Upload
douglas-west
View
255
Download
2
Embed Size (px)
Citation preview
Certified Certified Paraoptometric Paraoptometric Review CourseReview CourseCPOCPO
Lynn Lawrence, CPOTLynn Lawrence, CPOT
Be thankful for your Be thankful for your job!job!
Disclaimer…not sanction Disclaimer…not sanction by CPCby CPC
Disclaimer: This review course Disclaimer: This review course does not prepare you for the does not prepare you for the national examination, what it does national examination, what it does is review key areas from the most is review key areas from the most current test outline. To properly current test outline. To properly prepare for a national examination prepare for a national examination you should allow yourself ample you should allow yourself ample time to time to fullyfully review all the areas review all the areas being testedbeing tested
ObjectivesObjectives
Provide a 3 hour review ofProvide a 3 hour review of– Discuss practice managementDiscuss practice management– Thoroughly review anatomyThoroughly review anatomy– Clarify terminology used in reviewClarify terminology used in review– Explain the equipment used in reviewExplain the equipment used in review– Discuss primary diseasesDiscuss primary diseases– Review test proceduresReview test procedures
Give a 25 question review testGive a 25 question review test
Eyecare Specialists andEyecare Specialists and Ancillary Personnel Ancillary Personnel
(2%)(2%)
The Four “O’s”The Four “O’s”
Optometrist…state over sightOptometrist…state over sight Ophthalmologist…surgeonOphthalmologist…surgeon Optician…makes the glassesOptician…makes the glasses Ophthalmic Medical PersonnelOphthalmic Medical Personnel
– Optometry technicians Optometry technicians – Ophthalmology techniciansOphthalmology technicians
Roles of a Roles of a ParaoptometricParaoptometric
Collect patient dataCollect patient data Administer tests of visual capabilitiesAdminister tests of visual capabilities Assist in managing the officeAssist in managing the office Assist in primary patient care Assist in primary patient care
examination and treatmentexamination and treatment– Contact lensesContact lenses– Low visionLow vision– Vision therapyVision therapy– Optical DispensingOptical Dispensing
Practice Management Practice Management (10%)(10%)
Practice ManagementPractice Management
Telephone Techniques…Telephone Techniques…when/how when/how messagesmessages
Appointments…Appointments…whenwhen is the best time to is the best time to book?book?
Record Filing Systems…Record Filing Systems…whichwhich the the best?best?– AlphabeticalAlphabetical– NumericalNumerical
Recalls…Recalls…whichwhich is the best method?is the best method?
““Triage” use to Triage” use to categorizecategorize EmergencyEmergency
– Must be evaluated immediatelyMust be evaluated immediately UrgentUrgent
– 12-24 hours12-24 hours RoutineRoutine
– Next available appointmentNext available appointment
Triage QuestionsTriage Questions
What problem are you having? What problem are you having? (chief complaint)(chief complaint) How long has it been going on? How long has it been going on? (onset/duration)(onset/duration) Is it getting worse? Is it getting worse? (severity)(severity) Does it affect your vision? Does it affect your vision? (associated symptoms)(associated symptoms) Does anything make it better? Does anything make it better? (modifying factors)(modifying factors)
Which of these is most important?Which of these is most important?
Practice Management - Practice Management - continuedcontinued
Fee PresentationFee Presentation CollectionsCollections Third Party Payments…also know Third Party Payments…also know
as?as? ReceiptsReceipts Explanation of chargesExplanation of chargesWhen do you apologize for your fees?
HIPAAHIPAA
What is HIPAA?What is HIPAA?– Health Information Portability & Health Information Portability &
Accountability ActAccountability Act– Took effect April 14, 2003Took effect April 14, 2003
How long are you required to keep patient records?
HIPAA – continuedHIPAA – continued
Use and DisclosureUse and Disclosure UseUse
– The sharing, employment, application, The sharing, employment, application, utilization, examination or analysis of utilization, examination or analysis of Protected Health Information (PHI) Protected Health Information (PHI) within the covered entitywithin the covered entity
DisclosureDisclosure– The sharing or release of PHI in any The sharing or release of PHI in any
manner outside the covered entitymanner outside the covered entity
HIPAA – continuedHIPAA – continued Office ResponsibilitiesOffice Responsibilities
– Establish and maintain procedures consistent with Establish and maintain procedures consistent with the Privacy Actthe Privacy Act
– Prepare and publish notice of the existence and Prepare and publish notice of the existence and character of those systems consistent with character of those systems consistent with guidance by GSAguidance by GSA
– Establish reasonable administrative, technical, Establish reasonable administrative, technical, and physical safeguardsand physical safeguards
– Maintain an account system of all disclosures for Maintain an account system of all disclosures for six yearssix years
– Permit individuals to have access to personal Permit individuals to have access to personal recordsrecords
– Permit individuals to request records Permit individuals to request records amendments amendments
HIPAA – continuedHIPAA – continued
Minimum Necessary PrincipleMinimum Necessary Principle– Requires office to take reasonable Requires office to take reasonable
steps to limit the use or disclosure of, steps to limit the use or disclosure of, and request for, PHI to the minimum and request for, PHI to the minimum necessary to accomplish intended necessary to accomplish intended purposepurpose
HIPAA – continuedHIPAA – continued Considerations Prior to DisclosureConsiderations Prior to Disclosure
– Patient notification before releasePatient notification before release– Mutually agreed upon alternative communicationsMutually agreed upon alternative communications– Mutually agreed upon authorizationsMutually agreed upon authorizations– Potential or serious threat or imminent danger to Potential or serious threat or imminent danger to
