SUNY College of Optometry Low Vision Service Orientation Manual Dr. William F. O'Connell, Chief, Low Vision Service

Patients seen in the Low Vision Service are Patients with vision loss due to eye disease or disorders.
The Low Vision service provides the unique service of functional assessment and prescription of optical, and non-optical devices and appropriate training to maximize functional vision.

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Telephone Numbers - The best way to contact most of us is by e-mail.  If the message is very urgent try going through Susan first, then the front desk, than direct calling.
Susan Lee Shareef - Office Manager 780-4043
Front Desk - 5013 / 5014
Dr. Cohen - 5012
Dr. Cole - 5016
Dr. Innes - 5017
Dr. O'Connell - 4044 ( leave voice mail messages on 4043 with Susan)

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After completing the clinical rotation in the Low Vision Service it is expected students will meet the following competencies:

1. For all cases, the intern will be able to elicit a comprehensive case history, including identifying the reason for the visit, delineating functional problems with sufficient detail,  and obtaining personal, and familial ocular and medical history.  The intern will utilize appropriate interviewing skills and demonstrate precise, objective and reliable observation skills.

2. For all cases, the intern will be able to thoroughly, accurately and efficiently conduct all tests and evaluation procedures necessary to manage functional vision problems.

3. For all cases, the intern will be skilled at identifying patients' problems, investigating them fully, recognizing visual dysfunction and ocular/medical/systemic diseases.  The intern will utilize logical reasoning to produce a problem specific data base.

4. For all cases, the intern will be able to analyze data collected, integrate basic science with clinical care, utilize diagnostic protocols, demonstrate knowledge of reliability and ranges of clinical test findings and epidemiological data, and formulate a tentative diagnosis and treatment plan for the patients' problems.

5. For all cases, the intern will be able to formulate a tentative management plan which is consistent with the patients' needs and expectations and with examination results.

6. In regards to items 3-5, the intern should be able to analyze and interpret:

a. - the approximate success rates he/she would expect using any of the available treatment options.
    .
b. List, administer and interpret those tests necessary to evaluate a Low Vision Patient to include:

- single line/single letter/continuous text acuity
- pinhole acuity
- telescopic refraction
- contrast sensitivity
- fixation status

- Proper use of prescribed optical devices
- eccentric viewing techniques

- pupil responses
- extra ocular muscles
- external evaluation of the eye
- slit lamp evaluation
- direct ophthalmoscopy
- indirect ophthalmoscopy
- gonioscopy
- tonometry
- central and peripheral fields
- color vision assessment

f. Design a treatment approach for the various types of eye health problems.

g. For all cases, the intern will assume responsibility for the follow-up care and referrals that will ensure efficient, comprehensive, continuous and cost effective patient care.  The intern will initiate appropriate patient education.

h. For all cases, the intern will be responsible for coordinating any correspondence necessary to communicate the results of the evaluation to the parent or other professionals.

i. The intern will demonstrate knowledge of and compliance with legal/ethical aspects of practice, and policies of the University Optometric Center that relate to intern behavior, such as dress code and attendance.

j. The intern will establish and maintain an effective doctor/patient relationship, demonstrating compassion and sensitivity for the patient's rights, expectations and needs.  The intern must demonstrate the ability to interact and communicate with patients of all ages.  The intern will establish effective working relationships with the professional, technical and support staff and fellow interns, demonstrating interpersonal skills that reflect a team approach to health care.

k. The intern will demonstrate scholarly inquiry, critical thinking, self responsibility for the on-going development of clinical skills and knowledge, and for self assessment.

The low vision clinical experience, in house, has been totally revamped.  We feel that students involved with patients for 10 consecutive weeks will have a greater understanding of

 1.  The low vision examination.
 2.  Clinical evalaution techniques in low vision.
 3.  Prescribing for the low vision patient.
 4.  Patient management.
 

To complete the Low Vision Rotation, you will have to complete the following requirements:

 1.  Competency-based student evaluation.
 2.  Maintain log of patient encounters.
 3.  Inventory check and maintenance of assigned room.
 

CLINIC ATTENDANCE, DRESS, AND EQUIPMENT

The same rules that apply in Primary Care Clinic apply in the Low Vision Service:  No absences are allowed.  Clinic jackets MUST be worn when working with patients.

NON-JANITORIAL ROOM MAINTENANCE,

Making a professional impression upon ones patients is important in gaining patient confidence and, building and maintaining a patient base. Aside from the image one presents as a doctor, the condition of, ones surrounds (i.e.exam room) will naturally bias how a patient views the facility and the quality of care, received.
If you wish to help us maintain and build our patient base so that we can increase the number and variety of, patient encounters for each intern, it is imcumbent upon you to help us maintain the exam rooms. All we ask, is that at the end of each clinic session you check to be sure that all equipment is working. If there is equipment in need of a repair please list it on the repair sheet located in the lab. Be sure to check that the exam room is fully stocked with the solutions and pharmaceuticals needed. If something is missing it should  be listed on the esic inventory control sheet located in each exam room.

Thank you for your help in enhancing the clinical experience for both you and your classmates.

Essential Clinical Equipment

Listed below is the mandatory diagnostic equipment that each intern must bring to each low vision clinic session:

Occluder
Retinoscope
Ophthalmoscope
Near Point Card
Trial Lens Set
Millimeter Ruler
20 Diopter Lens (or equiv.)
90 Diopter Lens (or equiv.)
Gonio/Zeiss 4 Mirror
Trial Frame

INTERNS FAILlNG TO BRING THE APPROPRIATE DIAGNOSTIC EQUIPMENT TO CLINIC MAY BE SUBJECT TO A FAILING GRADE FOR THAT SESSION.
 
