9/4/2012 Vision Screening Minimalism The Eagles Eye Mobile, and - - PDF document

9/4/2012 1

Carter Liotta, OD

• St. Christopher’s Hospital for Children

Staff Optometrist, Eagles Eye Mobile  Vision Screening Minimalism  The Eagles Eye Mobile, and what

we offer An eye health first aid kit: What

 An eye health first-aid kit: What

every nurse should have and why

 Pinkeye, lumps and bumps  Optic nerve largeness

 PA Code mandates snellen

vision screening yearly.

 DOH Procedures Manual guides

nurses toward plus lens testing and depth perception testing

• nce, preferably in 1st grade.

 Color vision testing is

recommended, but not required.

 Your vision screenings must

include eye chart testing. Y i i i h ld

In other words…

 Your vision screenings should

ideally include plus-lens and stereopsis testing if never if never done done be befo fore.

 Prioritize color vision screenings

last.

 Beginning in October, for

Elementary and Middle Schools

 One-day as-many-as-we-can-

see vision screenings see vision screenings

 Eye Mobile staff  Team of volunteers  Overseen by the nurse  …and by Dr. Liotta.  Schools with least nurse

coverage prioritized first

 Distance and Near Acuities  Eye Alignment  Depth Perception  Autorefraction (plus lens)  Students will pass, be referred to  Students will pass, be referred to

EEM, or be referred to

• phthalmology through the

nurse.

 Dawn keeps paperwork at the end

• f the day; nurse gets it back in
• ne week.

 Results are entered into the e-

record system by the nurse.

9/4/2012 2

 A central, localized room to

which students can be called down en masse.

 Administrative support  Support from teachers for about

20 minutes.

 Lots of help identifying kids,

calling down classrooms, and moving them through.

 The Eagles Eye Mobile serves

Elementary and Middle Schools in the SDP, subject to the economics

• f the surrounding area.

 Children who fail your vision

i d h b screening and have not been seen

• n the Eye Mobile in the past school

year may use the service.

 Consent is needed from the

parents.

 Glasses and initial follow-up, if

needed, are at no cost to the kids and their families.

 All of the kids in the school

are screened. Some do not pass.

 Consents go home for kids

h d t who do not pass.

 When 20+ consents have

been returned, nurse confirms Eye Mobile visit with outreach worker.

 Eye Mobile visits the school.  Most kids needing glasses will

receive them within 3 weeks.

 The optician will call you to

schedule the fittings.

 Some kids will need more  Some kids will need more

advanced care.

 They may or may not get

glasses first.

 Referral consents will be given

to you. Send them home, and when they come back we will schedule the referral bus.  Know your secondary

contact.

 Be mindful of how long

g screenings take before scheduling with Dawn.

 Treatment of common eye

conditions in your office is l d b ’ limited, but it’s surprising what you can diagnose and treat with little equipment.

9/4/2012 3

 A penlight  A small magnifying glass  An ice pack  Saline solution

Bland ophthalmic

 Bland ophthalmic

• intment

 Q-Tips  Baby Shampoo  Cup and Tape  Your hand  A Pen

A Pen an and Pad d Pad

 Can be used to “shed light on the

situation,” and in combination with a magnifying glass.

 Can be used as a fixation target

as a child looks up, down, left right etc right, etc.

 Can be used to check pupils for

• dilation. Should constrict.

 Check each eye individually,

looking for the same response in either eye.

 Shine light into one eye and look

at the other. The eye wi with thout the light should constrict as much as the one wi with th the light in it.

 Bumps, bruises and the

• ccasional periorbital hematoma.

 Use your penlight.  Subconjunctival hemmorage is

common, and will resolve. H h i NOT d i

 Hyphema is NOT a good sign,

and should be sent to the ER.

 Ice packs can also be used to

help relieve seasonal allergy and conjunctivitis (pinkeye) – just dispose of it when finished.

 Ice packs can be effective

placebo treatments

 Cup and

Cup and tape tape foreign objects.

 Bland, Bland, Bland!  Saline, especially in “Sensitive

Eyes” formulation, is great for flushing & rinsing contacts.

 Large bottles should be replaced

yearly yearly.

 Smaller bottles can be squeezed

• nto the back of school

administrators pants, unnoticed.

 Eye lubricant is often marketed

as “night time” lubricant.

 The thickness, dotted on a Q-tip,

can help remove foreign bodies.

 Remember: For an acid or base

burn to the eye (cleaning agents, bleach, etc)…

 Run under lukewarm tap water

for 15 minutes.

 Find out EXACTLY what got into  Find out EXACTLY what got into

the eye, if you can.

 Call the nearest eye hospital ER

for further instruction.

