TIPS FOR A BETTER EYE EXAM Emily Schmidt COT I have no relevant - - PowerPoint PPT Presentation
TIPS FOR A BETTER EYE EXAM Emily Schmidt COT I have no relevant financial or nonfinancial relationships in the products or services described, evaluated or compared in this presentation. HOW COMMON IS NYSTAGMUS? A. 1 in 1,000 B. 1 in
TIPS FOR A BETTER EYE EXAM
Emily Schmidt COT
I have no relevant financial or nonfinancial relationships in the products or services described, evaluated or compared in this presentation.
HOW COMMON IS NYSTAGMUS?
The answer may surprise you…
According to the 2010 census the Minneapolis, St Paul metropolitan area population was 3,759,978 and 7.139 billion in the world. This means there are 3,760 people in the twin cities with nystagmus and 7,139,000 worldwide.
NYSTAGMUS GROUPS
Congenital Acquired Sensory Neurological
NYSTAGMUS FORMS
Manifest Latent Manifest-Latent
KINDS OF NYSTAGMUS NYSTAGMUS SUBTYPES
49 different subtypes
Congenital=lifelong 1 exception Spasmus Natans Acquired=???
ASSOCIATED CONDITIONS: CONGENITAL
Congenital Cataract Optic nerve hypoplasia Aniridia Severe refractive error Retina coloboma Other optic nerve and retina disorders Albinism (both regular and ocular) Fetal alcohol syndrome Idiopathic…
Duration
ASSOCIATED CONDITIONS: ACQUIRED
Medication use Vitamin deficiency Trauma Inner ear (vestibular) problems Stroke (most common cause in older people with acquired nystagmus Brain tumor (rare cause of acquired nystagmus) Multiple sclerosis Chiari Malformation NEVER IDIOPATHIC!!!
SOMEONE
WITH
CONGENITAL
NYSTAGMUS
SEE THE WORLD???
TYPES OF NYSTAGMUS MOVEMENTS
WAYS TO CAUSE TEMPORARY NYSTAGMUS
Rapid head shaking or spinning Optokinetic drum or the railroad effect
NYSTAGMUS MANAGEMENT METHODS
Correct vision with Rx if needed
Surgery
Prisms
Medications
Botox
reduced accommodation
High minus contacts with high plus glasses
Management Approach Examples
Oral Medications Gabapentin Memantine 4-aminopyridine 3,4-diaminopyridine Baclofen Clonazepam Valproate Trihexyphenidyl Benztropine Scopolamine Isoniazid Carbamazepine Barbiturates Alcohol Acetazolamide Brinzolamide (topical) Cannabis
Nystagmus Type Medication Common Side-Effects Peripheral Vestibular Nystagmus Treatment of underlying disorder Not applicable Downbeat Nystagmus 4-aminopyridine
3,4-diaminopyridine
Clonazepam Dizziness, paresthesias, incoordination Dizziness, paresthesias, incoordination Drowsiness, dizziness, incoordination Upbeat Nystagmus Memantine 4-aminopyridine Baclofen Lethargy, dizziness, headache Dizziness, paresthesias, incoordination Drowsiness, dizziness, lethargy
Nystagmus Type Medication Common Side-Effects Torsional Nystagmus Gabapentin Dizziness, incoordination, drowsiness Seesaw Nystagmus Alcohol Clonazepam Memantine Drowsiness, incoordination, vomiting Drowsiness, dizziness, incoordination Lethargy, dizziness, headache Periodic Alternating Nystagmus Baclofen Memantine Drowsiness, dizziness, lethargy Lethargy, dizziness, headache Acquired Pendular Nystagmus in MS Gabapentin Memantine Dizziness, incoordination, drowsiness Lethargy, dizziness, headache Acquired Pendular Nystagmus in OPT Gabapentin Memantine Trihexyphenidy Dizziness, incoordination, drowsiness Lethargy, dizziness, headache Dry mouth, blurred vision, dizziness
MANAGEMENT METHODS SUMMARY
All methods can yield similar results
Nystagmus may be lessoned but never gone Vision may be improve by up to 4 lines, 1 to 2 is more common, or it may not improved at all Drugs for acquired are mainly used to reduce
***LISTEN TO YOUR PATIENT!!!*** Let them use their null point Slow down, Slow down, SLOW DOWN!!!!!!!!!
Low vision does not equal low IQ Watch out for memorization Not everyone with nystagmus has a latent component Let them hold the near card where they want Always check binocular vision
Single vs double occluder??? Null point=single occluder Large movement=single occluder
Black vs Translucent Translucent patch occluder Clip on occluders Handheld pinhole Clip on pinhole
PHOROPTER VS TRIAL FRAMES
Null point=Trial frames Large movement=Trial frames Latent component=Trial frames*** Black occluder lens Pinhole lens Plus lens
OCT, fundus photos, visual field, topography, IOL master, etc…
Breath, don’t panic Adjust the machine to the patient Don’t get frustrated Use comment boxes Accept that you may not get a perfect test
THE UNNECESSARY “NECESSARY TESTS”
Ø Non Contact Tonometry Ø Autorefractors
2 Common Patient Surgery Questions
? Can I have LASIK ? Can I have cataract surgery
REFERENES
http://www.allaboutvision.com/conditions/nystagmus.htm http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1279675/ http://webeye.ophth.uiowa.edu/eyeforum/tutorials/Nystagmus/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1279676/ http://content.lib.utah.edu/utils/getfile/collection/ehsl- nam/id/47/filename/image http://www.aapos.org/terms/conditions/80 http://emedicine.medscape.com/article/1199177-overview#a0101 http://en.wikipedia.org/wiki/Nystagmus
RESOURCES FOR PATIENTS
American Nystagmus Network (ANN):
http://nystagmus.org/new/index.php
ANN Facebook Group Nystagmus Network (NN) UK based:
http://www.nystagmusnet.org/cms/
Nystagmus United Facebook group