalline lens they can watch television, read newspapers or magazines and pursue their hobbies. with a clear plastic implant), patients may only require Even those who do not have the concentration levels necessary for prolonged occupational reading glasses after the operation. Certain medial conditions, in particular diabetes activity will benefit from good near vision. It will allow them to see their meals clearly The operation is usually very straightforward and and high blood pressure, can affect the retina, or read their own letters and greetings cards. Stroke victims whose speech is impaired can be carried out under local anaesthetic. causing haemorrhages and other complications. can frequently feel isolated and frustrated, so their other senses – sight and hearing – are Early detection of these conditions is essential and extremely important. Retinal detachment requires diagnosis and treatment by the patient's GP Eye tests can be carried out without the need to ask the patient numerous questions If the retina becomes detached from the back of the so that blood pressure and blood sugar levels can by using ‘objective' methods. These methods can be employed when examining patients eye, the sight will be permanently damaged in the be controlled to prevent further damage. It must be who are confused or have cognitive impairment. For these individuals it is very important area of the detachment. When the detachment occurs remembered that often patients are unaware that they to have regular eye tests, as they will become increasingly disabled if deprived of at the edge of the retina only, then the peripheral have a problem until the optometrist refers them to visual stimulation.
vision will be affected and the individual will have very their GP for further tests and diagnosis. Diabetes is little visual disability. If the detachment is near the one of the major causes of blindness in the developed centre of the retina then the patient will be aware of a world and the majority of blind diabetic patients are Early detection of ocular conditions severe reduction in visual acuity. It is essential that any middle-aged or older. Between 20 and 40% have detachment is treated quickly to prevent the area of ocular involvement at the time of diagnosis. Many age-related ocular conditions can be detected by the optician detachment spreading – the whole of the retina could before the person is aware of any problems. This is particularly the come away, which could result in total blindness in case with glaucoma, which is discussed further on. Early detection that eye. Retinal detachments are normally treated Conjunctivitis is a relatively minor infection of the and treatment means that the condition can be controlled more membrane that covers the white of the eye and effectively and patients may never experience visual difficulties the inside of the lid. It is often associated with the related to the condition. Additionally, when the optician examines common cold or an allergy such as hay fever. The a person's eyes with an ophthalmoscope, he or she can see the Glaucoma is a condition that rarely affects people eye becomes blood-shot and feels gritty, and there blood vessels at the back of the eye. It is the only part of the under the age of forty, and the chances of developing is often a mucus discharge. It can usually be body where blood vessels can be seen in this way without it increase with age. A fluid (aqueous humour) is successfully treated with antibiotic drops.
surgery. This means that conditions that affect blood produced inside the eye at a constant rate and vessels and circulation, such as raised blood pressure, normally drains away at the same rate. If the drainage arteriosclerosis or diabetes, may be detected slows down or the eye produces more aqueous Blepharitis is a chronic inflammation of the eyelid during an eye test. humour than normal, the pressure of the fluid builds margins, giving rise to sore, red, crusty eyelids and up and damages the optic nerve. Unless the pressure burning, watering eyes. It can sometimes be managed is controlled that eye will eventually go blind. The by cleaning the eyelid margins morning and night using most common treatment is the use of eye drops, but cotton buds and a 50:50 solution of baby shampoo and if these are not effective, laser surgery can help. If the water. Due to the chronic nature of the condition, this disease is detected early enough, treatment is very treatment should continue for some time.
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Appropriate Eyecare Domiciliary eye tests Most of us visit the optician because we don't think we can see too well and to find out whether we need glasses or contact lenses to solve the problem. If a patient can't visit The domiciliary eye test the optician unaccompanied, the examination can be conducted in his or her place of residence, which may be their own home or a care home. The eye test, or ‘sight test' as it is described by the NHS, addresses visual problems as well as including other procedures which provide the customer with a more extensive check up than just visual capability. Eye tests are carried out by optometrists (persons who are qualified to test sight and prescribe and dispense glasses) or ophthalmic medical practitioners (medically qualified doctors who have undergone extra training in sight testing). The optometrist has a duty to carry out necessary tests to determine the patient's needs with regard to both eyesight and health, enabling him or her to assess the: • Standard and quality of all aspects of the patient's sight • Optical prescription and, where necessary, prescribe any corrective lenses that are required • State of the eye to detect any disease or abnormality which may be present and which may require referral to the GP, hospital or ophthalmologist for further investigation.
