ARMD Case Scenario

[plus-cyl]

Hi, i have a presentation to do on the following case scenario.. I was wondering if anyone could give me a few pointers etc.. (I'm a student.. )

Thanks


Case Scenario:

You examine Mr Simpson (age 67) who was diagnosed with ARMD 2 years ago. Initially, he was told that he suffered a macular hemorrhage in his right eye but vision in his left eye was stable. Three days ago he noticed some deterioration in his left eye. Mr Simpson is a retired teacher who always enjoyed reading, doing crosswords and playing the piano. He used to make model ships and would like to resume this hobby. He also like walking his dog and going out with the local running club. Due to his poor vision he had to give up driving a few years ago but he still goes out on his bicycle.


The inital clinical findings are:

Current Rx: Bifocal D22

Re: +2.50/+1.00x90 3/60 Le: +2.00/+0.50x90 6/24

Binoc: 6/18 Add: +3.00 Re: N40 LE: N10 slow


Refraction: Re: +3.00/+1.00x90 3/60 Le: +2.00/+1.00x90 6/24


Near Addition:

with add +3.00 (binoc) N10 slow at 33cm, readings seems more fluent when the right eye is occluded; with +6.00 binoc N6 can be read at 17cm; with the right eye occluded and additional lighting (anglepoise lamp) N5 is possible.


Tonometry (Pulsair NCT @ 3pm) Re: mean 14mmHg Le: mean 12mmHg




Clinical Management:

• discuss your clinical management plan for this patient, including additional tests that would need to be carried out.
• describe each of these techniques, how they are carried out and any instructions that you would give to your patients, in a language appropriate for lay patients.
• discuss the clinical condition that you suspect and describe possible treatment options, their advantages and limitation. what other visual difficulties, not describe here, may this patient have?

Optical Management:

• Recomment appropriate visual aids. using appropriate language, explain how you would advise this patient regarding the optical management of his visual problems. you can advise as many visual aids as necessary but you need to address all his visual problems.

[npdr]

Some thoughts:

1. What tasks does the patient want to do?
2. Are you capable, proficient or have the resources available to accommodate them?

Once you know the tasks desired, then you can start tailoring vision aids. At 6/24 vision, it is still quite workable. Starting aids now means that aids will be a habit when and if VA's got to worse than 6/120.

[plus-cyl]

hmm..

but could the patient have a cataract? possibly nuclear sclerosis?

or is it just a definite ARMD (dry) patient??

what visual aids could i give this patient? apart from lamps etc

[peregrinerose]

Wow, someone trying to pawn of their homework on other people.... isn't that the point of being in school?

If you had written up YOUR approach to working with the patient and asked for feedback before your presentation, I'd be happy to help out, but doing your work for you doesn't teach you anything.... with low vision you need to be creative.

[plus-cyl]

excuse you.. when did i pawn my work onto anyone? if you can READ, then you can see i wrote if anyone could give me any pointers..

bit ironic, but think you need to get your eyes checked!

[peregrinerose]

What a well-reasoned and mature response. :p I'm sure your future employers would be intregued to read this thread.

[hcjilson]

Plus asked for assistance, not a sermon. Most of us try, whenever possible, to refrain from being rude ....or judgemental. Your posts above this one were both.