FYP for TEAM OPHTHALMOSCOPE

Hi guys,

I hope you are coping well with ITP. Along with the task I have given you previously, can you guys also try to search for as many articles as you can regarding the topic we will be working on for the coming months.

Reason: Once you start reading the articles you will have a better understanding on the equipment you will be using as well as the objective of the project.

Please let me know if you are having any difficulties in collecting the information, journals, etc. Please post some comments so that I know you guys are reading the post.

I would like to meet you guys on the 10th March to check on the progress of "information" collection and to see if we are heading on the right track.

Vertical Cup to disc ratio: Agreement between direct ophthalmoscope, panoptic ophthalmoscope and fundus photo

Just in case you forgot what your FYP project is all about

Vertical and horizontal Cup to disc ratio: Agreement between direct ophthalmoscope, panoptic ophthalmoscope and fundus photo

Aim

Compare accuracy of estimation of vertical and horizontal cup to disc ratio obtained with direct ophthalmoscope, pan optic ophthalmoscope and fundus photo

Clinical Importance

Improvement in judgements of vertical and horizontal cup to disc ratio which is important in the management of patients with glaucoma or who are glaucoma suspects

Thanks guys

Task For Shi Min, Qing Hui and Hui Min

Hi guys,

thanks for the swift completion of your task every week.

Anyways, have a look at the pictures above.

The patient above came in for a general eye examination with no complains.

Name: Jacky Tan Age 6o years old

V/A in both eyes were 6/6

PERRLA results were normal

Silt Lamp: As shown above in both eyes

Ophthalmoscopy: Nothing significant found

List the differential dignosis for each picture and name your most possible diagnosis.

What are your management plans.

Vogt Limble Girdle

White Limbal Girdle of Vogt
Very common, bilateral, age-related condition.
Corneal degeneration.
Clinical features:
Symptoms: asymptomatic and requires no therapy.
Signs:
Crescenteric, white opacities of the peripheral cornea in the interpalpebral zone along the nasal and temporal limbus
May be separated from the limbus by a clear zone or without a clear zone in between

Taken from: http://dro.hs.columbia.edu/vogtlimbal.htm

Review on clinic on the 23 Feb 08 for Fenni and Michelle

1st Patient

Very friendly and chatty man

A patient everyone will like since he has no complains.

Great team work guys!

Near add

• Be careful when prescribing near adds. Look at his age and start the estimation from there.
• Age between 50 - 60 years old estimation of add is between + 2.50 DS- +3.00DS

Silt lamp

• Lens yellowing also term nuclear sclerosis
• Vogt Limbal girdle is just a age related changes. Not sight threatening
• Missed out Arcus

Great job on Ophthalmoscopy and patient rapport.

Can improve on timing

Patient 2

Very sweet old lady

How we start each examination is dependent on patient complaints and also the previous history of patient. Hence it is important to read patient's previous history.

Great job on writing referral letter.

Subjective refraction

• In cases whereby patient is not very sensitive, do not be afraid to use big steps such as +/-1.00DS. It will make your life much easier

Silt Lamp

• It is very IMPORTANT to label what you draw and where you see the defect. Be it on the iris or lens or cornea. Do not ASSUME the next examiner will understand your work of art.

Ophthalmoscopy

• Missed out on pigment changes at the macular region

Management

• Please remember to address all complaints

Task

Please comment on how you will grade yourself on each patient and why.

I will add another short post on vogt limbal girdle and athritis so as to keep you updated on such terms. Please keep a look out for the post as it will benefit you in 3rd year

Please also state one area in which you are not too comfortable with. So as to allow us to better help you.

Review on clinic on the 23 Feb 08 for Amanda and ShiMin

1st patient

Great refraction and history taken.

Near Add

• Important to ask patient what her occupation is and if she requires near add for it. For this particular patient she complained of having problems with reading the newspaper and sewing but no problems at work. Remember to prompt patient or else they will NEVER tell you

Silt lamp

• Missed out on arcus and mild staining
• Could also make an addtional comment regarding her loose lids
• Crystalline lens: Nuclear Sclerosis in both eye instead of cloudiness of lens

Ophthalmoscope

• Missed out on drusen and pigmentary changes at the macula region
• Good estimation of C/D ratio

Management

• Did you teach patient how to do lid scrubbing and warm compresses?
• Can improve on hand writing.
• Important to give summary of the test done and link the results back to her daily routine.
• EG: Patient has poor unaided distant V/A. Important to remind her to wear her glasses when she goes out or advise on a new pair of glasses. If you do not do that and she falls YOU WILL BE HELD RESPONSIBLE.

