Hello welcome to the clinic. So today we're going to be fusing some clinical skills with some ASMR.
We're going to be taking some eye and head measurements using the equipment set out here. We
have our beautiful volunteer, so let's get started first with the cover tests. So I'm going to be
covering the left eye looking at the right eye for any movements of the eye, coming back to the
primary position, cover the left, sorry, cover the right, looking at the left eye,
any movement. Excellent and we just do a swinging cover test, looking at the eye that's been
under the cover for any movements whether that's from out in top or bottom there
and the pupil measuring gauge
is pretty much self-explanatory, ask the patient to look into the distance
Take a measurement of the pupil sizes there moving along the scale,
probably about a five there in the right
and about a five in the left there marvellous
let's move on to some pupil distance measurements. I'm going to do the monocular one using this scale
here, place that on the bridge of the nose to keep it very steady, looking at this scale here,
lining up the centre of the pupil and then we do the same on this side here, use two hands
if it helps, patient must keep steady, looking off into the distance, excellent. I'm going to use the
vertical part there just to measure the vertical aperture that is the lower lid margin to the upper
just like so
and you can use any part of the scale there, that's about 9mm
wonderful
total pupillary distance measurement now, using the City rule there
I'm going to ask the patient to look into my left eye
right eye, double check by going back to the left and looking into my right eye there,
so use the scale from the outer Iris in the right to the inner Iris edge in the left there.
Sometimes it's hard to find the centre of the pupil if the patient has a darker Iris
so we use the edge of the iris to the inner Iris there for the total pupillary distance
okay let's move on to some
technical measurements, going to use this here
in conjunction with the ruler here, I'm going to try head width. Position like this
and this and we're reading off the top scale there, the top scale here so that is head width
turn the cursor there
and using this scale here
place this there
if this doesn't come quite long enough to the patient's temple, go back this way, there
we go. In fact I'm going to go this way
align that with the temple there, ruler here, read off the scale and that is your temple width
okay let's use this scale here very simple measurement this, this is the apical radius
like to start big, looking for a snug fit
the bridge of the nose
so eight is not too bad, a little bit of sideways movement there, let's try the seven.
We're going to just move it gently, you don't want to
dig into the patient's Bridge with the corners. Six is not quite fitting snugly,
seven looks good, eight a little bit loose. I'm going to go with an apical radius of 7mm there
okay let's turn and use the scale here for the front angle
the cursors here, the largest will align with the centre of the nose
and then we'll bring the cursor down until we have
contact and we'll take the measurement off the scale there
easy to do the other one just move the cursor
Slight contact, and read off the scale there. Excellent, for the splay angle, we're going
to continue with this here, going to place this line in the centre of the
nose again just there. You don't want this part to poke the patient in the eye so just be aware
that you're missing the eye there, the contact is here and we read off the scale there.
And for the opposing side, missing the eyeball there, the patient can close
their eyes if they wish, contact is made and we read off the scale just there. marvellous.
okay I've set up the measuring device, like so. Okay I'm going to use this side here like
this. We're going to do distance between rims at 10mm, bring that out there, I want to place this
like so, contact there and there, we're going to bring this little slider in
like this until we have contact here. There we go not too tight,
and then you can take your measurement off the scale here
flip it over, we have 15mm below crest
okay so contact is there, bring the slider in there
okay so we have contact here, here and just resting there,
and we can take the measurement off the scale there. Very low measurement, lovely
okay now I'm going to use the measuring device to check the crest height
and we'll be sure to add 5mm onto the reading, we're going to use this little scale here, so
we're going to hold like so, good and we're just going to
use this scale here and we're going to a measure down to the lower lid on the scale here
that's approximately 8mm there, we'll add five to that for the total crest height.
Flip around you'll see you have the scale there, you want the scale just off
or through the pupil centre. Nice and steady and we have a reading of 10mm there,
plus five crest height to 15mm so a little bit of disparity there
okay just bringing you down a little bit there ma'am, we're going to use the scale
in this particular way, to check the bridge projection I'm using the scale here.
Ideally we like the patient to look down. We place this part here with a line running
through the centre of the nose again and you want to gently slide the cursor in there,
bring it down for you so you can see better, until this part just touches the patients eyelashes.
As the patient's looking down you can ask them to blink
so you know that there's contact with the edge of the slider there. With
patient looking down, bring it in until you're close to the lashes, patient blinks,
when we just touch the lashes we can take the reading off the scale there, marvellous
right now we're going to try length to bend and angle of side. We have the scale here,
we just want it like so, top of the ear
just above the patient's eye, bring the cursor in, so it's like that against the eyes as you can see,
take the angular measurement there and length to bend shall be top of the ear there, marvellous.
okay let's try length to tangent. Going to place the ruler here, this will go behind the ear
and we'll take the measurement on the scale here to the front
okay now we're going to do the downward angle of drop.
We're going to use the scale here and the cursor
so usually you'd have to bring the ear forward
and this will touch in the space between the mastoid and the inner part of the ear from behind.
Place this there and we bring this cursor behind the ear there, very gently,
we flip around take the angular measurement on the scale there and we repeat on the other side