Deviation in the Standard of Ophthalmologic Care During Eye Examination Resulting in Loss of Vision, Retinal Disease, Cataracts, Glaucoma

Evaluate breaches in the standard of care by analyzing these questions and answers to determine if there was a Deviation in the Standard of Ophthalmologic Care During Eye Examination Resulting in Loss of Vision, Retinal Disease, Cataracts, Glaucoma

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following symptoms did the patient present? (Choose all that apply)
    Loss of vision
    Eye pain/twitching/tenderness
    Diplopia (double vision)
    Tearing/dryness
    Discharge/fullness of eyes/ blockage of drainage
    Redness/itching
    Spots/flashes
    Foreign body/burning sensation
    Retinal hemorrhage/distortion of vision
    None of the above
    Not elicited
    Answer unknown
    Why is this important?
    The major symptoms of eye disease are loss of vision, eye pain, diplopia, tearing and dryness, discharge, redness.
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  • Was a medical history obtained? Why is this important?
    Answer this question
    
A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests. It helps determine the value of incongruent and conflicting results that can emerge during the diagnostic process, and it can obviate the need for tests that are costly or expose the patient to discomfort or risk.

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  • With which of the following risk factors did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    
A risk factor is a variable that has a causal association with a disease or disease process; the presence of the variable in an individual or a population is associated with an increased risk of the presence or future development of the disease. Thus, risk factors may be useful for identifying subjects at increased risk for a disease or for a particular outcome that results from a disease process.

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  • Was a physical examination performed? Why is this important?
    Answer this question
    
A complete and carefully focused physical examination serves as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests.

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  • Which of the following evaluations were not performed? (Choose all that apply) Why is this important?
    Answer this question
    
The physical examination of the eye includes visual acuity, visual fields, ocular movements, external and internal eye structures and ophthalmoscopic examination. 

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  • Which of the following methods were used to evaluate visual acuity? (Choose all that apply) Why is this important?
    Answer this question
    
A simple but vital part of the ophthalmologic examination is a test of visual acuity and is essential for all patients who have visual complaints. A visual acuity test uses an eye chart, a Snellen chart, to measure ability to read letters. It is an easy, painless and quick way to diagnosis cataracts.

    (2008) 26 EMDCNA 1 17-34 



  • Which of the following abnormalities were not detected using visual field testing? (Choose all that apply) Why is this important?
    Answer this question
    
A visual field or perimetry test measures for visual field defects, the ability of the eye to see straight ahead and to the side (peripheral vision).

    (2003) 21 ENLOGC 2 445-481 



  • Which of the following ocular (eye) movements were not evaluated? (Choose all that apply) Why is this important?
    Answer this question
    
Ocular movements are effected by the contraction and relaxation of the extraocular muscles. This results in simultaneous movement of the eyes up or down from side to side, as well as in convergence. Assessment of the eyes is seen by observing the location of reflected light on the cornea. The condition of a deviated or crossed eye is called strabismus or tropia. The cover test is useful for determining whether the eyes are aligned.

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  • Which of the following external and internal eye structures were not examined? (Choose all that apply) Why is this important?
    Answer this question
    
The physical examination of the external and internal eye must include the orbits and eyelids, lacrimal apparatus, conjunctiva, sclera, cornea, pupils, iris, anterior chamber and lens.

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  • Which of the following were not inspected using an ophthalmoscope? (Choose all that apply) Why is this important?
    Answer this question
    
The ophthalmoscope is an instrument with a mirror optical system for viewing the interior anatomy of the eye. Ophthalmoscopic examination includes lens clarity, red reflex, retinal color and lesions, characteristics of blood vessels, depth of anterior chamber, disc and macula characteristics.

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  • Which of the following were not inspected using a slit lamp examination? (Choose all that apply) Why is this important?
    Answer this question
    
A slit lamp test is a special type of microscope that magnifies the eye, thereby enabling examination of the lens to determine the presence and severity of a cataract. 

    (2008) 26 EMDCNA 1 17-34 



  • Was a refraction test performed? Why is this important?
    Answer this question
    
A refraction test determines the degree of nearsightedness, farsightedness, or astigmatism.

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  • Which of the following examination techniques were used to evaluate glaucoma? (Choose all that apply) Why is this important?
    Answer this question
    
The clinical evaluation for glaucoma requires thorough review of a patient’s past medical and ocular history as well as a comprehensive ocular examination that should include visual acuity testing, pupillary response testing, slit-lamp biomicroscopy, tonometry, gonioscopy and optic nerve examination. The goal of the clinical evaluation is to diagnose the type of glaucoma affecting the patient, to assess its severity, and to determine the presence of progression over time.

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  • Which of the following external eye abnormalities were noted? (Choose all that apply) Why is this important?
    Answer this question
    
Abnormalities of the external eye include exophthalmos, episcleritis, band keratopathy, corneal ulcer and strabismus. 

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  • Which of the following internal eye abnormalities were diagnosed? (Choose all that apply) Why is this important?
    Answer this question
    
Abnormalities of internal eye include Horner syndrome, cataracts, diabetic retinopathy (background or non-proliferative), lipemia retinalis, retinitis pigmentosa, glaucoma, chorioretinitis

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  • Which of the following visual field defects were noted? (Choose all that apply) Why is this important?
    Answer this question
    
Visual field defects include defective vision or blindness, macular degeneration. Macular degeneration also called age related macular degeneration is caused when part of the retina deteriorates.

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  • To which of the following specialists was the patient referred? (Choose all that apply) Why is this important?
    Answer this question
    
Once a diagnosis has been made, and in many cases if a diagnosis is unclear, referral to the appropriate specialists needs to be made in a timely manner. To deliver care requires a coordinated approach that allows sharing of skills and expertise. The skills of members from all professional disciplines should be utilized.

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  • Which of the following treatment options were initiated? (Choose all that apply) Why is this important?
    Answer this question
    
Treatment is begun promptly with the goal of reducing intraocular pressure and preserving vision. If visual acuity is markedly reduced a combination of all topical glaucoma medications with intravenous osmotic and acetazolamide is recommended. The definitive therapy for primary angle closure glaucoma is surgical. Treatment of exudative detachment is aimed at the underlying cause or use of laser photocoagulation. Vascular retinopathy is managed with laser photocoagulation or cryotherapy, and retinal tears and detachments are repaired. The use of intraocular anti-vascular endothelial growth factor medications has significantly changed the management of age related macular degeneration.

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  • Was patient information/education provided? Why is this important?
    Answer this question
    
Communication and education of the patient are very important for those with vision threatening diseases.

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