DOCSLIB.ORG

SPOTTM VISION SCREENER Sample Results Tahoma Tahoma Bold

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
SPOTTM VISION SCREENER Sample Results Tahoma Tahoma Bold PHYSIC AL E X A M SPOTTM VISION SCREENER Sample Results Tahoma Tahoma bold SPOT VISION SCREENER Sample Results SPOT VISION SCREENER Table of Contents Understanding the Spot Display Data Display 4 Printed Report 5 Printed Label Report 6 Instant Screening Results Displayed 7 Definitive Result Samples Screening Complete 8 Myopia 9 Hyperopia 10 Anisometropia 11 Astigmatism 12 Strabismus 13 Anisocoria 14 Resources Glossary of Terms 15 3 SPOT VISION SCREENER Data Display pupillary distance PM • alignment 6.0 77 6.0 mm mm pupil size indicator indicator mm 0° R L 0° 0° 0° • degree and direction: E E vertical or +5.00 +4.50 OD = Right Eye OD S C s S C s OS horizontal +5.25 -0.75 @43° +4.75 -0.75 @23° OS = Left Eye oml am ommdd oa (OD/OS) om Moo Edit mma Retry Print cylinder convention • complete refraction • SE = spherical equivalent DS = sphere DC = cylinder Axis = axis 4 SPOT VISION SCREENER Printed Report Visio screenin do no replac a comlet ey examinatio b oml am A a ohhamoogi o otomtrist ommdd B A Disclaimer asio a ama o asio odi LLC Th o oo a iomao h o a h ama a o o ao o oh ao o LL Al h reserved. V i s i o S c r eenin Su m m a r y B Screening Result SUBJECT I 21081-1357 2 C D E Date/Time of Test C SCREENI 4: pm GENDER F A 3 Y FIRT NAM O livia D Demographic Information LAT NAM D ylan E Image of the Screened Person Vision screenin sho b conduct regularly a ey may han over time. P O TT C OND TO N F • Hyperoa (OD ) aght ] Data Display (see page 4 for detail) 6.0 77 6.0 mm mm mm 0° R L 0° • Astigmatism (OD ) [ problm fosi ] 0° 0° G Potential Conditions F • Anisometropia a power] G E E +3.00 +1.50 OD S C i s S C i s OS H Right Eye & Left Eye Results +4.00 -2.00 @99° +1.75 -0.75 @16° Results (In Range = blue, Out of Range = red) T E Y E LEF T E Y E B O T E Y E S I Analysis of Both Eyes OUT OF RANGE IN RANGE IN RANGE OUT OF RANGE myoa y r J ia Customizable Banner oa r hyeroa r o I H c astigmatism amm ao z aom a az dev. Welh lyn a ama o Welh l omaio h o o o h oh Welh Al rih reserved. SpotTM Vision Screener J WWW.WELCHALLYN.COM LEVY123456789_20170202_174320_OutOfRage_0_100000.pdf PRT O PM 5 SPOT VISION SCREENER Printed Label Report A Demographic Information B Cylinder Convention +/- A C OD/OS Refractions B D Pupil Size Indicator C E Pupillary Distance D E F F Alignment Indicator G G Potential Condition H H Date/Time of Test 6 SPOT VISION SCREENER Instant Screening Results Displayed PM PM 5.9 77 5.9 6.0 77 6.0 mm mm mm mm mm mm 2° R L 3° 0° R L 0° 0° 1° 8° 0° E E E E -0.50 -0.25 +2.25 +2.25 OD S C s S C s OS OD S C s S C s OS -0.25 -0.50 @10° 0.00 -0.25 @34° +2.75 -0.75 @45° +2.50 -0.75 @112° omle oml am ommdd mam a a a om om Moo Edit mma Retry Print Moo Edit mma Retry Print “Screening Complete” with the indication of “All measurements “Complete Eye Exam Recommended” with indication of potential in range” is consistent with screening results below the vision disorders is consistent with screening results above the configurable threshold setting. configurable threshold setting. 