Stephen Wetick sweticksco'edu cell: 901 230 4645

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Stephen Wetickswetick_at_sco.educell (901) 230 -
4645

• 2000 CBU Graduate GO BUCS!!
• Worked at M.D./O.D. practice 4 yrs
• post college
• Currently in 4th year, Southern
• College of Optometry (SCO)

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Doctor of Optometry (O.D.)

• Primary health care professional for the eye
• Examine, diagnose, treat, and manage diseases,
  injuries, and disorders of the visual system
• The visual system is complex, a lot of things
  can go wrong!
• Visual system one of many physiologic systems in
  the body all tied together

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Things that we look for during an eye examination

• Systemic Health
• Ocular Health
• Refractive Error
• VISUAL SKILLS
• Accommodation (Focusing Ability)
• Vergence Skills (eyes move in, eyes move out)
• Binocularity (stereovision/depth perception)

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• Do you see this clearly?

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Do you see this clearly?

• Do you see this clearly?

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Dif. Btw. Optometrist and Ophthalmologist

• Optometrist (O.D.)

• Ophthalmologist (M.D.)

• 4 year graduate study at Optometry School
• 1 year residency training (not requiredyet)
• Specialize in visual system and how this affects
  patients ability to function in the
  world/environment they live in
• Depend on ophthalmology (make referrals)

• 4 year graduate study at Medical School
• 3 years residency training
• Specialize in performing ocular surgeries
• Depend on optometry (make referrals)

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Applying to Optometry School

• Over 6,000 students attend optometry school
• 1,500 admitted each year
• 19 schools/colleges of optometry throughout the
  U.S., Canada, and Puerto Rico
• http//www.theaosa.org/schools/index.htm

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Applying to Optometry School

• Required Prerequisites (SCO)
• English composition and/or literature (one
  year)
• General Psychology (one course)
• Social Science (one year)
• Statistics (one course)
• Calculus (one course)
• General Biology with labs (one year)
• Microbiology with lab (one course)
• General Physics with labs (one year)
• General Chemistry with labs (one year)
• Organic Chemistry with lab (one course)
• Biochemistry (one course)

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Applying to Optometry School

• Optometry Admission Test (OAT)
• Standardized exam designed to measure academic
  ability and comprehension of scientific
  information
• Four Components
• Natural Sciences (Biology, Gen Chem, Organic
  Chem)
• Reading Comprehension
• Physics
• Quantitative Reasoning

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Applying to Optometry School

• OAT (cont)
• Computerized Exam
• Can take the OAT an unlimited number of times
  must wait 90 days btw testing dates
• Scores from the four most recent attempts and
  total number of attempts reported to school of
  interest
• Application Fee 199
• http//www.opted.org/info_oat.cfm

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Applying to Optometry School

• Spend time with an optometrist!
• Learn about what O.D.s do
• Learn about the role optometry plays in the
  healthcare arena
• Learn about what makes optometry different from
  other health professions services provided,
  past and future of the profession, legislation,
  politics, etc.

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Optometry School Curriculum

• First Year Fall

• First Year Spring

• Optometric Theory Methods I
• Optics of the Eye I
• Anatomical Sciences I
• Functional Neuroanatomy
• Human Physiology
• Introduction to Optometry

• Optometric Theory Methods II
• Optics of the Eye II
• Anatomical Sciences II
• Clinical Neuroanatomy
• Ocular Motility
• Visual Sensation Perception
• Ophthalmic Optics I

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Optometry School Curriculum

• Second Year Fall

• Second Year Spring

• Optometric Theory and Methods III
• Pathological Sciences
• Pharmacological Sciences I
• Biochemistry of the Eye
• Ocular Physiological Sciences
• Foundations of Binocular Vision
• Clinical Communication Patient Care
• Ophthalmic Optics II Environmental Vision

• Optometric Theory Methods IV
• Anterior Segment Disease
• Pharmacological Sciences II
• Posterior Segment I
• Pediatric Optometry
• Contact Lenses I
• Clinical Internship Introduction

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Optometry School Curriculum

• Third Year Summer

• Third Year Fall

• Physical Diagnosis
• Vision Therapy
• Strabismus and Amblyopia
• Contact Lenses II
• Clinical Internship I

