WORLD COUNCIL OF OPTOMETRY · (factors affecting absorption and distribution of pharmaceuticals):...

WORLD COUNCIL OF OPTOMETRY

Curricular Support Elementsfor an Optometry Programme

www.worldoptometry.org

World Council of Optometry 2

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Introduction 3

The Patient Examination 4

– Background 5 – Element 1 6 – Element 2 12 – Element 3 15 – Element 4 18 – Element 5 20 – Element 6 23 – Element 7 24 – Element 8 26

Patient Management 29

– Element 9 30 – Element 10 32

General Health Assessment 35

– Element 11 36

Specialized Care 38

– Element 12 39 – Element 13 42 – Element 14 45

Professional Responsibilites 48

– Element 15 49

Prepared by the World Council of Optometry Education Committee.

With thanks to the Brien Holden Vision Institute for supplying the images used in this document.

www.brienholdenvision.org

World Council of Optometry 3

This document will provide schools, colleges and universities intending to start or upgrade an optometry programme with a basis for designing their optometry curriculum. The foundations are what an optometrist needs to be competent in and the level is at highest international standards. Since this document is comprehensive not all programmes will include all elements to the same extent often depending of the regulations governing optometry in the country of the programme. The document does not take into consideration other elements of a general university education. This document considers the elements of the comprehensive eye examination and develops the curriculum content from the knowledge and skills that underpin each element.

The comprehensive eye examination is considered as the sum of the following ten universal elements:

1. Assess the patient’s case history

2. Assess the anterior ocular adnexa for their form, condition and functionality

3. Assess the anterior segment for their form, condition and functionality

4. Assess the ocular media for their form, condition and functionality

5. Assess the posterior segment for their form, condition and functionality

6. Assess the quality of the visual pathway and sensory visual function

7. Assess the refractive status

8. Assess the binocular and oculomotor (including near focus) function

9. Assess suitability of spectacles and prescribe

10. Assess contact lens-wear suitability and prescribe

With an element relating to the patient’s wellbeing:

11. Assess signs and symptoms of the patient’s general health

Together with three (3) additional elements specific to particular categories of patients:

12. Assess and provide care for the paediatric patient

13. Assess and provide care for the low vision patient

14. Assess and provide care for the geriatric patient

And a final important element linked with patient care that is the:

15. Continued professional development of the optometrist and practice based-learning so that modern evidence-based care can be provided

The knowledge and skills required for each of these elements determines the optometry curriculum. The required curriculum topics are listed in the Contents page.

INTRO

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THE PATIENT EXAMINATION


Formulate an examination plan

Requirement

• Selectproceduresthatwillacquirevitalinformationfordiagnosis and management based on the patient history

• Selectsuitabletestsandprocedurestothepatient’sabilities and condition

• Useaproblembased(subjective,objective,assessment,plan“SOAP”)/scientific approach to gather data relevant to the patient’s problems

• Considerrelevantinvestigationsnotnecessarilyassociatedwiththepatient’s history

• Reviewandanalyzedataforconsistency

• Formulateoneormorediagnoses

• Considermanagementoptionsanddetermineappropriatemanagement plans for each of the diagnoses

• Communicatewiththepatientregardingexaminationoutcome

• Includethepatientinmanagementdecisions

• Reviewmanagementoutcomes

BAC

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Assess the patient’s case history

Requirement

• Reasonsforvisit – Chief complaint – Othercomplaints/problemsthepatientwouldlikeaddressed

• Ocularhistory:including – Present and past optical appliances – Previous eye examination and outcomes – Injuries,infections,surgeries – Allergies to eyedrops

• Familyocularhistory – Eye conditions in close relatives – History of blindness or vision loss in family

• Medicalhistory:including – Allergies – Infections – Medicalconditions o Chronicfever,weightloss/gain/fatigue o Ear, nose, throat

– Medications o Prescribed o Supplements/traditionalmedicines

– Reviewofsystems o Cardiovascular o Respiratory o Gastrointestinal o Skin o Musculoskeletal o Urinary o Neurological o Psychiatric o Chronicfever,weightloss/gain/fatigue o Ear, nose, throat o Endocrine

• Useoftobaccoproducts,alcohol,recreationaldrugs

• Visualtasks – Occupational – Recreational – Specific visual demands

• Goalsfortheexamination

Enabling Sciences – topics to cover

Psychology in Health Care

• Conceptualapproachestobehaviouralstudies–humanbehaviourinvestigations: behavioural; psychoanalytical; humanistic; cognitive and biological paradigms

• Psychologicalfunctioning:perception;learning;motivation;emotions;stress and coping; health and illness behaviours

• Communicationandinterpersonalskills:developmentofcommunication and interpersonal skills

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Anatomy

• Structureofthehumanbodywithrespecttoregionalanatomy

• Functionsofthehumanbodywithrespecttosystemicanatomy

• Systemicandregionalanatomyintegrationwithrespectto medical imaging

• Thehumanbodyandanatomicalterminology

• Skin(integumentarysystem)

• Skeletalsystem

• Muscularsystem

• Nervoussystem

• Specialsenses

• Cardiovascularsystem

• Respiratorysystem

• Blood,lymphaticandimmunesystem

• Digestivesystem

• Renal(urinary)system

• Endocrinesystem

• Reproductivesystem

Cell Biology and Biochemistry

• Fundamentalconceptsinbiochemistry

• Functionalsystemswithinanorganism,wherecellsfunctionasbasic building blocks

• Rolesofbiologicalmoleculesinlivingsystems

• Interactionsbetweenbiochemicalpathwaysinanorganism

• Cellstructuresandfunctionoforganellesandthecellasanentity:prokaryotic and eukaryotic cells, architecture of plasma membrane, transport across membrane, internal membranes and cell energetic, chemical signalling between cells, cytoskeleton and cell movement, cilia and flagella, endoplasmic reticulum, ribosome, Golgi apparatus, lysosome and peroxisomes and the nucleus

• Cellcyclesanddevelopmentofcellspecificityineukaryotes,cell cycle and cells in early stage of development, determination and differentiation of cells in higher eukaryotes, and important roles of stem cells

• Introductiontoimportantmethodsincellbiology:microscopyandhistological methods, cell fractionation and analysis of subcellular components, cytochemical techniques, autoradiography and radioisotope labelling techniques

• Structure,propertiesandfunctionsofmoleculesoflife:water,carbohydrates, lipids, proteins and vitamins, vision biochemistry and its relation to Vitamin A

• Geneinformationexpression:geneticinformationcode; transcription; translation


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• Enzymes:natureandmodeofactionofenzymes,regulationandimportanceinbiologicalsystems,isoenzymesandcoenzymes, enzymekinetics

• Catabolismandgenerationofenergy:bioenergeticprinciples,glycolysis, citric acid cycle, hexose monophosphate shunt, electronic transport, oxidation of fat, proteolysis, deaminations, fate of carbon skeleton, urea cycle

• Biosynthesisandutilizationofenergy:gluconeogenesis,glycogenesis,biosynthesis of lipids, amino acids and proteins

