A&P - General for all appointments

Released new spec rx today. 

RTC in 1 yr for CEE, unless symptoms arise sooner. 

Edu pt on risk of retinal detachments, holes, breaks, and tears. Edu pt on signs/symptoms of retinal detachment including but not limited to sudden onset and/or increase in frequency of floaters and flashes & curtaining/reduction in vision. Edu pt to RTC asap if such symptoms arise for an immediate fundus evaluation.

Released new spec rx today.

RTC in 1 yr for CEE, unless symptoms arise sooner. 

Edu pt and parent on risk of retinal detachments, holes, breaks, and tears. Edu pt and parent on signs/symptoms of retinal detachment including but not limited to sudden onset and/or increase in frequency of floaters and flashes & curtaining/reduction in vision. Edu pt and parent to RTC asap if such symptoms arise for an immediate fundus evaluation. 

Edu pt on exam findings. Advised pt on risk of vision loss associated with glaucoma & need for treatment compliance. 

After discussion with parent regarding myopia control options & the risks/benefits of each treatment option, parent decided to begin use of Atropine eye drops. Parent is not interested in CLs or other myopia control options at this time. Edu parent that atropine is not FDA approved at this time (edu parent that this is an off-label use of the medication) and edu pt & parent on possible side effects associated with atropine use - both systemic and ocular. Pt understood all instructions and risks involved with initiation of medication. Pt would still like to proceed. RTC in ____ months for atropine myopia control follow up, then follow up every 6 months. Edu pt to call the clinic asap (sooner than the scheduled follow up appointment) for an urgent evaluation if unexpected systemic or ocular symptoms arise from the medication (edu pt on what symptoms to be aware of). 

Sent atropine 0.05% prescription to Crossroads pharmacy.

Edu pt and parent on importance of dilating the pupils to obtain better view of fundus. Edu pt & parent that without dilation, only limited view of retina is possible. Edu pt and parent on risks associated with not dilating (including possible permanent vision loss due to a limited view of fundus) and pt & parent understood all instructions & risks involved. Despite discussion & explanation of risks involved, pt & parent decided to decline dilation.

HEADACHES:

Edu pt on condition & exam findings. Edu pt to monitor symptoms and to RTC if HA symptoms continue to persist, increase in frequency or severity or are associated with other symptoms such as reduction in vision and severe pain. Pt understood all directions.

No reported pt systemic or ocular hx, no surgeries reported.

No reported family systemic or ocular hx.

Edu pt on condition & exam findings. Edu pt on urgency of evaluation with Retina Center of Texas to determine if hole in ___ eye requires treatment and for a peripheral retinal evaluation OU to ensure there are no other holes or breaks in the retina. Edu pt on consequences of delaying evaluation with retina including but not limited to permanent reduction/loss of vision. Edu pt on risk of retinal detachments and associated symptoms such as but not limited to flashes of light/floaters in vision and reduction/curtaining of vision. Pt understood all instructions and risks involved. Sent pt records to Retina Center of Texas. Provided pt with contact information for Retina Center of Texas.

AOV: 90 deg R, 90 deg L

(+) arteriolar constriction and vascular changes associated with HTN ret

Edu pt that symptoms should continue to improve over time. Edu pt to RTC asap if symptoms do not improve or worsen over time including but not limited to reduction in VA & increase in pain, 

Likely blood vessel damage due to longevity of the disease - diabetics

will you write it down for the cash amount

Throw all on medical then 

Foreign Body:

Edu pt on condition & findings. Instilled 1 gtt Proparacaine in left eye. Cleaned needle tip using Providone Iodine pad & alcohol pad. Removed 1 piece of metal OS with 25 gauge needle and removed metal particles on eyelid margins using cotton swab. Instilled 1 drop of Proparacaine into right eye, then removed 2 pieces of metal OD with 25 gauge needle & removed metal particles on eyelid margins using cotton swab. Washed each eye with saline rinse at end of procedure. Placed bandage soft contact lens on each eye following procedure. Prescribed Maxitrol drops to be used qid for next week in both eyes, sent to pt's preferred pharmacy. Alternate Advil & Tylenol for pain prn.

Edu pt that condition should continue to improve (less pain, irritation & redness) over time and not worsen. Edu pt that if condition worsens prior to f/u appt including but not limited to symptoms such as reduction in vision, increase in pain or redness, then RTC asap for evaluation. 

RTC in 3 days for follow up and BSCLs removal OU. Make sure to float lens before removing BSCLs at f/u - instill saline prior to CLs removal.

VF 10-2 OU: Reliable OU, Central mild defects OU consistent with plaquenil toxicity. RTC for further VF testing to ensure defects are consistently repeatable.