7 SCREENING COMPLETE All Measurements in Range Visio screenin do no replac a comlet ey examinatio b oml a ohhamoogi o otomtrist asio a ama o asio odi LLC Th o oo a iomao h o a h ama a o o ao o oh ao o LL Al h reserved. V i s i o S c r eenin Su m m a r y SUBJECT I 31076-11212 SCREENI 2: pm GENDER F A 3 8M FIRT NAM Briaa LAT NAM aao Vision screenin sho b conduct regularly a ey may han over time. P O TT C OND TO N 5.9 77 5.9 mm mm mm PM 2° R L 3° 0° 1° 5.9 77 5.9 mm mm mm E E 2° R L 3° -0.50 -0.25 0° 1° OD S C i s S C i s OS -0.25 -0.50 @10° 0.00 -0.25 @34° E E -0.50 -0.25 OD S C s S C s OS -0.25 -0.50 @10° 0.00 -0.25 @34° T E Y E LEF T E Y E B O T E Y E S OUT OF RANGE IN RANGE IN RANGE OUT OF RANGE omle myoa y mam a r ia oa r hyeroa r o c astigmatism amm ao om z aom Moo Edit mma Retry Print a az dev. Welh lyn a ama o Welh l omaio h o o o h oh Welh Al rih reserved. SpotTM Vision Screener WWW.WELCHALLYN.COM LEVY123456789_20170202_174320_OutOfRage_0_100000.pdf PRT O PM 8 MYOPIA Near-sightedness Visio screenin do no replac a comlet ey examinatio b oml am a ohhamoogi o otomtrist ommdd asio a ama o asio odi LLC Th o oo a iomao h o a h ama a o o ao o oh ao o LL Al h reserved. V i s i o S c r eenin Su m m a r y SUBJECT I 31076-11234 SCREENI 2: pm GENDER M A 11 Y FIRT NAM a LAT NAM mh Vision screenin sho b conduct regularly a ey may han over time. P O TT C OND TO N • Moa (OD/OS) [ ah] 6.0 77 6.0 mm mm mm PM 0° R L 0° 0° 0° 6.0 77 6.0 mm mm mm E E 0° R L 0° -2.25 -2.50 0° 0° OD S C i s S C i s OS +2.25 -0.75 @43° +2.00 -1.00 @86° E E -2.25 -2.50 OD S C s S C s OS +2.25 -0.75 @43° +2.00 -1.00 @86° T E Y E LEF T E Y E B O T E Y E S OUT OF RANGE IN RANGE IN RANGE OUT OF RANGE oml am ommdd myoa y oa (OD/OS) r ia oa r hyeroa r o c astigmatism amm ao om z aom Moo Edit mma Retry Print a az dev. Welh lyn a ama o Welh l omaio h o o o h oh Welh Al rih reserved. SpotTM Vision Screener WWW.WELCHALLYN.COM LEVY123456789_20170202_174320_OutOfRage_0_100000.pdf PRT O PM Myopia 9 HYPEROPIA Far-sightedness Visio screenin do no replac a comlet ey examinatio b oml am a ohhamoogi o otomtrist ommdd asio a ama o asio odi LLC Th o oo a iomao h o a h ama a o o ao o oh ao o LL Al h reserved. V i s i o S c r eenin Su m m a r y SUBJECT I 31076-113 SCREENI 3: pm GENDER F A 3 Y FIRT NAM hao LAT NAM William Vision screenin sho b conduct regularly a ey may han over time. P O TT C OND TO N • oa (OD/OS) [ah] 6.0 77 6.0 mm mm mm PM 0° R L 0° 0° 0° 6.0 77 6.0 mm mm mm E E 0° R L 0° +5.00 +4.50 0° 0° OD S C i s S C i s OS +5.25 -0.75 @43° +4.75 -0.75 @23° E E +5.00 +4.50 OD S C s S C s OS +5.25 -0.75 @43° +4.75 -0.75 @23° T E Y E LEF T E Y E B O T E Y E S OUT OF RANGE IN RANGE IN RANGE