Download We have no budget for this eye screening.

Introduction
Screening Details
• Reporting time: 0800 hours
• Date: 8th December 2013
• Time: 0900 – 1300
• Venue: Senja-Cashew Community Centre Multi-Purpose Hall
• Address: 101 Bukit Panjang Road Singapore 679910
• Contact person: Ms Wong Lai Peng
• Contact Number: 6219 4561
• Contact Email: [email protected]
Dress Code
• School of Health Sciences Polo Shirt
• Long Pants/Jeans
• Covered shoes
Budget
We have no budget for this eye screening.
Light refreshments
Light refreshments were provided by the Community Centre.
Analysis of data
A total of 105 participants were screened, ranging from age 3 to 79 years old.
A total of 7 paediatrics(7%), 23 adults (22%), 75 geriatrics (71%) were screened.
Paediatrics: age 16 years old and below
Geriatrics: age 50 years old and above
Adults: age between 17 to 49 years old
Participant History
Referrals
39 participants were referred to NPOC and 6 were referred to Ophthalmologist.
Reasons for referral to NPOC
Retinopathy include drusens, exudates, etc.
Maculopathy includes Age-related Macular Degeneration, drusens or exudates within macular
area, macular pigment changes, etc.
Suspicious C/D ratio include large C/D ratio and large difference in C/D ratio of both eyes.
Suspicious intra-ocular pressure (IOP) include high IOP and large difference in IOP between
both eyes.
Others consists of large exophoria and narrow Van Herick angle
15 participants were referred for cataract.
7 participants were referred for poor VA.
8 participants were referred for retinopathy.
7 participants were referred for maculopathy.
5 participants were referred for suspicious C/D ratio.
4 participants were referred for suspicious IOP.
2 participants were referred for pterygium.
3 participants were referred to have an eye examination at NPOC.
2 participants were referred for other reasons.
Reasons for referral to Ophthalmologist
2 participants were referred for cataract.
2 participants were referred for diabetic retinopathy.
1 participant was referred for maculopathy.
1 participant was referred for glaucoma suspect.
1 participant was referred for ocular motility problem.
Learning Points
After the eye screening, our team have learnt to be aware of all stations’ criteria (pass/fail) and
happenings so better update ourselves and to troubleshoot if any problems arises. This also
helps us in interpreting results from all the other stations if the student helper did not record
clearly. A good eye screening recording form is important to allow proper recordings of student
helpers’ findings, and to let the other helpers better interpret the conditions of the participants.
Punctuality was emphasized our team as we felt that it allows the eye screening to run smoothly
and on time. This also made us accountable to those participants who came to register earlier.
Also, our team have acquired knowledge on space usage. We were given a large area for the
eye screening but however, only used a part of the area; to reduce the walking of the elderly
participants. As our team did not bring the stereofly chart to the eye screening, we are sure that
if we have another eye screening, we will check that all necessary equipment are packed to
bring the site of eye screening. Our team, including the year 2 student helpers all learnt how to
view the fundus in scotopic situation because we were unable to switch off the lights at the
ophthalmoscopy station. Everyone has learnt and has to learn to be more flexible as this is an
eye screening, not a perfect clinical setting.
Communication is key. There is a common communication barrier during the eye screening
between different races and dialects, especially amongst older participants. We should translate
some of the simple instructions in other languages and dialects; and teach or help each other
out when there are difficulties communicating with the participants. Communication amongst the
student helpers and between stations is also equally important. Especially between the fundus
stations and ophthalmoscopy station, where both stations are assessing the health of the retina,
they might have similar findings; hence the need for better communications and recording. Our
team have also learnt to take care of the year 2 student helpers, to ensure they are doing their
duties right, and to guide them along if they encounter any problems or queries.
Without everybody’s help, the eye screening would not be able to go on smoothly. Teamwork
between student helpers is what can impact the eye screening the most.
Discussion
Troubleshooting
Registration
Problems: Initially, the registration form number was jumbled up as they did not take the forms
according to ascending numbers. So at some point of time when we went over to management
to check the number of patients we had, we saw registration number 30 when there are still
registration number 20 form.
Problem solving: So we just continue using the form but start with the smallest form number
first. Eventually, the form number was in ascending order and no repetition of numbers.
