visual and /or ocular problems : the importance of multidisciplinarity
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Visual and /or ocular problems : the importance of multidisciplinarity. - PowerPoint PPT PresentationTRANSCRIPT
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Visual and/or ocular problems: the importance of multidisciplinarity
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WHO: “The process by which a group of workers from health related occupations with different educational backgrounds are able to collaborate in providing preventive, curative, rehabilitative and other health-related services.”
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Professionals• Optician-
optometrist• Ophthalmologist• General practitioner• Specialist• Psychologist• Speech pathologist
• Occupational therapist
• Physiotherapist• (CLS) • Osteopath • Homeopath• Others
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Competences:• Expert• Communicator• Teamplayer• Care provider• Longlife learning
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Expert• Aware of his professional expertise• Aware of his boundaries • Aware of the expertise from others • Seeks and reads relevant information
on a regular base
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Communicator• Develops an ethical and “therapeutic” relation
(based on trust) with the patient/client and with colleagues from other disciplines
• Gives and analyzes relevant information and shares this with colleagues
• Communicates and clarifies (patients/clients + colleagues)
• Communication is oral and written
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Teamplayer• Collaborates with other team
members avoiding conflicts and optimizing care
• Places the patient/client in the central of the treatment plan
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Care provider• Takes individual questions and needs
into account (patients/clients/other team members)
• Contribues to continuous improvement of general and specific health problems
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Longlife learning• Maintains and continuously improves
multidisciplinary activities • Evaluates constantly and critically the
obtained results and uses these results in team
• Stimulates this attitude in encouraging others • Contributes to continuous improvement of
care
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Types of problems:• Physical• Physiological• Psychological• Pathological• Personal• Other
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Multidisciplinarity implies:• Exchange of information• Exchange of ideas• Exchange of recommandations
• Common vision/mission • Adequate treatment plan
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Multidisciplinarity Refer/send
Recieve
Both
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Optician-optometrist• Optician• Optometrist• Behavioural optometrist• Contact lens specialist• Low vision specialist
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Optician refers • Optometrist• Behavioural optometrist• Contact lens specialist• Low vision specialist • Ophthalmologist• General practitioner
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Optician refers • Physical problem: no ears: refer to contact
lens fitting
• Physical problem: insufficient convergence: refer to the behavioural optometrist
• Pathological problem: red eyes: refer to the ophthalmologist
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Optometrist refers • Optician• Behavioural optometrist• Contact lens specialist• Low vision specialist • Ophthalmologist• General practitioner
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Optometrist refers • Physiological problem: photophobia
refer to the ophthalmologist
• Physical problem: torticolis (spasmodic) refer to the behavioural optometrist
• Pathological problem: exophthalmia (unilateral) refer to the ophthalmologist
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Behavioural optometrist refers • Ophthalmologist• Speech pathologist • Psychologist• Physiotherapist • Optician • Contact lens specialist
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Behavioural optometrist • Hysterical amblyopia:
– Simulated amblyopia – Real amblyopia (hysterical) – Streff Syndrome
• Dyslexia and dyscalculia
• Reading problems
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Behavioural optometrist Hysterical amblyopia: • Monocular loss of vision • Accommodation spasm • Changing pupil • Nervousness
Prescribe “Relaxing” convex lenses Refer to the psychologist, the neurologist
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Behavioural optometrist Streff Syndrome: • Loss of vision to 4/10• Eyestrain • Headache • Lack of concentration
Prescribe “Relaxing” convex lenses Refer to the psychologist, the neurologist, the general practitioner (hormonal)
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Behavioural optometrist • Dyslexia and dyscalculia:
Refer to the speech pathologist, the psychologist
• Reading problems: Refer to the speech pathologist, the
psychologist
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Contact lens specialist refers • Behavioural optometrist• Low vision specialist• Ophthalmologist• General practitioner • Others • Optician
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Contact lens specialist refers to The ophthalmologist and/or the general practitioner
• Keratoconus • Refractive surgery • Trauma • Pathologies (Blepharitis, allergies, herpes,
pterygium, ...)
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Low vision specialist refers • Behavioural optometrist • Occupational therapist • Psychologist• Ophthalmologist• General practitioner • Optician
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Low Vision specialist refers to The psychologist
Different stages:• Denial • Anger • Sadness and depression • Acceptance
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Low Vision specialist refers to The occupational therapist
Using magnifying devices: • Monoculars • Reading magnifiers
Getting around: • Using a white cane
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Multidisciplinarity implies:• Exchange of information• Exchange of ideas • Exchange of recommandations
• A good structure of the file!!!• A good structure of the protocol!!!
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The protocol of the behavioural optometrist contains: As much information as possible:
– Data from the patient/client – Refraction– Tests performed – Proposed solutions (glasses, training exercises ...) – Results– Practical information for teachers – ...
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Creating a good file • To record the acts of the optometrist
• The patient has right to inspection
• The optometrist should be able to demonstrate his recommandations afterwards
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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)
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A good file contains:• Personal data of the patient • Ophthalmic diagnosis• Inventory of existing devices (as complete
as possible)• Anamnesis: extensive questioning – How is the patient’s participation? – What activities are limited?
• Inventory of activities
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Activities list with ICIDH categories
1. See and recognize2. Learn, apply knowledge and tasks3. Communicate4. Moving activities5. Move (from one place to another)
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Activities list with ICIDH categories
6. Activities of daily living7. Household activities8. Interpersonal behavior9. Deal with special situations10. Use of visual and/or other
technology
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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
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Finding out the participation
The patient "chooses" its own category of participation based on what he considers important!
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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
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Evaluation of existing visual aids
Education: Advantages and disadvantages
– Understanding the benefits:
• Visualization of details• Enlarge
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Evaluation of existing visual aids
Education: Advantages and disadvantages
– Understanding the disadvantages: • Physical boundaries (vision)• Practical limits (unaesthetic, heavy, ...)• Technical limits (diameter of a magnifier)• Others (rheumatism, spasms, emotional objections)
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A good file contains:• Observation of the patient– Independance in movement
(correlation peripheral vision)– Position of the head – Movement to observe something/somebody
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A good file contains:• Low vision examination– Screening– Objective refraction– Subjective refraction (trial frame)– Contrast sensitivity for near (newsprint)– Visual field– Selection of devices (visual aids)– Testing visual aids
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Low vision examination• General instructions (selecting and testing) visual
aids – Magnifiers
• Hand-held• Stand magnifiers• Mounted in a frame
– Telescopic systems• Kepler• Galileï
– Electronic devices
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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.
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Thank you !