OUT OF RANGE oml am ommdd myoa y oa (OD/OS) r ia oa r hyeroa r o c astigmatism amm ao om z aom Moo Edit mma Retry Print a az dev. Welh lyn a ama o Welh l omaio h o o o h oh Welh Al rih reserved. SpotTM Vision Screener WWW.WELCHALLYN.COM LEVY123456789_20170202_174320_OutOfRage_0_100000.pdf PRT O PM Hyperopia 10 ANISOMETROPIA Unequal Refractive Power Visio screenin do no replac a comlet ey examinatio b oml am a ohhamoogi o otomtrist ommdd asio a ama o asio odi LLC Th o oo a iomao h o a h ama a o o ao o oh ao o LL Al h reserved. V i s i o S c r eenin Su m m a r y SUBJECT I 21081-1357 2 SCREENI 4: pm GENDER F A 3 Y FIRT NAM O livia LAT NAM D ylan Vision screenin sho b conduct regularly a ey may han over time. P O TT C OND TO N • Hyperoa (OD ) aght ] 6.0 77 6.0 mm mm mm PM 0° R L 0° • Astigmatism (OD ) [ problm fosi ] 0° 0° 6.0 77 6.0 • Anisometropia a power] mm mm mm E E 0° R L 0° OD +3.00 +1.50 OS 0° 0° S C i s S C i s +4.00 -2.00 @99° +1.75 -0.75 @16° E E +3.00 +1.50 OD S C s S C s OS +4.00 -2.00 @99° +1.75 -0.75 @16° T E Y E LEF T E Y E B O T E Y E S OUT OF RANGE IN RANGE IN RANGE OUT OF RANGE oml am ommdd myoa y oa mam omoa r ia oa r hyeroa r o c astigmatism amm ao om z aom Moo Edit mma Retry Print a az dev.
Load more

Recommended publications
  • URGENT/EMERGENT When to Refer Financial Disclosure
    URGENT/EMERGENT When to Refer Financial Disclosure Speaker, Amy Eston, M.D. has a financial interest/agreement or affiliation with Lansing Ophthalmology, where she is employed as a ophthalmologist. 58 yr old WF with 6 month history of decreased vision left eye. Ache behind the left eye for 2-3 months. Using husband’s contact lens solution made it feel better. Seen by two eye care professionals. Given glasses & told eye exam was normal. No past ocular history Medical history of depression Takes only aspirin and vitamins 20/20 OD 20/30 OS Eye Pressure 15 OD 16 OS – normal Dilated fundus exam & slit lamp were normal Pupillary exam was normal Extraocular movements were full Confrontation visual fields were full No red desaturation Color vision was slightly decreased but the same in both eyes Amsler grid testing was normal OCT disc – OD normal OS slight decreased RNFL OCT of the macula was normal Most common diagnoses: Dry Eye Optic Neuritis Treatment - copious amount of artificial tears. Return to recheck refraction Visual field testing Visual Field testing - Small defect in the right eye Large nasal defect in the left eye Visual Field - Right Hemianopsia. MRI which showed a subacute parietal and occipital lobe infarct. ANISOCORIA Size of the Pupil Constrictor muscles innervated by the Parasympathetic system & Dilating muscles innervated by the Sympathetic system The Sympathetic System Begins in the hypothalamus, travels through the brainstem. Then through the upper chest, up through the neck and to the eye. The Sympathetic System innervates Mueller’s muscle which helps to elevate the upper eyelid.
