1. COURSE SYLLABUS 1.Psychology and visual health 2.Non-verbal communication 3.The visual exam 4.Performance of the optometric exam 5.Giving bad news 6.Difficult patients and managing complaints

2. THEME 4: PERFORMANCE OF THE OPTOMETRIC EXAM STRUCTURE OF THE THEME: 1.Case history 2.Adaptation of the exam to the age of the patient 3.Children and adolescents 4.Adult population 5.The elderly 6.Poor vision

3. THEME 4: PERFORMANCE OF THE OPTOMETRIC EXAM 1.ANAMNESIS Two professionals do case histoies of the same patient and extract different information Good rapport Good form, it is not necessary to follow “to the letter” Flow of information in two senses: –Begin with open questions: Which is better? “What is the reason for your visit?” or “Do you have some specific reason for coming in to visit today?”

4. THEME 4: PERFORMANCE OF THE OPTOMETRIC EXAM Adapt the order of the questions to the openess of the patient –Do not “fire questions” at the patient from the very start –Patient’s concerns Does the patient remain silent or find it difficut to talk about the subject? –Do not ask closed or administrative questions –Respect silence and use non-verbal communication –Uncomfortable? Return to the questions Suggest our perception of what is happening Do not insist

5. 2. Adaptation of the exam to the age of the patient Young population Adult population The elderly Poor vision THEME 4: PERFORMANCE OF THE OPTOMETRIC EXAM

6. DEVELOPMENT PSYCHOLOGY Importance of family and social environment Evaluation of development studying tasks that each individual is capable of completing Tasks successfully completed: increase motivation Failure in the task: feeling of frustration

7. 3. Children and adolescents TASKS: –Learning to walk and talk –Developing concepts –Learning language to describe social and physical reality HANDICAPS TO THE DEVELOPMENT OF BLIND CHILDREN: –Floppy hands –Difficulty grabbing objects –They walk at a later age –No touch+hearing integration with the vision –Less expressive –Difficulty learning through observation: how to eat alone, maintain posture… THEME 4: PERFORMANCE OF THE OPTOMETRIC EXAM a) Children to to 5-years-old

8. THEME 4: PERFORMANCE OF THE OPTOMETRIC EXAM BABY: –Determine the date and time of the visit with a parent –Do the exam after the baby has eaten and is wearing clean diapers –Do not cooperate: be present in an observing capacity 12 MONTHS: –Easy execution test FRISBY With gaurantee after 2-years-old Reinforcement: baby rattle, lights…

9. THEME 4: PERFORMANCE OF THE OPTOMETRIC EXAM CHILDREN’S FEARS: 7 to 9 months: the are scared in the presence of strangers Fear of unexpected changes Fear of new experiences. Oclusion is nearly impossible between 1 and 2-years-old. Rejection of test glasses.

10. THEME 4: PERFORMANCE OF THE OPTOMETRIC EXAM b) Children over 8 and adolescents TASKS: Reading and writing Calculations Development of concepts for everyday life Creating relationships “in twos” Development of attitudes with respect to social groups and institutions

11. THEME 4: PERFORMANCE OF THE OPTOMETRIC EXAM Active cooperation: clear explanations TO THE CHILD 4 years: knows that he/she is ill from external clues 8 years: can describe the illness in terms of what happens or is happening Avoiding metaphors Possibility for rejection of glasses PREVENT ANXIETY: –Fear because of the association of ideas –Create an attractive atmosphere –Blame –Simple explanations –Do not wear a white robe –DIRECT ATTENTION TO THE CHILD AND NOT THE PARENTS –Do not lie: cycloplegics burn!!! –They do not understand jokes

12. THEME 4: PERFORMANCE OF THE OPTOMETRIC EXAM 4. Adult population TASKS: Pairing up Raising children Managing a household Building a career Adjusting to physiological changes implicit to midlife

13. THEME 4: PERFORMANCE OF THE OPTOMETRIC EXAM MEN: little contact with health services TOYS WRITTEN PLANNING OF VISITS DETERMINING NEEDS –Vision: close up –Vision: far away –Color vision –Ocular protection AVOID ECONOMIC IMPLICATIONS IN THE QUESTIONS PHYSICAL SYMPTOMS OF AGING: farsightedness

14. THEME 4: PERFORMANCE OF THE OPTOMETRIC EXAM A visual exam can provoke anxiety Unexpected or disagreeable news FEARS: image, deteriorated vision, general health problem… Allow catharsis and the freeing of emotions Do not minimize problems if they are serious Calm unfounded fears Make the patient aware of dangerous situations

15. THEME 4: PERFORMANCE OF THE OPTOMETRIC EXAM 5. The elderly TASKS : Adjusting to lessening physical strength Adapting to retirement Reduced income In some cases, widowhood

16. THEME 4: PERFORMANCE OF THE OPTOMETRIC EXAM 2020: 15% of the population > 65 años Women: 2/3 of the elderly population. Nearly half are widows Social isolation due to a precarious economic situation, bad health, or lack of transport THESE DEMOGRAPHIC CHANGES WILL AFFECT THE VISUAL ATTENTION!!

17. THEME 4: PERFORMANCE OF THE OPTOMETRIC EXAM 1.The majority of people over 65 are senile (deficient memory, disorientation, dementia) 2.The five senses (sight, hearing, taste, smell, and touch) tend to weaken with age 3.The majority of elderly do not have the interest nor the capacity to maintain sexual relationships 4.The vital capacity of the lungs diminishes with age 5.Almost all older people feel bad or ill most of the time 6.Physical strength tends to diminish with age 7.A least a tenth of elderly people live in institutions (residences, hospitals, psychiatric wards) 8.Older drivers have fewer accidents than people younger than 65 9.Older workers generally cannot work with the same effectiveness as younger workers. MYTHS ABOUT THE ELDERLY

18. THEME 4: PERFORMANCE OF THE OPTOMETRIC EXAM 10. Almost ¾ of elderly people are healthy enough to participate in normal activities 11. The majority of older people are incapable or adapting to changes 12. Generally, elderly people find it more difficult to learn new things 13. It is very difficult for an older person to learn new things 14. Older people tend to react more slowly than young people 15. In general, older people look similar 16. The majority of the elderly affirm that they do not get bored easily 17. The majority of the elderly are socially isolated 18. Older workers have fewer accidents than younger workers

19. THEME 4: PERFORMANCE OF THE OPTOMETRIC EXAM Worried about their sight Health (and not age!): principal cause of daily decline Dependence, perceived support, perceived health ↓ Visual acuity, contrasts and field of vision: falls, mobility, independence Questionaire NEI-VFQ

20. THEME 4: PERFORMANCE OF THE OPTOMETRIC EXAM Slow and prudent in their judgements Medications Preferably, they live at home. Visual attention to the domicile? Lots of patience!! Diminished memory Great variability in the state of health Do not shout to be heard

21. THEME 4: PERFORMANCE OF THE OPTOMETRIC EXAM 6. Poor vision Depression or mourning? A feeling of dysfunction Sudden losses of vision: depression in 5-15% of cases Frustration → regression Reconstruction of their abilities. Something to do! Artesanal, therapeutic actions

22. THEME 4: PERFORMANCE OF THE OPTOMETRIC EXAM Blind: solitary, destitute, dependent, depressed... Be careful with certain behavior in front of blind people! Attention to people who still haven’t lost all of their vision