Birla Institute of Technology and Science, Pilani and Elite School of Optometry (Unit of Medical Research Foundation)

CLINICAL LOG BOOK B.S OPTOMETRY 20 - 20

Name: ID No:

Course No: Course Title:

Birla Institute of Technology and Science, Pilani and Elite School of Optometry (Unit of Medical Research Foundation)

Checklist: S No 1 2 3 4 5 6 7 8 9 10 11 12 No of Observed Cases No of Independent Cases

Procedure Refraction Keratometry Gonioscopy Applanation tonometry Colour Vision Testing Pupillary Evaluation (Neuro and Glaucoma Cases) Amsler Charting Tear Film Evaluation Stereopsis WFDT Testing Squint Evaluation Independent work ups

Target 100 30 15 50 20 30 10 20 15 15 10 50

Name & Signature of the Student: Name & Signature of the Evaluator: Name & Signature of the Mentor: Name & Signature of the Principal:

Date of Submission:

Details of Continuous Education

Date

Topic

Speaker

Details of Vision Screening

Date

Type of Screening

Venue

Total Number of Cases seen by individual

Guidelines for Log Book Maintenance: 1. Posting name, Date and page number in all postings 2. Classify the cases which you had observed with optometrists/ophthalmologists as OBSERVED CASES and in which you had independently seen the patient classify it as INDEPENDENT CASE. Include cases seen in GOPD as Independent cases. 3. Details of CME attended with topic(s) and date should be entered 4. Details of vision screening should be indexed and entered 5. Learning from each case can be added at the end of case 6. At the end of each posting the statistics on various conditions seen should be mentioned (For example: in Glaucoma Postings: Congenital Glaucoma: 4 cases, Juvenile Glaucoma: 1 case, POAG: 20 cases etc.) 7. At the end of the postings, student should get the signature from the respective evaluator (Person designated for the same) 8. Student should submit the log book to the mentor and get the signature at the end of each postings

Objectives for Clinical skills: 1. 2. 3. 4. 5. Able to take relevant history Have independently seen 50 cases with appropriate referrals and have followed up the cases Document the findings and arrive at tentative diagnosis Able to refer to appropriate department Communicate the diagnosis to the patient in an effective manner

Out Patient Department: At the end of the postings the students must be
1. Able to perform good objective and subjective refraction 2. Independently done at least 50 refractions and supervised 3. Able to perform Keratometry 4. Independently done at least 25 K readings and validated 5. Able to perform Auto K/ Manual K 6. Able to perform Tear film evaluation 7. Able to perform Applanation Tonometry, Gonioscopy, Colour vision test, Amsler Testing and Pupillary Evaluation 8. Independently should have done 30 GAT, 5 Gonio, 10 Colour Vision, 10 pupillary Evaluation and 10 Amsler Charting. 9. Perform sensory and motor evaluation and interpret the findings i. Worth four dot test for Distance and near ii. Stereopsis testing for near using Titmus/ Randot stereo plates iii. Cover test in all nine cardinal positions of gaze and documentation iv. Squint evaluation v. Parks three step test vi. Double Maddox rod test vii. Bagolini striated lens testing 10. Independently should have done 5 squint evaluation

Knowledge Aspects: 1. Should gain basic knowledge on the corneal diseases and degenerations 2. Should gain basic knowledge on the refractive surgery 3. Should gain basic knowledge on ocular emergencies 4. Should gain basic knowledge on Anti-glaucoma medications 5. Should gain basic knowledge on types of glaucoma 6. Should gain basic knowledge on interpretation of visual fields 7. Should gain Basic knowledge on EOM anatomy and physiology 8. Should gain Basic knowledge on ocular Development 9. Should have basic knowledge on Retinal anatomy and physiology 10. Should have basic knowledge on interpretation of OCT and FFA

Posting: _____________________ MRD No: Purpose of visit

Date: Age/Sex

Chief Complaints:

Past Ocular History:

Current Medications:

Past Medical History:

Recent Investigations:

Family History:

Birth History:

Allergy History:

Keratometry:

Cover Test: EOM:

NPC: SUBJ & OBJEC: NPA: OD/OS/OU:

WFDT: D N

Stereopsis:

Pupillary Evaluation:

External Examination:

Slit Lamp Examination

Tonometry (mmHg): Method & Time: OD: Gonioscopy: OD: OS: OS:

TBUT: OD: Schirmers test: OD: Syringing: OD: OS:

OS: OS:

Blink Rate:

ROPLAS:

OD: OS:

Other Procedures (If Any):

Dilatation Instructions:

Fundus:

Diagnosis:

Intervention Planned:

Learning: