Visual and/or ocular problems: the importance of multidisciplinarity

WHO: “The process by which a group of workers from health related occupations with different educational backgrounds are able to collaborate in providing preventive, curative, rehabilitative and other health-related services.”

Professionals• Optician-

optometrist• Ophthalmologist• General practitioner• Specialist• Psychologist• Speech pathologist

• Occupational therapist

• Physiotherapist• (CLS) • Osteopath • Homeopath• Others

Competences:• Expert• Communicator• Teamplayer• Care provider• Longlife learning

Expert• Aware of his professional expertise• Aware of his boundaries • Aware of the expertise from others • Seeks and reads relevant information

on a regular base

Communicator• Develops an ethical and “therapeutic” relation

(based on trust) with the patient/client and with colleagues from other disciplines

• Gives and analyzes relevant information and shares this with colleagues

• Communicates and clarifies (patients/clients + colleagues)

• Communication is oral and written

Teamplayer• Collaborates with other team

members avoiding conflicts and optimizing care

• Places the patient/client in the central of the treatment plan

Care provider• Takes individual questions and needs

into account (patients/clients/other team members)

• Contribues to continuous improvement of general and specific health problems

Longlife learning• Maintains and continuously improves

multidisciplinary activities • Evaluates constantly and critically the

obtained results and uses these results in team

• Stimulates this attitude in encouraging others • Contributes to continuous improvement of

care

Types of problems:• Physical• Physiological• Psychological• Pathological• Personal• Other

Multidisciplinarity implies:• Exchange of information• Exchange of ideas• Exchange of recommandations

• Common vision/mission • Adequate treatment plan

Multidisciplinarity Refer/send

Recieve

Both

Optician-optometrist• Optician• Optometrist• Behavioural optometrist• Contact lens specialist• Low vision specialist

Optician refers • Optometrist• Behavioural optometrist• Contact lens specialist• Low vision specialist • Ophthalmologist• General practitioner

Optician refers • Physical problem: no ears: refer to contact

lens fitting

• Physical problem: insufficient convergence: refer to the behavioural optometrist

• Pathological problem: red eyes: refer to the ophthalmologist

Optometrist refers • Optician• Behavioural optometrist• Contact lens specialist• Low vision specialist • Ophthalmologist• General practitioner

Optometrist refers • Physiological problem: photophobia

refer to the ophthalmologist

• Physical problem: torticolis (spasmodic) refer to the behavioural optometrist

• Pathological problem: exophthalmia (unilateral) refer to the ophthalmologist

Behavioural optometrist refers • Ophthalmologist• Speech pathologist • Psychologist• Physiotherapist • Optician • Contact lens specialist

Behavioural optometrist • Hysterical amblyopia:

– Simulated amblyopia – Real amblyopia (hysterical) – Streff Syndrome

• Dyslexia and dyscalculia

• Reading problems

Behavioural optometrist Hysterical amblyopia: • Monocular loss of vision • Accommodation spasm • Changing pupil • Nervousness

Prescribe “Relaxing” convex lenses Refer to the psychologist, the neurologist

Behavioural optometrist Streff Syndrome: • Loss of vision to 4/10• Eyestrain • Headache • Lack of concentration

Prescribe “Relaxing” convex lenses Refer to the psychologist, the neurologist, the general practitioner (hormonal)

Behavioural optometrist • Dyslexia and dyscalculia:

Refer to the speech pathologist, the psychologist

• Reading problems: Refer to the speech pathologist, the

psychologist

Contact lens specialist refers • Behavioural optometrist• Low vision specialist• Ophthalmologist• General practitioner • Others • Optician

Contact lens specialist refers to The ophthalmologist and/or the general practitioner

• Keratoconus • Refractive surgery • Trauma • Pathologies (Blepharitis, allergies, herpes,

pterygium, ...)

Low vision specialist refers • Behavioural optometrist • Occupational therapist • Psychologist• Ophthalmologist• General practitioner • Optician

Low Vision specialist refers to The psychologist

Different stages:• Denial • Anger • Sadness and depression • Acceptance

Low Vision specialist refers to The occupational therapist

Using magnifying devices: • Monoculars • Reading magnifiers

Getting around: • Using a white cane

Multidisciplinarity implies:• Exchange of information• Exchange of ideas • Exchange of recommandations

• A good structure of the file!!!• A good structure of the protocol!!!

The protocol of the behavioural optometrist contains: As much information as possible:

– Data from the patient/client – Refraction– Tests performed – Proposed solutions (glasses, training exercises ...) – Results– Practical information for teachers – ...

Creating a good file • To record the acts of the optometrist

• The patient has right to inspection

• The optometrist should be able to demonstrate his recommandations afterwards

Creating a good file • Medical data may not be

communicated to third parties unless the patient requests it in writing

• Save the file no longer than 10 years after the last visit of the patient (some countries)

A good file contains:• Personal data of the patient • Ophthalmic diagnosis• Inventory of existing devices (as complete

as possible)• Anamnesis: extensive questioning – How is the patient’s participation? – What activities are limited?

• Inventory of activities

Activities list with ICIDH categories

1. See and recognize2. Learn, apply knowledge and tasks3. Communicate4. Moving activities5. Move (from one place to another)

Activities list with ICIDH categories

6. Activities of daily living7. Household activities8. Interpersonal behavior9. Deal with special situations10. Use of visual and/or other

technology

A good file contains:• Finding out the participation

• 1. In home care2. In mobility3. In exchanging information4. In social relationships5. In education, work, leisure and spirituality6. In civil and social life

Finding out the participation

The patient "chooses" its own category of participation based on what he considers important!

A good file contains:• Evaluation of existing visual aids

- Some activities require specific visual aids- Estimation of the "possible increase" of activity: often differs between the optometrist and the patient (much more positive than the reality)- Visual aids quickly reach their limits of potential

Evaluation of existing visual aids

Education: Advantages and disadvantages

– Understanding the benefits:

• Visualization of details• Enlarge

Evaluation of existing visual aids

Education: Advantages and disadvantages

– Understanding the disadvantages: • Physical boundaries (vision)• Practical limits (unaesthetic, heavy, ...)• Technical limits (diameter of a magnifier)• Others (rheumatism, spasms, emotional objections)

A good file contains:• Observation of the patient– Independance in movement

(correlation peripheral vision)– Position of the head – Movement to observe something/somebody

A good file contains:• Low vision examination– Screening– Objective refraction– Subjective refraction (trial frame)– Contrast sensitivity for near (newsprint)– Visual field– Selection of devices (visual aids)– Testing visual aids

Low vision examination• General instructions (selecting and testing) visual

aids – Magnifiers

• Hand-held• Stand magnifiers• Mounted in a frame

– Telescopic systems• Kepler• Galileï

– Electronic devices

Finding out the participation For what purpose the patient is doing

activities?

If the answer to this question is unknown, the recommended devices are probably not adequate but for a complete other purpose (other forms of participation) than actually needed.

Thank you !