    [Show full text]
  • Intermittent Mydriasis Associated with Carotid Vascular Occlusion
    Eye (2018) 32, 457–459 © 2018 Macmillan Publishers Limited, part of Springer Nature. All rights reserved 0950-222X/18 www.nature.com/eye 1,2 2 2 Intermittent mydriasis PD Chamberlain , A Sadaka , S Berry CASE SERIES 1,2,3,4,5,6 associated with carotid and AG Lee vascular occlusion Abstract the literature as benign episodic pupillary dilation or BEUM. We report two patients with Purpose To describe two cases of 1 stereotyped, intermittent, neurologically acquired occlusive disease of the ipsilateral ICA Department of Ophthalmology, Blanton isolated, unilateral mydriasis in patients who developed multiple, stereotyped, neurologically isolated, transient episodes of Eye Institute, Houston with a history of acquired internal carotid Methodist Hospital, artery (ICA) occlusive disease on the mydriasis consistent with BEUM. We discuss the Houston, TX, USA ipsilateral side. possible mechanisms, differential diagnosis and 2 Patients Two patients with intermittent recommended evaluation for atypical cases for Department of episodic mydriasis. Ophthalmology, Baylor mydriasis. College of Medicine, Methods Case Series. Houston, TX, USA Results Case one: A 78-year-old man Case one 3 experienced 10 episodes of intermittent, Departments of Ophthalmology, Neurology, unilateral, and painless mydriasis in the left A 78-year-old man presented with 10 episodes of and Neurosurgery, Weill stereotyped, intermittent, unilateral, painless eye and had 100% occlusion of the left ICA Cornell Medical College, artery due to atherosclerotic disease. Case two: pupillary dilation of the left eye (OS) lasting New York, NY, USA A 26-year-old woman with history of migraine minutes to hours at a time without diplopia or fi 4Department of developed new painless, intermittent episodes ptosis.
    [Show full text]
  • Anisocoria in an Intubated Patient with COVID-19 Sam Myers ‍ ‍ ,1,2 Minak Bhalla,1 Rohit Jolly,3 Saurabh Jain3
    Case report BMJ Case Rep: first published as 10.1136/bcr-2020-240003 on 22 July 2021. Downloaded from Anisocoria in an intubated patient with COVID-19 Sam Myers ,1,2 Minak Bhalla,1 Rohit Jolly,3 Saurabh Jain3 1Department of Ophthalmology, SUMMARY CASE PRESENTATION Whittington Health NHS Trust, The effects of COVID-19 on the eye are still widely A- 74- year old man was admitted to the hospital London, UK 2 unknown. We describe a case of a patient who was with a 2- week history of cough, fever and progres- UCL Medical School, University intubated and proned in the intensive care unit (ICU) sive shortness of breath. He had a background of College London, London, UK hypothyroidism, hypertension and benign pros- 3Department of Ophthalmology, for COVID-19 and developed unilateral anisocoria. Royal Free London NHS CT venogram excluded a cavernous sinus thrombosis. tate hypertrophy. His initial imaging and swab test Foundation Trust, London, UK MRI of the head showed microhaemorrhages in the confirmed COVID-19. The patient was placed midbrain where the pupil reflex nuclei are located. After on a trial of continuous positive airway pressure Correspondence to the patient was stepped down from ICU, intraocular to support his deteriorating oxygen saturation. Dr Sam Myers; pressure (IOP) was found to be raised in that eye. A However, after a week of supportive therapy, he sam. myers1@ nhs. net diagnosis of subacute closed angle glaucoma was made. was transferred to the ICU and was supported with It is important for clinicians to rule out thrombotic mechanical ventilation and proning.
