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Thread: Tips for working with patients who have physical issues?

  1. #1
    ABOC-NCLEC tigerlilly's Avatar
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    Tips for working with patients who have physical issues?

    I had a patient today who suffered from both a fair degree of spasticity and a high degree of uncontrolled motor movement. She may have had Parkinson's or another of that family of conditions. Poor woman had more difficulties controlling her movements and posturing every time she tried to be still or take frames on and off than when she wasn't trying to force her body to do something, which made measuring for her progressive and PD rather difficult. I was concerned about getting accurate measurements without shaming or embarrassing her, but I wasn't sure what would be best. I did each measurement twice to verify that I was getting the same numbers, and then compared them to her last glasses.

    Is there anything that might have worked better? Any veterans have suggestions on getting good measurements on people who are hard to measure?

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    Master OptiBoarder rbaker's Avatar
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    I wonder about the efficacy of fitting progressive lenses to patients with Parkinson's, Tardive Dyskinesia, Nystagmus and other conditions of this nature. The severity of the condition and the nature of the Rx can make fitting and adapting a real challenge.

    First of all, determine the geometry of the patients existing glasses and if there are no complaints, duplicate what is worn.

    If existing eyewear is not available and you can not obtain a seg height measurement that you feel confident with you may be able to reduce uncontrolled head and eye movement by giving the patient a task requiring hand eye coordination such as touching your nose with both fingers. Particularly, in the case of Parkinson's the tremors will usually abate and sometimes stop completely. You can usually get accurate monocular PD's in this manner using a PD ruler and muscle light.

    Finally, accurate monocular PD's can be obtained by having the patient close both eyes while you measure from the outer canthus of one eye to the inner canthus of the fellow eye. Trying this on a whole bunch of regular patients will give you confidence in its accuracy.

    It is a challenge but you should be able to come up with effective solutions to these interesting problems without having to resort to large doses of Thorazine.

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    OptiBoardaholic
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    We have found, since we have several group homes in our area, that you sometimes have to resort to "averages," meaning that measure more than twice, and cut once, as the old saying goes.

    It takes a lot of patience and practice with this population, but it is very rewarding.

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    ABOC-NCLEC tigerlilly's Avatar
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    If she hadn't already been in a progressive and been happy with it, I would have recommended a FT. I did make sure that we were not going any smaller on her frame and tried to get her into something that had the same fit and measurements as her current pair.

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    Doh! braheem24's Avatar
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    I immediatly ask about the obvious. I followup with advice or question relating to thier condition and use of eyewear. Make the person feel they are in a medical enviornment, there is nothing shameful about a handicap. People with handicaps are generally much more intuitive then us 'take everything for granted fools' dont make them feel uncomfortable by your uncomfort in the situation.

    dot the eyewear off the patient, put on the patient, re-dot put back on patient, measure.

    Thank the patient for her patience with you.

    I still remember my encounter with a man who had half of his face removed (I assumed cancer) he was missing an eye, ear, cheek bones, half his forehead was gone. He basically had a hole one one side of his face. He came in for an adjustment, I was 19 at the time. I adjusted his glasses but froze and said nothing... 16 years later I still feel like scum for freezing up and not making him feel welcomed.

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    Master OptiBoarder rbaker's Avatar
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    Quote Originally Posted by braheem24 View Post
    I immediatly ask about the obvious. I followup with advice or question relating to thier condition and use of eyewear. Make the person feel they are in a medical enviornment, there is nothing shameful about a handicap. People with handicaps are generally much more intuitive then us 'take everything for granted fools' dont make them feel uncomfortable by your uncomfort in the situation.

    dot the eyewear off the patient, put on the patient, re-dot put back on patient, measure.

    Thank the patient for her patience with you.

    I still remember my encounter with a man who had half of his face removed (I assumed cancer) he was missing an eye, ear, cheek bones, half his forehead was gone. He basically had a hole one one side of his face. He came in for an adjustment, I was 19 at the time. I adjusted his glasses but froze and said nothing... 16 years later I still feel like scum for freezing up and not making him feel welcomed.
    Braheem,

    Your reaction was quite normal and you should feel no regret.

    I used to fit Monoplex eye prosthetic at AO in Southbridge where we saw patients from all over the world with conditions as simple as enucleations to horrible facial deformities such as you describe. I was there for a year and never became completely used to working with these patients although as my ability to help these patients increased my repulsion of their injuries decreased.

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    Master OptiBoarder
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    Working with patients who have disabilitys is a challenge. I have done it so long I take it in stride but I do remember what it was like as a young dispensor having someone come in with half a nose or one ear or motor issues. I froze as well. A kind optician told me something I never forgot. "Underneath what you see is a person just like you and I". I think because of these special patients I became to "go to" person for difficult adjustments. The last person I had come in with Parkinson's had a family member with them to hold their head steady while I measured. That helped...a lot. Ohter than that I do the measure twice and use the average method on pds and sometimes use the B measurement standard (half the B plus 4)on the frame to check my progressive seg ht.

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    ABOC-NCLEC tigerlilly's Avatar
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    Fortunately (or unfortunately, depending on your perspective) I am well-versed in mixing with folks who have various disabilities, both physical and developmental. It takes a lot to shock me, and I have no problem dealing with differently abled people on a friendly or service-based level. What I don't know are the tricks or tips for fitting and measuring for that population, and I don't want to give substandard glasses to anyone just because I've no experience with that group optically speaking.

    Sounds like there really is no best way, though. It seems like it's just diligence and extra effort. I can do that. :)

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