Clinical Optometric Procedures – Introduction

CLINICAL OPTOMETRIC PROCEDURES MODULE

INTRODUCTION TO THE OPTOMETRIC EXAMINATION

The optometric examination or refraction is aimed at detecting ocular abnormalities and determining functional corrections for eye defects. The examination must be carried out thoroughly in relation to the specific needs of the patient. In addition to the detection, the practitioner must suggest or provide remedial visual training where necessary and provide advice to the patient on aspects of visual efficiency. The comprehensive eye examination comprises a battery of tests and investigations to elicit the information in order to determine the patient’s needs, provide a diagnosis and offer remediation (if possible) for the problems reported. In addition to performing the tests, equally essential is the recording of information which in most cases is a legal requirement to safeguard both the patient and the practitioner. Ultimately the practitioner must exercise his or her professional judgment in determining which tests are relevant to the specific patient examination given the patient complaints. However, he or she must not lose sight of the tests which are mandatory in order to make a diagnosis regarding the various aspects that are investigated in refraction. These include an assessment of the motor, refractive and sensory systems and an assessment of the ocular health of the patient. List of tests that investigate these various aspects are listed in Appendix 1 at this end of this module.

• Four Key Areas of the Optometric Examination

A: Preliminary Examination

• B: Visual function assessment
• C: Ocular health examination

D: Management plan

Each of these key areas has numerous investigations or procedures which make up the comprehensive optometric examination. The procedures follow a sequential pattern from the eliciting of patient complaints, investigation of tentative diagnoses through a series of problem and patient appropriate tests of eye health, refraction and binocular vision. The formulation of an appropriate management plan is the end result of the assessment process. This approach is sometimes referred to as the “problem-oriented” optometric examination.

• Procedures Incorporated in the Key Areas of Optometric Examination
• A: Preliminary examination
• Patient profile and case history
• Visual acuity
• Near point of convergence
• Cover test
• Motilities and saccades
• Pupil reflexes
• Confrontation fields
• Interpupillary distance measurement
• Colour vision testing International Centre for Eyecare Education
• B: Visual function assessment
• Objective refraction: retinoscopy, autorefraction, keratometry
• Subjective refraction
• Corrected visual acuity
• Measurement of horizontal and vertical phorias
• Fusional vergences
• Fixation disparity
• Accommodation testing
• Stereoacuity
• C: Ocular health assessment
• Fundus examination under non-dilated and dilated conditions
• Slit-lamp biomicroscopy
• Other tests as indicated

D: Management plan

Clinical decision making is an integral part of the management plan. It requires a practitioner’s ability for “clinical judgment, inference and diagnostic reasoning”. The deductive clinical reasoning behind patient care can be systematically managed by employing the “SOAP” format. This acronym stands for Subjective, Objective, Analysis and Plans. This basically translated indicates the practitioner would carefully gather the subjective and objective information gathered from the patient assessment, he would develop an assessment and plan and follow-up for each problem identified during the comprehensive optometric assessment.

Appendix II has a suggested order for performing various procedures in refraction. This has been adapted from Clinical Procedures in Primary Eye Care by DB Elliot. International Centre for Eyecare Education

SECTION A – PRELIMINARY EXAMINATION