patient or publicpatient or public– Authority of requestorAuthority of requestor– Minimum amount of information necessary for Minimum amount of information necessary for
purposepurpose– Can information be de-identifiedCan information be de-identified– Documentation of releaseDocumentation of release
HIPAA – continuedHIPAA – continued
Requirements for DocumentRequirements for Document– Date of disclosureDate of disclosure– Name, address, and identity of requestorName, address, and identity of requestor– Brief description of PHI disclosedBrief description of PHI disclosed– Brief statement of the purpose of the Brief statement of the purpose of the
disclosure that reasonably informs the disclosure that reasonably informs the individual of basis for disclosure or copy individual of basis for disclosure or copy of written requestof written request
– Verified identity of requestorVerified identity of requestor
AnatomyAnatomy(15%)(15%)
EyelidEyelid 7 Layers of the eyelids 7 Layers of the eyelids
1. Skin-thinnest layer 1. Skin-thinnest layer
2. Subcutaneous 2. Subcutaneous
connective tissueconnective tissue
3. Striated Muscle3. Striated Muscle
4. Sub-muscular 4. Sub-muscular connective tissue connective tissue
5. Tarsal plate or fibrous 5. Tarsal plate or fibrous layerlayer
6. Smooth muscle6. Smooth muscle
7. Conjunctiva 7. Conjunctiva (Bulbar/Palpebral)(Bulbar/Palpebral)
Lipid Secretion: Meibomian Lipid Secretion: Meibomian GlandsGlands
(WC Posey, Diseases of the Eye, 1902)
Transillumination ofmeibomian glands
(Transillumination image from Dry Eye and Ocular Surface Disorders, 2004)
The lipid layer restricts evaporation to 5-10% of tear flowThe lipid layer restricts evaporation to 5-10% of tear flow– Also helps lubricateAlso helps lubricate
Tear Film LayersTear Film Layers
oilaqueous
snot
Healthy Tears….gee whiz Healthy Tears….gee whiz slideslide
A complex mixture of proteins, mucins, and electrolytes coated by
a lipid layer• Antimicrobial proteins
• Growth factors & suppressors of inflammation
• Soluble mucin helps stabilize tear film
• Electrolytes for proper osmolarity (295-300)– pH slightly alkaline (7.4)
This is not testable, info only
ConjunctivConjunctiva a
An epithelial membrane An epithelial membrane which covers the anterior which covers the anterior sclera and continues to the sclera and continues to the back surfaces of the lids to back surfaces of the lids to form a conjunctival sacform a conjunctival sac
Has blood vessels which can Has blood vessels which can burst and cause burst and cause subconjunctival hemorrhage subconjunctival hemorrhage
Three partsThree parts– BulbarBulbar– PalpebralPalpebral– Fornix - where bulbar and Fornix - where bulbar and
palpebral meetpalpebral meet
Adnexa: Orbital BonesAdnexa: Orbital Bones
7 Orbital Bones7 Orbital Bones– MaxillaMaxilla– FrontalFrontal– ZygomaticZygomatic– EthmoidEthmoid– LacrimalLacrimal– PalatinePalatine– Sphenoid Sphenoid
Ethmoid
Palatine
Sphenoid
Maxilla
Which bone is the weakest?
Adnexa: Extraocular Adnexa: Extraocular MusclesMuscles
4 Rectus 4 Rectus MusclesMuscles– SuperiorSuperior– InferiorInferior– LateralLateral– MedialMedial
Adnexa: Extraocular Adnexa: Extraocular MusclesMuscles
2 Oblique 2 Oblique MusclesMuscles– SuperiorSuperior– InferiorInferior
Lipid Secretion: Meibomian Lipid Secretion: Meibomian GlandsGlands
(WC Posey, Diseases of the Eye, 1902)
Transillumination ofmeibomian glands
(Transillumination image from Dry Eye and Ocular Surface Disorders, 2004)
What eye is this?
How does the lipid layer aid in contact lens wear?
Adnexa: Lacrimal Adnexa: Lacrimal SystemSystem
Lacrimal glandLacrimal gland
Excretory Excretory ductsducts
Superior punctumSuperior punctum
Inferior punctumInferior punctum
Inferior canaliculusInferior canaliculus
Nasolacrimal ductNasolacrimal duct
Lacrimal sacLacrimal sac
Nasal Nasal cavitycavity
Superior canaliculusSuperior canaliculus
Anatomy and Anatomy and Physiology of the Physiology of the EyeballEyeball3 Layers3 Layers Fibrous LayerFibrous Layer *Cornea*Cornea
*Sclera*Sclera
Vascular LayerVascular Layer *Choroid*Choroid *Ciliary body*Ciliary body *Iris*Iris
Nerve LayerNerve Layer *Retina *Retina
*Macula*Macula *Optic nerve*Optic nerve
What function does each layer have?
Anterior Segment…Anterior Segment…where where is itis it
CorneaCornea ConjunctivaConjunctiva
– PalpebralPalpebral– BulbarBulbar
Anterior chamberAnterior chamber IrisIris
– PupilPupil Crystalline lensCrystalline lens
– AccommodationAccommodation Ciliary BodyCiliary Body
– Muscle/ProcessesMuscle/Processes Graphic courtesy of National Eye Institute, National Institute of Graphic courtesy of National Eye Institute, National Institute of HealthHealth
Posterior SegmentPosterior Segment
Vitreous humorVitreous humor ChoroidChoroid RetinaRetina
– MaculaMacula– Fovea CentralisFovea Centralis
Retina
How many layers are in the retina?
Posterior Segment: Posterior Segment: Macula/FoveaMacula/Fovea
FunctionFunction– Central visionCentral vision– Color visionColor vision
What is the purpose for rods and cones?
Posterior Segment-Posterior Segment-Optic NerveOptic Nerve
Optic DiscOptic Disc– Correlates with the physiological blind spotCorrelates with the physiological blind spot
Optic NerveOptic Nerve– Cranial nerve # 2Cranial nerve # 2
What type of vision is in the Optic nerve head?
The Eye ExaminationThe Eye Examination(17%)(17%)
Case HistoryCase History
■ Chief Complaint…critical for Chief Complaint…critical for insurance filing!insurance filing!■ Reason for visit-recorded in patient’s Reason for visit-recorded in patient’s
own wordsown words■ History of present illnessHistory of present illness
■ Detailed information on chief complaintDetailed information on chief complaint■ Medical/ocular history (Dx)Medical/ocular history (Dx)■ Family History (FHx)Family History (FHx)■ Social history (age-appropriate)Social history (age-appropriate)
■ Alcohol? Smoke? Occupation? Live Alcohol? Smoke? Occupation? Live alone?alone?
Ocular HistoryOcular History
Rule out specific ocular Rule out specific ocular problems and conditions, problems and conditions, such as:such as:– GlaucomaGlaucoma– CataractsCataracts– KeratoconusKeratoconus
Match the diseases to the structure…
MedicationsMedications
NameName Amount takenAmount taken FrequencyFrequency Prescribed for Prescribed for Prescribed byPrescribed by Illegal drugs too!Illegal drugs too!