Physiology

• Normalfunctioningofthehumanbodywithemphasisonmode of mechanisms

• Integrativenatureoftheoperationofdifferentbodysystemsin health and illness

• Functionsofphysiologicalsystemsinnormalbodymaintenance

• Tissuetypesandorganization:classificationoftissues,histologicalstructureandfunctionoftissues;generalorganizationofthehumanbody in relation to organs and systems

• Nervoussystem:classification,structure,functionandpropertiesofneurons and synapses; basic anatomy and divisions of the nervous system; roles of the central and autonomic nervous systems; receptors andchemicaltransmissionatnerve-nerveandnerve-musclejunctions;neurotransmitters;organizationandfunctionofthesensorysystemforboth general and special senses; control of body movement

• Endocrinesystem:definitionofhormone,endocrineglands;physiologicalfunctionsofmajortypesofhormones;generalmechanisms of hormone actions for water soluble and insoluble hormones; structure of pituitary gland and hypothalamus and regulations of hormone release

• Cardiovascularsystem:structureandfunctionoftheheartandbloodvessels; control of cardiac functions; function of the systemic and pulmonary circulation; haemodynamics; components and properties of blood; structure and function of the lymphatic system

• Respiratorysystem:organizationandstructureoftherespiratorysystem;ventilation and lung mechanics; exchange of gases in alveoli and tissues; transport of blood gases; chemical control of ventilation

• Digestivesystem:structureofthedigestivesystem;digestionandabsorption; regulation of digestive processes

• Immunesystem:classificationsofcellsoftheinternaldefencesystem;recognition of self and ‘non-self’; non-specific defence processes; specific defence processes; roles of antibodies and complement pathways

• Motorsystem:maincomponentsoftheskeletonbasicjointanatomy;principles of muscle arrangements, mechanisms of muscle contraction

• Reproductivesystem:generalprinciplesofgametogenesis;malereproductive physiology; female reproductive physiology; female sex cycle; pregnancy

• Renalsystem:organizationoftheurinogenitalsystem;structureofatypical nephron; basic renal processes; regulation of sodium and water balance; regulation of potassium, calcium and hydrogen ions


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Foundation of Disease

• Principleofdiseases:introductiontothestudyofpatterns,causes,mechanisms and effects of diseases; cellular adaptive responses toinjuryandindisease;tissueresponsestomicrobialinfections; immune, infective, environmental and nutritional factors in disease; neoplasia; molecular mechanisms in cell proliferation and necrosis

• Diseasetopicsinlocalareas:prevalenceofdiseaseinthelocal area, mode of disease pattern, causes, mechanisms, effects and complications

• Acuteinflammationandpneumonia;chronicinflammation and tuberculosis; viral infections in human diseases; peptic ulceration and stomach cancer; introduction to neoplasia; lung cancer and nasopharyngeal carcinoma; hepatitis, liver cirrhosis, liver cancer; peripheral vascular diseases; intracranial expanding lesions;AcquiredImmuneDeficiencySyndrome

• Pathophysiologyandbasichistopathologyofdiseases

• Macroscopic,microscopicanddiagnosticimagingindiseaseprocesses

General Pharmacology

• Introductiontopharmacologyandsourcesofpharmaceuticalagents:scope of pharmacology; plants, animals, minerals, micro-organisms, and chemical synthesis as sources of pharmaceuticals

• Pharmacokinetic–routesofadministrationofpharmaceuticals:enteral,parenteral, topical, transdermal, and sublingual administration; methods and frequency of administration of pharmaceuticals; factors affecting route of administration, and relative merit of one route over others

• Pharmacodynamic–absorptionanddistributionofpharmaceuticals(factors affecting absorption and distribution of pharmaceuticals): pH-partition theory, physio-chemical properties of drugs; host factors

• Biotransformationofpharmaceuticals:phasesofmetabolism of pharmaceuticals, factors affecting metabolism of pharmaceuticals, prodrugs

• Eliminationofpharmaceuticals:degradationofpharmaceuticals,systems involved in elimination and excretion of pharmaceuticals, routes of elimination, factors affecting elimination of pharmaceuticals

• Modesofactionofpharmaceuticals:extracellular,intracellular,receptorand rate theories in the mechanism of action of pharmaceuticals

• Ocularsideeffectsofsystemicallyadministeredpharmaceutical agents: therapeutic agents that induce ocular side effects, dose dependence and idiopathic ophthalmic adverse reactions to pharmaceuticals, interaction between ophthalmic and systemically administered pharmaceuticals, drug-related ocular emergencies


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Optometry Curriculum – topics to cover

Clinical Optometry (with focus on theory)

• Interpretingbackgroundinformationcollectedfrompatientsinprimaryeye care

• Principlesandevaluationofocularhealthassessmentproceduresandoptometric investigations

• Applyingoptometricinvestigations

• Comprehensivepatienthistorytaking,devisingaworkinghypothesisand formulating tests to evaluate clinical symptoms

• Proceduresforassessmentsselected

• Caseanalysis – Diagnosis – Management – Patient training – Patient education – Follow-up

• Professionalresponsibilityandcommitmentinprimaryeyecareinthecommunity in diagnosis and treatment

• Integratingandsynthesizingclinicalfindings/informationfordiagnosisand management plans

• Professionalattitude,ethics,andcareinperformingclinicalassessment

• Inter-andintra-professionalcommunication:handlinginter-andintra-professional relationships; skill of communicating information amongst professionals; writing referral letters

Optometry Clinic (with focus on clinical competency)

• Caseanalysis:extractingrelevantinformationandformulatingtentativeapproaches of investigation based on a patient’s presented history

• Applyingclinicalprocedures:performingadditionalclinicalproceduresas required in the management of patients

• Patientexamination:performingfullvisionexaminationsonpatients in the Optometry Clinic

• Accurateassessmentanddiagnosisofvisualperformanceandocularcharacteristics

• Effectivecommunicationwithpatientsandotherprofessionals:presentation of symptoms; critical analysis of clinical findings; proposed plan of action

• Hospitalvisits

• Ethicalandprofessionalclinicaloptometrypractise;understanding of the optometrist’s role in the healthcare system

• Diversityofclinicalfacilitiesineyecareservices

• Effectivevisualandocularproblemsidentificationinaclinicalfacilityand relevant information collection pertinent to problems

• Provisionofvisioncareandtreatment:opticaltreatments;ophthalmicpharmaceutical agent prescriptions; vision therapy; referrals


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Case Conference

• Organizingandanalyzinginformationrelatedtoagivencase

• Identifyingrelevant/importantandirrelevant/lessimportantelements of a case

• Recognizingdifferentapproachesthatcouldbetakenandoutcomesthat may result

• Integratinginformationfromdifferentsubjectareasandfromone’sownexperience in making appropriate decisions regarding patient care

• Developingappropriatemanagementplansandstrategiesforcopingwith unusual cases or clinical entities

• Critiquingpatientcaredecisionsmadebyoneself,orbyothers

• Communicatingimportantelementsofacasetoprofessionalcolleagues in writing and verbally