Visual Acuity
Problems: There are some student helpers who did not write down their names so it was difficult
to find the person if the helpers in management station have questions regarding the results.
Aided or unaided was not circled so it is time consuming for the people at management to ask
the participant or for them to circle it again. Our group set the criteria for both distance and near,
however we only included the distance VA criteria in the recording form. We should have
included both distance and near VA so that the student helpers will not be confused.
Tonometry
Problems: One of the I-care machine was not able to work halfway through the screening. We
did not bring spare batteries thus we were unable to determine if the I-care was down due to low
battery. Time was not recorded down on the paper; it is an important data as IOP is affected by
the time taken.
Ophthalmoscopy
Problems: Recording was not done properly and some of the blanks such as ‘Neural Retinal
Rim’ were not filled up. It was difficult for the student helpers to manage the participants if there
are blanks in the form. Lighting was an issue because the place is too bright and we were
unable to switch off the lights as the management station would be affected.
Problem solving: Inform all ophthalmoscopy helpers to fill in all the blanks. The helpers were
able to adapt to the bright environment and able to perform the tests with minimal help.
Fundus Photography
Problems: There was a long queue for fundus photo and the some participants waited for a very
long time. Student helpers circled ‘pass’ even when abnormalities such as drusens, exudates
or haemorrhages were observed in their fundus. Participants were not referred to Additional
Tests station when abnormalities were seen. Recording such as C/D ratio was not recorded on
the form after fundus photo was taken, leaving blanks on the form.
Additional Test
Problems: We did not bring Stereofly test on that day even though it was included in the packing
list. Thus, we were unable to perform stereopsis for paediatrics. Recording for slit lamp was not
included in the screening form; there was actually no check box for student helpers to tick under
‘slit lamp’ if they want participant to undergo this test.
Management
Problems: ‘Pass’ or ‘fail’ was circled wrongly as VA criteria was unclear. ‘Pass’ or ‘fail’ and name
of student helper were not recorded in some forms. Participants with arcus senilis were not
referred to General Practitioner.
Problem solving: Student helpers in charge of management went over to take a look at fundus
photo to record in the form and decide whether to refer the participant or not.
Ushers
Problem: Helpers from VA station were asked to stand outside the hall to recruit participants in
instead of ushers. So there were lesser manpower in the VA station.
Fundus Camera
Problems: The extension plug which comes together with the fundus camera belongs to
Mandarin was however, brought back to school instead. The Community Centre in-charge gave
us a call to notify us about this incident.
Problem solving: We called Mandarin and told them that we will deliver the extension plug to
them personally.
Roles and Contributions
Name
Roles
Contributions on the day of eye
screening
Wong Kai Lin
• Leader
• In-Charge of ‘Additional
Tests’ station
- Briefed the student helper
• Ensured the flow of the eye
screening
- Make sure every stations runs
smoothly
Heng Irene
on the different tests to do
in additional station, 1 week
before the eye screening.
- Briefed the student
helpers on the pass/fail
criteria and ensured that
they know how to perform
the tests and clear of the
recording before the eye
screening commences.
• Made decisions with the assistant
leader
- Makes the final decision
• Troubleshoot questions and
problems faced in other stations
(the whole eye screening)
- Made necessary changes in the
floor plan and allocation of
wasmanpower (Asked 2 students to
usher participants in from outside as
the community centre did not state
the eye screening is at level 2 when
they publicise).
• Co-ordinate with the community
centre regarding the refreshments
and no. of participants
• To solve any
anger/disputes/unhappiness
amongst the students
• Guided the student helper in my
station with the tests that she is not
familiar with
• Conducted tests at the ‘Additional
Station’
• Assistant Leader
• In-Charge of Ushers
- Briefed the student
helpers about ushering and
their location of duty, 1
week before and on the day
on eye screening.
•Usher the participants to the
respective stations
- Ensure that the whole screening
goes smoothly
- Make sure they did not skip any
compulsory stations
• Clarify doubts for my helpers in my
usher station
- Make sure they do not bring
patients to the wrong station to
avoid any unhappiness
• Report any facility problems (AirConditioner and the lighting) with
the community centre members and
asked them to fix it
- To make patients and helpers
comfortable
- To have a darker area for
ophthalmoscopy
• Clear the doubts for visual acuity
(VA) criteria
- To avoid wrong recording and
clear confusion
• Debrief for all at the end of the
screening
- Summarise everything by
informing the number of participants
and discuss the problems faced in
every stations.