The precise routine and content of the examination will be determined by the professional judgement of the practitioner and minimum legal requirements. This requirement must be fulfilled whether the patient is in the consulting room or in a domiciliary environment. Disability is no bar whatsoever to receiving a comprehensive eye test. Practitioners may have to adjust their routines to allow for patients who, for one reason or another, are not able to fully co-operate with all the tests, for instance in the case of cognitive impairment or difficulty with communication. Techniques are, however, available to deal with many possible difficulties and, just because a patient suffers with cognitive impairment, it does not follow that they should be denied eyecare as they may well benefit from improvement in their vision. The role of the carer The eye test consists of a number of procedures and can be a significant tool in the detection One of the most important requirements of any examination is the necessity to keep of systemic conditions. Regular eye tests, particularly for the older person, are an essential comprehensive records. As well as recording the standard information such as name, element in the maintenance of quality of life and must be offered to all patients, including address, date of birth etc., the optometrist will wish to know, where possible, some of those who cannot co-operate or communicate. all of the following: In the residential home environment, obtaining information directly from the patient is • Any previous history of eye problems and use of glasses not always possible, particularly information about their medication. The presence of • Any symptoms which may be present in relation to vision or the eyes nursing or care staff during the clinic is therefore vital. • Any current medication in use, whether ocular or otherwise • The visual needs of the patient, for instance the wish to watch television or read Prior to the start of the clinic, the optical team, comprising an optometrist and an optical • The reason for the domiciliary visit and why the patient is unable to visit a high adviser or a dispensing optician, will wish to talk to senior care staff to discuss the patients street practice unaccompanied they are seeing. The daily experience of carers in observing patient behaviour and problems • The financial circumstance that may entitle the patient to help towards the that may be vision-related is crucial to ensuring that any symptoms are understood and cost of glasses, along with evidence of this entitlement.
investigated. Many residents, for instance, profess to read a lot but this is not always borne out by carers. The fact that a patient does not read, however, does not necessarily preclude the need for glasses as these are used for any close activity, such as eating. The optometrist will of course not want to prescribe glasses that will never be used. Knowledge of the financial circumstances of patients is also important since NHS funding for all or part of the cost of glasses is only available to patients in receipt of certain benefits. 12082_Healthcall_Training Doc_MASTER.indd 11-12
Having taken full notes of history and symptoms, the optometrist will carry out the eye test. Some or all of the following procedures will be undertaken depending upon the needs and ability of the patient: Assessment of visual acuity (the standard of vision) with and without any current glassesThis will normally be achieved by asking the patient to read letters on the optometrist's chart and will help to indicate any major visual problems. It allows the practitioner to assess whether any change in the final optical prescription will actually improve the vision.
Objective assessment of the glasses correction Rather than going through the many hundreds of lenses in the optometrist's lens case, asking the patient whether they see better with one lens or another, the practitioner can make a very accurate assessment of the glasses correction which is required, without asking any questions. There are two main techniques available for this test. Retinoscopy is the method whereby the optician uses a hand held instrument to shine a light into the eye, which is then reflected back from the retina. The optician will add lenses to the trial frame until there is no movement of the light returning from the eye, indicating that the prescription in place is a good approximation of the prescription required.
The autorefractor is a hand-held or stand instrument that electronically measures the optical prescription, usually producing a printout of the results. Each practitioner will wish to decide upon a suitable way of doing an objective assessment and both methods can produce satisfactory results. The final accuracy may depend upon customer co-operation and clarity of the internal media of the eye. These techniques are invaluable in examining any patient, particularly if there is no previous prescription. However, the great value of the objective procedures is that they do not require any patient response and little co-operation, making it possible to provide an optical assessment for patients who are unable to co-operate or communicate.