Assess the anterior ocular adnexa for their structure, health and functional ability

Requirement

• Assessandevaluatewithmacro-observation,slitlampbiomicroscopy,loupe, palpation, lid eversion, photography, and use of diagnostic pharmaceuticals

– Conjunctiva – Lids – Lashes – Puncta – Meibomianglands – Lacrimal glands – Skin lesions near the eye


Anatomy

• AsperAnatomyinElementOne


• AsperCellBiologyandBiochemistryinElementOne

Physiology

• AsperPhysiologyinElementOne

Microbiology

• Microbiologyprinciples:anaidtodiagnosis;specimensrequired for diagnosis; characteristics of commonly found microorganisms; differences between bacteria, fungi and viruses

• Structuresandpropertiesofmicroorganisms

• Pathogens:sitesandsourcesofinfection;propertiesofmicroorganismsthat cause disease; differentiation of commensals from pathogens

• Parasitism:relationshipbetweenhostandparasiteandbetweenthecharacteristics of microorganisms and their mode of parasitism

• Spreadofmicroorganism:transmissionofdisease;infectiousdisease,epidemic, endemic and carrier; reservoirs of infection and mode of spread; measures to control the spread of infections by controlling transmission, use of quarantine and vaccination

• Eyeinfections:aetiologicagentsofeyeinfections;theenvironment, and physical chemical defence mechanisms of the eye

• Chemotherapeutics:principlesanduseofcommonlyusedantibiotics;mutation and adaption of bacteria to antibiotics

• Careofopticalinstruments:methodsofstorage;propertiesanduse of microbiocides

• Sterilization:principlesofsterilizationanddisinfectionandtheagentscommonly used; methods of use of those agents and reasons for their choice; monitoring of the effectiveness of these procedures


• AsperFoundationofDiseaseinElementOne

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Anatomy for Optometry

• Embryologyoftheeye:sequenceofeventsinthedevelopmentoftheeye and its appendages in the human foetus

• Theocularadnexa:eyelids,lacrimalglandsandteardrainagesystem

• Vasculatureintheeye,orbitandadnexa;arterialsupplyandvenousdrainage; origins and destinations

• Relationshipsandfunctionsbetweenstructuresinthevisualsystem

Ocular Physiology

• Originandfunctionsoftears,tearfilmandtheirimportanceinrelation to ocular health

• Tearphysiology:productionanddrainageoftears;composition;function; pH; secretion rate of tears (Schirmer test and cotton thread test); tear film break up time and glucose concentration in tears

• Theeyelids:controlofblinkactions;functionsofeyelidglandsandsecretory cells

Ocular Disease

• Anteriorsegment:congenitalanomaliesoftheanteriorsegment;infection, inflammatory and toxic conditions; degenerative and dystrophicconditions;differentialdiagnosisofredeye;conjunctivalproblems, optometric management

• Signsandsymptomsofprimaryandsecondaryeyediseasesinvolvingthe anterior segment encountered in clinical practice

• Diseasesofeyelidsandthelacrimalsystem:signsandsymptomsofinflammation, trauma, tumour and degeneration; differential diagnosis of congenital anomalies; optometric action

Clinical Optometry

• Thepreliminaryexamination:goalsofperformingpreliminarytests

• Slitlampbiomicroscopy:methodsandpracticeofillumination andobservation;recognizeappearancesofnormaloculartissues;clinical applications of biomicroscopy; use of vital stains

• Clinicalusesofdifferentkindsofdiagnosticpharmaceuticalagents:clinical applications of ophthalmic diagnostic agents – indications, contraindications and precautions for use; and evaluation of effectiveness of various preparations

• Photo-documentation:methodsofocularphotography–anterioreye

• Arterialbloodpressureandintra-ocularpressuremeasurementandinterpretation for ocular health evaluation

• Clinicaldatasamplingandanalysisforocularhealthdiagnosis

• Clinicalfindings/informationintegrationandsynthesisfor diagnosis and management plans


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Ocular Pharmacology

• Preservatives:preservativecommonlyusedinophthalmic preparations, physio-chemical and antimicrobial properties, side effects and interactions

• Factorsaffectingpenetrationofpharmaceuticalsintheeye:physical-chemical properties of pharmaceuticals, drainage system of the eye, vasculature of the eye

• Aspectsofophthalmicpharmaceuticals,formsandmethods of administration: dosage forms, principal requirements of ophthalmic preparations, factors affecting efficacy and stability of ophthalmic preparations

• Topicalanaesthetics:mechanismsofaction,types,biotransformation,and their side effects

• Stainingagents:stainingpropertiesoffluorescein,lassaminegreen and rose bengal, and side effects

• Anti-allergicandanti-inflammatoryagentsandtheirresponsecascades: types and classification of pharmaceuticals, modes of action, conditions under which they are to be used, side effects and precautions in use

• Clinicaluseofvasoconstrictors,antihistamines,mastcellstabilizers,corticosteroid, and non-steroidal anti-inflammatory pharmaceuticals for different ocular problems

• Anti-infectivepharmaceuticalsforoculardiseases:types and classification of individual groups of pharmaceuticals, modes of action, conditions under which they are to be used, side effects and precautions in use; clinical use of anti-infective pharmaceuticals for different ocular problems

• Epilation,punctualocclusionandirrigationofthelacrimalsystem

• Treatmentofdryeye:lubricants,artificialtears,punctalocclusion and oral supplements

• Systemicsideeffectsofocularpharmaceuticalagents:ocularabsorption of topically applied pharmaceuticals, factors contributing to excessive accumulation of pharmaceuticals, types of adverse reactions of pharmaceuticals, precautions, and contra-indications in the use of ocular medications

• Therapeutictreatmentforanterioreyedisorders:conditionsaffectingthelids,adnexa,andconjunctiva,andthelacrimalapparatus

• Developmentofmanagementstrategiesfordifferentoculardiseases:via case studies and computer assisted learning

• Cardio-PulmonaryResuscitation(CPR):recognitionofsignsandsymptomsofaheartattack;howtoprovideCPRuntilmedicalhelparrives; how to give first aid for choking. Emergency action principles; contacting emergency services; mouth-to-mouth breathing (manikin practise) for adults, children and babies; signs of choking – action in conscious and unconscious adults, children, and infants; recognition of cardiac arrest and action to be taken; recognition of stroke and action to be taken


Assess the anterior segment for their structure, health and functional ability

Requirement

• Assessandevaluatewithvitaldyesanddiagnosticpharmaceuticals, slit lamp biomicroscopy, keratometry, keratoscopy, topography, gonioscopy, pachymetry, tonometry, photography, exophthalmometry, optical coherence tomography (OCT), ultrasonography

– Cornea – Anterior chamber – Aqueous humour – Anterior chamber angle – Anterior chamber depth – Episclera – Sclera – Iris – Pupil – Ciliary body


Anatomy




Physiology


Microbiology

• AsperMicrobiologyinElementTwo



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• Nervesupplytotheeye,orbitandadnexa:motor,sensoryandautonomic nerve supply

