Age-related macular degeneration
MediumGrace Turner: Central Vision Distortion (AMD)
Setting: High street optometry practice. Your role: Optometrist
Mrs. Grace Turner, a 64-year-old part-time librarian, has presented today concerned about new onset central vision distortion in her right eye. She is worried about what this might mean for her vision, especially given her age and a family history of macular degeneration.
- Greet Mrs. Turner and confirm the specific nature of her central vision distortion and her reason for visiting.
- Gather a focused history regarding her visual symptoms, including onset, progression, and any relevant family or medical history.
- Examine or clarify findings by discussing relevant tests to differentiate between wet and dry Age-related Macular Degeneration (AMD).
- Explain the likely cause of her symptoms, Age-related Macular Degeneration (AMD), its types, and the proposed management plan in clear, accessible language.
- Confirm Mrs. Turner's understanding of her condition and the next steps for monitoring and potential treatment.
Practise this cardDryness after laser eye surgery
HardPost-LASIK Dry Eye Management and Prayer Time Accommodation
Setting: Contact lens consultation room. Your role: Optometrist
Mr. Alan Brooks, a 60-year-old security guard, had LASIK surgery 5 years ago and has since developed increasing dry eye symptoms. He has an appointment today for a contact lens fitting, but also wishes to discuss his current dry eye management, particularly regarding his daily eye drop regimen.
- Listen to Mr. Brooks' request regarding how his daily Islamic prayer (Salah) schedule impacts his ability to consistently use prescribed eye drops for his dry eyes.
- Understand the cultural and religious context of his Salah and Wudu (ablution) practices, and the significance of integrating his eye care into this routine.
- Assess the clinical feasibility and potential risks of modifying his current eye drop schedule or considering alternative lubrication strategies for his worsening post-LASIK dry eye.
- Propose a specific and practical accommodation plan for his dry eye management that respects his prayer times while ensuring adequate lubrication and symptom control.
- Confirm with Mr. Brooks that the proposed eye drop schedule and management plan is acceptable and sustainable for him, addressing any remaining concerns he may have.
Practise this cardShort-sightedness in a child
MediumLeo's Myopia & Cultural Preference
Setting: High street optometry practice. Your role: Optometrist
Mrs. Hannah Lee has brought her 6-year-old son, Leo, for an eye examination. Leo's short-sightedness has worsened significantly from -1.50 to -2.25 in the last six months, and she is seeking stronger glasses and discussing myopia control options. She has a specific request regarding the clinician.
- Listen carefully to Mrs. Lee's initial request regarding the examination of her son, Leo, without making assumptions.
- Understand the underlying cultural context or reasons for her preference for a female clinician with an open and non-judgmental approach.
- Assess the clinical feasibility of her request, considering the practice's resources and Leo's urgent need for stronger glasses and myopia control for his -2.25 prescription.
- Propose a practical accommodation or compromise that respects her cultural preference while ensuring Leo receives appropriate optometric care, including options for myopia control.
- Confirm with Mrs. Lee that the proposed accommodation is acceptable and addresses her concerns for Leo's treatment and comfort.
Practise this cardEmily's Vision & Family Consultation
Setting: High street optometry practice. Your role: Optometrist
Ms Emily Wong, 30, who is 30 weeks pregnant, has experienced sudden reduced vision in her left eye since yesterday morning. Her partner, Mr Isaac Wong, has brought her in for an urgent assessment. Mr Wong has an important cultural request regarding decision-making for Emily's care.
- Listen carefully to Mr Wong's request regarding family involvement in Emily's care, without making assumptions about its nature or intent.
- Understand the cultural context of Mr Wong's request for his mother's consultation, asking clarifying questions with curiosity to grasp its importance to him and his family.
- Assess the clinical feasibility of accommodating the request, considering the urgency of Emily's sudden vision loss and the potential impact on her pregnancy, without dismissing the cultural need.
- Propose a specific, feasible accommodation or compromise that respects both the cultural request and the clinical necessity for timely diagnosis and management.
- Confirm with Mr Wong that the proposed accommodation is acceptable and addresses his concerns for Emily's well-being and cultural traditions.