Why is illegal drug use important?
Visual Acuity: Snellen Visual Acuity: Snellen FractionFraction
NumeratorNumerator– Represents the testing distance in feet or Represents the testing distance in feet or
meters meters – 20/_____; 6/______20/_____; 6/______
DenominatorDenominator– Represents the distance at which the letter Represents the distance at which the letter
subtends a 5-minute angle of arc in distance subtends a 5-minute angle of arc in distance or meters. Also referred to as the letter or meters. Also referred to as the letter size.size.How would you document a patient that can only see the big “E” at 10 feet?
Visual AcuityVisual Acuity
Test of macular Test of macular functionfunction
Snellen fractionSnellen fraction– Numerator-# of ft. Numerator-# of ft.
away from viewed away from viewed letterletter
– Denominator-# of Denominator-# of ft. a person with ft. a person with “normal” vision “normal” vision could see the could see the letterletter
What is optical infinity?
Accommodation vs Accommodation vs AcuityAcuity Accommodation is the ability of Accommodation is the ability of
the to focus from a distance to the to focus from a distance to near and vice versanear and vice versa
Acuity is the ability of the eye to Acuity is the ability of the eye to see fine detailsee fine detail
KeratometryKeratometry
KeratometerKeratometer– Measures the Measures the
curvature of the curvature of the corneacornea
– Response from Response from the patient not the patient not needed to needed to perform = perform = objective testobjective testMeasures how much of the cornea?
Manual KeratometryManual Keratometry
++
Starting Point End Point
++
Prize slidePrize slide
Clearly explain these instruments and what they function they perform?
RefractionRefraction
Objective RefractionObjective Refraction– RetinoscopyRetinoscopy– Auto-refractorAuto-refractor
Subjective RefractionSubjective Refraction– PhoropterPhoropter– Patient neededPatient needed
What is the difference between subjectiveand objective refractions?
OphthalmoscopyOphthalmoscopy
Evaluates the Evaluates the posterior segmentposterior segment
Patient must be Patient must be dilateddilated
Types of Types of ophthalmoscopyophthalmoscopy– Indirect…on headIndirect…on head
Less magnified, Less magnified, wider viewwider view
– Direct…in handDirect…in hand More magnified, More magnified,
narrower viewnarrower view
Indirect Ophthalmoscope
Direct Ophthalmoscope
BiomicroscopyBiomicroscopy
Commonly called “Slit Commonly called “Slit Lamp”Lamp”– Evaluates the anterior Evaluates the anterior
segment of the eye segment of the eye (cornea to lens)(cornea to lens)
– Evaluates intraocular Evaluates intraocular pressure by attachment pressure by attachment of a Goldmann of a Goldmann applanation tonometerapplanation tonometer
TonometryTonometry
Goldmann ApplanationGoldmann Applanation– Mounted on slit lampMounted on slit lamp– Requires anesthesia and fluorescein dyeRequires anesthesia and fluorescein dye
Tonopen®Tonopen®– PortablePortable– Requires anesthesiaRequires anesthesia
Non-contact (air-puff)Non-contact (air-puff)– Easy to useEasy to use– No anesthesia requiredNo anesthesia required
Fundus Photography Fundus Photography TermsTerms
Fundus – Fundus – interior posterior surface of interior posterior surface of the eyeballthe eyeball
Posterior Pole – Posterior Pole – refers to the retina refers to the retina between the optic nerve and macular between the optic nerve and macular areaarea
Arcades – Arcades – normal pattern of retinal normal pattern of retinal blood vessels as they leave the optic blood vessels as they leave the optic nerve head and arch around the maculanerve head and arch around the macula
Cup-to-Disc ratio – Cup-to-Disc ratio – numerical expression numerical expression indicating percentage of disc occupied indicating percentage of disc occupied by the optic cupby the optic cup
Fundus Photography Fundus Photography TermsTerms
Exudates – Exudates – protein or fatty fluid that leaks protein or fatty fluid that leaks from blood vessels into retinal tissue (hard is from blood vessels into retinal tissue (hard is less fluid, more dense) (soft fluffy looking less fluid, more dense) (soft fluffy looking also called cotton wool spots)also called cotton wool spots)
Cotton Wool Spots – Cotton Wool Spots – fluffy looking white fluffy looking white deposits resembling small tufts of cotton deposits resembling small tufts of cotton within the retinal nerve fiber layer that within the retinal nerve fiber layer that represent small patched of retina that have represent small patched of retina that have lost their blood supply from vessel lost their blood supply from vessel obstructionobstruction
Nevus – Nevus – mole small and flat usually mole small and flat usually pigmented area, benign tumor made of pigmented area, benign tumor made of specific cells called nevus cells found in skin specific cells called nevus cells found in skin and eye tissue and eye tissue
Fundus Photography Fundus Photography ExamplesExamples
Normal Fluorescein Angiography
Papilledema Lasered Diabetic Retinopathy
Optical Coherence Optical Coherence Tomography (OCT)Tomography (OCT)
What is this machine used for?
Corneal TopographyCorneal Topography
Measurement of Measurement of the curvature of the curvature of the anterior corneal the anterior corneal surface. surface.
PachymetryPachymetry
A Pachymeter A Pachymeter determines thickness determines thickness of the cornea by use of the cornea by use of ultrasoundof ultrasound– Refractive surgeryRefractive surgery– Glaucoma diagnosisGlaucoma diagnosis
How might IOP pressure be impacted byThe thickness of a cornea?
Optical Coherence Optical Coherence Tomography (OCT)Tomography (OCT) A laser-based, non-contact, non-invasive A laser-based, non-contact, non-invasive
imaging technique that is capable of imaging technique that is capable of obtaining high resolution images of the retina obtaining high resolution images of the retina and its components. and its components.