- To thank all the helpers for helping
and collect feedback forms from the
helpers
Fiona Lee Hui Ping
• In-Charge of Registration
- Briefed the student
helpers about registration
(things to take note), 1
week before and on the day
of eye screening.
• In-Charge of Manpower
allocation
- Recruited student helpers
for the eye screening.
Berlinda Tan Ying Bing • In-Charge of Manpower
allocation
- Recruited student helpers
for the eye screening.
• Helped in briefing the
student helpers on the
procedure, grading and
recording of the shadow
test, 1 week before the eye
screening.
• Helper in
‘Ophthalmoscopy’ station
Lim Qian Hui
• Troubleshoot problems faced in
‘Registration’ station
• Ensure the registration was done
correctly and accurately, with the
necessary tests indicated for
paediatrics
• Guided the student helpers in the
station
• Assisted in ushering participants
from ‘Registration’ station to ‘Visual
Acuity’ station
• Mark attendance of student
helpers
• Assisted in setting up chairs and
tables
• Performed ophthalmoscopy on
participants
• Troubleshooting problems faced
on the ophthalmoscopy station
• Ushered participants from IOP
station to ‘Ophthalmoscopy’ station
• Ushered participants from
‘Ophthalmoscopy’ station to ‘Fundus
Photography’ station.
• In-Charge of Floor plan
• Assisted in setting up the tables
- Gathered pictures of eye
and chairs according to the floor
screening location and did a plan layout
floor plan for the eye
screening.
• Helped in briefing the
student helper for
‘Additional Tests’ station on
the tests to do, 1 week
before the eye screening.
• Helper in ‘Management’
station
• Impromptu planning and
rearrangement of our setup due to
the large space
• Managing participants, giving
advice and answering their queries.
Checked their near VA and did
some small tests for certain
individuals.
• Sort out participant records’ after
the eye screening
Leong Li Tat
• In-Charge of ‘Fundus
Photography’ station
- Briefed the student helper
on the pass/fail criteria and
points to take note, 1 week
before and on the day of
eye screening.
- Guided the student helper
on the operation of the
fundus camera
• In-Charge of Data
Management
- Collating and analysis of
data obtained from the eye
screening
• Helped in the setting up of
tables and chairs
• Perform fundus photo taking
for the patients
• Taught and demonstrated the
usage of the fundus camera to
year 2 helpers
• Troubleshooting any problems
that surfaced from fundus
camera
Shen Li Peng
• In-Charge of ‘Tonometry’
station
- Briefed the student
helpers on points to take
note for taking eye pressure
and the criteria, 1 week
before the eye screening.
- Briefed the student
helpers on the pass/fail
criteria of the station before
the eye screening
commences.
• In-Charge of Data
Management
- Collating and analysis of
data obtained from the eye
screening
• Helped in setting up the station on
the day of the eye screening
• Measured IOP for participants
during the eye screening and
ensuring the station runs smoothly
• Troubleshooting any problems with
the equipment and handling difficult
participants
Yeo Yuen Wen
Clarissa
• In-Charge of
‘Ophthalmoscopy’ station
- Briefed the student
helpers on pass/fail criteria
of ophthalmoscopy and
points to take note of, 1
week before the eye
screening.
- Briefed the student
helpers on shadow test and
ophthalmoscopy
procedures, grading and
recording before the eye
screening commences.
• In-Charge of Logistics
- Collected the necessary
equipment and charts
needed for the eye
screening.
• Ensured the good flow between
the previous station (Tonometry)
and ‘Ophthalmoscopy station’, and
the next station (Additional Tests,
Fundus Photography, or
Management)
- Asked the students helpers to help
in ushering the participants from the
‘Tonometry’ station to
‘Ophthalmoscopy’ station
• Helped in setting up the station
- Sufficient chairs for the waiting
area and the testing area
• Troubleshooting any problems
faced in the station
- Ensure that all student helpers are
able to perform the tests in normal
lighting conditions
• Clarify and doubts by the student
helpers
Lee Yun He
• In-Charge of
‘Management’ station
- Briefed the student
helpers on pass/fail criteria,
referral criteria and points to
take note of, 1 week before
and on the day of eye
screening.