Ocular Physiology

• Thecornea:functions,itsdifferentlayersandthecommonconditionsthat affect the cornea and vision, metabolism and maintenance of transparency

• Mechanismofaqueoushumourformation,itsfunctionandcompositionand relate the understandings to intraocular pressure (IOP) and ocular pathophysiology

• Theintraocularpressure:itsorigin,rangeanddistributioninthepopulation; measurement; diurnal variations

• Thepupil:factorscontrollingpupilsize;relationshipbetweenpupilsizeand visual function

Ocular Disease

• Signsandsymptomsofprimaryandsecondaryeyediseasesinvolvingthe anterior segment encountered in clinical practice

• Diseasesofthescleraanduvealtract

• Laboratorytestsappropriateforaidingdiseasediagnosis

• Anteriorsegment:congenitalanomaliesoftheanteriorsegment;infection, inflammatory and toxic conditions; degenerative and dystrophic conditions; differential diagnosis of red eye; corneal problems; optometric management

• Ocularinjuryandtrauma–definition:ocularfirstaid;optometricmanagement

• Conditionsrequiringimmediatereferral:recognitionand necessary action

• Refractivesurgery:differenttechniquesinrefractivesurgery;pre-operative optometric examination; complications and management of post-refractive surgery


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Clinical Optometry

• Theevaluationofnormalandabnormalpupilresponsesandiriscolour

• Pathologicalchangesinanteriorangle

• Intraocularpressuresandtonometry:measurementofintraocularpressure; applanation and indentation tonometry; non-contact tonometry; clinical applications of tonometry in practice

• Gonioscopy:principlesofmethods;typesofgonio-lenses,their methods of application; and the appearance of the anterior angle by gonioscopy; abnormal signs in the anterior angle; three-mirror retinal evaluation

• Electrophysiology:principlesandapplicationsofvisualelectrophysiological techniques in optometric practice

• Ultrasonographyandotherimagingtechniques:principlesandapplications of A-scan, B-scan and ultrasound pachymetry in clinical optometric practice

• Keratometry:clinicalapplicationinrefraction

• Sphygmomanometry:principleandmethodofsphygmomanometry;applications in optometric practice; ophthalmodynamometry – theory and application in optometric practice

Ocular Pharmacology

• Therapeutictreatmentforanterioreyedisorders:conditionsaffectingthe cornea, and the sclera

• Autonomicnervoussystem,innervationoftheeye,neuronaltransmittersin the eye and their interactions with receptor subtypes; fate of transmitter substances and their action in the eye: biotransformation of acetylcholine and norepineprine; receptor types and their distribution in ocular tissues

• Miotics:parasympathomimetic,sympatholytic,anti-cholinesterases, and their side effects

• Cycloplegicsandmydriatics:anticholinergicscycloplegicagents; direct and indirect acting sympathomimetic and anticholinergic mydriatic agents, and their side effects

• Pharmacologicalmanagementofpre-andpost-refractive surgery patients

Visual Science

• Measurementofocularcomponents:methodologyandtechniques of ocular measurements including ultrasonography, keratometry and pachometry; frequency of distribution of ocular component dimensions


Assess the ocular media for their structure, health and functional ability

Requirement

• Assessandevaluatewithdirectandindirectophthalmoscopy,retinoscopy, photography, diagnostic pharmaceuticals, slit lamp biomicroscopy and ultrasound

– Ocular lens – Lens implant – Lens capsule


Anatomy




Physiology


Microbiology






• Structuresandmediawithintheeyeball:adetailedstudyofthe different layers of the eyeball, their structures and functions

Ocular Physiology

• Thecrystallinelens:metabolismandfunctionsinrelationtovision, the formation of cataract

• Accommodation:itsfunction,causesandcontrol;thenatureandcauses of presbyopia in terms of the malfunction of accommodation

Ocular Disease

• Crystallinelensandcataract:differentialdiagnosisoflenticularanomalies; signs and symptoms of cataract; senile cataract; secondary cataract; complications and management; optometric management

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Clinical Optometry

• Retinoscopy:spotandstreakretinoscopy–staticmethods;retinoscopyinastigmatism;nearpointretinoscopy–Mohindratechnique;dynamicmethods;variationsofdynamicretinoscopy–MEMretinoscopy,chromoretinoscopy

• Directophthalmoscopy:basicaspects;appearanceofthenormalfundus and its variations; an introduction to the ophthalmoscopic signs of ocular disease; clinical practice of ophthalmoscopy

• Indirectophthalmoscopy:principlesofindirectophthalmoscopy;monocular indirect and binocular indirect ophthalmoscopy – instrumentation and clinical procedures; appearance of the normal fundus; abnormal changes; clinical applications of techniques

General and Ocular Pharmacology

• Ocularsideeffectsofsystemicallyadministeredpharmaceuticalagents:therapeutic agents that induce ocular side effects, dose dependence and idiopathic ophthalmic adverse reactions to pharmaceuticals, interaction between ophthalmic and systemically administered pharmaceuticals, drug-related ocular emergencies

• Clinicaluseandsideeffectsofcorticosteroidpharmaceuticalsfordifferent ocular problems

• Miotics:parasympathomimetic,sympatholytic,anti-cholinesterases, and their side effects

• Cycloplegicsandmydriatics:anticholinergicscycloplegicagents; direct and indirect acting sympathomimetic and anticholinergic mydriatic agents, and their side effects

Visual Science

• Opticsoftheeye:opticalpropertiesofdifferentocularstructures;different schematic eye models

• Optometers:opticsandprinciplesofthesimpleoptometer,Badal’soptometer, Young’s optometer, retinoscopy

• Accommodation:relationshipbetweenstimulusandresponse;mechanism and properties of accommodation; spectacles and ocular accommodation

• Effectsofdifferentradiationstotheeyeandeffectsofocular aberrations on vision

• Importanceoflightinvisionandorganisms

Optometry Specialties

• Aphakiaandpseudophakos:advantagesanddisadvantagesofaphakic corrections; types of aphakic corrections; problems of the newly corrected aphake; the pseudophakic eye post-operatively; types of pseudophakic correction; complications of pseudophakos


Assess the posterior segment for their structure, health and functional ability

Requirement

• Assessandevaluatewithdirectandindirectophthalmoscopy,slitlampbiomicroscopy and slit lamp funduscopy, retinoscopy, photography, diagnostic pharmaceuticals, colour vision tests, Amsler test, visual field test, photostress test, pupil reactions, diagnostic imaging and ultrasound

– Retina – Choroid – Vitreous – Blood vessels – Optic disc and neuro-retinal rim – Maculaandfovea


Anatomy




Physiology


Microbiology






• Theorbit:theboneswhichmakeuptheorbitandthevariousfossaeand canals in the orbit

• Thevisualpathway:locationandanatomicalnatureofstructurescomprising the visual pathway; arrangement of nerve fibres from retina to visual cortex; implications of this arrangement on binocularity and visual fields