    [Show full text]
  • Anisocoria Greater in the Dark: It’S Not Just All About Horner Pupil
    RESIDENT & FELLOW SECTION Pearls & Oy-sters: Anisocoria Greater in the Dark: It’s Not Just All About Horner Pupil Emily Witsberger, MD, Sasha A. Mansukhani, MBBS, John J. Chen, MD, PhD, and M. Tariq Bhatti, MD Correspondence Dr. Bhatti Neurology 2021;96:719-722. doi:10.1212/WNL.0000000000011221 ® Bhatti.Muhammad@ mayo.edu Pearls MORE ONLINE c An initial step in the evaluation of anisocoria is assessing the pupillary light reflex. If a pupil Video is not responsive to light, then the near pupillary reflex needs to be evaluated. Unilateral light-near pupil dissociation occurs due to a lesion of the ciliary ganglion, postganglionic parasympathetic pathway, retina, or optic nerve. Oy-sters c In addition to a Horner pupil, anisocoria can be more pronounced in the dark with physiologic anisocoria, miosis due to posterior iris synechiae, pharmacologic miosis due to a parasympathomimetic agent (i.e., pilocarpine), traumatic miosis, iris ischemia, and a chronic Adie tonic pupil. c Adie tonic pupil most frequently presents with a mydriatic pupil, light-near dissociation, vermiform iris sphincter muscle movement, and anisocoria greater in the light. However, a chronic Adie tonic pupil may be characterized by a miotic pupil, light-near dissociation, and anisocoria that is greater in the dark. An asymptomatic 65-year-old patient with no prior ocular surgery but a history of hypertension, hyperlipidemia, and hypothyroidism was noted to have a left miotic pupil during a routine ophthalmic examination. The anisocoria was noted to be greater in the dark and was interpreted as a left Horner pupil. No pharmacologic testing was performed.
    [Show full text]
  • Marfan Syndrome: Jeffrey Welder MSIII, Erik L
    Marfan Syndrome: Jeffrey Welder MSIII, Erik L. Nylen MSE, Thomas Oetting MS MD May 6, 2010 Chief Complaint: Decreased vision and glare in both eyes. History of Present Illness: A 28 year old woman with a history of Marfan syndrome presented to the comprehensive ophthalmology clinic reporting a progressive decrease in vision and worsening glare in both eyes. She had been seen by ophthalmologists in the past, and had been told that her crystalline lenses were subluxed in both eyes. She had not had problems with her vision until recent months. Past Medical History: Marfan syndrome with aortic stenosis followed by cardiology Medications: Oral beta blocker Family History: No known family members with Marfan Syndrome. Grandmother with glaucoma. Social History: The patient is a graduate student. Ocular Exam: External Exam normal. VA (with correction): OD 20/40 OS 20/50 Current glasses: OD: 6.75+ 5.00 x 135 OS: -5.25 + 4.25 x 60 Pupils: No anisocoria and no relative afferent pupillary defect Motility: Ocular motility full OU. Anterior segment exam: Inferiorly subluxed lenses OU (figure 1 and 2). The angle was deep OU and there was no lens apposition to the cornea in either eye. Dilated funduscopic exam: Posterior segment was normal OU with no peripheral retinal degeneration . Course: The patient’s subluxed lenses led to poor vision from peripheral lenticular irregular astigmatism and glare. She was taken to the operating room where her relatively clear lenses were removed and iris sutured intraocular lenses were placed. The surgical video for one of the eyes may be viewed at http://www.facebook.com/video/video.php?v=153379281140 Page | 1 Figure One: Note the inferiorly subluxed lens.