 Use on a washcloth

to gently clean

• ozing, crusty eyes.

 Use with a Q-Tip to

Q p help control blepharitis

 “No Tears” formula  No Conditioner!

9/4/2012 4

 Your hand is a powerful tool in

determining the severity of an eye

• turn. Please wash it first.

 Have the student look at your nose.

Cover the eye staring at you.

 Does the turned eye take up

y p fixation?

 When you uncover the eye, what

happens?

 Constant vs. Intermittant  Alternating vs. R or L  Eso vs. Exo  Pair this information w/ Depth

Perception.

 A pen and pad are crucial in the

nurse’s office, for two reasons.

 Patient History (Dr. Flops)

• Duration – How long does it last?
• Relief? – What brings relief?
• Frequency – How often does it happen?

Frequency How often does it happen?

• Laterality/Location
• Onset – When did it start?
• Pain – Scale of 1-10
• Symptoms?

 Document, Document, Document!!

 The public at large is horrified of pinkeye, or

conjunctivitis

 More likely to get questions, comments and

calls from parents about a pinkeye epidemic than a contagious stomach flu.

 Conjunctivitis comes in three flavors

• Allergic
• Bacterial
• Viral

 Allergic conjunctivitis follows most major

seasonal allergy symptoms. It is not contagious

 Treatment includes systemic medication that

may already be taken (Claritin, Benadryl)

 Cool compresses  Artificial Tears  OTC Drops – Zaditor or Alaway

• recommended. Visine advised against for

more than very occasional use.

 Hallmark of Bacterial conjunctivitis is slimy discharge.

Lids stick together, and heavy crusting – especially in morning.

 Gritty, itchy and sometimes painful.  Can affect one or both eyes.  Treatment with antibiotics is indicated, but overused.

, Inform the parent that a doctor visit is necessary and an antibiotic needed, just to cover your bases.

 When parents ignore your advice, remember that even

without treatment, bacterial conjunctivitis will generally self-resolve unless the bacterial strain is stubborn. Studies show that antibiotics reduce duration from 4.8 to 3.3 days.

 Viral conjunctivitis is the most

common form of “pinkeye.”

 The stereotype of pinkeye spreading

like wildfire is based on viral conjunctivitis, which spreads like any virus or common cold.

 Lids may be crusty with some  Lids may be crusty with some

discharge, but not thick and yellow. Eyes appear pink (not red) watery, and glazed.

 Follicles (bumps) under the lid are a

hallmark.

 Don’t share towels and washcloths  Use artificial tears and warm

compresses

 Should self-resolve in 3 weeks.

9/4/2012 5

 Should I keep my child home from

school? For how long?

 There is no clear-cut answer.

All of that being said, the $64,000 question about pinkeye is…

 There is no clear cut answer.  If a child is school-age and can be

good about washing his/her hands, there’s no reason to keep them out

• f school.

 Toddlers, preschoolers, and younger

kids may more easily transfer germs.

 If keeping them at home, they may

return when the visible symptoms subside, usually in a few days.  Excessive pain, chronic blur and prominent

light sensitivity are generally not symptoms

• f basic conjunctivitis, and may be signs of

a more serious eye condition.

 An antibiotic/steroid combination such as

Tobradex Zylet or Maxitrol ($4) can ease Tobradex, Zylet or Maxitrol ($4) can ease redness in more mild cases of

• conjunctivitis. An eye exam is needed first.

 Parent education that most cases of pinkeye

are “a cold in the eye” can ease tensions, but where diagnostic abilities are limited, refer!

 Very common in kids.  Two varieties:

Chalazion and H d l ( t ) Hordeolum (stye)

 Caused by gland

blockages in the eye lid.

 Acute Onset  Hordeolum are Hot and

they Hurt

 Why? Because they’re a

bacterial infection

 Usually a small bump on

the margin of the eye.

 Avoid makeup, eyeliner,

etc.

 Warm compress  Do not try to pop it.  Chronic  Blocked meibomian

gland

 Painless  Some resolve with

warm compress

 Some have to be

surgically removed and biopsied.

 A hordeolum, if not

treated, can become a chalazion

 Optic nerve is the “pipe” that

connects your eyes to your brain.

 The opening of the pipe

(“cup”) should be smaller than the walls of the pipe (“disc”).

 In glaucoma a larger cup  In glaucoma, a larger cup

could indicate disease

 African-Americans often have

larger cups, which can be confused for glaucoma

 When this happens, it is

prudent for more tests to be run.

 Eye pressure tests, photos,

and a visual field

9/4/2012 6

 Please ask any questions you may have at this

time

 Thank you for your time and attention!