Clinical techniques and refraction

Clinical techniques and refraction
Óptico de Atención Primaria (Tahoma 10 negrita y alineado izquierda) Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Clinical techniques and refraction OBJECTIVES OF THE MODULE:

Óptico de Atención Primaria (Tahoma 10 negrita y alineado izquierda)
Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Case History The objectives of this section are: Give the relevant material that corresponds to the procurement of a patient’s case history Introduce the concept of the optometric file and its sections This section is structured for: 3 hours of theory 2 hours of specific practice 1 task outside of the classroom La metodología básica de las clases teóricas es la clase magistral, pero es importante que el docente introduzca ejemplos de pacientes. Esto permitirá hacer más amena la clase, pero principalmente que el estudiante vea la aplicación directa de los contenidos del módulo.

Clinical thought Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Case history (1) Optometrical investigation Tentative diagnosis (2) Specific tests The visual investigation is a logical process that consists of the following steps: Identify the main and the secondary visual problems of the patient and evaluate his/her expectations Identify possible logical causes of the symptomology of the patient (tentative diagnosis) Plan a logical scheme of visual investigation for the patient Extract information through the necessary clinical tests Analyze the results Make a definitive diagnosis of the case Choose the best optometric solution for the main motive for the patient’s consultation. Inform the patient, explaining the clinical terms in adequate terminology, explain the options for treatment. If there is more than one, indicate which we consider most appropriate for his/her case. Plan future check-ups/revisions This phase of conversation and extraction of the patient’s symptoms constitutes the first part of the visual investigation and it is begun before the realization of other objective or subjective tests. (3)-(4) Treament plan Definitive diagnosis Analysis of information (5) (6) (7)-(8)-(9)

Objective of the clinical history
Óptico de Atención Primaria (Tahoma 10 negrita y alineado izquierda) Objective of the clinical history Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Objective Extract information from the patient that will be useful in determining the specific tests that should be performed during the visual investigation in order to, after their interpretation and analysis, arrive at a definitive diagnosis and a treatment plan. Note: take away the frame from the notes page.

Reflections before beginning
Óptico de Atención Primaria (Tahoma 10 negrita y alineado izquierda) Reflections before beginning Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Important points The patient’s case history begins in the first few minutes of the visit but continues throughout the duration of the clinical examination When creating a case history, keep in mind the prevalence and incidence of visual conditions and ocular illnesses as well as their relation to age. It is important to establish an appropriate professional-patient relationship. Taking the clinical history is a part of the visual investigation to which we do not simply dedicate the first five minutes of the visit. We know that it begins when the patient sits down and that it continues throughout most of the time that the patient is with us. It is necessary to: Listen and give meaning to the patient’s explanations Ask the necessary questions to avoid missing relevant information Starting off with these two points and paying attention to our own knowledge of the epidemiology of visual and ocular problems, we will eventually end up with a list of possible causes of the symptomology. Obviously, other factors enter into consideration, such as the patient’s age. Then the moment will have arrived for the extraction of information through the realization of optometric tests considered necessary. Nonetheless, even during this activity it will be necessary to ask the patient new questions in the hopes of improving upon the information already given, while rejecting certain hypotheses and maintaining others. In order to be able to extract the most information possible it is necessary to establish a respectful and trusting relationship between the patient and the professional. Note: take out the frame from the notes page

Reflection before beginning
Óptico de Atención Primaria (Tahoma 10 negrita y alineado izquierda) Reflection before beginning Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Example of the question in the case history Let’s give the class an example that can facilitate comprehension. The teaching methodology to use with these examples is one of interaction with the students through questions and answers. EXAMPLE: a 34-year-old female office worker. She has never worn glasses and it has been almost 10 years since her last eye exam. She has noted that recently she has headaches and discomfort in the ocular zone and wants to know if she needs to wear glasses. Ask the class: What condition or conditions do you think the patient might show? (Wait for the students answers) With this information one can think of a great number of possible causes, but it may be necessary to get some complementary information: How long has this been happening? (an answer saying that she has noted the symptoms for 2 weeks, and another answer saying 2 years do not have the same meaning for us) How frequently? (once a day, a week, a month?) Do you get up with discomfort or does it appear at the end of the day? (the ETIOLOGICA cause can be very different) Is the appearance of headaches related to the use of vision? What does she do when the symptoms appear? Does she take any medication? Does it have an effect? Does she think she sees well from a distance? Does she think she sees well from up close? Has she noted any loss of vision recently? Has she noted at any time if vision is similar in both eyes? Does she suffer or has she suffered from any general or ocular illness? Etc. Note: take away the frame from the notes page