    [Show full text]
  • Unilateral Mydriasis in a Child with A
    Case report BMJ Case Rep: first published as 10.1136/bcr-2020-237257 on 22 December 2020. Downloaded from Unilateral mydriasis in a child with a ventriculoperitoneal shunt for obstructive hydrocephalus: a diagnostic dilemma Monidipa Banerjee, Eiman Haj Ahmed, Kathryn Foster, Arundoss Gangadharan Department of Paediatrics, SUMMARY glucose remained stable throughout the stay. Ysbyty Gwynedd, Bangor, UK There are several causes for sudden onset unilateral Blood gases were also stable with a peak lactate mydriasis, however impending transtentorial uncal of 2.6 mmol/L during salbutamol infusion. The Correspondence to herniation needs to be ruled out. This unique case theophylline levels were within the therapeutic Dr Arundoss Gangadharan; range during aminophylline infusion. A nasopha- Drarundoss@ yahoo. com highlights an uncommon adverse response to a common mode of treatment that leads to a diagnostic dilemma. A ryngeal aspirate was positive for respiratory syncy- tial virus. Chest X- ray showed minimal opacity at Accepted 30 November 2020 3-year -old boy with a ventriculoperitoneal (VP) shunt for an obstructive hydrocephalus presented with an acute left middle zone with hyperinflated lung fields. respiratory distress. He developed unilateral mydriasis with absent light reflex during treatment with nebulisers. DIFFERENTIAL DIAGNOSIS An urgent CT scan of the brain did not show any new Although he was treated for worsening acute viral- intracranial abnormality. A case of pharmacological induced wheeze, blocked VP shunt with increasing anisocoria was diagnosed that resolved completely intracranial pressure and risk of uncal herniation within 24 hours of discontinuation of ipratropium needed ruling out. bromide. Although ipratropium-induced anisocoria has been reported in children, but to our knowledge none in a child with VP shunt for hydrocephalus.
    [Show full text]
  • Acute Visual Loss
    425 Acute Visual Loss ShirleyH.Wray,MD,PhD,FRCP1 1 Department of Neurology, Massachusetts General Hospital, Boston, Address for correspondence ShirleyH.Wray,MD,PhD,FRCP, Massachusetts Department of Neurology, Massachusetts General Hospital, 55 Fruit St, Boston 02114, MA (e-mail: [email protected]). Semin Neurol 2016;36:425–432. Abstract Acute visual loss is a frightening experience, a common ophthalmic emergency, and a diagnostic challenge. In this review, the author focusses on the diagnosis of transient Keywords monocular blindness and visual loss due to infarction of the retina and/or the optic nerve ► ocular stroke —the ocular parallel of cerebral stroke. Illustrative Case the left supraclinoid internal carotid artery (ICA) just proximal to the origin of the left posterior communicating artery. Day 1: The patient is a 75-year-old ophthalmologist who Day 22: The patient consulted a neurovascular surgeon experienced an acute transient “white out” of her vision in who obtained a head and neck computed tomographic her left eye lasting for 20 minutes. She had no accompanying angiogram that showed that the ICA aneurysm was symptoms. At this time, the patient was concerned and unchanged in size and morphology from the previous anxious that the white out of vision was an attack of transient exam. No other aneurysm was seen. The surgeon reviewed monocular blindness—a transient ischemic attack that can all the imaging studies with the patient and reassured her herald stroke. that there was minimal risk of rupture of the aneurysm. Day 4: She asked her ophthalmology fellow to examine her eye including intraocular pressure, dilated funduscopy, and Special Explanatory Note automated (Humphrey) visual fields.