Clinically useful in visualization of:Clinically useful in visualization of:– Macula holesMacula holes– Macula edemaMacula edema– Age-related Macula Degeneration Age-related Macula Degeneration – Epiretinal membranesEpiretinal membranes– Central serous chorioretinopathyCentral serous chorioretinopathy
Tomography Tomography AdvantagesAdvantages Non-contact, non-invasive scan Non-contact, non-invasive scan
obtained in one secondobtained in one second
Shows living histology with minimal Shows living histology with minimal discomfort to the patientdiscomfort to the patient
No injections of exposure to painful No injections of exposure to painful high-intensity lighthigh-intensity light
Increased patient comfort and safety, Increased patient comfort and safety, reduced photophobiareduced photophobia
Visual FieldVisual Field
What is a visual field?What is a visual field?– The area of space visible to the eyeThe area of space visible to the eye
What is a scotoma?What is a scotoma?– Blind spotBlind spot
What is used to measure a visual What is used to measure a visual field?field?– PerimetryPerimetry
Refractive StatusRefractive Status(12%)(12%)
Refractive ErrorsRefractive Errors
MyopiaMyopia HyperopiaHyperopia AstigmatismAstigmatism PresbyopiaPresbyopia AmblyopiaAmblyopia
Emmetropia vs. Emmetropia vs. AmetropiaAmetropia
EmmetropiaEmmetropia– No refractive errorNo refractive error– Rays of light focus on the retinaRays of light focus on the retina
AmetropiaAmetropia– An optical errorAn optical error– Corrected by glasses, contact lens or Corrected by glasses, contact lens or
refractive surgery refractive surgery
Emmetropic EyeEmmetropic Eye
Emma is a perfect woman
MyopiaMyopia
Also called “Nearsighted”Also called “Nearsighted” Axial myopiaAxial myopia
– Eye is too longEye is too long– Rays of light fall in front of retinaRays of light fall in front of retina
Index myopiaIndex myopia– Diabetes/cataractsDiabetes/cataracts
Corrected by a concave, or minus Corrected by a concave, or minus lenslens
Myopic EyeMyopic Eye
MyopiaMyopiaMyopiaMyopia
A refractive condition A refractive condition where parallel light where parallel light rays focus in front of rays focus in front of the retina when the the retina when the eye is at resteye is at rest
Termed Termed nearsightednessnearsightedness
Patient may have Patient may have 20/20 vision at near, 20/20 vision at near, but distance vision but distance vision will be reducedwill be reduced
Corrected with minus Corrected with minus lenseslenses
HyperopiaHyperopia
Also called “Farsighted”Also called “Farsighted” Axial length of the eye is too Axial length of the eye is too
shortshort– Rays of light fall virtually behind the Rays of light fall virtually behind the
retinaretina Affected by accommodationAffected by accommodation Corrected by a convex, or plus Corrected by a convex, or plus
lenslens
Hyperopic EyeHyperopic Eye
HyperopiaHyperopiaHyperopiaHyperopia
A refractive condition A refractive condition where parallel light where parallel light rays focus behind the rays focus behind the retina when the eye is retina when the eye is at restat rest
Termed farsightednessTermed farsightedness Patient may have Patient may have
20/20 vision at 20/20 vision at distance and neardistance and near
Corrected with plus Corrected with plus lenseslenses
AstigmatismAstigmatism
Corneal AstigmatismCorneal Astigmatism– 2 different points of focus2 different points of focus– Cornea is “football-shaped”Cornea is “football-shaped”– Corrected by cylinder at a specific axisCorrected by cylinder at a specific axis
Lenticular AstigmatismLenticular Astigmatism– Crystalline lensCrystalline lens
Irregular AstigmatismIrregular Astigmatism– Cannot be corrected by a lensCannot be corrected by a lens
KeratoconusKeratoconus Corneal traumaCorneal trauma
AstigmatismAstigmatism
FocusedLight Rays
Light RaysLight RaysLight RaysLight Rays
AstigmatismAstigmatism
AstigmatismAstigmatism
AstigmatismAstigmatismAstigmatismAstigmatism
A refractive condition A refractive condition where different where different meridians of the eye meridians of the eye have different powershave different powers
Corrected by lenses Corrected by lenses which incorporate which incorporate cylinder powercylinder power
Usually due to Usually due to different curvatures of different curvatures of the corneathe cornea
PresbyopiaPresbyopia
Natural aging of the crystalline lensNatural aging of the crystalline lens Affects accommodationAffects accommodation Corrected by additional plus power Corrected by additional plus power
at nearat near– BifocalBifocal– TrifocalTrifocal– ProgressiveProgressive– Reading glassesReading glasses
PresbyopiaPresbyopia
A condition in A condition in which lost which lost elasticity of the elasticity of the lens leads to the lens leads to the inability to inability to accommodate accommodate
Age related Age related conditioncondition
What age does presbyopia begin?
AccommodationAccommodation
The Ophthalmic The Ophthalmic PrescriptionPrescription
(9%)(9%)
The Ophthalmic The Ophthalmic Prescription Prescription Components of a Components of a
lens prescriptionlens prescription– Sphere, cylinder, Sphere, cylinder,
axisaxis– +2.00 -1.00 x 095+2.00 -1.00 x 095– Add powerAdd power– PrismPrism
LensometerLensometer– Used to measure Used to measure
lens componentslens components
Unit of MeasurementUnit of Measurement
Diopter - unit of measure for Diopter - unit of measure for optical lenses. optical lenses. – Based on fact that a 1 diopter lens will Based on fact that a 1 diopter lens will
focus parallel light at 1 meter.focus parallel light at 1 meter.
1 Diopter Focus Light at 1 1 Diopter Focus Light at 1 MeterMeter
- 1 D- 1 D
+ 1 D+ 1 D
1 Meter1 Meter
Ophthalmic LensesOphthalmic Lenses(5%)(5%)
RefractionRefraction
DefinitionDefinition– Altering of the Altering of the
pathway of light pathway of light from its original from its original direction as a direction as a result of passing result of passing obliquely from one obliquely from one medium to another medium to another of different densityof different density
– Pivoting or bending Pivoting or bending of light raysof light rays
LightLightLightLight
Visible wavelengths extend from Visible wavelengths extend from 400-740 nanometers (nm), 400-740 nanometers (nm), 400nm being violet and 740nm 400nm being violet and 740nm being red. being red.
A change of wavelength is A change of wavelength is perceived as color change.perceived as color change.
