This is a draft cheat sheet. It is a work in progress and is not finished yet.
Case Hx
|
1. Chief Complaint What is the main reason for your visit?
|
|
2. History of present illness (HPI) F: How often does it occur?
O: When did you first notice?
L: Where do you experience this? OD,OS,OU?
D: How long does it last?
A: Any associated sx such as HAs, red eyes, diplopia, blurry vision
R: Does anything make it better?
S: How severe?
|
|
3. Ocular History LEE
Glasses or CL
Patching
Strabismus Surgery
VT
|
|
4. Medical History LME
Medications
Allergies
|
|
5. Academic History Current grade? Any repeated grade?
Academic struggle?
Any special testing?
|
|
6. Developmental History Any complications at birth?
Birth weight? Premature?
Reaching milestones?
OT/PT/ST
Any behavioral issues?
|
|
7. Family History Any significant family eye or medical problems?
Any eye turns, vision loss, cancer, or systemic conditions that may put current pt at risk?
|
|
8. Social History Do you smoke/drink/use drugs?
|
|
9. Occupation and Hobbies |
Diabetic Case Hx
When were you dx? |
Type I or Type II? |
What medications are you taking? |
Compliance of medications? |
Do you check your blood sugar regularly? How often? |
Last time you checked your blood sugar level? |
What was the reading? Is that normal or avg for you? |
Fasting or non-fasting? |
Do you know your HbA1C? |
When is your next F/U with your PCP? |
Diagnosis of DM (any of the 4)
polydipsia/uria/phagia |
fasting glucose level |
>120 mg/dL |
2hr blood glucose |
>200 mg/dL during OGHTT |
HbA1C |
>6.5% |
| |
Metformin |
(controlled) |
Insulin |
(uncontrolled) |
Duration >15yrs |
check for DR! |
|
|
HTN Case Hx
When were you dx? |
What medications are you taking? |
Compliance of medication? |
Do you check your BP regularly? How often? |
When was the last time you had your BP taken? |
What was the reading? Is that normal or avg for you? |
HTN and High Cholesterol Norms
Blood pressure |
120/80 mmHg |
Total cholesterol |
<200 |
Triglycerides |
<150 |
LDL |
<100 |
HDL |
>50 |
Checking significantly reduced VAs
1. Counting fingers |
2. Hand motion |
3. Light projection |
4. Light perception |
5. NLP |
Cover Test - Von Graefe Norms
Horizontal Distance |
1 EXO +/-2 |
Horizontal Near |
0-6 EXO |
Vertical @ D/N |
ortho |
Vergence Norms
DBI: |
x/7/4 |
DBO: |
9/19/10 |
NBI: |
13/21/13 |
NBO: |
17/21/11 |
Supra/Infra @ D&N |
3-4/1.5-2 |
Drug Dosing Abbreviations
QD = once a day |
BID = twice a day |
TID = three times a day |
QID = four times a day |
qh = every hour |
PRN = as needed |
qhs = every night |
gtt(s) = drops (1 mL=20 drops) |
Estimating Amplitude of Accomm.
Minimum |
= 15 - 0.25(age) |
Average |
= 18.5 - 0.30(age) |
Maximum |
= 25 - 0.40(age) |
Age Expected ADDs
40-44 |
+1.00 to +1.25 |
45-49 |
+1.25 to +1.50 |
50-54 |
+2.00 to +2.25 |
55-59 |
+2.25 to +2.50 |
60 or older |
+2.50 or more |
Anisometropic Amblyopia
Myopia |
>3.00D |
Hyperopia |
>1.00D |
Astigmatism |
>1.50D |
Isoametropic Amblyopia
Myopia |
>8.00D |
Hyperopia |
>5.00D |
Astigmatism |
>2.50D |
General Guidelines: Prescribing for Children
|
|
Visual Field - Glaucoma
Minimum loss |
outside normal limits (GHT)
Cluster of 3 or more non-edge points in same hemifield, at least 1p<1%
PSD p<5% |
Mild loss |
MD: <6dB
PD: <25% of the points are below 5% and <half of those points are depressed below 1%
None of the central 4 points have <20dB |
Moderate loss |
MD: <12dB
PD: <50% of the points are below 5% and <25% points are below 1%
Only one hemifield has a raw value of <20dB, but not both
Central 4 points: none have sensitivity <10dB |
Severe loss |
MD depressed more than -12dB
PD: >50% of the points are below 5% and >25% are below 1%
Both hemifields have points <20dB
Central 4 points: at least 1 has <10dB |
REDO any VF with more than 2 FALSE POSITIVES |
2 consecutive tests need to confirm VF loss |
Diabetic Retinopathy - NPDR
Mild NPDR |
Micro-aneurysms only!
F/U: 9 months - 1 yr |
Moderate NPDR |
More than MA, but not severe (4-2-1)
F/U: 6 months |
Severe NPDR |
One of the following:
4 quad of >20 dot and blots
2 quad of venous beading
1 quad of IRMA
F/U 3 months and refer for consult |
Very Severe NPDR |
At least two of the above 4-2-1 rule |
Diabetic Retinopathy - PDR
Low Risk |
Neo present, but not high risk |
High Risk |
NVD >1/4DD with or without VH
NVD any size with VH
NVE 1/2DD with VH |
Follow Up Schedule
Referral for serious problem |
call after 1 week |
Ocular hypertension |
RTC every 6 months |
Diabetic Eye Exams w/o DR |
RTC every year |
If Rx was not given due to disease state |
RTC in 4 months |
CRVO/CRAO |
RTC in 3 months |
Macular edema (severe) |
RTC within 1st week |
Retinal hemorrhage |
RTC in 1 week |
Glaucoma (POAG) |
RTC every 3 months |
Spectacle/CL Rx released |
RTC in 1 year |
Measurements for Adult Multifocals
Progressives |
Dot the pupil |
Lined Trifocals |
Bottom edge of pupil |
Bifocals |
Bottom lid/lash margin |
Bifocal Guidelins for Children
< 2 years old |
SV Rx |
3-5 years old |
FT 28 at mid pupil |
6-8 years old |
FT 28 at lower lid margin |
> 9 years old |
PAL |
|
