1 / 18

Case Analysis I- Lecture 6

Liana Al-Labadi, O.D. Case Analysis I- Lecture 6. If you hear hoof beats, think horses—not zebras. The Dissatisfied Patient. A 78yo PF c/o persistent poor vision with new specs F requency: Constantly (all the time, everyday) @ D&N O nset: Since she got the specs L ocation: Both eyes

nova
Download Presentation

Case Analysis I- Lecture 6

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Liana Al-Labadi, O.D. Case Analysis I- Lecture 6

  2. If you hear hoof beats, thinkhorses—not zebras

  3. The Dissatisfied Patient • A 78yo PF c/o persistent poor vision with new specs • Frequency: Constantly (all the time, everyday) @ D&N • Onset: Since she got the specs • Location: Both eyes • Duration: Notices it all the time • Associated Factors: • No other symptoms • Relief: None • Old specs are just as bas as the new ones • Severity: N/A

  4. DIFFERENTIAL DIAGNOSIS????

  5. The Dissatisfied Patient • POH: • Negative for HA, DIPL, asthenopia, surgery, trauma, pain, F&F • Negative for AMD, DR & Glc • Positive for Cataracts OU • Fears surgery because of “weak” heart • LEE: 3 weeks ago by Dr. Curtis • FOH: Negative for AMD, DR, Glc, Cat • LPE: Last year by Dr. Nixon; 2 months ago saw “nutritionist” • PMH: Negative for HTN/DM/Cancer/Neuro • FMH: (+) HTN- parents; (+) DMII- father • MED: Dietary supplements • Allg: NKDA; No seasonal allergies • SH: Reading • Occupation: Retired • No alcohol consumption & no smoking

  6. Entrance Testing????

  7. The Dissatisfied Patient • Entrance Testing: • Lensometry (New glasses): • OD: +3.00 -1.00x 090 • OS: +3.25 -1.25x 090 +2.50 add • Lensometry (Old glasses): • OD: +2.25 -1.00x 090 VA: 20/40 • OS: -+2.75 -1.25x 090 VA: 20/40 +2.50 add

  8. The Dissatisfied Patient • Entrance Testing: • DVA (c): 20/30 OD; 20/25 OS • NVA (s): 20/30 OU • Motility: S&F OD, OS • Confrontations: Full OD, OS • Pupils: 4mm/4mm RRL OD, OS; No APD

  9. Additional Testing????

  10. The Dissatisfied Patient • Cover Test: • (D) : 2pd XP • (N): 2pd EP • Retinoscopy: • OD: +3.00 -1.00x 090 • OS: -+3.25 -1.25x 090 • Manifest Refraction: • OD: +3.00 -1.00x 090 VA: 20/30 • OS: -+3.25 -1.25x 090 VA: 20/25 • Add: +2.50 add (20/25)

  11. Additional Testing????

  12. The Dissatisfied Patient • SLE: • L/L: Quiet OD, OS • Conj: No injections OD, OS • K: Clear OD, OS • Iris: Flat & brown OD, OS • AC: No cell & no flare/ D&Q OD, OS • Lens: • OD: 2+ NS; trace-1+ cortical; tr PSC • OS: 1+ NS; tr cortical • IOP (TA): • 15mmHg OD; 15 mmHg OS @ 1:30pm • DFE: Unremarkable OD, OS

  13. FINAL DIAGNOSIS

  14. The Dissatisfied Patient • Assessment: • Visually significant cataracts OD>OS • Pt fears surgery 2˚ “weak heart” • Compound hyperopic astigmatism OU with presbyopia • Difficulty seeing with new specs • Plan: • Recommend PE IOL OD then OS • Discuss R&B/A-scan measurements/IOL options • Discuss limitation of new specs in the presence of cataracts/

  15. The Dissatisfied Patient • Exert care in advising what benefit the patient can expect with the new correction • Use trial lenses to demonstrate change or no change with the new specs vs. the old specs • Indicate to these patients that this is the best corrected vision possible

  16. Trace: 20/20 Trace-1: 20/20-20/25 1+2-: 20/30-20/40 2-2+: 20/50-20/60 3:20/70-20/100 4:20/100 or worse Nuclear Sclerosis- Grading Trace: 20/20 Trace-1: 20/20-20/25 1+2-: 20/30-20/40 2-2+: 20/50-20/60 3:20/70-20/100 4:20/100 or worse

  17. Trace: 20/20 Trace-1: 20/20-20/25 1+2-: 20/30-20/40 2-2+: 20/50-20/60 3:20/70-20/100 4:20/100 or worse Cortical Cataracts- Grading Trace: 20/20 Trace-1: 20/20 2-2+: 20/25 2+-3: 20/30-20/40 4:20/60 or worse

  18. Trace: 20/20 Trace-1: 20/20-20/25 1+2-: 20/30-20/40 2-2+: 20/50-20/60 3:20/70-20/100 4:20/100 or worse Posterior Subcapsular Cataracts- Grading 1:20/25 2—2: 20/25-20/40 2+: 20/30-20/60 3: 20/60-20/100 4: 20/200 or worse

More Related