400 500 600 700
LightLightLightLight
Light travels in a vacuum at 186,000 Light travels in a vacuum at 186,000 mps and in various other transparent mps and in various other transparent media at slower speeds. It is this media at slower speeds. It is this characteristic of light, traveling at characteristic of light, traveling at different speeds in different media, different speeds in different media, that causes the bending or refraction that causes the bending or refraction of light, for example, light travels at of light, for example, light travels at 77,000 mps in diamond and 120,000 77,000 mps in diamond and 120,000 mps in crown glass mps in crown glass
DeviationDeviationDeviationDeviation Bending of lightBending of light Image deviates towards the ApexImage deviates towards the Apex Light is deviated towards the baseLight is deviated towards the base
Apex
Base
Prescriptions: Light Prescriptions: Light RaysRays Rays move from left to rightRays move from left to right
Converging RaysConverging Rays
Diverging RaysDiverging RaysLight always deviates toward the base of a prism
Prescription: Prism Prescription: Prism
Displaces lightDisplaces light
Light bends toward base, Light bends toward base, Image displaced toward Image displaced toward apexapex
General Lens FormsGeneral Lens FormsPLUS MINUS PLANO
Convergent Divergent Zero
Thicker in the middle
Thinner in the middle
Equal thickness
Produces a real focus
Produces a virtual focus
No change
Lens TypesLens Types
Types of LensesTypes of Lenses– Single visionSingle vision– SphericalSpherical– PlanocylindricalPlanocylindrical– SpherocylindricalSpherocylindrical– MultifocalMultifocal
BifocalBifocal TrifocalTrifocal Progressive additionProgressive addition
Lens MaterialsLens Materials
Lens MaterialsLens Materials– GlassGlass– Plastic (CR-39)Plastic (CR-39)– PolycarbonatePolycarbonate– High indexHigh index– Trivex ™Trivex ™
Bifocal LensesBifocal Lenses
Trifocal Lenses Trifocal Lenses (Executive)(Executive)
7mm7mm
17mm17mm
28mm28mm
Bifocal Lenses (FT-28, D-28)Bifocal Lenses (FT-28, D-28)
Progressive LensesProgressive Lenses
Progressive Addition Lenses Progressive Addition Lenses
Aberration ZonesAberration Zones
Near ViewingNear Viewing
Zone Zone Intermediate Intermediate
Viewing Zone Viewing Zone
Distant Viewing ZoneDistant Viewing Zone
Ophthalmic DispensingOphthalmic Dispensing(8%)(8%)
LensesLenses
Plus- Lens that is thicker in the center than at the edges, Plus- Lens that is thicker in the center than at the edges, adding optical power to incoming light rays. Corrects adding optical power to incoming light rays. Corrects farsightednessfarsightedness
Minus- Lens that is thicker at the edges than in the center, Minus- Lens that is thicker at the edges than in the center, increasing divergence of incoming light ray. Corrects increasing divergence of incoming light ray. Corrects nearsightedness nearsightedness
Cylindrical- Lens that produces a different refractive power Cylindrical- Lens that produces a different refractive power in each meridian; used for correcting ocular astigmatism. in each meridian; used for correcting ocular astigmatism.
PrismPrism - Power = Deviation in cm/distance- Wedge-shaped, - Power = Deviation in cm/distance- Wedge-shaped,
transparent medium that bends light rays toward its base. transparent medium that bends light rays toward its base. Does not focusDoes not focus
Lenses cont…Lenses cont…
Prism and decentration Prism and decentration MultifocalsMultifocals Lens TypesLens Types - Crown glass – heavy, scratch - Crown glass – heavy, scratch
resistantresistant - CR-39 – thicker, scratch easily- CR-39 – thicker, scratch easily hard resinhard resin Polycarbonate –thinner, safestPolycarbonate –thinner, safest High Index – thinnest, lacks strengthHigh Index – thinnest, lacks strength
Frame AnatomyFrame Anatomy
Frame Frame AnatomyAnatomy– Frame frontFrame front
EyewireEyewire BridgeBridge HingeHinge NosepadsNosepads
– TemplesTemples
Frame Size and Frame Size and MeasurementsMeasurements
Boxing System
BB
AA
DBDBLL
EDED
Frame MaterialsFrame Materials
Frame MaterialsFrame Materials– PlasticPlastic– MetalMetal
Frame SelectionFrame Selection
Frame SelectionFrame Selection– Frame fit is most importantFrame fit is most important– Frame width equal face widthFrame width equal face width– Longer face, deeper the frame can beLonger face, deeper the frame can be– Bridge fit importantBridge fit important– Temples need to be long enough for Temples need to be long enough for
a proper benda proper bend– Cosmetic concernsCosmetic concerns
Pupillary DistancePupillary Distance
PupillometerPupillometer
1 2 3 4 5 6 7
1st measurement 60 mm
1 2 3 4 5 6 7
2nd measurement 64 mm
Seg HeightSeg Height
Bifocal Seg HeightBifocal Seg Height Trifocal Seg HeightTrifocal Seg Height
Frame AdjustmentsFrame Adjustments
Basic Frame AdjustmentsBasic Frame Adjustments– Fitting triangleFitting triangle– Frame heightFrame height– Vertex distanceVertex distance– Face formFace form– Pantoscopic anglePantoscopic angle– Retroscopic angleRetroscopic angle– Temple adjustmentTemple adjustment
Basic Adjustments Basic Adjustments
Fitting TriangleFitting Triangle
Pantoscopic AnglePantoscopic Angle
4 mm4 mm
Optical Optical centercenter
Optical Optical centercenter
CorrectCorrect
WrongWrong
17 degreetilt
OrderingOrderingJ ones Optical
5209 South PennOkl ahoma City, OK 73109
638-7889
Patient J a n e Doe Date 2/23/01SPH CYL AXIS DEC PRISM PLASTIC GLASS
OD In Out
+1.00 - 0.25 90 1/2 Δ BU SV FDA TestedOS
+1.00 - 1.00 95 1/2 Δ BD RND
Seg Ht. Width Insert Total Pup Dist EXEC LENTR R Dist Near
+2.00 20ST 28 TRIFOCAL
L L
ADD
+2.00 2028 66 62 OTHER
Set Lens Shape Edge Colour
F.P.D. A B ED LOC UNCUT
Rimless Grove Drill Metal ZYL
Size BDG Temp Style ColorFRAMES
58 16 145 Sa fi loTi ta n i u m 109
Gra yOT30
PINK
GREEN
GRAY
BROWN
OTHER:
GRADIENT TO
1
1
1
1
1
Lite
2
2
2
2
2
3
3
3
3
3
Clear
ACCT: REMARK SUPPLY TRAY#RX LENS $MISCTAXTOTALDATEINVOICE
Polarizing lensPolarizing lensPolarizing lensPolarizing lens
A lens that transmits all light rays in A lens that transmits all light rays in one meridian, and eliminates all light one meridian, and eliminates all light rays in the meridian 90 degrees rays in the meridian 90 degrees awayaway
Light reflected off a surface is Light reflected off a surface is partially polarizedpartially polarized
Elements of an Rx Elements of an Rx Elements of an Rx Elements of an Rx
– Abbreviations - the following is Abbreviations - the following is a listing of accepted a listing of accepted abbreviations:abbreviations: O.D. = right eye O.D. = right eye O.S. = left eye O.S. = left eye O.U. = both eyes O.U. = both eyes + = convex, plus + = convex, plus - = concave, minus - = concave, minus
Contact LensesContact Lenses(8%)(8%)
Contact LensesContact Lenses
Soft contact Soft contact lenseslenses
Rigid contact Rigid contact lenseslenses
Care & handlingCare & handling Patient educationPatient education
Success with a contact lens candidate begins with what?
