Clinical examination Visual acuity: central, peripheral visual acuity is hard to check due to its subjective nature: depends on the response of the patient (intelligence, previous experience, alertness)
Measurment of visual acuity monocular vs binocular, wit or without correction far and near
Accurate clinical eye examination reduces the para clinical expensive testing Poor ophthalmoscopy may call for ocular sonography, OCT, FA… Define the best corrected visual acuity first Refraction is the beginning step of clinical examination clinical judgment without refraction can be miss guiding RAPD (Retrobulbar neuritis) Judgment by observation alone may be misleading A relatively pale optic disc Reduced light reflex of fovea Optometrist referral for retinal problem
Refractive error: retinoscopy, subjective refraction including the pin hole, autorefraction.
subjective refraction To find the best corrected visual acuity
Autorefrctor may give wrong numbers
Observation of the fundus structures is very important for clinical diagnosis.
Visual loss: 1. Refractive error: retinoscopy, subjective refraction including the pin hole, autorefraction. (Irregular astigmatism) 2. Opacity of media: ophthalmoscopy, retinoscopy, biomicroscopy. (red reflex) 3. Retina & Optic nerve : ophthalmoscopic observation, RAPD, visual field, ERG, EOG, VEP, angiography, OCT, ultrasonography. (Amblyopia) Amblyopia: history & phsical: Anisometropia, Isoametropia, Strabismic, (Monofixation synd) 4 prism base out test Malingering: age, gain, tricks Legal writing Beyond the optic nerve: RAPD,VEP, Visual field, brain imaging Deprivation
Evaluation of retina & optic nerve Observation: Compare between the two eyes, and compare with the population. Correlate between BCVA, clarity of visual pathway and fundascopic findings Relative afferent pupillary defect Function tests: visual field,VEP, ERG, EOG..