Subjective assessment of the glasses correction at distance and nearThe subjective techniques involve asking the patient whether they can see better with one lens or another. Following the objective test, this is usually a fine-tuning of the prescription found and allows the practitioner to ensure that the final result achieves the best and most comfortable prescription. Again, the technique involves reading letters on the Snellen chart or a reading card. Where a patient is unable to recognise letters, picture charts are also available. When assessing the prescription for reading glasses, the optometrist will wish to ensure that the glasses are focused at the distance which most suits the patient (some people like to read close and others further away). Further variations may be needed for other activities, such as using a computer, playing a musical instrument or painting. The subjective assessment does, of course, require some co-operation from the patient but, even if this is limited, the procedures can be carried out with useful results. 12082_Healthcall_Training Doc_MASTER.indd 13-14
Measurement of intra-ocular pressure (IOP)Measuring the pressure of the eye is important in identifying glaucoma. All eyes maintain their shape because of the pressure of the fluids inside them. If the pressure rises too much it can cause damage. Traditionally there have been two main methods used to measure the IOP: contact and non-contact tonometry. The contact method requires the tip of the instrument to touch the surface of the eye, and necessitates the use of a drop of topical anaesthetic. The non-contact method blows a puff of air at the eye, and does not require drops. Specsavers Healthcall uses the iCare tonometer, which has been shown in studies to be more ‘patient friendly' than the other two methods. It uses a very small probe to touch the surface of the eye so quickly and gently that, in the majority of cases, the patient is completely unaware that the measurement has been taken. There is no puff of air and no drops are required, making it perfect for the domiciliary environment. Examination of the external and internal structures of the eyesThe optometrist will want to examine the eye to check for disease or abnormality. Externally, this will be achieved largely without instrumentation and includes a note of the state of the lids and conjunctiva etc. Any redness, excessive lacrimation (tear secretion) or dryness may need attention. Internally, the clinician will use an ophthalmoscope to examine Investigation of the mobility of the eyes and any muscular the eye from the cornea at the front, through the pupil, to the retina at the back, including imbalances at distance and near the lens and media. As well as the retina, the ophthalmoscope will present a view of the optic Tests to evaluate the actions of the six extraocular muscles, which give the eyes their nerve head (particularly important in recognising glaucoma and neurological problems) and movement, may be carried out. Often used for children to assess any possible squints, retinal blood vessels. This entire panorama of the back of the eye is known as the fundus. they are also performed on adults to ensure that the eyes are working together and in The veins and arteries of the fundus are the only vessels in the body not covered by the skin muscular balance. Any symptom of diplopia (double vision), particularly of recent origin, and so they present a unique opportunity to view these structures. Small haemorrhages needs to be investigated to assess whether any of the muscles are performing incorrectly or blockages will be visible, indicating conditions such as diabetes, hypertension or other and to allow a full investigation of the cause and possible treatment. systemic problems. These conditions are frequently first identified during an eye test and should be referred to the patient's GP. The optometrist will, of course, also wish to note Assessment of the quality and extent of peripheral vision any changes to the retina itself. The measurement of visual fields is an important aspect of the eye test in ascertaining any loss of peripheral vision. Glaucoma is characterised by a reduction in peripheral Supplementary procedures vision, which, in its early stages, will be unnoticeable to the patient. The practitioner may wish to, or need to, carry out other procedures, dependent upon Other conditions, such as strokes and retinal conditions, can also affect visual the needs of the patient. These may include colour vision tests or tests for stereopsis fields. In the older person in care, diagnosis and treatment are both important, (depth perception), although these will rarely be general practice in the care home but the condition might not affect their daily lives much. In a patient who, for environment. More detailed examination of parts of the eye that are of particular concern instance, drives a vehicle, any reduction in visual field would be significant. may also be carried out, including dilation of the patient's pupils, or the use of the many One of the problems in assessing visual field loss is that the tests are diagnostic instruments available to the domiciliary optometrist.