Contact Lens Contact Lens ParametersParameters ParametersParameters
– Base curve radiusBase curve radius– Lens powerLens power– Overall diameterOverall diameter– Optical zone diameterOptical zone diameter– Peripheral curvesPeripheral curves– Edge & center thicknessEdge & center thickness
Contact Lens DesignContact Lens Design
Overall Diameter (OAD)Overall Diameter (OAD)
Optical Zone Optical Zone OZOZ
Secondary Curve (SC)Secondary Curve (SC)
Peripheral Curve Peripheral Curve (PC)(PC)
Secondary Curve Secondary Curve Width (SCW)Width (SCW)
Peripheral Curve Peripheral Curve Width (PCW)Width (PCW)
Contact Lens DesignContact Lens Design
Peripheral Curve (PC)Peripheral Curve (PC)
Center Thickness (CT)Center Thickness (CT)
Base Curve (BC)Base Curve (BC)
Secondary Curve (SC)Secondary Curve (SC)
Optical Zone Optical Zone (OZ)(OZ)
Edge Edge ShapeShape
Overall Diameter Overall Diameter (OZ)(OZ)
What type of contact lens has correction for astigmatism?
Tri-Curve Contact Lens Tri-Curve Contact Lens DesignDesign
OAD = Overall DiameterOAD = Overall Diameter
OZ = Optical ZoneOZ = Optical Zone
PCW = Peripheral Curve Width PCW = Peripheral Curve Width
SCW = Secondary Curve Width SCW = Secondary Curve Width
OADOAD
OZOZ
PCWPCW
PCWPCW
SCWSCW
SCWSCWJUNCTIONJUNCTION
JUNCTIONJUNCTION
JUNCTIONJUNCTION
JUNCTIONJUNCTION
OrderingOrderingCONTACT LENS ORDER FORM
Patient Name: J ohn DoeSpecifications Ordered Specifications VerifiedDate 2/23/01 Date
O.D. O.S. O.D. O.S.B.C.R 7.89 7.81 B.C.R
S.C.R./W 8.90 / .3 8.80 / .3 S.C.R./W
I.C.R./W I.C.R./W
P.C.R./W 110.9 / .3 10.8 / .3 P.C.R./W
O.Z.D. 8.0 8.0 O.Z.D.
Dia 9.2 9.2 Dia
Power - 2.50 - 2.50 Power
C.T. .16 .16 C.T.
Blend Med Med Blend
Tint Blue Blue Tint
Dot O.D. Verified byAdditional Information
Accepted Rejected Returned for Credit Date ReturnedReason for return/reorder
TORICTORIC
What is a high water contact lens?
Types of Contact Types of Contact LensesLenses
Soft Contact LensesSoft Contact LensesRigid Contact LensesRigid Contact Lenses
What are advantages and disadvantages of soft and rigid contact lens?
TRAUMATIC TRAUMATIC IRIDECTOMYIRIDECTOMY
What is used to measure the power of a contact lens?
COLORCOLOR
What is used to measure the base curve of a contact?
SPORT TINTSPORT TINT
Amber—tracking fast Amber—tracking fast moving balls moving balls (baseball, soccer, (baseball, soccer, tennis, football)tennis, football)
Grey-green—Grey-green—decrease sun glare decrease sun glare (golf, running)(golf, running)
Safety First!Safety First!
Wash your hands!Wash your hands!
Procedure must Procedure must be safebe safe
Explain procedureExplain procedure Explain do’s and Explain do’s and
don’tsdon’ts
Insertion and Removal Insertion and Removal TechniquesTechniques
SoftSoft– Patient comfortPatient comfort
RGPRGP– More difficultMore difficult– Use gravityUse gravity
Contact Lens CareContact Lens Care
QuestionsQuestions
What parameters are needed to order What parameters are needed to order Contact lens’s?Contact lens’s?
What is used to measure the base What is used to measure the base curve of a contact lens?curve of a contact lens?
What is used to measure the power of What is used to measure the power of a contact lens?a contact lens?
What is the primary curve of a What is the primary curve of a contact?contact?
What medication is used to view CL’s?What medication is used to view CL’s?
Common Eye DisordersCommon Eye Disorders(6%)(6%)
BlepharitisBlepharitis…inflammation of …inflammation of the lidsthe lids
ConjunctivitisConjunctivitis…inflammation of …inflammation of the conjunctivathe conjunctiva
Why do you get more mucus when the conjunctiva is swollen?
Bacterial ConjunctivitisBacterial Conjunctivitis
Subconjunctival Subconjunctival HemorrhageHemorrhage
Trauma induced
Non-trauma related
Pinguecula…Pinguecula…isis small likesmall like penguinpenguin
Normally at 3 and 9 o’clock
PtygeriumPtygerium…is large like …is large like pterodactylpterodactyl
Covers the cornea
Hordeolum…hurtsHordeolum…hurts
Chalazion…painless Chalazion…painless bumpbump
CataractCataract
Eye without Eye without cataractcataract
Eye with cataractEye with cataract
Cataract…Cataract…an opacity of the an opacity of the lenslens
Mature cataractMature cataract
CataractCataract
Glaucoma…Glaucoma…acute and open acute and open
angleangle Increased intraocular pressureIncreased intraocular pressure Increased cupping (cup to disc Increased cupping (cup to disc
ratio)ratio) Decrease in peripheral visionDecrease in peripheral vision Optic Nerve Head (ONH) Optic Nerve Head (ONH)
involvementinvolvement
KertaconusKertaconus…corneal …corneal thinningthinning
Macular DegenerationMacular Degeneration
Diabetic RetinopathyDiabetic Retinopathy
Effects Of Macular Effects Of Macular DegenerationDegeneration
Diabetic RetinopathyDiabetic Retinopathy
BackgroundBackground ProliferativeProliferative
– NeovascularizationNeovascularization
Retinal DetachmentRetinal Detachment
FloatersFloaters
Why is it that older patients complain more of floaters than younger ones?