Most frequent errors Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Premature or hasty conclusion: a conclusion before obtaining all of the information necessary and stopping the investigation. Pseudodiagnosis or inadequate synthesis: all of the information is extracted but at the end there is no diagnosis. Lack of trust on the patient’s behalf Letting oneself be guided by intuition, etc There are a series of factors that help us realize a correct case history but they are developed with practice. We can, however, enumerate the most frequent errors: Hastiness: a hypothesis of the visual problem that the patient may show is made before all of the information has been extracted. This can cause us to miss information that is important to the case we are facing. The pseudodiagnosis is the most frequent error in students of the sciences of visual health. They ask appropriate questions but, because of lack of experience, they do not end up processing the obtained information and, therefore, do not make an appropriate hypothesis. On occasion, they combine the information inappropriately and arrive at erroneous conclusions. Lack of trust on the patient’s behalf: added difficulty generally for students and recently certified youths. Common errors

Sections of the case history
Óptico de Atención Primaria (Tahoma 10 negrita y alineado izquierda) Sections of the case history Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Sections of the case history Personal information Main reason for the consultation (MC) Personal history (PH) Ocular and general health history Family history (FH) Visual needs at work and other activities The way of carrying out the interview with the patient can vary, but in general it consists of the following sections: Extraction and anotation of the patient’s personal information. The object of this is to establish first contact, to try to create a professional but comfortable atmosphere, and to obtain some very important information for the correct diagnosis and treatment (such as the age of the person, their types of visual demands, etc.). Then, determine the main reason for the consultation. Just two reflections on this: there may be more than one reason for the consultation, and it is necessary to interpret and orient the patient in his/her transmission of information. Personal history. In this section we will ask about previous visual and ocular problems, previous treatments, the patient’s subjective opinion about his/her vision from a distance and from up close, as well as his/her visual health. After that we will try to obtain information about the ocular and general health history of the patient’s direct relatives. Then, getting to know the patient’s specific needs will help us to give him/her a better solution. It is worth it to emphasize that one visual problem, in people of different ages, with different visual demands, or with a different visual history can lead to different treatments.

Personal information Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Personal information First and last names Date of the appointment Date of birth and current age Complete address and telephone number(s) Sex/Race Profession Sent/recommended by Observations The patient’s general information is obtained in the first part of the interview and it initiates an appropriate interaction with the patient and increase his/her level of trust. The information in this section is provided with three ends in mind: Adequately organize all the information from all patients. To do this we need their full name, age, date of birth, address and telephone number(s). The prevalence of ocular and visual problems depends on factors such as the age, race, and sex of the person. Knowing this information allows a better orientation for later visual exploration. It speaks of three ends but there are only two points??

Main reason for the consultation
Óptico de Atención Primaria (Tahoma 10 negrita y alineado izquierda) Main reason for the consultation Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Reason for the consultation Reason for the consultation (MC): the objective is to determine the possible etiologies of the visual problem the person shows, depending on the symptoms that the person manifests. In general, this part of the case history is begun with open questions and, as the patient explains the main reasons for the visit, secondary questions can be asked to better define the patient’s request/demand/etc. We consider it best that this information is extracted by the specialist that is going to realize the following visual investigation. Nonetheless, on other occasions, the reason for the consultation is extracted by: An assistant that must have experience and important knowledge of vision A questionaire or list of symptoms that the patient must fill out.