- Briefed the student
helpers on pass/fail criteria,
referral criteria, near VA
criteria and other points to
take note, before the eye
screening commences.
• In-Charge of Logistics
- Collected the necessary
equipment and charts
needed for the eye
screening.
• Ensured the ‘Management’ station
is smooth flowing
- Ensure that the student helpers
know how to manage participants’
condition
• Provide assistance to student
helpers if the need arises
• Managed participants of a caseby-case basis, giving appropriate
advices and answered to their
queries
• Ensured that all student helpers
know what to do with the Ngee Ann
Polytechnic Optometry Centre
(NPOC) vouchers
- To be given out to participants who
are interested to have full general
eye examination at NPOC
• Double check the results recorded
by other stations when the pass/fail
criteria was not recorded properly
Sri Devi D/O
Banogaran
• In-Charge of creating the
eye screening recording
forms and referral forms
• Helped in briefing the
student helpers on near
visual acuity measurement
criteria and things to take
note of, 1 week before the
eye screening.
• Helper in VA station
• Helped in setting up the ‘Visual
Acuity’ (VA) station before the eye
screening started
• Checking the visual acuity of the
participants
• Helped in ushering participants
from the VA station to the
Tonometry station
• Alternated with the co-helper in
pointing the chart/conversing with
the participant and recording of the
VA
Madinah Bte
Mohamed Rahim
• In-Charge of ‘Visual
Acuity’ (VA) station
- Briefed the student
helpers on VA criteria and
things to take note of, 1
week before the eye
screening.
- Briefed the student
helpers on VA criteria
before the eye screening
commences.
• In-Charge of creating the
eye screening recording
forms and referral forms
• Helped in setting up the station on
the day of the eye screening
• Ensured that helpers paired up for
easier testing of VA
• Ensured the stations runs
smoothly and does not jam up
- Set an order so that each pair
knows when to go first, second, and
subsequently.
• Troubleshooting any problems and
clarification of VA criteria
• To gather helpers back to the
station when they dispersed
themselves
•Checking the VA of the participants
Score and Area of Improvement for Individual Team Member
Name
Score
Area of Improvement
Wong Kai Lin
9.1 / 10
To be more proactive in addressing issues and
problems
Heng Irene
9.1 / 10
To handle situations and problems more
efficiently on the day of screening
Fiona Lee Hui Ping
8.3 / 10
Should have been more specific during the
briefing
Berlina Tan Ying Bing
8.4 / 10
Could have been more proactive in her station
(ophthalmoscopy)
Lim Qian Hui
8.5 / 10
Should be more aware of what is happening at
her station (management)
Leong Li Tat
7.6 / 10
Should check the student helper’s assessment
during eye screening as she wasn’t present for
briefing
Shen Li Peng
7.9 / 10
Could have participated more in the discussions
Yeo Yuen Wen Clarissa
8.8 / 10
Could have coordinated the flow better, to
delegate team mates whether who to attend to
which participant
Lee Yun He
8.7 / 10
Should be more aware of what is happening and
guide the rest if they are unsure of the referral
Sri Devi D/O Manogaran
8.4 / 10
To be more proactive and give more
suggestions during discussion
Madinah Bte Mohamed
Rahim
8.5 / 10
Could have organised the VA station better (eg.
Arranging the seats, number of seats)
Geriatric Eye Health – Common ocular conditions in elderly
*Note: Please avoid jargons and keep to layman terms. .
Brief description of condition
(Includes etiology, signs,
symptoms etc)
Arcus Senilis
●
●
Management ( Includes
treatment, advice etc)
it is a grey or white arc around ●
Arcus Senilis in patients below
the surface structure of the
50 years of age should be
eye which is known as
referred for a lipid profile, since it
cornea.
may indicate hyperlipidemia,
Eventually, the arc may
hypercholesterolemia, or
become a complete ring
hyperlipoproteinemia.
around the cornea.
●
It is most commonly seen in
elderly patients.
●
Arcus senilis is common in
However, the relationship between
arcus senilis and cardiovascular
older adults. It is caused by
disease is yet to be established.
fat deposits accumulating in
the edge of the cornea.