Ocular Physiology

• Thevitreoushumour:itsproduction,composition,metabolism, and functions

• Theretina:metabolismandfunctionsofthevariouslayers;phototransduction mechanism; and relationship of retinal functions with various vegetative functions of other ocular structures

• Photochemistryofvision:visualpigments;chemicalnatureofrhodopsin;responses to light

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Ocular Disease

• Conditionsoftheorbitandorbitalstructures:congenitalanddevelopmental anomalies; signs and symptoms of infection and inflammatory conditions; sings and symptoms of orbital trauma and tumours

• Proptosis:conditionsaffectingtheeyesandocularadnexa

• Clinicalaspectsofultrasound,CT(computerizedtomography)and MRI(magneticresonanceimaging):investigativetechniques,clinicalapplication for diagnosis of ocular disease

• Glaucoma:definitionandincidence;reviewofaqueousphysiology and angle anatomy; signs and symptoms, investigative techniques; secondary glaucoma; criteria for referral

• Diseasesofthevitreousandretina:vascularanomalies;inflammatoryconditions; retinal detachment; degeneration and dystrophies; laser and cryotherapy treatment; congenital and developmental conditions; trauma and foreign bodies; optometric involvement

• Macula:congenitalandinheritedconditions;degenerationanddystrophies; toxic conditions; treatment

• Ocularsignsofsystemicdiseases:signsandsymptoms;optometricmanagement

• Neuro-ophthalmology:reviewofanatomy,physiology,andretinotopicvisualfieldorganization;symptomsandinvestigativetechniques of visual field loss: signs and symptoms of optic nerve disease; differential diagnosis of ophthalmoplegia; papillary pathway and tests; congenital and developmental papillary anomalies; differential diagnosis of papillary defects; neural problems involving visual pathway

Clinical Optometry

• Fundusbiomicroscopy:contactfunduslens;theHrubyandVolklensesand their principles and applications in clinical practice; fundus appearance with biomicroscopy

• Visualfieldsandvisualfieldtests:Bjerrumscreen;visualfieldscreeners;principles and practice; perimetry – static and kinetic perimetry; automated perimetry; detection of visual field defects

• Macularfunctions:varioustechniquestoassesstheintegrityandfunctionality of the macula, Amsler grid, photostress test, neutral-density filter test, colour comparison test and brightness comparison test

• Pathologicalfunduschanges

• Colourvisionandcolourvisiontests:clinicalassessmentofcolourvision;applications of colour vision tests; congenital vs. acquired colour vision defects; clinical manifestations of acquired colour vision defects

• AdvancedOptometricInvestigation–principlesandclinicalapplicationsofnewoptometricinstruments:NerveFibreAnalyzer(NFA);Orbscansystem;IOLMasterandOpticalCoherenceTomography(OCT)


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Ocular Pharmacology

• Medicaltreatmentofglaucoma:typesandclassificationofindividualgroups of pharmaceuticals for glaucoma treatment, modes of action, conditions under which they are to be used, side effects and precautions in use

Visual Science

• Anatomyofthevisualpathway:nervefibredistributionintheretina,optic nerve, optic chiasma and optic pathway; visual and synaptic relations in the midbrain and cerebrum

• Lightandthevisualsystem:introductiontophotometry;lightasaphysiological stimulus, characteristics of light, representation of visual stimulus on the retina, brightness sensation; circadianism and vision, effect of melatonin on the retina

• Retinalintegrationofvisualinformation:convergentproperties of retinal signals in the retina; integration of visual information in the retina in relation to control of retinal sensitivities, wavelength andspatial/spectralsampling

• Electrophysiologyofthevisualsystem:physiologicalbasisofERG,EOG,andVERtostructuredandunstructuredstimuli;knowledgeofmultifocaltechnique in visual electrophysiology

• Neuralorganizationofthevisualsysteminthebrain:representation of the visual stimulus on the visual cortex; receptive fields and properties of various cells involved in the visual pathway; relationship betweencorticalorganizationandlight,form,oculardominance, spatiallocalization/orientation;parallelism;functionalorganization of visual cortex

• Codinginthevisualsystem:conceptandorganizationofreceptivefields, edge detection, spatial frequency tuning, neural channels, signal and noise

• Psychophysicsofmeasurement:frequencyofseeing,signal detectiontheoryROCcurves,visualthreshold,signalandnoise, criterion-dependent and criterion-dependent methods in vision research

• Colourvision:spectralsensitivity,wavelengthdiscrimination,colourmatching, colour contrast, defective colour perception, classical and recent theories of colour vision, design of colour vision tests

• Visualperception:sensationandperception,theoriesof perception, perception of space, form and motion, constancies, factors affecting perception


Assess the sensory visual function and integrity of the visual pathway

Requirement

• Assessandevaluatecontrastsensitivityfunction,glare,optokineticnystagmus, pinhole vision, binocular vision

– Visual acuity

• Assessandevaluatewithconfrontation,kineticandstaticscreening and threshold, short wavelength automated perimetry (SWAP) and frequencydoublingtechnology(FDT)

– Visual fields



• AsperAnatomyforOptometryinElementsTwotoFive

Ocular Physiology

• Reflexarcs:thenervouspathwayofvariousocularreflexesincludingpupillary, accommodation and convergence; eye movements

Ocular Disease

• Decreaseinvisualacuityofacuteandchroniconsets

Clinical Optometry

• HabitualVAanditssignificance

• Contrastsensitivityfunction:theoryandclinicaluseofcontrastsensitivityfunction, contrast sensitivity function curve, commercially available contrast sensitivity charts and systems; clinical significance and interpretations of contrast sensitivity function


Visual Science

• Visualacuity:limitationsforvisualresolution;introductionofvisual acuity measurement; design of visual acuity chart; factors affecting visual acuity

• Spatialvision:spatialresolution,spatialcontrastsensitivity,hyperacuities

• Temporalvision:temporalresolutionandflicker,deLangecurve,spatio-temporal characteristics of vision

• Assessmentofvisualacuity:conceptsofaidedandunaidedacuity;comparisons between systems of recording visual acuity; clinical methods of measurement; relationships between refractive error and acuity, high contrast versus low contrast visual acuity

• Effectofamblyopiaandabnormaleyeconditionsonvision

• Oculartransmissionandaberrations:transmissionandabsorptionspectra of the media components; their effects on vision; aberrations of lens systems as applied to the eye; effects of these upon vision

• Entopticphenomena:physiologicalvisualsensationsandtheircauseand effects

ELEMEN

T 6


Assess the refractive status

Requirement

• Assessandevaluate

– Spherical ametropia – Astigmatism – Presbyopia


Mathematics

• Applyingmathematicalreasoningforanalysisofdifferentproblems

• Extendingknowledgeofmathematicaltechniquesandadaptingknown solutions to different situations arising in optics

• Developingandextrapolatingmathematicalconceptsinsynthesizingand solving Optics problems

• Resolvingmathematicalprobleminoptometryrelatedtopics

• Basicmathematics:trigonometry,complexnumbers,simplematrices

• Differentialcalculus:differentiationfromthefirstprinciples,ratesofchange, differentiation of algebraic, trigonometric, logarithmic and exponential functions, differentiation of inverse functions and implicit functions,Leibniz’stheorem,geometricandphysicalapplications