 

A NOTE ABOUT APPROPRIATE CLINIC BEHAVIOR

We would prefer that everyone not "hover" around the patient.  One clinician will be working with the patient.  The others should sit in the observation room, or one clinician can sit in the chairs provided in the examination rooms--away from the patient--and watch/assist from there.  If questions need to be asked, your supervisor should meet with you OUTSIDE the room.  PLEASE DO NOT DISCUSS THE PATIENTS CASE, OR DEAL WITH YOUR QUESTIONS, IN FRONT OF THE PATIENT.  Case discussions and final write-up should be done in the Conference Room.

THERE WILL BE NO EATING OR DRINKING IN ANY EXAMINATION ROOM.
 

INSTRUCTIONS AND COMMENTS ABOUT THE LOW VISION REQUIREMENTS

As part of the rotation, you will be expected to complete the requirements listed above.  These will be described briefly below, and discussed in more detail when you get into the clinic.  The forms for doing the requirements are included in this handout package.
 

COMPETENCY-BASED STUDENT EVALUATION

The competency-based student evaluation is designed to insure that you can demonstrate basic competency in certain areas of the low vision evaluation.  You must be observed by your instructor either in the room or through the observation mirrors (i.e., you cannot complete these based on reading the examination form itself).  If the instructor feels that you have demonstrated competency, he/she will sign and date the evaluation form.  If there are problems, your instructor will discuss them with you, and you will have to "retake" the competency.  The last competency ("Identification of Low Vision Aids" will be given by your supervisor in the form of an oral exam.
 

MAINTAIN LOG OF PATIENT ENCOUNTERS

You must maintain a log of all patient encounters.  The form should be self-explanatory.  Any questions can be addressed when you are in clinic.  The Log will help you ensure that you are credited for each patient encounter.

You will be assigned a room for which you will have the responsibility to

 1. check the inventory as listed on the enclosed list at least one time a week.
 2. make certain that the room is neat and all equipment covered and put away AT THE END OF EACH CLINIC SESSION.  You will not necessarily be working in the room on any given day, but will still be responsible for its maintenance.  If you plan on leaving before the room becomes available (because it is being used), make certain that the intern using the room will clean it up and cover the equipment.  YOU WILL STILL BE RESPONSIBLE FOR THE ROOM.  Specific items will be listed on the inventory list.
THE ASSIGNED ROOM IS NOT NECESSARILY THE ROOM YOU WILL BE SEEING PATIENTS IN.

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 Fourth year students are scheduled for two to three patients per session.
Intern Handout Package for
Low Vision Rotation[Handout_Intro.ltr]
 [Last Updated: 7/3/97]

You will be in Low Vision Service for a 10 week rotation.  It is important that some ground rules and policies be stated now so that there will be no confusion or misunderstandings when clinic starts.  You also need to have certain information that will be useful when you are in clinic.  Please read the following attached pages:

 F. Copies of Test Charts Used
  1. The Lighthouse Distance Acuity Chart.
  2. Designs for Vision Distance Test Chart.
  3. The Lighthouse Near Visual Acuity Test.
  4. Near Vision Test Card ("GAME" Card).
  5. Lighthouse Continuous Text Charts–Adult and Children
  6. Amsler grid

Please also review your class and lab notes, and any handouts you received during the course.  We anticipate doing a lot of teaching, but expect you to have a base of knowledge upon which we can build.

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At present time we have 5 exam rooms.  When necessary and available, we will also use rooms in the pathology service.

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Evaluation of interns is based on demonstrated clinical competence in direct patient care and participation in Grand Round Case Discussions.  The grading scale is on a basis of 0 through 4, or Incomplete.

Assessment of clinical performance is based on the student's competency in meeting the course objectives described above.  The components of clinical competency encompass all of the following:

1. General knowledge and understanding
2. History taking
3. Technical skills - accuracy, efficiency, thoroughness
4. Cognitive skills - analysis, synthesis, decision-making
5. Interpersonal (communication) skills
6. Attitudes and Values - personal characteristics

A clinical grade of below 2 is given when a student fails to demonstrate satisfactory performance.  A clinical incomplete is given to a student who has not completed all clinical or educational assignments.  These must be made up within 4 weeks of the following quarter.

It is important for you to understand how your performance during the quarter will be evaluated.  The grading form which you must fill out at the end of each patient encounter, is graded by the clinical supervisor.  It is important that you make sure the form is graded on the day of the exam, since it is difficult at best to reconstruct the grades at a later date.  If no form is submitted, or if you do not completely fill out the form, you will receive no grade for that patient encounter.

Attendance is mandatory at all clinical assignments and case discussions.  All students must notify the Chief of Low Vision Service (either directly or via the Low Vision Service Manager) regarding sickness and any other reason for absence from assigned activities.  Unexcused absences are to be reported to the Chairperson of the Clinical Sciences Department and will be noted in the student's permanent file.  Students with unexcused absences will be required to meet with the Chief of Service.  It will also be reflected in the student's clinical evaluation relative to attitudes and values. Any unexcused absence, at the minimum, must be made up.  Additional assignments may result, as well as suspension from clinical activities and a potential grade of "F" for the clinical rotation.

Unexcused latenesses and excessive absences also fall under the above policy.

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LOW VISION Service
Minimum Required Data Base

• Case history
• Visual Acuity: DV and NV, uncorrected and corrected. Pinhole where indicated.
• Externals:
• Confrontation fields (age 8 and above)
• Retinoscopy
• Subjective
• Amslere Grid
• Contrast Sensitivity
• Color Vision Assessment
• Functional Optical Aids Assessment
• Ocular health: pupils, SLE, IOP evaluation, DFE

Same as for first time low vision patient except

NOTE: Patients seen within a 1 year period will be seen on a problem specific basis.