Day 2: Male, 72. (OH)

Spent the morning learning how to do pachs and run Goldmann and Humphrey VF machines, retinal fundus cam, and taking BPs. My CCT is ~570! Good to know in case I need LASIK in the future. 11 hours in clinic. Learned a lot today in terms of equipment, but still don't know how to interpret fields.

length of exam: ~3 hours

Hx:
- risk for glaucoma
- Raynaud's
- IOPs 15 OD, 16 OS
- large disk, loss in neural rim tissue
- BCVA OD: 6/6 OS: 6/12
- history of bv problems: left hyperdeviation -> exocyclodeviation, double vision at near hence prescribed glasses with near add in OD only. Blur in OS makes him suppress and avoid double vision.


1. Predilation workup

• VA
• Angles - get slit down as thin as possible, then move in from the side until you JUST see the shadow, then grade.
  
• Pressures - repeat for repeatability
  
• Pupils
  

2. Humphrey VFs:

• 30-2 central standard
• 10 minutes per eye
• very limited in accommodation for px with posture problems
• head posture and direction of gaze affects thresholds

3. HRT

• views nerve fiber layer thinning around the disc

4. Retinal fundus camera

• move in or out until crosshairs turn yellow
• zoom in via zoom in button
• align focus bars
• make sure eyes are wide and open
• take pic
  

5. Referral letter

• SOAP format