    [Show full text]
  • Evaluation and Management of Ocular Trauma
    Ocular Trauma and Emergencies Jacob J. Yunker, M.D. Retina & Vitreous Surgery Macular Diseases and Degeneration Assistant Professor, Department of Ophthalmology University of Kentucky College of Medicine Epidemiology • Accidental eye injury is one of the leading causes of visual impairment • >2.4 million eye injuries in the US per year • 90% are preventable • Most common cause of visual loss in persons under age 25 Epidemiology • Leading causes: – Sports accidents – Consumer fireworks – Household chemicals and battery acid – Workshop and yard debris • 48% of eye injuries occur at home – 1 in 5 are due to home repair or power tool use 3 Epidemiology History • Age • Occupation • Brief history of accident • Specific symptoms • Prior condition of eyes • General health • Allergies • Tetanus prophylaxis Examination - Inspection • Gross appearance • Hand held light or penlight • Slit lamp • Fluorescein and Wood’s lamp • Direct ophthalmoscope Examination • Visual Acuity • Motility • Pupils • Visual Field • Inspection Examination - Acuity Examination - Motility Pupils • Direct & Consensual Response • ―Swinging Flashlight‖ Test 10 Pupils: RAPD 11 RAPD • Optic Neuritis, Optic Nerve compression, Optic Nerve ischemia • Central Retinal Artery or Vein Occlusion • Large Retinal Detachment 12 Eyelid Anatomy Extraocular Muscles Review of Anatomy Timing of Emergent Evaluation • Within minutes: Retinal artery occlusion Chemical burns • Within hours: Endophthalmitis Intra-ocular foreign bodies Orbital cellulitis Methodology • When evaluating ocular emergencies
    [Show full text]
  • Billing Vision Insurance for Medically Necessary Contact Lenses
    Billing Vision Insurance for Medically Necessary Contact Lenses This information has been gathered from other successful offices, and following these guidelines DOES NOT guarantee coverage or payment. Regional accuracy is not guaranteed. Practices are advised to confirm all details with their insurance companies. VSP EYEMED Visually Necessary Contact Lenses Visually Necessary Contact Lenses • Covered for conditions below • Prior authorization is no longer required, • Patients must be eligible for materials but it’s advisable to check the online portal • Exam and material copays may apply or call to verify the benefits and coverage of each patient. Benefit Coverage Criteria • Must fill out Medically Necessary Contact • Aphakia Lens Claim Form and fax to 866.293.7373. • Nystagmus One benefit per calendar year. • Keratoconus • Aniridia Benefit Coverage Criteria • Corneal transplant • Anisometropia – Select this if spectacle Rx • Hereditary corneal dystrophies has a 3D difference in meridian powers • Anisometropia >= 3.00 D in any meridian - CPT Code – 92310AN • High Ametropia >= 10.00 D in any meridian - ICD-10 Code – H52.3_ • Irregular Astigmatism - Enter U&C Fee • Achromatopsia - Check box V2599 and enter U&C Fee • Albinism • High Ametropia – Select this if spectacle Rx • Polychoria exceeds -10D or +10D in meridian powers • Anisocoria (congenital) in either eye. • Pupillary Abnormalities - CPT Code – 92310HA - Enter U&C Fee Filing the Claim - Check box V2599 and enter U&C Fee. • Claim may be filed electronically on e-Claim • Keratoconus (mild/moderate) – Select this if • No prior authorization needed diagnosis is mild to moderate keratoconus where • Select Necessary Contact Lens as the BCVA through spectacles is worse than 20/25.
    [Show full text]
  • Ipratropium-Bromide-Induced Acute Anisocoria in the Intensive Care Setting Due to Ill-Fitting Face Masks
    Joshua O Benditt MD, Section Editor Teaching Case of the Month Ipratropium-Bromide-Induced Acute Anisocoria in the Intensive Care Setting Due to Ill-Fitting Face Masks Rebecca A Bisquerra MD, Gregory H Botz MD, and Joseph L Nates MD Introduction Case Report 1 Anisocoria, or unequal pupil size, may be an early sign A 78-year-old woman with acute myelogeous leukemia, of an impending neurologic emergency in any patient.1 atrial fibrillation, and coronary-artery disease was admit- Acute unilateral mydriasis is often suggestive of a life- ted to our ICU with respiratory insufficiency following threatening condition affecting cranial nerve function, such induction chemotherapy. Noninvasive positive-pressure as tumor compression, intracranial hypertension with im- ventilation delivered via oronasal mask was used to sup- pending uncal herniation, expanding intracranial aneurysm, port oxygenation and alveolar ventilation. Nebulized le- or hemorrhage. Benign mydriasis can be due to prior trauma, valbuterol and ipratropium bromide were administered for medication effects, and congenital abnormalities. Deter- wheezing noted on physical examination. On ICU day 2 mining the cause of anisocoria can be challenging in crit- (hospital day 18), the patient had an acute mental-status ical care settings because patients often are sedated, par- change. A noncontrast head CT revealed no mass effect, alyzed, intubated, or have a baseline altered mental status nor intracranial hemorrhage. On ICU day 4, a magnetic that makes full neurologic examination difficult.