2nd Patient

Great timing on the 2nd patient

Late 50s man

Similar points as before.To relate what you have done to patient's daily routine.

EG: Patient's distance V/A does not meet driving requirements

Flashes of light important to tell patient's the symptoms of retinal detachment just in case.

Other than that, great job overall.

TASK

Please comment on how much you will grade yourself for each patient and why.

Please note down the areas on where you think you are not so comfortable with eg: refraction or taking a fundus camera etc to enable us to better help you and prepare you for your coming 3rd year.

Message to Michelle,Fenni,Amanda,ShiMin,Sze Yee, Yun Chong, Jacob, AC, Ruo Han

Hi guys,

You guys did great today.You deserve a big pat on the back of your back. Keep up the good work and don't be dishearted. You are on the right path!

I really have to comment on your GREAT LEARNING ATTITUDE! Really proud of you guys!

FYP for Joycelyn, Lilin, Sabrina

Hi guys,

I hope you ITP is going well.

Anyways, I hope you guys have read the email I sent few days ago.

For a start, I would require you guys to do some background reading:

1. Advantages and Disadvantages of Pan Optic Ophthalmoscope
2. Advantages and Disadvantages of Direct Ophthalmoscope
3. Advantages and Disadvantages of Fundus Camera

You can get the information from textbooks, internet and journals. Please remember to note down where you get the information from as that will form part of your references at the end of your write up. Very much preferred that you get as much information as possible from journals. Do let me know if you have any difficulties.

PS: The above is just a guideline, if you find anything interesting regarding the equipements above do include as well. Objective for the background reading is to aid you in writing your introduction and have some prior knowledge before you start your project.

I will also require you guys to do up a draft of consent form for your patients. (Hint: Read the document I sent you, that will roughly give you a guide on what to include in your consent form)

Please complete draft of consent form by 29th Feb 2008.

Please complete reading by the 10th March 2008.

Task For Shi Min, Qing Hui and Hui Min

Hi guys, this will be your task for this week. I assume that you guys have no problems with the 1st task that I have given you?

Task 2

Name May Tan Age 23 years old Wears Monthly Contact lenses Rx -1.00Ds both eyes

Hours of Lens wear: 14/24, 7/7 Uses Opti Free lenses but does not rub lenses

Age of current lenses 1 month and 3 days

Complains: Itchy eyes, Eye looks abit red. Can't wear lenses as long as before. Vision not as clear

V/A: 6/7.5 both eyes

Silt lamp

As above

What are your differential diagnosis?

What are your management plans?


Do let me know if you have any queries. You have my number.

Enjoy the task.

When was the last time you visited your Optometrist?

Something for you guys to sit back and relax after a long day of clinic.

You deserve it!

Too Short a Lunch Break?

Hello Everyone,

I hope the 2nd day of clinic has been a better day for you guys.

Just need some feedback from you guys on a few things

1. Is the Lunch break too short?
2. What is one thing about clinic you find most challenging?

Guys please do post comments so as to allow us to make necessary ( if possible) changes for a more enjoyable clinic in the future.

IMPORTANT

Hey guys,

as I was saying, please do feel free to pen down your thoughts and experiences. However, please be responsible of the comments you post.

A few guidelines

1. No Vulgarities
2. No sharing of patient details
3. No cursing or swearing of patients or clinicians or fellow classmates

Rule of thumb:

Ensure that whatever you post is not going to hurt anyone directly or indirectly and that it is not against the law.

Thanks

YourFriendlyLecturer

Coloured eyes?

Please do not do this to your patients.... I don't think your patients will appreciate it.

Poly 50

Greetings!

Although Poly 50 is still some time away, please train for poly50. Continue the tradition! Thats a picture of my classmates and I during our Poly days! I'm proud to say that during my 3 years in Poly, we have participated every year in the poly 50.

We have spied that Ruth and company does secret trainings every week. Hmm....

Hi guys, this is my artist impression of our friendly and cool west coast dudes!

Some quickies on directions

Take a train to Clementi MRT station

Take either bus number 189 or 175 from the bus stop opposite Mcdonalds.

After 2 stops, alight the bus

We are located in West Coast community centre #02-01

Still unsure if directions? Please call hotline number 67769058

Welcome

Hello everyone! This is crazy clinic's first entry. This blog is for everyone to share your clinic experiences with everyone. Be it good or bad. Of course if you have any interesting, bad good experience, feel free to share it. There is no right or wrong here!

If you have any interesting information that you think will benefit everyone, do post it as well.

Questions are more than welcome. Anyone is free to answer to the questions!

I will also try to post pictures of you guys in clinic. So watch out for the snapping camera. Make sure you are looking your best. You never know when I will be around to snap you! hahaha