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Hi guys. Um Thanks for joining on time. We're just gonna give it two or three minutes um for folk who are just rolling in. So if you've not got a cup of tea or got ac a cup of coffee and you've just uh joined and you want to grab one, you'll have time to do that. Okie Dokie. Let's get going. Thanks for waiting guys. I hope you can all see the slides and see me and at least hear me. Um uh today's session will be led by myself Wesley, um and my colleague um Atif who's in Reddit is currently helping um just moderate and just to help me manage the tech. Um So today we're recovering um visual pathways, visual fields, defects and then a bit about the eye exam. Um It'll be a fairly fast paced session. So hopefully we won't use up the whole hour, but it's also gonna be interactive. Um There's only a few folk here today and there's honestly no judgment. So if you've um if we ask a question um that you can pop an answer to the, into the chat, then please do. Um They're mainly fairly easy questions. So you won't have to think too much in terms of. Um is this gonna be this or is it something else? It'll probably be quite an obvious answer for most of the questions. And then we'll also have a few Mc Qs to run through. Um So it's not like going through the learning outcomes. Um So today, hopefully by the end of the session, you'll be able to understand what a visual pathway is and how it works. Recall common visual field defects with the anatomical location, conduct a fairly basic eye examination, one that will see you through UK MLA and then also through foundation um and then interpret eye exam findings to consider possible differential diagnoses. So we'll start off with the structure of the eye exam. Um the things that you've probably all heard heard of before. So we usually start by looking at the eye. So general observation, um checking the visual acuity of the eye, um checking visual fields, then looking at the pupils, um making sure to check for relative afferent pupillary defect. And then sometimes we do cover testing, then we test the muscles of the eye with what some people call the H test. And then if you're lucky to have a fundoscope, uh you can do fundoscopy. So we'll start by talking about visual acuity first. Um When you're on the wards, often they don't have a Snellen chart. Um So if you have an android phone, you can use the app called Peak Acuity. If you've got an iphone, you can use Ola Check. They're free apps pretty easy to use and they tell you how to do the test. Um II use the check all the time. Um And you basically just sit at the end of the bed about 3 m from the patient and you click through and um the patient can read the letters and then you can click whether it's 123 incorrect or all correct. And it'll take you through and then it will tell you um what the visual acuity is. So, visual acuity is, it's important to test at both distance and near. Um sometimes people use the NOLA OD and OSO D is right. Um OS is left and they usually use a Snellen chart um which is the one that we've got on the right. Um And it's usually done at 6 m. Um So for example, if someone had 660 vision uh in here, um the top, the top number is uh the patient to chart distance. So it's 6 m and the denominator at the bottom number is the line that the patient can read. So, on this chart, that would be a um for most of us, it'd probably be the line that says six U AZ and F DT. Um If you're looking at American stuff, it's often in feet. So 6 m would be 20 ft. And then so 66 is 2020. Um And I put a wee note here about pinholes. Um So when you're testing, patient patients visual acuity, you'll usually use it with glasses, but sometimes people don't have glasses and they actually do need glasses. So if you can use a pinhole, that can quickly test whether they have any refractive error that can be corrected if their va improves the pinhole, that probably means they have a refractive error. If their eyesight is so bad that they can't use the silon chart. So they can't read a, then you'd probably be thinking about the um acronyms at the bottom. So it would be counting fingers, hand movements, only perception of light or no perception of light at all. So um those are some acronyms that you can consider using. Um we come on to confrontational visual fields. I'm sure you've all done this as part of your neurological examination. So, in the picture that we've got here, you can see the guy on the left is testing the guy on the right. So he's testing his left eye vision. So it's important to test each eye one at a time. It's a quick screening tool. Um It's for very gross uh visual field defects. There's more specialized equipment that you can use if you want to look to closely map visual field defects change over time, but that's not the kind of thing that we'd probably use in the ward. Um And I'm just like the neurologist, like to say, visual field defects are all about localizing lesions. So, thinking about at what level, um there's a, a problem that's causing the defect that we're seeing. So we'll start off with our first question. Um And I'll pull up a wee poll so that you guys can vote. Um I don't think the poll, um, the poll tells anyone who's voted for whatever. So I'll let you guys, I'll give you a minute to, um, read the questions and then you can vote.