Pinguecula
Pinguecula is a common benign
growth on conjunctiva also
known as the white part of the
eye. It can grow at either nasal
or temporal side and due to long
term UV exposure. Can affect
one eye or both eyes.
Signs
-Yellowish-white deposits on the
nasal or temporal side of
conjunctiva
Asymptomatic
-Advise Px to wear UV protection
sunglasses
Symptomatic
-Advise Px to use artificial tears to
provide lubrication due to uneven
conjunctiva which causes dry eyes
-If inflamed(pingueculitis), refer for
steroidal treatment
Symptoms
-dry eyes
-irritation/scratchiness
-foreign body sensation
Pterygium
- Extra growth on the white part
of the eye and extends into the
cornea and contains visible
blood vessels.
- Common in people who are
exposed to sunlight often or
engaged active outdoor
activities.
Cataracts
- For those who have no
complaints, treatment is not
required
- Artificial tears may be used to
lubricate the eyes and prevent the
pterygium from getting inflamed
- Mild steroids for inflammation.
- Many do not experience or feel
it and may not know of its
existence but in some cases it
may get inflamed and irritated.
Vision will be affected if it grows
into the cornea.
-Surgery to remove the pterygium if
vision is affected. Vision is good
after removal. However, the
pterygium may return after removal
- Clouding of the lens, blocking
light rays from entering the eye,
causing blurring of vision
Management:
- Common in the elderly due to
- Surgery, especially for dense
cataracts where vision is affected
ageing
- Advise patient to wear UV
protection sunglasses
Causes:
- Degeneration of the lens
- Exposure to Ultra-Violet light
- Long term use of medications
e.g. Steroids
Symptoms:
- Blurry vision at all distances
- Glare
- Diplopia
- The need to constantly update
the prescription, which becomes
increasingly unsatisfactory
Types of Cataract:
- Age related Cataracts (Nuclear
Sclerosis, Cortical Cataracts,
and Posterior Subcapsular
cataracts)
- Congenital Cataracts; present
at birth or formed during a baby’s
first year
- Secondary Cataracts; results
from certain diseases or
medications
- Traumatic Cataracts; results
from an injury to the eye
Glaucoma
Suspect
Glaucoma is an eye disease that
causes high eye pressure in the
eyeball that presses onto the
optic nerve head resulting in
permanent visual field loss.
Glaucoma can be divided into
angle closure glaucoma and
open angle glaucoma.
Treatment of glaucoma can be eye
drops, tablets, laser treatment or
surgery intervention.
Signs:
Typically, there are no signs and
symptoms as disease progress
gradually.
Acute angle closure glaucoma:
- Red eye
- Eye Pain
- Nausea and vomiting
- Headache
Open angle glaucoma:
- Seeing halos
- Watery eyes
- Pain around the eye
- Fluctuating eye pressure
Age-Related
Macular
Degeneration
Suspect
Age-related Macular
degeneration (AMD) is the
damage of the macula, a small
spot near the centre on the
retina responsible for our
sharpest vision. There are two
types of AMD, dry AMD and wet
AMD.
There is currently no treatment for
dry AMD. Patients are advised to
take supplements like anti-oxidant,
beta carotene and omega-3 fatty
acids to slow down progression of
disease.
Wet AMD is usually treated with
injections or laser treatments to seal
dry AMD
of vessel leakages and stopping
Dry AMD is the breakdown of the abnormal vessel growth
light-sensitive cells, causing
intravitreal anti-VEGF injection:
visual loss.
● macugen
wet AMD
● lucentis
Wet AMD is a degeneration of
● avastin
the retina caused by abnormal
● eyelea
growth blood vessels that leak
intravitreal anti-VEGF stops the
fluid or blood into the region of
growth of abnormal vessels hence
the macula
reducing the leakage of fluids onto
the retina
Ihotodynamic therapy:
● seal of leaky vessels without
killing of macula cells
●
do not reduce abnormal
vessel growth
laser photocoagulation:
● seal off leaks of vessels
● kills of healthy macula cells
too
● not commonly used
anymore
Retinopathy:
Diabetic
Retinopathy
It is one of the leading cause of
legal blindness among patients.
Management: Treat underlying
causes, manage and control
diabetes. → Prevention of DR
Occurs when elevated blood
sugar levels cause blood vessels Treatments:
in the eye to swell, be damaged
and leak into the retina.
