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Adults in Educational Therapy
Published in Maxine Ficksman, Jane Utley Adelizzi, The Clinical Practice of Educational Therapy, 2017
Jean Piaget’s theories that so elegantly explain the development of the child’s ability to make sense of the world are aptly applied to the adult client who is delayed or deficient in the development of executive functions. Piaget’s stages of cognitive development are a useful analytical tool for the ET working with adults. The adult client with EF deficits experiences age-inappropriate developmental challenges and may exhibit characteristics of earlier stages of operation when in “cognitive distress.” Though many who seek educational therapy possess the intellectual capacity for formal operations, when engaged in activities that place too high a demand upon the capacity for executive function, clients often revert to behaviors characteristic of the concrete operational or even pre-operational stages. For example, difficulty in dividing attention may result in the pre-operational behavior of centration (focusing on only one perceptual aspect at a time). Some clients may adapt by using egocentric monologue to mediate challenging tasks, just as small children do and for the same reason, because the capacity for internal self-talk is limited; in the child it is developmental, but in the adult it may be attributable to a deficit of working memory or attention. The educational therapist is responsible for helping clients to adjust a host of failing assimilations involving flawed schemata that are causing them to live in a constant state of Piagetian disequilibrium (Wadsworth, 2004).
Accommodating intraocular lenses
Published in Pablo Artal, Handbook of Visual Optics, 2017
The principle of lens refilling is different compared to accommodating IOLs. The idea is to refill the lens capsule after removing the crystalline lens.43 However, as shown in Figure 13.12, lens refilling changed significantly over the years. Primarily, the capsular bag was filled directly (Figure 13.12a), but leakage occurred in many cases. In a next step, different techniques were developed to overcome this problem, such as an endocapsular balloon (Figure 13.12b), which prevented silicone leakage with reasonable preservation of accommodation. Other methods, such as a specially designed sealing plug (Figure 13.12c), and later on an optic plug (Figure 13.12d,e) were also tested. To improve on the endocapsular balloon technique, a plug to seal a continuous curvilinear capsulorhexis was developed by Nishi and Nishi (Figure 13.12f).44 This technique showed to be feasible due to a good outcome concerning centration and only little PCO. A more recent method uses an innovative foldable silicone IOL and a thin plate-disk haptic.45 This technique allows the anterior capsule to cover the injection hole to prevent leakage of the silicone. There are two additional advantages of this technique. The cohesive silicone polymer with its high molecular weight does not leak through the space between the anterior capsule and the IOL and the injected liquid silicone polymerizes 2 h after injecting it; therefore, postoperative leakage is not be expected.46
Hallucination-focused Integrative Treatment
Published in Jack A. Jenner, Hallucination-focused Integrative Therapy, 2015
Assessing the strengths and successes of a patient has diagnostic as well as therapeutic value. Diagnostically, it tells us to what degree symptoms monopolize the life of the patient, and about the patient’s relative centration on his or her disabilities. The more a patient’s attention can be therapeutically diverted to other subjects or objects, the better the chances of improvement. Asking about successes may raise hope, but can also focus patients more on their problems, and make them feel ignored or misunderstood. Some patients may interpret our questions about delusions as proof that we do not believe them, or see them as poseurs. Reframing and positive labelling are useful here.
Augmentation of telemedicine post-operative follow-up after oculofacial plastic surgery with a self-guided patient tool
Published in Orbit, 2023
Davin C. Ashraf, Amanda Miller, Meleha Ahmad, Loreley D. Smith, Seanna R. Grob, Bryan J. Winn, Robert C. Kersten, M. Reza Vagefi
In order to facilitate more effective future applications for collecting patient photographs, the authors explored photograph features associated with higher surgeon-reported quality. Facial centration was generally good in this study, perhaps owing to the detailed instructions and example images guiding patients. This feature was considered because the authors suspected that the autofocus feature of digital cameras might not perform as well for decentered faces. However, there was only a weak correlation between facial decentration and lower photograph quality. Extreme cases did appear to have lower quality, likely due to worse focus or partial capture of the face. There is limited consensus regarding the minimum resolution required for clinical photography; some authors have suggested values ranging from 1.5 to 12 MP,40–42 but these have been based on expert opinion rather than quantitative analysis. The quantitative findings of the present study suggest there is only weak correlation between resolution and subjective image quality in the range produced by modern smartphone cameras; notably, few photographs had values less than 1.5 MP, and there did appear to be a lower mean quality when photograph resolution was at or below that of maximal video resolution (0.9 MP). Not surprisingly, the most influential factor in photo quality appeared to be blurriness.
Femtosecond Laser Assisted Cataract Surgery: A Review
Published in Seminars in Ophthalmology, 2021
The capsulotomy incision starts below the surface of the anterior capsule and continues through the capsule cutting in a cylindrical or spiral fashion.4,27 The Catalys initiates its capsulotomy incision at a depth of 0.6 mm whereas the Z8 initiates it at 0.8 mm. The VICTUS depth is unknown.2 The capsulotomy can be centered on the pupil center, pupil maximized center, scanned capsule (specific to Catalys), or custom placement. Bafna conducted a study comparing capsulotomy-IOL centration after scanned capsule versus pupil-centered capsulotomy, given the haptics make the IOL center within the bag itself naturally. In 82% of patients, the scanned capsule capsulotomy method offered better centration between the capsulotomy and IOL and 100% had 360 degree capsulotomy-IOL overlap.32 Kránitz et. al. found IOL decentration was six times more likely to occur in patients with a manual capsulorrhexis versus FSL capsulotomy.33 Centration is pivotal when creating capsulotomies for patients receiving multifocal and toric IOLs, as capsulotomy-IOL centration is key to their efficacy.
General pain perception sensitivity, lid margin sensitivity and gas permeable contact lens comfort
Published in Clinical and Experimental Optometry, 2020
Daniela S Nosch, Roland E Joos, Dominik Müller, Stefanie M Matt
At the second visit, the baseline lid wiper sensitivity threshold measurement at the upper and lower lid of the right eye was repeated on each subject. The RGP CLs (cleaned with surfactant, stored in conditioning solution and thoroughly rinsed with saline) were inserted in both eyes. The subjects were instructed to look straight ahead when the CL comfort was acceptable and to look downwards, if they perceived significant discomfort. After an initial adaptation period of 30-minutes, the CL fit was assessed statically and dynamically (with use of fluorescein) and filmed with a digital camera, according to an evaluation scale previously applied.2007 The central part as well as the mid‐periphery and the periphery of the CL in each quadrant were evaluated on a scale between −5.0 (maximal pressure on the cornea) and +5.0 (maximal, excessive pool). If the sum of all figures (without prefix) exceeded 5.0, the subject was excluded from the study. CL centration was evaluated on a scale between 0 (perfectly centred) and 5.0 (extremely decentred, CL slides off the cornea during a blink or changed direction of gaze), whereby a grade of > 2.0 resulted in exclusion from the study.