extremely subjective and mostly require a high degree of patient involvement. The patient has to indicate awareness of the lights or targets. Recent advancements have made these instruments In the domiciliary situation, the optometrist may not carry out all the procedures more portable and suitable for domiciliary work but they are described, and the order of tests will vary between clinicians. The eye test is a thorough not ideal for patients with limited concentration. and important examination, emphasising how optometry plays an important role in primary and secondary health care. 12082_Healthcall_Training Doc_MASTER.indd 15-16 How To Support A Visit By The Optometrist The following guidelines are helpful in Lens strength is measured in dioptres. A prescription showing a + lens indicates the patient is long-sighted and one showing a – lens indicates the patient is short-sighted. facilitating a visit from the optometrist. Many people have astigmatism, which can be in one or both eyes. Astigmatism is when the eye is not quite a perfect shape i.e. the eye is rather like a rugby ball instead of a football. This causes images on the back of the eye to be distorted. This condition is more common than people realise and, like short and long-sightedness, can be corrected by glasses and Make an appropriate room available. It should be private, at least three metres in length, equipped with electrical points and capable of being darkened. The cornea is the c Remember that as people get older, more light is required for the eye to function properly. Advise the patients' relatives that the eye tests are taking place and invite them to Please make sure that all your patients have access to a desk lamp or direct reading light attend. If they're not attending, make sure that the patients' relatives have agreed to the dispensing of glasses if required. Specsavers Healthcall provides information letters for patients' relatives. It is extremely important that glasses lenses are kept clean and free of smears to allow for maximum vision and penetration of light. Current ophthalmological opinion is that over- Check the patients' financial status and inform Specsavers Healthcall. This information exposure to ultraviolet light can cause an earlier onset of cataracts. Sunglasses, which is very important if any of the patients require glasses. absorb UV light, should always be worn in bright sunlight. It is also important that patients Get HC1 (SC) forms for customers of unconfirmed status. Please ask Specsavers are wearing the appropriate glasses for reading, eating, sewing or looking at photographs, Healthcall if you do not have these forms. and distance glasses for walking about, watching television and general use. If any patients are new to the home, find out when they last had an eye test. If the patient has been prescribed bifocals or varifocals, they should be worn for all activities.
Was it over a year ago? Are they currently attending the eye hospital? Advise Specsavers Healthcall of any patients suffering with conditions such as glaucoma, diabetes, MRSA or hepatitis.
Nominate a member of staff to help liaise between patients and the optical team on Useful Organisations the day of the eye tests. It is important that the optometrist is aware of any medication the patients are taking and their medial histories. Access to the patients' care plans would be very much appreciated. Make sure the patients are aware that they will need to bring their current and Royal National Institute of Age UK – Head Office any old glasses along to the eye test. Blind People (RNIB) 1-6 Tavistock Square Tel: 0300 3030 111 Tel: 0303 123 9999 Tel: 0800 169 6565 For assistance in determining a patient's eligibility for help towards the cost of glasses, we recommend calling the Pension Credit Helpline on 0800 99 1234, 8am-8pm Mon-Fri, 9am-1pm Saturday.