• Integralcalculus:definiteandindefiniteintegrals,techniquesofintegration, reduction formulas, applications of integrations



• AsperAnatomyforOptometryinElementsTwotoFive

Ocular Physiology

• AsperOcularPhysiologyinElementsTwotoSix

Ocular Disease


Clinical Optometry

• Oculartransmissionandaberrations:transmissionandabsorptionspectra of the media components; their effects on vision; aberrations of lens systems as applied to the eye; effects of these upon vision

• Auxiliaryrefractivetechniques:principles,methodsandapplications of autorefraction, photorefraction and laser refraction

• Subjectiverefraction:monocularsubjectiverefraction;principles and methods – fogging techniques, fan and block techniques, Jackson’scrossedcylinder;monocularrefractiveendpoints–+1.00D blur,duochrometests;binocularequalizationmethods–infinity balance,prismatictechniques;binocularsubjectiverefraction;nearsubjectiverefraction

ELEMEN

T 7


Elem

en

t 7

• Refractiveerrortypesandsubnormalvisualacuitycaseidentification

• Opticalmanagementofametropia

• Appropriateprescriptioncorrectionperrefractiveandnon-refractiveconditions and management plan

• Accommodationandpresbyopia:comfortablenearvision;amplitudeof accommodation – methods of measurement, effects of age; crossed-cylinder tests of accommodation; relative ranges of accommodation; accommodative facility test; determination of the presbyopic addition

Optics

• Physicalandgeometricaloptics

• Identifyingandresolvingopticalproblems

• Opticalinstrumentation:stops,pupilsandwindows;cameras,simplemagnifiers and eyepieces, microscopes, and telescopes

• Opticsofthicklensesandlenssystems:Gaussianoptics–reflection and refraction at plane and spherical surfaces; cardinal points of thick lenses and lens systems; image forming systems; matrix method

• Productionandmeasurementoflight:dualnatureoflight;black body radiation; luminous intensity; illuminance; luminance; Lambert’s law of emission; fundamental laws of photometry; reflectance, transmittance and absorbance; examples of photometers; principles and applications of lasers

• Lensaberrations:dispersivepowerofopticalmaterials;achromaticprisms and lenses; monochromatic aberrations; ray tracing

• Wavenatureoflight:Fresnel’slawofreflection;interferometry andapplications;opticalcoating;FresnelandFraunhoferdiffraction; zoneplatesandtheirapplication;resolvingpower;polarizationbyreflection;scattering,dichroismandbirefringent;polarizers,applicationsofpolarizedlight

Ophthalmic Optics and Dispensing

• Ophthalmiclenspowerandformpresentation:lenspowerandformtransposition; writing of prescriptions and lens shapes presentations

General and Ocular Pharmacology

• AsperGeneralandOcularPharmacologyinElementsOnetoThree

Visual Science

• Emmetropiaandametropia:definitionofdifferentrefractiveconditions;frequency of distribution of ametropia

• Retinalimagesizeandmagnification:effectsofrefractiveerrorsonretinalimagesize;spectacleandcontactlenscorrectiononretinalimagesize


Assess the oculomotor and binocular function

Requirement

• Assessandevaluatewithprisms,covertest,headtilttest;ocularalignment and binocular function; placement and adaptability of accommodation; visual information processing

– Manifestdeviation – Latent deviation – Fixation – Versions – Vergences – Ocular pursuits – Saccades – Ocular motility – Suppression – Diplopia – Stereopsis – Normal and anomalous correspondence – Accommodation


Mathematics

• AsperMathematicsinElementSeven



• Theextraocularmuscles:anatomy,functions,nervousand vascular supply

Ocular Physiology


Ocular Disease


ELEMEN

T 8


Elem

en

t 8

Clinical Optometry

• Entopticphenomena:physiologicalvisualsensationsandtheircauseand effects

• Investigationofbinocularity:theoriesandprinciplesofbinocularvisualfunctions; heterophoria and heterophoric tests – principles and methods;accommodation-convergencerelationship–AC/Aratios;assessment of fusional vergences – methods and normal findings, vergence-facility test; stereopsis – measurement and clinical applications; identification of binocular anomalies – nomenclature, analysis of binocular status

• Hirschbergtestandanglekappatest,theoryandmethodsoftheunilateral and alternate cover tests; assessment of binocular motility; near point of convergence and other evaluations; near point of accommodation; evaluation of ocular dominance

• Headaches:clinicalpresentationsofheadaches;variouscauses of headaches; management of patients with headaches as the chief compliant

Optics

• AsperOpticsinElementSeven

Visual Science

• Binocularvisioninhumansandotheranimals:anatomicalandstructuralfeatures in different species with binocular vision; levels of binocularity in different species; evolution and environmental adaptation

• Sensoryaspectsofbinocularvision:visualprojection;correspondingand disparate retinal points; theoretical and empirical horopters; Panum’s area and fusional space; physiological diplopia; fixation disparity

• Fusionalresponsesandnearvisioncomplex:fusionalmovement;heterophoria; accommodation, convergence and pupillary action

• Depthperceptionandstereopsis:physicalfactorsaidingdepthjudgment;stereopsis;theoreticalmodelsforstereopsis

• Normaleyemovements:fixationeyemovement;saccades;pursuit;ductions; versions; vergence

• Aniseikonia:effectofunequalretinalimagesizeonbinocularvision and space perception

• Binocularinteraction:advantagesofbinocularvision;binocularsummation and inhibition; theoretical models

• Developmentofnormalbinocularvision:binoculardevelopmentfrominfancy to adulthood; sensitive period; effect of visual deprivation


Elem

en

t 8

Clinical Binocular Vision

• Visiontherapyconcepts,procedures,andinstrumentation:synotophore,synotiscope, stereoscopes, anaglyphs, physiological diplopia techniques and their applications

• Heterophoriaanditsmanagement:aetiologyandclassification;clinicalsigns and symptomatology; compensation and decompensation; factors affecting compensation; investigation of compensation; fixation disparity; management of heterophoria problems – effect of the refractive correction, visual therapy and prismatic therapy, prognosis

• Accommodationandconvergenceanomalies:accommodationandconvergence excess and insufficiciency, investigation and management

• Heterotropia:aetiologyandclassification;comitanceandincomitance

• Sensoryadaptations:developmentofsensoryadaptationsinstrabismus;amblyopia, eccentric fixation, anomalous correspondence, suppression – clinical signs and investigations

• Managementofcomitantstrabismusandsensoryadaptations:occlusion therapy, pleoptics, antisuppression training, restoration of normal correspondence; training the motor angle of strabismus; selection of cases for treatment and prognosis; pre and post surgical orthoptics; role of refractive correction and prisms

• Managementofincomitantstrabismus:developmentofmotoradaptations; clinical signs and investigations; indications for referrals; optometric management

• Nystagmus:latentandmanifestnystagmus;formsofnystagmus,clinicalinvestigation and significance, optometric management