• Vision Rehabilitation
• Glaucoma
• Neuro Eye Disease
• Practice Management I
• Posterior Segment II
• Clinical Internship II
• Integrative Clinical Analysis I

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Optometry School Curriculum

• Third Year Spring

• Peri-operative Management Techniques
• Systemic Disease Ocular Manifestations
• Practice Management II
• Public Health Geriatrics
• Legal Ethical Aspects of Optometry
• Clinical Internship III
• Integrative Clinical Analysis II
• Seminar

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Optometry School Curriculum

• Fourth Year Externships

• Fourth Year In House Rotation at School
  Clinic (4 months)

• 2 Externships (four months each) one at an
  institution, one at a private practice
• Student chooses where they want to go

• Clinical Adult Primary Care
• Clinical Contact Lens
• Clinical Pediatric Primary Care Vision Therapy
• Clinical Advanced Care Ocular Disease

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National Board of Examiners in Optometry (NBEO)

• Must pass all 3 parts to obtain a license to
  practice optometry
• Part I (basic science)
• 2-day written exam
• Part II (clinical science)
• 2-day written exam
• Treatment and management of ocular disease
  section (TMOD) -- within Part II

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NBEO (cont)

• Part III
• Clinical Skills Examination performance of 19
  clinical skills are evaluated
• Patient Assessment and Management (PAM) written
  examination evaluation of 40 patient cases

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Optometric Residencies

• Solidify optometric knowledge and clinical skills
• Licensed doctor, but still have the ability to
  get advise from experienced physicians
• Broaden comfort zone less referrals
• Specialize in area of interest (ocular disease,
  cornea and contact lens, refractive and ocular
  surgery, pediatrics, vision therapy, primary
  care, etc.)
• Not requiredyet

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Case Study
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CP, 57 year old black female

• Referred by ER physician
• ER visit prompted by sudden vision loss OD
  vision went dim for one hour
• Horizontal diplopia since the episode, especially
  when looking to the left
• Shooting pain, originating from behind OS and
  traversing to the back of her head
• CT scan of head wnl

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Medical Hx

• () Type 2 DM insulin dependent
• () HTN multiple meds
• () Hyperlipidemia
• () Asthma
• a.m. BS 180 mg/dL
• BS and BP unstable x6mo

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Objective Findings

• Unaided DVA OD 20/40
• OS 20/100¹
• Aided DVA OD 20/20²
• OS 20/20²
• Refraction OD 0.50 sphere
• OS 1.25 sphere
• CVF FTFC OD, OS

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Objective Findings

• Distance Cover Test constant, left esotropia
• 25? LET in primary gaze
• 40? LET in left gaze
• 4? LET in right gaze
• EOMs 50 reduced mvmt OS up left, down left,
  directly left
• Ductions slight improvement OS

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Objective Findings

• BP 175/111 mmHg
• PERRL (-) RAPD OD, OS
• SLE 1? NS and 1? CS OD, OS
• AC anatomy/structures wnl
• TAG OD 15 mmHg, OS 14 mmHg

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Objective Findings

• Posterior Pole NRRI OU, maculas flat and mottled
  OU, () tortuous arteries, scattered CWS,
  exudates, and Hgs OU

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Assessment

• Left Cranial Nerve VI Palsy suspect
  vasculopathic origin 2 to uncontrolled DM and
  HTN
• Amaurosis Fujax OD per Hx
• Moderate NPDR OU
• Hypertensive Retinopathy OU
• Combined Form Cataracts OU

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Plan

• Consult with PCP regarding uncontrolled systemic
  disease RTC 1 mo for refraction, EOM eval, and
  DFE OU RTC STAT if ? diplopia or ? VA patient
  to patch OS until diplopia resolves
• Suggest carotid ultrasound in follow up letter to
  PCP
• 4) 5) CTM

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Conclusion

• As one can see, the visual system involves
  multiple components. Refractive error is just one
  of these components.
• As future healthcare participants, keep in mind
  the importance of good ocular health and the
  impact this has on ones quality of life.

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THANK YOU!