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Optometric Case Study Myopia* is the common term for short-sightedness Using the example below, you may wish to write The left conjunctiva and sclera were quiet. Internal Hypermetropia* or more usually known as hyperopia is long-sightedness your own case study based on your personal examination revealed what was believed to be old Emmetropia means that there is no refractive error in the eye experiences with someone for whom you have choroidal lesions (scarring) spaced around both fundi. Presbyopia* is the loss of near focusing ability due to age responsibility of care. There was some slight dry disturbance of the macula on the left side and extensive age-related macular *All these eye defects can be corrected and vision improved with glasses Patient Mr A T, Born: 30 August 1919 degeneration on the right. Mr A T is over 90 years old. He lives alone following Other conditions that can affect vision include: He presented with nuclear cataracts in both eyes, the death of his wife in 1999 and suffered a mild which were only mild in development and not stroke in 2000, which left him partially paralysed considered an issue. He also presented with a on the left side. small flame-shaped haemorrhage on the left optic The cornea is the c He has stopped taking the aspirin prescribed by disc, which was of concern as this can be a sign of Patients suffering from these neurological disorders could experience his GP. Mr A T had an exemplary war record, being glaucoma. Intra ocular pressures were, however, visual problems and may require ophthalmic assessment. commended by the King and was awarded the MBE in within acceptable norms of right eye: 16mm/Hg 1978 for services to the Scout movement. He remains and left eye: 17mm/Hg. Other ocular functions mobile using a stick but moves slowly and cannot appeared normal. walk far. He presents with some transient dysphasia. Mr A T was referred in relation to the disc Mr A T requested a domiciliary visit through his Social haemorrhage and the possibility of a condition Services visitor because he had not had an eye test known as low-tension glaucoma, an even greater concern in view of the lack of vision in the right eye. Ophthalmic diagnosis On examination, Mr A T wears a pair of The ophthalmologist confirmed the choroidal non-prescription sunglasses for bright days lesions as presumably being old choroido-retinal but has no prescription glasses. scars (toxoplasmosis). He diagnosed glaucoma and Refraction reveals: this he treated with Xalatan drops at night in both eyes. Mr A T has now received his glasses and Right eye: Hand movements enjoys watching the television. Mr A T is a classical case of lack of optometric care Right eye: -2.25 / -1.25 x 90 through not being able to get out, not experiencing Visual acuity: 1 / 120 any particular symptoms and being unaware of Left eye: -1.25 / -1.00 x 85 the availability of domiciliary care. His sight would Visual acuity: 6 / 12 + Add + 3.00 undoubtedly have deteriorated in time, maybe to Near visual acuity: N6 the point of partial sight or worse. Treatment for the glaucoma will, hopefully, delay progress of Mr A T had long been aware of the poor the condition, providing he continues to take his vision in his right eye but was not particularly medication. This will allow Mr A T to continue to lead concerned about his left eye. He was prescribed a life, which is satisfactory for his needs and wants. a distance prescription for television but declined help with reading. External examination revealed right lower lid ectropion (lid turning out) and the conjunctiva was infected on this side. He admitted that he had some drops for this, but had stopped using them. 12082_Healthcall_Training Doc_MASTER.indd 19-20 Name of eye condition Description and effect Difficulty seeing things close up. The following questions and activities will help you think about Occurs from middle-age onwards.
and develop what you have learnt from the awareness session Macular degeneration and the learning materials in the candidate pack.
You can obtain further training manuals, DVDs and simulation glasses by calling 0800 198 1135. Remember, this is not an exam, it is a record of what you have learnt. Perceptual problems There may be difficulty recognising If you want to use this section as evidence towards other training, remember that familiar objects or knowing how to your assessor is interested in your understanding and not in your presentation or use them. Although vision may not be written skills. Your assessor can also ask you additional questions or discuss your affected directly, it may be difficult for answers, so your written work does not have to be perfect.
the brain to interpret what the eyes see. Seen in patients who have suffered List six parts of the eye.
stroke, head injury or dementia.
Join the boxes. Match the parts of the eye with their correct descriptions.
4 For some people an eye condition is something they have accommodated in their lives. For others Opening in the iris that it can have serious effects on their health and/or well-being. For each of the following headings list opens and closes to adjust three or four ways in which someone who has a visual impairment may be affected.
the amount of light entering Provides the most detailed level of vision.
Multi-layered, light sensitive membrane. The innermost Emotional effects layer of the eyeball where light is converted into nerve impulses.
Elastic, colourless, transparent body of cells behind the iris. Shape modified to focus on subjects at different distances.
Passes images from the inside of the eye to the brain.
Each row on the following table looks at a common List three warning signs that might suggest that a patient or service user may be having problems eye condition, its description and a common treatment. with their eyes (for example, changes in behaviour).