Reasons for the consultation
Óptico de Atención Primaria (Tahoma 10 negrita y alineado izquierda) Reasons for the consultation Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Reasons for the consultation Reasons for the consultation (MC): Main reason for the consultation Open question “What is the reason for your visit?”, “Why have you come to see us?”, “What’s wrong?”… Write it down in the patient’s words Continue with more questions in order to get to the main and any secondary symptoms: when, how, where, from distances, from near… Tend to start with an open question: What is the main reason for your visit? In order to avoid erroneous interpretations afterwards we should write down the answer in the patient’s words. For example, if a 45-year-old patient who has never worn glasses for near vision explains that he/she does not see well from up close we should not write down, “presbyopia”, or, if a 15-year-old says that he see poorly from far away we shouldn’t write down “myopia”. The next step is extracting as much information as possible with respect to any other secondary symptoms.

Reasons for the consultation
Óptico de Atención Primaria (Tahoma 10 negrita y alineado izquierda) Reasons for the consultation Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Examples of questions to center on the reasons for the consultation EXAMPLE: An 18-year-old girl says that she “has noticed that her sight tires when she spends a long time reading.” We have identified the main symptom, but more information is needed: Does she believe she sees well from far away? Has she realized at any moment whether both eyes see in a similar way? Does this tired sensation translate into: blurry vision, red eyes, headaches, etc.? Does she ever have blurry vision? When she starts reading or when she has been reading for a while How long does the visual tiredness she refers to take to appear when she begins reading? Does it happen every time she reads or only in some concrete periods? Has she ever seen double? What does she do when the discomfort appears? Does she stop reading? Take medication? Etc.? Does she hold the book very close to her face when she is reading? Does she suffer from the discomfort no matter where she is reading? What type of lighting does she use?

Most frequent symptoms
Óptico de Atención Primaria (Tahoma 10 negrita y alineado izquierda) Most frequent symptoms Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Most frequent symptoms Blurry vision Visual fatigue External ocular discomfort Headaches Loss of vision Other visual discomfort Next, the most frequent symptoms described by patients will be discussed and an attempt will be made to relate them to their possible etiological causes. It is good to point out that we are not planning to make an exhaustive list of all the possible symptoms and causes, if not refer only to those with the highest prevalence in the general population.

Most frequent symtoms Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Blurry vision (functional causes): Ametropia/Presbyopia Amblyopia Accomodative dysfunction Binocular dysfunction Simulation/ocular hysteria Blurry vision (pathological causes): Corneal/crystalline alteration Inflammation Vitreous opacities Macular problems Problems with the optic nerve The symptom of blurry vision is frequent, but it is necessary to remember that there are many causes that can produce it. One of the determinating factors responds to the question “since when?” In this section, reference will be made to the visual conditions that can provoke blurry vision, whether occasional or constant, with a variable period of time of evolution. Students must keep the following considerations in mind: Blurry vision from distances but not from near: possible myopia Blurry vision from near after working with near vision: will depend on the age of the individual. So: Youths: it could be hypermetropia, astigmatism, or some binocular or accomodative dysfunction Middle-aged adult: suggests presbyopia Blurry vision in one eye: could be an undetected amplyopia or from a pathology. In this last case the age of the patient can also guide us: If the blurry vision is transitory and takes place in a young patient: it could be migraines or optical neuritis (idiopathic or due to multiple sclerosis). If it is produced mainly in very bright environments and the individual is at an advanced age: it could be a nuclear or subcapsular posterior cataract. In an elderly person: it could be secondary to, among other causes, cataracts or a macular degeneration associated with the age.

Óptico de Atención Primaria (Tahoma 10 negrita y alineado izquierda) Most frequent symptoms Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Visual fatigue: Ametropia/Presbyopia Binocular dysfunction Accomodative dysfunction Anisometropia/aniseikonia Inadequate optical correction Inadequate environment The term “visual fatigue” is general and refers to a series of unspecified discomforts localized in and around the ocular zone and whose appearance the patient relates with the use of vision. The term ocular or visual asthenopia is considered a synonym. Generally, the etiology of visual fatigue is considered functional. Next, some of the conditions that can provoke said discomfort with the most frequency are described: Errors of refraction: In young patients or young adults they can be caused by hypermetropia or astigmatism. They can also be secondary to the existence of functional dysfuctions of accomodation or binocularity. In middle-aged adults they can be related with the appearance of presbyopia. By an inadequate optical correction. By an error in the prescription, but also must not forget the possibility of an error in the assembly. Because the use of near vision takes place in an inadequately lit environment, or the posture of the subject is uncomfortable or the work distance is too close, etc. The students must understand that the term “visual fatigue” can be too ambiguous when the patient uses it and that a deeper investigation into the meaning of the phrase is advisable for the patient present. In the course of the class an example like the following can be used: There is no example?????