    [Show full text]
  • Pupil Assessment in Optic Nerve Disorders
    Eye (2004) 18, 1175–1181 & 2004 Nature Publishing Group All rights reserved 0950-222X/04 $30.00 www.nature.com/eye Pupil assessment in FD Bremner CAMBRIDGE OPHTHALMOLOGICAL SYMPOSIUM optic nerve disorders Abstract Uses in clinical practice Pupil assessment is invaluable when distinguishing functional Background The normal pupillary from organic visual loss. Its usefulness in constriction to light is an involuntary reflex distinguishing between different causes of that can be easily elicited and observed optic neuropathy and as a prognostic sign is without specialized equipment or discomfort gradually emerging. to the patient. Attenuation of this reflex in Eye (2004) 18, 1175–1181. doi:10.1038/sj.eye.6701560 optic nerve disorders was first described 120 years ago. Since then, pupil examination Keywords: pupil; optic nerve; reflex; afferent has become a routine part of the assessment defect; perimetry of optic nerve disease. Clinical techniques The original cover/ uncover test compares pupillomotor drive in Introduction the two eyes, but requires two working pupils and is relatively insensitive. The swinging Reflexes are extensively used in clinical flashlight test is now the standard clinical tool neurology to assess function in sensory or motor to detect pupillomotor asymmetry. It requires nerves. Reflexes are involuntary and therefore only one working pupil, is easily quantified, serve as objective indicators of function. The and has high sensitivity in experienced hands, optic nerve forms the afferent limb of a number but interpretation of the results needs care. of brainstem reflexes that could potentially be Measurement of the pupil cycle time is the exploited when testing its function, but the most only clinical test that does not rely on useful has proved to be the pupil light reflex comparison with the fellow eye, but it can (PLR): the PLR can be easily observed, causes only be measured in mild to moderate optic no distress or discomfort to the patient, and may nerve dysfunction, is more time consuming, be quantified.
    [Show full text]
  • Pupillary Responses in Amblyopia Br J Ophthalmol: First Published As 10.1136/Bjo.74.11.676 on 1 November 1990
    676 BritishlournalofOphthalmology, 1990,74,676-680 Pupillary responses in amblyopia Br J Ophthalmol: first published as 10.1136/bjo.74.11.676 on 1 November 1990. Downloaded from Alison Y Firth Abstract light was then alternatively switched from one Relative afferent pupillary defects (RAPD) eye to the other, giving a period of stimulation of were detected in 32*3% ofpatients with ambly- 1 to 2 seconds, and the initial pupillary con- opia by a modification ofthe swinging flashlight striction was observed. The light was then left in test and the synoptophore. After consideration front ofeach eye for a count of3 and the pupillary ofvarious clinical investigations the significant escape noted. factors identified in patients showing a RAPD If a pupillary defect was observed, a neutral were: anisometropia, early age of onset where density filter was placed in the arm of the strabismus was present, level of visual acuity synoptophore in front of the eye without the following treatment, longer period ofocclusion defect. In practice it was not found possible to therapy. These points bear similarities to the quantify the defect to within 0-1 log unit as has results of pattern electroretinograms (PERG) previously been reported,5 but merely to confirm in amblyopes, and the possibility of the its presence. Where no defect was initially causative defect being at ganglion cell level is apparent, a 0-3 log unit NDF was placed in discussed. The effect of occlusion treatment either arm in turn to produce a difference in cannot be predicted from the presence or response. In some cases this revealed a subtle absence of a RAPD.
    [Show full text]