Practise this cardDiabetic retinopathy screening
MediumMr. Wilson's Diabetic Retinopathy Review
Setting: High street optometry practice. Your role: Optometrist
Mr. George Wilson, a 72-year-old retired mechanic, is returning for a review after being diagnosed with early non-proliferative diabetic retinopathy (NPDR) in his left eye three months ago. You advised him to focus on improving his glucose control, aiming for an HbA1c below 7.0%, and to increase his daily physical activity. He has brought his daily blood sugar readings and a recent HbA1c result.
- Assess his response to the previous plan by reviewing his recent HbA1c result (previous was 8.2%) and discussing his daily blood sugar readings.
- Review any changes in his visual symptoms or general well-being that Mr. Wilson has noticed since his last visit.
- Adjust the management plan for his diabetic retinopathy, if needed, explaining the reasoning behind any changes to Mr. Wilson.
- Reinforce positive behaviours, such as any improvements in glucose control or physical activity, and encourage their continuation.
- Schedule his next review appointment, ensuring it is timed appropriately based on his current retinopathy status and glucose control.
Practise this cardScreen-related eye strain
HardTaxi Driver's Screen Eye Strain
Setting: High street optometry practice. Your role: Optometrist
Mr. Peter Lawson, a 63-year-old taxi driver, has returned for a follow-up regarding his screen-related eye strain. He understands the advice about the 20-20-20 rule and blinking, but is reluctant to follow it, finding it impractical for his job.
- Explore the specific reasons behind Mr. Lawson's reluctance to implement the recommended eye care practices while working.
- Validate Mr. Lawson's concerns about the practical challenges of managing eye strain in his demanding profession without dismissing them.
- Share evidence or specific information relevant to how sustained screen use, particularly for driving navigation, impacts eye health for someone his age and occupation.
- Offer adjusted options for managing his eye strain that respect his values and the realities of his work as a taxi driver, such as specific lens coatings or strategic breaks.
- Agree on one concrete, manageable step Mr. Lawson is willing to take this week to alleviate his screen-related eye strain.
Practise this cardCataracts and vision changes
MediumCataract Surgery Consent for Mr. Arthur Reed
Setting: High street optometry practice. Your role: Optometrist
Mr. Samuel Reed, son and carer for his 78-year-old father Mr. Arthur Reed, is here to discuss cataract surgery. Mr. Arthur Reed's vision has significantly deteriorated due to cataracts, causing glare and blurred vision, making driving unsafe. The ophthalmologist has recommended surgery, and Mr. Samuel Reed needs to give consent on his father's behalf.
- Check Mr. Samuel Reed's current understanding of cataract surgery for his father, Mr. Arthur Reed, and the reasons for the recommendation.
- Explain the cataract surgery procedure and its rationale, including its typical 10-minute duration and how it will address Mr. Arthur Reed's driving difficulties, in simple language.
- Name at least two specific risks associated with cataract surgery for Mr. Arthur Reed, such as the 1 in 1000 risk of infection and the 1 in 500 risk of retinal detachment, explaining their potential impact.
- Verify Mr. Samuel Reed's understanding of the procedure and its risks by asking him to explain it back in his own words, ensuring he can reiterate the key points for his father.
- Confirm Mr. Samuel Reed's consent for his father, Mr. Arthur Reed, to proceed with the cataract surgery, ensuring he expresses his decision clearly and without pressure.
Practise this cardNear vision changes with age
HardMr. Murphy's Multifocal Contact Lens Adherence
Setting: Contact lens consultation room. Your role: Optometrist
Mr. Jack Murphy, a 57-year-old chef, is here for a 6-month follow-up regarding his multifocal contact lenses. He previously reported difficulty reading small print on menus and recipes but seems to have stopped consistently wearing the lenses prescribed at his last visit.
- Explore — Mr. Murphy's challenges with consistently wearing his multifocal contact lenses, particularly during his demanding work as a chef, without making him feel judged.
- Validate — the practical difficulties of wearing contact lenses in a busy, hot kitchen environment, while still emphasising the importance of clear near vision for his work and safety.
- Co-design — a revised vision correction plan that is practical for Mr. Murphy's lifestyle, perhaps considering options like daily disposable multifocal lenses, modified monovision, or dedicated reading glasses for specific kitchen tasks.
- Safety-net — what Mr. Murphy should do if the new plan proves difficult to maintain, such as contacting the clinic or trying an alternative strategy immediately.
- Schedule — a specific follow-up appointment within 4-6 weeks to review the effectiveness and comfort of the revised vision correction solution.
Practise this card