- Early stages of diabetic
retinopathy often can be treated
with laser surgery called
photocoagulation.This procedure
seals the blood vessels to prevent
them from leaking or growing.
- Advanced stages of diabetic
retinopathy, it can be treated by
vitrectomy. A surgery where it
removes scar tissue, blood, and
cloudy fluid from inside the eye
Signs and Symptoms:
- Floaters
- Blurred Vision
- Blank or dark areas in field of
vision
- Poor night vision
- Vision loss
Risk Factors:
- Long duration of diabetes
- Pregnancy
- Poor Metabolic Control
- Hypertension
- Renal Disease
- Obesity
Prognosis:
Photocoagulation:
- Unable to restore lost vision.
- Chances of blindness can be
lowered up to 90%
Vitrectomy
- Able to improve your vision.
- Hyperlipidemia
- Anaemia
- Smoking
Types of Diabetic Retinopathy:
•Mild nonproliferative diabetic
retinopathy (NPDR)
•Moderate NPDR
•Severe NPDR
•Very Severe NPDR
Proliferative diabetic retinopathy
(PDR)
-CSME: Clinically Significant
Macular Edema
Clinical Signs:
- Micro aneurysms
- IRMA (Intraretinal
Microvascular Abnormalities)
- Intraretinal haemorrhages
- Exudates
- Cotton wool spots
- Venous beading
- Neovascularization
- Pre-retinal haemorrhages
- Vitreous haemorrhage
- Traction retinal detachment
- Macular Edema
Retinopathy:
Hypertensive
Retinopathy
Hypertensive Retinopathy is the
damage to the retina caused by
Hypertension in the eye.
High blood pressure causes the
blood vessel in the retina to be
damaged. Therefore putting
pressure on the optic nerve. This
causes vision issues.
Signs:
●
●
●
●
Microaneurysms
Retina & macular
oedema
Retinal hemorrhages
Retinal lipid deposits
Control hypertension
● Diet changes
● Medications
●
●
Cotton-wool spots
Nipping of A/V
Symptoms:
● Sudden vision loss
● Headaches
● Double vision
● Dim vision
References:
1. What is a pinguecula and a pterygium?. (n.d.). Retrieved from
http://www.geteyesmart.org/eyesmart/diseases/pinguecula-pterygium.cfm
2. Chitra Badii: Making Sense of Hypertensive Retinopathy (Aug, 2012). Retrieved on
21/1/14 from http://www.healthline.com/health/hypertensive-retinopathy
3. Kean Theng Oh: Ophthalmologic Manifestation of Hypertension (Sept, 2012). Retrieved
on 21/1/14 from http://emedicine.medscape.com/article/1201779-overview#a11
4. MedicineNet.com (1996) Glaucoma Retrieved on 21 January 2014 from
http://www.medicinenet.com/glaucoma/page4.htm#what_are_glaucoma_symptoms_and
_signs
5. What's the relationship between arcus senilis and high cholesterol (2014) retrieved from
http://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/expertanswers/arcus-senilis/faq-20058306
6. Pterygium. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002006/
7. National Eye Institute. Age-Related Eye Diseases and Conditions: See well for a
Lifetime. Retrieved on 26 January 2014 from
http://www.nei.nih.gov/nehep/programs/visionandaging/materials/VandAToolkit_Mod2_P
owerpoint_508.pdf
8. Prabhakar, D. (2012). Diabetic Retinopathy. Retrieved on 26 January 2014 from
http://www.slideshare.net/drdevin/16-sep-2012-phfi
9. Nazario, B. (2011). Diabetes Complications: Eye Problems and Blindness. Retrieved on
26 January 2014 from http://www.webmd.com/diabetes/ss/slideshow-eye
10. Kalra, P. (2012). Diabetic Retinopathy. Retrieved on 26 January 2014 from
http://www.slideshare.net/paavankalra/diabetic-retinopathy-12254969
11. Aggarwal, G. (2012). Diabetic Retinopathy. Retrieved on 26 January 2014 from
http://www.slideshare.net/drgarima9/diabetic-retinopathy-15800903
12. Keenan, J. P. (n.d.). Retrieved on 26 January 2014 from http://www.webmd.com/eyehealth/cataracts/health-cataracts-eyes