Visual and /or ocular problems : the importance of multidisciplinarity

1. Visual and/or ocularproblems: the importance of multidisciplinarity

2. WHO: “The processbywhich a group of workersfrom health relatedoccupationswith different educational backgrounds are abletocollaborate in providingpreventive, curative, rehabilitativeandother health-related services.”

3. Professionals • Optician-optometrist • Ophthalmologist • General practitioner • Specialist • Psychologist • Speech pathologist • Occupationaltherapist • Physiotherapist • (CLS) • Osteopath • Homeopath • Others

4. Competences: • Expert • Communicator • Teamplayer • Care provider • Longlifelearning

5. Expert • Aware of his professional expertise • Aware of his boundaries • Aware of the expertise fromothers • Seeksandreads relevant information on a regular base

6. Communicator • Developsanethicaland “therapeutic” relation (based on trust) with the patient/clientandwithcolleaguesfromother disciplines • Givesandanalyzes relevant information and shares thiswithcolleagues • Communicatesandclarifies(patients/clients+ colleagues) • Communication is oralandwritten

7. Teamplayer • Collaborateswithother team members avoiding conflicts andoptimizing care • Places the patient/clientin the central of the treatment plan

8. Care provider • Takes individualquestionsandneedsinto account (patients/clients/other team members) • Contribuestocontinuousimprovement of generalandspecific health problems

9. Longlifelearning • Maintainsandcontinuouslyimprovesmultidisciplinaryactivities • Evaluatesconstantlyandcritically the obtainedresultsandusesthese results in team • Stimulatesthis attitude in encouragingothers • Contributes to continuous improvement of care

10. Types of problems: • Physical • Physiological • Psychological • Pathological • Personal • Other

11. Multidisciplinarityimplies: • Exchange of information • Exchange of ideas • Exchange of recommandations • Common vision/mission • Adequate treatment plan

12. Multidisciplinarity • Refer/send • Recieve • Both

13. Optician-optometrist • Optician • Optometrist • Behavioural optometrist • Contact lens specialist • Low visionspecialist

14. Opticianrefers • Optometrist • Behavioural optometrist • Contact lens specialist • Low visionspecialist • Ophthalmologist • General practitioner

15. Opticianrefers • Physicalproblem: no ears: refertocontact lens fitting • Physicalproblem: insufficientconvergence: refertothe behavioural optometrist • Pathologicalproblem: red eyes: referto the ophthalmologist

16. Optometrist refers • Optician • Behavioural optometrist • Contact lens specialist • Low visionspecialist • Ophthalmologist • General practitioner

17. Optometrist refers • Physiologicalproblem: photophobiarefertothe ophthalmologist • Physicalproblem: torticolis (spasmodic) refertothe behavioural optometrist • Pathologicalproblem: exophthalmia(unilateral) refertothe ophthalmologist

18. Behavioural optometrist refers • Ophthalmologist • Speech pathologist • Psychologist • Physiotherapist • Optician • Contact lens specialist

19. Behavioural optometrist • Hysterical amblyopia: • Simulatedamblyopia • Real amblyopia (hysterical) • StreffSyndrome • Dyslexiaanddyscalculia • Reading problems

20. Behavioural optometrist Hysterical amblyopia: • Monocularloss of vision • Accommodationspasm • Changing pupil • Nervousness Prescribe“Relaxing” convex lenses Refertothe psychologist, the neurologist

21. Behavioural optometrist StreffSyndrome: • Loss of visionto 4/10 • Eyestrain • Headache • Lack of concentration Prescribe“Relaxing” convex lenses Refertothe psychologist, the neurologist, the general practitioner (hormonal)

22. Behavioural optometrist • Dyslexiaanddyscalculia: Refertothe speech pathologist, the psychologist • Reading problems: Refertothe speech pathologist, the psychologist

23. Contact lens specialist refers • Behavioural optometrist • Low visionspecialist • Ophthalmologist • General practitioner • Others • Optician

24. Contact lens specialistrefersto The ophthalmologistand/or the generalpractitioner • Keratoconus • Refractivesurgery • Trauma • Pathologies(Blepharitis, allergies, herpes, pterygium, ...)

25. Low visionspecialist refers • Behavioural optometrist • Occupationaltherapist • Psychologist • Ophthalmologist • General practitioner • Optician

26. Low Vision specialist refersto The psychologist Different stages: • Denial • Anger • Sadnessanddepression • Acceptance

27. Low Vision specialist refersto The occupationaltherapist Using magnifyingdevices: • Monoculars • Reading magnifiers Gettingaround: • Using a whitecane

28. Multidisciplinarityimplies: • Exchange of information • Exchange of ideas • Exchange of recommandations • A goodstructure of the file!!! • A goodstructure of the protocol!!!

29. The protocol of the behavioural optometrist contains: As much information as possible: • Data from the patient/client • Refraction • Tests performed • Proposedsolutions (glasses, training exercises...) • Results • Practical information forteachers • ...

30. Creating a good file • To record the acts of the optometrist • The patient has right toinspection • The optometrist shouldbeabletodemonstrate his recommandationsafterwards

31. Creating a good file • Medical data may not be communicated to third parties unless the patient requests it in writing • Save the file no longer than 10 years after the last visit of the patient (some countries)

32. A good file contains: • Personal data of the patient • Ophthalmic diagnosis • Inventory of existingdevices (as complete as possible) • Anamnesis: extensivequestioning • How is the patient’sparticipation? • Whatactivities are limited? • Inventory of activities

33. Activities list with ICIDH categories • See and recognize • Learn, apply knowledge and tasks • Communicate • Moving activities • Move (from one place to another)

34. Activities list with ICIDH categories 6. Activities of daily living 7. Household activities 8. Interpersonal behavior 9. Deal with special situations 10. Use of visual and/or other technology

35. A good file contains: • Finding out the participation • 1. In home care2. In mobility3. In exchanging information4. In social relationships5. In education, work, leisure and spirituality6. In civil and social life

36. Finding out the participation The patient "chooses" its own category of participation based on what he considers important!

37. A good file contains: • Evaluation of existing visual aids- Some activities require specific visual aids- Estimation of the "possible increase" of activity: often differs between the optometrist and the patient (much more positive than the reality)- Visual aids quickly reach their limits of potential

38. Evaluation of existingvisual aids Education: Advantages and disadvantages • Understanding the benefits: • Visualization of details • Enlarge

39. Evaluation of existingvisual aids Education: Advantages and disadvantages • Understandingthe disadvantages: • Physicalboundaries (vision) • Practicallimits (unaesthetic, heavy, ...) • Technical limits (diameter of a magnifier) • Others (rheumatism, spasms, emotional objections)

40. A good file contains: • Observation of the patient • Independance in movement (correlation peripheral vision) • Position of the head • Movement to observe something/somebody

41. A good file contains: • Low vision examination • Screening • Objectiverefraction • Subjectiverefraction (trial frame) • Contrast sensitivity for near (newsprint) • Visual field • Selection of devices (visual aids) • Testingvisual aids

42. Low vision examination • General instructions(selectingandtesting) visual aids • Magnifiers • Hand-held • Stand magnifiers • Mounted in a frame • Telescopic systems • Kepler • Galileï • Electronic devices

43. Finding out the participation For what purpose the patient is doing activities?If the answer to this question is unknown, the recommended devices are probably not adequate but for a complete other purpose (other forms of participation) than actually needed.

44. Thankyou !