SignificanceSignificance
8-10% Males8-10% Males .4% Females.4% Females Green defect occurs most Green defect occurs most
frequentlyfrequently– This is strange due to the color of This is strange due to the color of
money money Who passes the defected gene that causes color deficiencies?
Exam EquipmentExam Equipment RetinoscopeRetinoscope OphthalmoscopeOphthalmoscope Biomicroscope (Slit lamp)Biomicroscope (Slit lamp) PhoropterPhoropter KeratometerKeratometer Fundus CameraFundus Camera Optical Coherence Optical Coherence
Tomographer Tomographer Which one of these can be used during objective refraction?
Pupil TestingPupil Testing
SizeSize ShapeShape Response to direct lightResponse to direct light Response to indirect Response to indirect
(consensual) light(consensual) lightWhat is the proper room lighting condition?
TerminologyTerminology(4%)(4%)
PrefixesPrefixes
a, an, aniso-withouta, an, aniso-without epi-aboveepi-above sub-belowsub-below Endo -Endo -
What is a contextual clue?
Root WordsRoot Words
Kerat-corneaKerat-cornea Blephar-eyelidBlephar-eyelid Palpebr-eyelidPalpebr-eyelid Cor-pupilCor-pupil Lacrim-tearLacrim-tear
SuffixesSuffixes
itis-inflammationitis-inflammation al-pertaining to…(palpebral)al-pertaining to…(palpebral) metropia-eye measurementmetropia-eye measurement Opia- diseaseOpia- disease Edema- swellingEdema- swelling
What is papilledema?
Surgery Surgery (2%)(2%)
Cataract SurgeryCataract Surgery
Opening the Opening the lenslens
Cataract Surgery-Cataract Surgery-continuedcontinued
PhacoemulsificationPhacoemulsification AphakiaAphakia
Cataract Surgery-Cataract Surgery-continuedcontinued
IOL in capsule bagIOL in capsule bag PsuedophakiaPsuedophakia
Intraocular LensesIntraocular Lenses
Iris Fixated Posterior Chamber
Refractive SurgeryRefractive Surgery
Uses laser to reshape the cornea, Uses laser to reshape the cornea, resulting in a diminished resulting in a diminished refractive errorrefractive error
Types of Refractive Types of Refractive SurgerySurgery PRK-Photo Refractive KeratectomyPRK-Photo Refractive Keratectomy LASIK – Laser-Assisted In Situ LASIK – Laser-Assisted In Situ
KeratomileusisKeratomileusis LASEK – Laser Epithelial KeratomileusisLASEK – Laser Epithelial Keratomileusis Epi-LASEKEpi-LASEK ALK – Automated Lamellar ALK – Automated Lamellar
Basic Pharmacology Basic Pharmacology (2%)(2%)
Drop InstillationDrop Instillation
Clean handsClean hands Explain Explain
procedureprocedure Remember safetyRemember safety Inspect bottleInspect bottle Check dateCheck date
What is wrong with this picture?
Diagnostic DrugsDiagnostic Drugs
DilationDilation– MydriaticMydriatic
Neo-SynephrineNeo-Synephrine– CycloplegicCycloplegic
CyclogylCyclogyl MydriacylMydriacyl Atropine,Atropine, HomatropineHomatropine ScopolomineScopolomine
DyesDyes– Fluorescein…used to evaluate contact lensFluorescein…used to evaluate contact lens– Rose bengalRose bengal
Therapeutic DrugsTherapeutic Drugs
AntibioticsAntibiotics AntiviralsAntivirals AntifungalsAntifungals Glaucoma dropsGlaucoma drops SteroidsSteroids LubricantsLubricants
Which medication stops inflammation?
Mydriatic And Miotic Mydriatic And Miotic EffectsEffects
Which is miotic and which is mydriatic?
Normal Normal – The “normal” for adults is approximately The “normal” for adults is approximately
120mmHg /between 70-80mmHg120mmHg /between 70-80mmHg AbnormalAbnormal
– Mild HypertensionMild Hypertension 145-159mmHg/90-104mmHg145-159mmHg/90-104mmHg
– Severe HypertensionSevere Hypertension 160mmHg or more/100mmHg or more160mmHg or more/100mmHg or more
– HypotensionHypotension Below normal blood pressureBelow normal blood pressure
ReadingsReadings
Abnormal Blood Abnormal Blood PressuresPressures Systolic greater than 140*Systolic greater than 140* Diastolic greater than 90*Diastolic greater than 90* Difference less than 30 between Difference less than 30 between
the Systolic and Diastolic the Systolic and Diastolic Pressures.*Pressures.*
These are general guidelines and may differ from the guidelines that These are general guidelines and may differ from the guidelines that the provider you are employed by uses.the provider you are employed by uses.
What’s Next?What’s Next?
TodayToday– Lightly review the materialLightly review the material– Get a good night’s sleepGet a good night’s sleep– Arrive a little early to testArrive a little early to test
FutureFuture– Look for details about the CPOA test - Look for details about the CPOA test -
begin studying the Self-Study Course begin studying the Self-Study Course for Paraoptometric Certificationfor Paraoptometric Certification
25 Gun Salute Review25 Gun Salute Review
Here are 25 review questions that Here are 25 review questions that you can test your skills with…you can test your skills with…
No multiple choice answers…do No multiple choice answers…do you know the answer?you know the answer?
Review QuestionsReview Questions
What part of the Rx is the cylinder What part of the Rx is the cylinder power?power?– +1.25 – 0.75 X 130+1.25 – 0.75 X 130
What is the difference between acuity What is the difference between acuity and accommodation?and accommodation?
What does Blepharitis mean?What does Blepharitis mean?
