1. OSPE (Objective Structured
Practical Examination)
Dr Md Anisur Rahman (Anjum)
anjumk38dmc@gmail.com
01711-832397
Wednesday, February
05, 2014
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2. OSCE
• Objective: Examiner use a check list forObjective: Examiner use a check list for
evaluating the trainee.evaluating the trainee.
• Structured: Trainee sees the same problemStructured: Trainee sees the same problem
and perform the same tasks in the same timeand perform the same tasks in the same time
frame.frame.
• Clinical: The tasks are representative of thoseClinical: The tasks are representative of those
faces in real clinical situation.faces in real clinical situation.
Wednesday, February
05, 2014
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3. Modification of OSCE
• OSER: Objective Structured Examination
Record.
• OSPE: Objective Structured Practical
Examination.
• OSVE: Objective Structured Video
Examination.
• OSPRE: Objective Structured Performance
Related Examination.
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05, 2014
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4. 1. History taking (Congenital cataract/ Cataract
in Children)
• History:
• When was white reflex noted?
• Congenital cataract in the family– sibling history.
• Trauma/ child abuse
• Redness, pain before cataract.
• Behavioral pattern of child at home, school.
• Visual status – ambulation in familiar & unfamiliar
surroundings.
• School performance, especially reading.
Wednesday, February
05, 2014
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5. 1. History taking (Congenital cataract/ Cataract
in Children)
Birth History:
 H/O consanguinity.
 Maternal infection especially 1 st trimester.
 Gestational age.
 Birth weight.
 Birth trauma, unwanted event during delivery.
 Supplemental oxygen therapy or being kept in
incubator
 Developmental anomalies.
 Developmental milestone.
Wednesday, February
05, 2014
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6. 2. History taking R.P
 Age of onset of symptoms.
 Duration of night blindness.
 Duration of progressive loss of visual field.
 Duration of dimness of vision . Is it progressive?
 Family history of R.P.
 H/O consanguinity.
 H/O trauma.
 H/O drug intake.
 H/O hearing disorder, ataxia, nystagmus.
Wednesday, February
05, 2014
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7. 2. History taking R.P
• H/O mental retardation.
• H/O heart disease.
• H/O hypogenitalism, obesity, polydactyly.
• H/O diarrhea, skeletal deformity.
Wednesday, February
05, 2014
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8. Question
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Q1) Here is a child with ptosis
since birth. What would be the
most important examination?
Q 2) By seeing of which point
you will decide to early
surgery?
Q 3)How could you decide
clinically if this child's ptosis is
caused by a dystrophic levator?
Q 4) What other ocular sign
may be present? And why?

9. Answer
1) Visual Acuity & Refraction.
2) Is it cover the pupil or not?
3) There is lid lag when the patient looks down.
4) The ipsilateral superior rectus may also be
maldeveloped resulting in poor globe
elevation on upgaze.
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05, 2014
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10. Question
A patient who is about to undergo cataract surgery
has the following results during her pre-assessment.
 Axial length = 23.00 mm
 K1 = 42.00 DS
 K2 = 44.00 DS
 A-constant of the lens to be used = 118.0
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05, 2014
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11. Question
a. Calculate the lens power needed to achieve
emmetropia.
b. During the operation, the patient has a large
ruptured posterior capsule and you decide to
fit the lens in the sulcus. Would you use a lens
(same A-constant) with a higher or lower
power compared with a?
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05, 2014
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12. answer
a) Using the IOL formula
P = {A - 2.5 x (axial length) - 0.9 x (average K
reading )}
= {118 - 2.5 (23) - 0.9 (43)}
= 21.8 D
( As the lens come in step of 0.5 D, the one
used would be 22.0D)
b) Moving the lens forward increases the power of the
lens and therefore a weaker lens is needed. This
is usually 0.5D less than in the bag IOL
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05, 2014
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13. Question
• A patient has a visual acuity of 6/6 in both eyes while
wearing glasses with the following prescriptions:
• OD -1.00/-0.50 X 90
OS -2.25 / -1.75 X 180
• The keratometry reveals the following results:
• OD 7.85 mm along 1800
(43.00D)
7.85 mm along 900
(43.00D)
• OS 7.80 mm along 1800
(43.25D)
7.50 mm along 900
(45.00D)
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05, 2014
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14. Question
• 1) Which structure contributes to the
astigmatism in the
• a. right eye?
b. left eye?
• 2. If the patient were to wear spherical hard
contact lenses, which eye will see better
•
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05, 2014
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15. Answer
1) a) The lens
• b) The cornea.
Total ocular astigmatism= corneal astigmatism +
lentricular astigmatism.
• 2) The left eye. A hard contact lens can neutralize
about 90% of corneal astigmatism. Therefore the left
eye will see better than the right eye as the
astigmatism in left eye is entirely corneal.
•
•
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05, 2014
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