Óptico de Atención Primaria (Tahoma 10 negrita y alineado izquierda) Most frequent symptoms Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Double vision (diplopia): Ametropia Binocular dysfunction Monocular diplopia When a patient refers to double vision, the next step is to determine the type of “double vision”: Does it consist of two seperated images vertically or horizontally? Or does it consist of two images superimposed on one another as if there were a shadow? The answer to this simple question will inform us as to the possile etiology of the condition. It is also appropriate to ask if it happens only with both eyes open or whether when the patient covers one eye the sensation continues. Starting with the answers we can find ourselves with the possible hypotheses: Uncompensated refractive defect: generally perceived as a superimposed double image or like a shadow. It tends to be caused by astigmatism but, depending on the distance at which it occurs, could also be related with hypermetropia or the appearance of presbyopia. If it is true double vision with two separated images it is probable that it is a binocular dysfunction. In order to be more sure, questions are recommended. How long has this been happening? Does it happen all the time or only on occasion? Does it happen when looking at things from far away, when looking at things from close up, or indistinctly? Does the patient notice it mainly with a specific look or from a specific position of the head? Etc. If double vision continues or manifests itself principally when one eye is closed we can suspect that: Keratoconus: protrusion of the corneal apex which comes associated with a thinning of the corneal structures. Position changes of the crystalline or secondary to a cataract operation.

Óptico de Atención Primaria (Tahoma 10 negrita y alineado izquierda) Most frequent symptoms Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Loss of vision (of visual acuity): Migraine Optic neuritis Occlusion of retinal vein or artery Temporary arthritis Papilloedema Loss of vision (of field of vision): Retinal lesions/loosening Anomalies of the visual pathway In this section we refer to the sudden losses of vision. When a person refer to “loss of vision” the first questions to ask would be: Since when? A patient may come in complaining of loss of vision, but when asked about the time of evolution their answers indicate that the loss has been gradual and over the span of several years. Sudden or gradual? From far away, up close, or at all distances? We try to rule out the possibility that the patient refers to an ametropia. In one eye or in two? If the patient does not know how to respond to the question have him/her test it in the moment? Does the patient see worse or see nothing? On occasion a person might indicate that he/she “does not see with one eye” but when asked this question they reveal that the reality is that they “do not see well with one eye”. Would the patient say that it happens in the entire field of vision or just in one zone? Some of the possible causes of a total or partial sudden loss of vision are those shown in the slide and in the majority of cases it involves pathologies that require an adequate remission of the patient. NOTE: the text fields of the slide are at a distinct height, I have aligned them to the upper part

Óptico de Atención Primaria (Tahoma 10 negrita y alineado izquierda) Most frequent symptoms Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Discomfort related to the anterior segment of the eye Excessive tearing Reddening/Itchy eyes Sensation of foreign body Within this slide reference is made to a new group of inspecific ocular discomforts that are not related with the use of vision and that include excessive tearing, red eyes, sensation of foreign body, itching, sensation of heat, constant sensation of grit or sand, etc. Again we find ourselves with a great variety of etiological causes that are impossible to cover completely which is why we will only make reference to those which are found most frequently in the general population. Insufficient lacrimal film or dry eye. At any age this can happen but it is more frequent with the elderly and middle-aged women. It is the consequence of a reduction of lacrimal fluid that provokes irritation and an excessive increase of the lacrimal reflex. Problems with the lacrimal drainage or in the position of the lower eyelid, mainly in the elderly (ectropion). Ocular infections like conjunctivitis and keratitis. The tend to come associated with ocular reddening (conjunctival hyperaemia) and with a greater or lesson production of “sleep” in the corners of the eyes. Foreign body in the eye. Small bits of dust or material of whatever type (due to a strong wind, for example) can be deposited in the conjunctiva. In the majority of cases these residues are eliminated in a few minutes, but on occasion they remain trapped beneath the eyelids. They tend to provoke serious discomfort and conjunctival hyperaemia. Inadequate environments: poorly ventilated, too hot, little environmental humidity, excess of smoke, etc.