PATIENT MANAGEMENT


Assess suitability of spectacles and prescribe

Requirement


– Visual requirements: recreational and vocational – Magnificationrequirements – Prism requirements – Dispensingrequirementsandlimitations – Anisometropia – Aniseikonia – Lens design


Mathematics

• AsperMathematicsinElementSeven


Clinical Optometry

• Casehistorytakingandsymptomatology:roleofcasehistoryin the consultation; questioning techniques and question types; what comprises a case history; recording the history; symptomatology – an overview of symptoms found with various forms of ocular problems (refractive, binocular, organic)

• Prescriptiondecisions:aetiologyofrefractiveerrorsandtheinfluence of etiological theories on the refractive prescription and monitoring the refraction; relating the prescription to the occupational and other needs of the patient

• Clinicalcasemanagement:simulatedandrealclinicalcasestobuildup problem solving techniques in case management

Optics

• AsperOpticsinElementSeven

Visual Science

• AsperVisualScienceinElementsThreetoEight

ELEMEN

T 9


Elem

en

t 9

Ophthalmic Optics and Dispensing

• Vergencemethodofraytracing:theory,methodandapplication of tracing paraxial ray through single and complex lens systems

• Basicopticalpropertiesofsinglevisionlenses:opticalproperties of spherical and sphero-cylindrical lenses; principles of focimeter and lens measure

• Ophthalmiclenspowerandformpresentation:lenspowerandformtransposition; writing of prescriptions and lens shapes presentations

• Ophthalmicprismsandlensdecentration:specificationofophthalmicprisms and interactions of prisms; theory and calculation of prismatic effects on lens decentration

• Obliquelycrossedcylinders:effectsandcalculationofcylinderscrossedat any angle

• Accuratetransposition:calculationofexactlensformsforthicklenses,with bi-toric surfaces

• Lensmaterialsandtheirfabrication:opticalandphysicalproperties of common ophthalmic lens materials; selection of lens materials; processes of lens making

• LenticularandFresnellenses:opticalprinciplesandophthalmicuses oflenticularandFresnellenses

• Framematerialandtypes:meritsofdifferenttypesofspectacleframematerials; frame types and component parts; effects of frame designs on fitting

• Frameandfacemeasurement:introductiontospectacleframeandface measurement

• Assessinglensimagequality

• Bifocalsandtrifocals:principleandterminology,opticalproperties and fitting of bifocals and trifocals with maximum visual efficiency and wearing comfort

• Multifocals:principleandterminology,opticalpropertiesandfittingofmultifocals with maximum visual efficiency and wearing comfort

• Lensthicknessconsiderationsandcalculation:calculationofthickness in edged lenses

• Lenseffectivity:effectsofworkingdistanceandvertexdistanceon the prismatic and refractive powers in spectacles

• Spectaclelensdesign:principlesandmethodsofophthalmiclensdesigns; aberration correcting lenses; lens material selection for spectacle prescriptions; safety prescriptions

• Tintedlenses:radiationandtheeye;ophthalmicusesoftinted/photochromatic lenses; Polaroid lenses

• Spectaclefitting:factorstobeconsideredinlensandframeselections;principlesandpracticalaspectsofspectacleframefitting;adjustments;safety and efficiency; optical and fitting suitability evaluation

Optometry Clinic

• Spectacleframedispensingandadjustment:fittinganddelivery of spectacles to patients


Assess contact lens-wear suitability and prescribe

Requirement


– Contact lens visual requirements – Fittingparameters – Patient compliance – Contact lens performance




Physiology


Microbiology


Foundation Disease

• AsperFoundationPathologyofDiseaseinElementOne



• AsperAnatomyforOptometryinElementsTwotoFive;andEight

Ocular Physiology


Ocular Disease


• Managingocularemergencies

• Cornealandconjunctivalproblems

Clinical Optometry

• AsperClinicalOptometryinElementsTwotoThree;andSixtoNine

Optics

• AsperOpticsinElementTwo

Ocular Pharmacology

• Pharmacologicalmanagementofcontactlensrelatedproblems

ELEMEN

T 10


Elem

en

t 10

Visual Science

• AsperVisualScienceinElementsThreetoEight

Contact Lens Practice

• Cornealshapeandmeasurements:cornea,cornealshape(topography) and the use of keratometer in contact lens practice; sources of error; contact lens terms

• Cornealphysiologyandlenswear:opticalpachometer;introductiontocontact lenses, indications and contra-indications for contact lens wear

• Tearfilmandblinking:effectsofnormalblinkingonlenswear,tearexchange and lens rotation; abnormal blink patterns and their effects; effect of lens wear on the tear film; tear function tests and their significance

• Propertiesofcontactlensmaterials:rigidcontactlensmaterials;oxygenpermeability and transmissibility; wettability; water absorption

• Lensverification:measuringBOZRandotherradii,diameters,thickness,back vertex power; measuring water content; examining edges and surfaces

• Astigmatismandcontactlenses

• Contactlensconsultations:functionsprocedures;preliminary,fitting,aftercare routines (stress on slit lamp examinations) and delivery visits

• Softlenses:lensdesigns;specificindicationsandcontraindications;fitting principles and assessment of fit; effect of altering parameters; optimum fitting

• Solutionsandstains:preservativesusedincontactlenssolutions;solutions necessary for care of all types of contact lenses; use of stains in contact lens practice; sodium fluorescein

• Opticsofcontactlenses:tear/cornealenssystem;residualastigmatism;magnification and accommodation with contact lenses and their implications;toricRGPs

• Gaspermeablerigidlenses:objective;specificindicationsandcontraindications; trial sets and initial lens selection; fluorescein pattern; assessment of lens fit; over-refraction; effect of altering parameters; optimum fitting criteria

• Rigidandgaspermeablerigidlensesfittingphilosophiesanddesigns;fluorescein patterns; common fitting techniques; forces acting on the lens/eye

• Managingcontactlenscomplications:contactlensspoilageandpreventative measures; ocular and lens deposits

• Managingcontactlens-relatedocularcomplications:signs,symptoms,aetiology, treatment and prognosis; importance of compliance in contactlenswear(usageandcareprocedures);breachesinusage/careprocedures;waystomaximizecompliance

• Extendedwearlensesanddisposablelenses:patientselectionandmanagement;fittingphilosophies;softversusRGP;management

• Cosmeticcontactlenses


Elem

en

t 10

• Scleral,hybridandpiggy-backlenses

• Contactlensesforprebyopesandkeratoconus

• Introductiontoorthokeratology:indicationsandcontraindications,limitations,howortho-Kdiffersfromextendedwear,myopiccontrol withortho-K

Contact Lens Clinic

• Comprehensivecontactlens-historytaking

• Suitabilityofpatientsforcontactlenswear

• Assessinganterioreyeandmeasuringocularparametersrequiredforcontactlensfitting/aftercare

• Evaluatingandhandlingdifferentlenstypes;identificationofcommoncontact lens-related issues

• Lensfitting,evaluationanddispensing

• Managingpatientandaftercare(routineandproblemsolving)