Which encroaches upon the pupil, a Which encroaches upon the pupil, a pterygium or pinguecula?pterygium or pinguecula?
Review Review
Opia means what?Opia means what?
What is the difference between a tropia What is the difference between a tropia and a phoria?and a phoria?
Avascular means what?Avascular means what?
How many extra-ocular muscles are How many extra-ocular muscles are oblique?oblique?
Review QuestionsReview Questions
How long do you keep records for HIPAA?How long do you keep records for HIPAA?
Where do you measure a trifocal height?Where do you measure a trifocal height?
What part of the eye regulates light?What part of the eye regulates light?
What instrument measures the power of What instrument measures the power of a contact lens?a contact lens?
Review QuestionsReview Questions
Identify the name for the parts of the Identify the name for the parts of the conjunctiva on the eye and back of the conjunctiva on the eye and back of the eyelideyelid
What is the near vision test distance?What is the near vision test distance?
In what layer of the eye will the retina be In what layer of the eye will the retina be found?found?
What is the strongest bone of the bony What is the strongest bone of the bony orbit?orbit?
Review QuestionsReview Questions
What in the macula controls the ability to see What in the macula controls the ability to see color?color?
Which lens is thicker in the center?Which lens is thicker in the center?
What is the most important part of the Hx?What is the most important part of the Hx?
Which lens is the safest?Which lens is the safest?
What is the rating on a high water contact?What is the rating on a high water contact?
Review QuestionsReview Questions
What is the difference between a subjective What is the difference between a subjective and objective test?and objective test?
Where is the anterior chamber and what Where is the anterior chamber and what instrument do you use to look at it?instrument do you use to look at it?
When is the best time to schedule an When is the best time to schedule an appointment?appointment?
What handle held instrument aids in refraction?What handle held instrument aids in refraction?
Where is your central vision located?Where is your central vision located?
QuestionsQuestions
How often should a EW SCL patient enzyme How often should a EW SCL patient enzyme their contacts?their contacts?
“ “Ex” as in exo means _______ and “es” in Ex” as in exo means _______ and “es” in “eso” means ________?“eso” means ________?
What is the unit of measure for lens power?What is the unit of measure for lens power? How many extra-ocular muscles are there? How many extra-ocular muscles are there?
Name them if you dare…..Name them if you dare…..
Which lens is designed to be shatter Which lens is designed to be shatter resistant?resistant?
QuestionsQuestions
What is the purpose of the fitting What is the purpose of the fitting triangle?triangle?
Which tonometers require an Which tonometers require an anesthetic?anesthetic?
What instrument is used to obtain What instrument is used to obtain a prescription from a contact or a prescription from a contact or ophthalmic lens?ophthalmic lens?
What is the heaviest lens What is the heaviest lens material?material?
QuestionsQuestions
What is the difference between What is the difference between acuity and accommodation?acuity and accommodation?
Spell the scientific name for your Spell the scientific name for your eyelid ______________?eyelid ______________?
What percentage of water is in a What percentage of water is in a low water content ______ or high low water content ______ or high water content _______ contact water content _______ contact lens.lens.
QuestionsQuestions
The person who normally grinds The person who normally grinds lenses is called a(n) lenses is called a(n) _________________?_________________?
What is the difference between What is the difference between a mydriactic and miotic?a mydriactic and miotic?
What is the definition of the What is the definition of the word “plano”?word “plano”?
Review QuestionsReview Questions
The point where the upper and lower eyelids The point where the upper and lower eyelids meet is called?meet is called?
The blockage of the meibomian gland is called The blockage of the meibomian gland is called the ___________ when it causes pain, and the the ___________ when it causes pain, and the _________ when it does not cause pain?_________ when it does not cause pain?
What is a good tear break up time?What is a good tear break up time?
What is amblyopia?What is amblyopia?
Review QuestionsReview Questions
The eyelid will protect your eyes from what?The eyelid will protect your eyes from what?
What main muscles raises the eyelid?What main muscles raises the eyelid?
What is the main layer of the eye lid?What is the main layer of the eye lid?
Review QuestionsReview Questions
What is the difference between visual acuity What is the difference between visual acuity and accommodation?and accommodation?
What is decentration?What is decentration?
Name a test performed binocularly?Name a test performed binocularly?
Through a prism the image deviates which Through a prism the image deviates which way?way?
Review QuestionsReview Questions
Which is the heaviest lens material?Which is the heaviest lens material?
What is the ora serrataWhat is the ora serrata
What comprises the vascular layer?What comprises the vascular layer?
Name one of two indentation Name one of two indentation tonometerstonometers
Review QuestionsReview Questions
What is the speed of light?What is the speed of light?
What is optical infinity?What is optical infinity?
What chronic disease is normally associated What chronic disease is normally associated with internal bleeding in the eye?with internal bleeding in the eye?
What is conjunctivitis? Another name What is conjunctivitis? Another name for it is?for it is?
Review QuestionsReview Questions
What is emmetropia?What is emmetropia?
Papilladema refers to what structure?Papilladema refers to what structure?
What is vertex distanceWhat is vertex distance
What are the parts of a standard What are the parts of a standard frame?frame?
I want you to pass life’s I want you to pass life’s testtest
Good Luck!Good Luck!The person who makes a success of living is the one who see his goal steadily and aims for it unswervingly. That is dedication.
Cecil B. DeMille (1881 - 1959)
CreditsCredits
Individual support:Individual support: Al Levin, O.D.Al Levin, O.D. Darrell Grise, O.D. Darrell Grise, O.D. Mile Brujic O.D.Mile Brujic O.D. Billie TaylorBillie Taylor Mary Jameson, CPOTMary Jameson, CPOT Kathy Wood, CPOTKathy Wood, CPOT Belen Holbrook, CPOABelen Holbrook, CPOA Emma E. Gomez, CPOEmma E. Gomez, CPO Lynn Lawrence, CPOTLynn Lawrence, CPOT Leah Schneider, NREMTLeah Schneider, NREMT
Industry Support:Industry Support: Ziess/MeditecZiess/Meditec VistakonVistakon XalatanXalatan 3D Eye 3D Eye
ImaginationsImaginations Google search Google search
sites…sites…
Course EvaluationCourse Evaluation
Thank youThank you Please take a few moments to Please take a few moments to
complete the course evaluation.complete the course evaluation.