Using the learning materials, can you fill the gaps? 12082_Healthcall_Training Doc_MASTER.indd 21-22 Case study oneYou have noticed that one of your patients is becoming quiet and withdrawn. When you have a chat with him he complains of difficulty reading his favourite book. He wears glasses but they are no longer working. Without being able to read he is getting very bored and is unable to distract himself when his arthritis starts niggling him.
a What could you and your care team do to help? b What other organisations could help in providing care? Case study twoA patient who has recently suffered visual impairment is becoming tearful and has had several accidents whilst trying to get to the toilet. When you talk to her she is very angry at her loss of vision and is frightened of falling. This is causing her to delay going to the toilet until she is desperate.
a What can you and the care team do to help this lady? b Which people or organisations could you get involved in this person's care? c Where could this person get information about her condition? Describe two patients your care team has cared for who have benefited from the services of an optometrist. What were the problems they had and how were they resolved? 8 List five key roles of the optometrist.
How can a patient who is living in a care home or sheltered accommodation access the services of an optometrist? 10 Using the Specsavers Healthcall eye test checklist, list two ways you can support patients during a visit (for example check that they have their normal glasses with them at the time of the appointment).
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Varenicline and Depression: a Literature Review Dr Eugene YH Yeung; Dr Beverly L Bachi; Dr Shann Long; Dr Jessica SH Lee; Mr Yueyang Chao August 2015 Doctors Academy Publications Varenicline is the most effective smoking cessation monotherapy medication. Pre-marketing trials excluded participants with psychiatric disorders. This literature review investigated the effects of varenicline among patients with depression
FOR IMMEDIATE RELEASE CONTACT: FDA APPROVES THE FIRST 3D PRINTED DRUG PRODUCT Aprecia Introduces its First Product Using the ZipDose® Formulation Platform for the Treatment of Epilepsy BLUE ASH, Ohio, August 3, 2015 – Aprecia Pharmaceuticals Company today announced that the U.S. Food and Drug Administration (FDA) has approved SPRITAM® levetiracetam for oral use as a prescription adjunctive therapy in the treatment of partial onset seizures, myoclonic seizures and primary generalized tonic-clonic seizures in adults and children with epilepsy. 1 SPRITAM utilizes Aprecia's proprietary ZipDose® Technology platform, a groundbreaking advance that uses three-dimensional printing (3DP) to produce a porous formulation that rapidly disintegrates with a sip of liquidWhile 3DP has been used previously to manufacture medical devices, this approval marks the first time a drug product manufactured with this technology has been approved by the FDA. "By combining 3DP technology with a highly-prescribed epilepsy treatment,2 SPRITAM is designed to fill a need for patients who struggle with their current medication experience," said Don Wetherhold, Chief Executive Officer of Aprecia. "This is the first in a line of central nervous system products Aprecia plans to introduce as part of our commitment to transform the way patients experience taking medication." ZipDose Technology enables the delivery of a high drug load, up to 1,000 mg in a single dose.2 As a result, SPRITAM enhances the patient experience - administration of even the largest strengths of levetiracetam with just a sip of liquid. In addition, with SPRITAM there is no measuring required as each dose is individually packaged, making it easy to carry this treatment on the go. SPRITAM is expected to be available in the first quarter of 2016. "In my experience, patients and caregivers often have difficulty following a treatment regimen. Whether they are dealing with a swallowing disorder or the daily struggle of getting a child to take his or her medication, adherence can be a challenge," said Marvin H. Rorick III, M.D., neurologist at Riverhills Neuroscience in Cincinnati, Ohio. "Especially for children and seniors, having an option for patients to take their medication as prescribed is important to managing this disease." Nearly three million people in the United States have been diagnosed with active epilepsy, with an estimated 460,000 of those cases occurring in children. 3 Additionally, in a recent survey of people age 65 and older living in an independent living facility, 15 percent reported difficulty swallowing.4 Other chronic conditions can impair the ability to swallow, further exacerbating the problem.5 While there are many reasons, including swallowing difficulties, for which patients may not take their medication as prescribed, missed doses of medication can undermine