Óptico de Atención Primaria (Tahoma 10 negrita y alineado izquierda) Most frequent symptoms Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Headaches: Ametropia/Presbyopia Binocular dysfunction Accomodative dysfunction Vascular: migraine, tensional, etc. Inflammatory, tumoral, etc. Headache (cephalea) Is symptom referred to frequently by people that visit a vision specialist. It does not have to be secondary to a visual problem, but it is one of the first etiological causes that should be ruled out, before submitting the patient to costly tests or a possibly unnecessary medication. When we ask the patient about the main reason for his/her visit and he/she indicates headache we must continue extracting further : How long has the patient had these headaches? Can the headaches appear at any time of day? Does the patient sometimes get up in the morning with headaches already present? With what frequency does the patient have them? How long do they last? Does he/she take any specific medication for the headaches? If so, what is the effect? In which zone of the head does it hurt? Is the discomfort very severe? Is it a dull pain? Acute? Pulsating? Does he/she believe that the appearance of the headaches is related to the use of vision? Can they appear independent of the activity being or already performed? With all of these previous questions we will have obtained valuable information. Nevertheless, it is essential to follow with an evaluation of the individual’s ametropia as well as one of his/her visual health. Functional, visual causes of headaches: Some ametropias, even Presbyopia Binocular and accomodative dysfunctions

Óptico de Atención Primaria (Tahoma 10 negrita y alineado izquierda) Most frequent symptoms Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Headaches: Ametropia/Presbyopia Binocular dysfunction Accomodative dysfunction Vascular: migraine, tensional, etc. Inflammatory, tumoral, etc. With all of these previous questions we will have obtained valuable information. Nevertheless, it is essential to follow with an evaluation of the individual’s ametropia as well as one of his/her visual health. Functional, visual causes of headaches: Some ametropias, even Presbyopia Binocular and accomodative dysfunctions NOTE: The slide appears repeated, I suppose because all of the text did not fit in one, if reduced a little the text fits. It is another option.

Personal history Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Personal history Visual and ocular personal history If he/she wears glasses and/or CL How long have you worn glasses? How long have you had this prescription? When was your last check-up? When or for what do you wear the glasses? Do they work well for you? Test the graduation to the frontal focometer and the centration distance,  effects, material, color, design, etc. If he/she does not wear glasses Have you ever worn glasses? When was your last eye exam? The next step in the case history is determining the important and vision-related events that the patient has had. It is usually begun by asking about the visual and ocular history. This interrogation is based on the questions in the slides.

Personal history Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Personal history Visual and ocular personal history Ocular traumas Is the person using any drops or creams for the eyes? Has he/she ever used any? Past or present ocular illnesses Ocular operations or operations in surrounding areas Next, we ask about any incidence of ocular trauma, illness, surgical intervention, etc. This interrogation is based on the questions in the slides.

Personal history Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Personal history of general health General health Current state of health? Any health problems like diabetes, hypertensión, etc.? Medication: Is he/she taking any medication? Why? For what? When? Since when? How much? Has he/she taken any medication recently? Are there any known allergies? The determination of the personal history continues with questions about the general health of the individual in question and the possible ingestion of medication. This interrogation is based on the questions in the slides. It is interesting, on occasion, to give an example. When asking about general health problems we are looking for, mainly, systemic illnesses with ocular repurcussions. This is why it begs for concrete examples: Diabetes: not only can provoke important loss of vision if not also change refraction (just as will be seen in the corresponding chapter) Arterial hypertension: can also provoke loss of vision When asking about medication we are looking for information regarding: Systemic illnesses not referenced in the previous section Secondary effects of medication that can affect functional vision and therefore be a main reason for the patient’s consultation.

Family history Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Family history (FH) Ocular history and general health Interrogation directed at conditions with a possible hereditary factor and that can affect the vision: glaucoma, diabetes, retinal detachment, severe loss of vision, ocular or arterial hypertension, etc. Just as is indicated in the slide, the questions are now directed to detect the existence of any hereditary condition within the family that can have repurcussions on the general or visual health of the patient.

