Certified Paraoptometric Review Course CPO Lynn Lawrence, CPOT.

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


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


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


FocusedLight Rays

Light RaysLight RaysLight RaysLight Rays


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?


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?


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?


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?


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”?


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?


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?


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?


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


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?


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.

Certified Paraoptometric Review Course CPO Lynn Lawrence, CPOT.

Documents

Transcript of Certified Paraoptometric Review Course CPO Lynn Lawrence, CPOT.