Visual needs Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Visual needs What do you do? Distance, lighting, size, etc.? Any hobbies that require visual exertion?: reading, painting, sewing, music, etc. The objective of this section is to get the student to understand that on occasion the case’s diagnosis is not the same as the treatment that has just been proposed, since the visual needs of the person must always be kept in mind.

Relevant observations
Óptico de Atención Primaria (Tahoma 10 negrita y alineado izquierda) Relevant observations Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Observations: any relevant TRAZO from external factors This section of the file is reserved for noting down any relevant information that we may have detected during the interview with the patient. Factors like: Facial asymmetries Anomalous positions of the head Eczema or redness Difficulties with expression Etc.

Case file Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Personal information MC, PH, FH Refractive section: PD AV Retinoscopy and Subjective Others Visual efficiency: Binocularity Accomodation Ocular motility The case file is the place where all of the patient’s information and the results of the visual investigation are kept. The following sections point out: Case history. Explained in the current chapter. Refractive tests. Including: The measurement of the interpupillary distance (PD) necessary as much for a correct centration of the necessary lenses to evaluate the patient’s refractive defect as for their later assembly, if necessary. Measurement of visual acuity (AV): from far and from near Objective test of refraction: Retinoscopy, autorefractometer Subjective refraction test Tests of visual efficiency. Within this section we include: Tests of binocularity. Mainly directed at determining the binocular alineation on the object of interest. Efficiency of the accomodative system in young patient’s (non-presbyopes). Abilities of the ocular motility when it is precise. NOTE: put that with every day the autorefractometer is used more to measure the subjective refraction, maybe it should be included.

Case file Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Personal information MC, PH, FH Refractive section: PD AV Retinoscopy and Subjective Others Visual efficiency: Binocularity Accomodation Ocular motility Ocular health: Anterior segment Eye exam Visual field Pupillary function Intraocular pressure (IOP) Ex. complementary: Color vision Diagnosis Tests to evaluate the ocular integrity and the integrity of the visual pathway. Any other complementary test that is considered necessary because of the patient’s age and/or the symptomology mentioned. In the case file, the complete visual diagnosis should always be present. In this moment it is necessary for the students to understand that the diagnosis is not a synonym for the final treatment that ends up being recommended to the patient. In the treatment we keep in mind age, visual needs, the main reason for the consultation, and any other relevant factor. It is also necessary to note down a plan of future check-ups in the case file. Treatment plan Future visits

Associated practice Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Practice 1: Case history between fellow students in the group Practice 2: Case history of external patients It is interesting to have the students practice the case history amongst themselves before confronting their first external patient. Practice 1: is done in pairs of students under the supervision of the professor. The questions they ask are as important as the form of note-taking. It is interesting if, once they have done the case history in pairs, it is a different student who presents the case. This will easily help us find out if the case history lacks any relevant information. The objective is that the student presenting the case is capable of realizing an appropriate diagnostic hypothesis Practice 2: It is also appropriate for the students to work in pairs. The objective of this is that they realize the case history on an external patient. Supervision in this case can be carried out by the professor or by another student in a higher level course. NOTE: the way of planning practice 1 is a very good idea. In practice 2, perhaps at the beginning to overcome embarassment they could do it pairs so that they do not forget anything and so that they can support each other; but afterwards they should also work alone, since that will be how they will do it when it is their profession.

Work outside the classroom
Óptico de Atención Primaria (Tahoma 10 negrita y alineado izquierda) Work outside the classroom Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha) Creation of a list of questions to ask in distinct hypotheses: 15-year-old that attends a revision due to loss of far vision 38-year-old adult that attends a revision due to loss of near vision 70-year-old elderly patient that attends a revision for loss of vision

Bibliography Asignatura Número y Título del tel tema (Tahoma 10 negrita y alineado derecha)

Clinical techniques and refraction

Similar presentations

Presentation on theme: "Clinical techniques and refraction"— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

Clinical techniques and refraction

Similar presentations

Presentation on theme: "Clinical techniques and refraction"— Presentation transcript:

Similar presentations

About project

Feedback