• Legalandethicalissuesrelatedtocontactlenspractice

GENERAL HEALTH ASSESSMENT


Assess signs and symptoms of the patient’s general health

Requirement

• Perform

– CPR

• Identify

– Patient’s general welfare o Emotional and social factors o Abuse and assault

• Recognizeandunderstand

– Signs of malingering – Deviationsfromphysicaldevelopmentalnorms – Elements of a physical examination – Medicalreports – Medicalpathologylaboratoryreports

o Complete blood counts o Erythrocytesedimentationrates(ESR) o Cholesterol levels o Blood glucose measurements o Thyroid function tests

– Endocrine diseases and the eye o Diabetes o Grave’s disease and endocrine orbitopathy

– Radiologicalreports o X-rays o Magneticresonanceimaging(MRIs) o Computedaxialtomography(CAT/CTscans)

– Cardiovascular diseases and the eye o Sphygmomanometry readings and hypertension o Atherosclerosis and carotid auscultation o Aneurysm and stroke

– Blood diseases and the eye o Anemia o Leukemia o Lymphoma o Human Immunodeficiency Virus (HIV)

– Neurologic diseases and the eye o Headache o Multiplesclerosis o Brain tumors o Intracranial pressure o Neuromuscular diseases

– Nutritional disorders o Vitamin deficiencies

– Rheumatoiddisorders,vasculitisandcollagenosis o Rheumatoidpolyarthritis o Ankylosing spondylitis o Reiter’ssyndrome o Sjögren’ssyndrome o Giant cell arteritis

ELEMEN

T 11


Elem

en

t 11

– Tumors o Brain tumors and vision o Ocular metastasis of primary tumors

– Congenital and hereditary conditions o Common genetic disorders o Common congenital disorders • Fetalalcoholsyndrome • Rubella • Syphilis • Toxoplasmosis


Anatomy




Physiology


Microbiology


Foundation Disease




Physiology


SPECIALIZED CARE

Specialized Care 39

Assess and provide care for the paediatric patient

Requirement

• Understandthedevelopmentandnormsofchilddevelopment

• Knowthevisualandrefractivedevelopmentnorms

• Understandrelationofvisionandlearning

• Beabletoexaminetheinfantandchild

• Managementofvisualproblemsintheinfantandchild


Anatomy


Physiology


Microbiology


Foundation Disease





Ocular Physiology


Optics


Ocular Disease

• Diseasesoftheeyelidsandthelacrimalsystem:signsandsymptoms of inflammation, trauma, tumour and degeneration; differential diagnosis of congenital anomalies; optometric action

• Anteriorsegment:congenitalanomaliesoftheanteriorsegment;infection, inflammatory and toxic conditions; dystrophic conditions; differential diagnosis of red eye; optometric management

• Crystallinelensandcataract:differentialdiagnosisoflenticularanomalies; signs of cataract; complications and management; optometric management


ELEMEN

T 12

Specialized Care 40

Elem

en

t 12

• Conditionsoftheorbitandorbitalstructures:congenitalanddevelopmental anomalies; signs and symptoms of infection and inflammatory conditions; sings and symptoms of orbital trauma and tumours

• Proptosis:conditionsaffectingtheeyesandocularadnexae

• Diseasesofthevitreousandretina:vascularanomalies;inflammatoryconditions; dystrophies; laser and cryotherapy treatment; congenital and developmental conditions; trauma and foreign bodies; optometric involvement

• Macula:congenitalandinheritedconditions;dystrophies;toxicconditions; treatment

• Neuro-ophthalmology:reviewofanatomy,physiology,andretinotopicvisualfieldorganization;congenitalpapillaryanomalies

• Conditionsrequiringimmediatereferral:recognitionofconditionsrequiring immediate referral; necessary action

Clinical Optometry

• Thepreliminaryexamination:goalsofperformingpreliminarytests

• Historytaking;Hirschbergtestandanglekappatest,theoryandmethods of the unilateral and alternate cover tests; assessment of binocular motility; near point of convergence and other evaluations; near point of accommodation, the evaluation of ocular dominance.

• Assessmentofvisualacuity:clinicalmethodsofmeasurement;relationships between refractive error and acuity; effect of amblyopia and abnormal eye conditions on vision

• Retinoscopy:spotandstreakretinoscopy–staticmethods;retinoscopyinastigmatism;nearpointretinoscopy–Mohindratechnique;dynamicmethods;variationsofdynamicretinoscopy–MEMretinoscopy,chromoretinoscopy

• Auxiliaryrefractivetechniques:principles,methodsandapplicationsofautorefraction, photorefraction and laser refraction

• Investigationofbinocularity:theoriesandprinciplesofbinocularvisualfunctions; heterophoria and heterophoric tests – principles and methods;accommodation-convergencerelationship–AC/Aratios;assessment of fusional vergences – methods and normal findings, the vergence-facility test; stereopsis – measurement and clinical applications; identification of binocular anomalies – nomenclature, analysis of binocular status

• Clinicalusesofdiagnosticdrugs:cycloplegicrefraction

• Directophthalmoscopy:basicaspects;appearanceofthenormalfundus and its variations; ophthalmoscopic signs of ocular disease; clinical practice of ophthalmoscopy

• Indirectophthalmoscopy:principlesofindirectophthalmoscopy;mononocular indirect and binocular indirect opthalmoscopy – instrumentation and clinical procedures; appearance of the normal fundus; abnormal changes; clinical applications of techniques

• Colourvisionandcolourvisiontests:clinicalassessmentofcolourvision;applications of colour vision tests; congenital vs. acquired colour vision defects; clinical manifestations of acquired colour vision defects

Specialized Care 41

Elem

en

t 12


• Paediatricoptometry:visualandrefractivedevelopmentand norms; clinical examination of children; management of visual problems in children

• Refractivenormsandmeasuringrefractiveerrorininfantsand young children; norms and measurement of visual acuity and other visual parameters; genetic and environmental factors in myopia; vision and learning problems; management of visual problems in children

Specialized Care 42

Assess and provide care for the low vision patient

Requirement

• Considerationof

– Magnificationrequirements – Working distances – Associated pathology – Lighting requirements – Computer software for low vision – Closed circuit television – Independent living aids – Mobilityaids – Telescopes

• Prescribelowvisiondevicestomeetpatient’svisualand functional requirements

• Knowledgeoforganizationsprovidingrehabilitative and low vision services


Microbiology





Ocular Physiology


Optics


Ocular Disease

• Anteriorsegment:anomaliesoftheanteriorsegment;infection,inflammatory and toxic conditions; degenerative and dystrophic conditions; differential diagnosis of red eye; optometric management



• Conditionsoftheorbitandorbitalstructures:developmentalanomalies;signs and symptoms of infection and inflammatory conditions; signs and symptoms of orbital trauma and tumours

• Glaucoma:definitionandincidence;reviewofaqueousphysiology and angle anatomy; signs and symptoms, investigative techniques; secondary glaucoma; criteria for referral

ELEMEN

T 13

Specialized Care 43

Elem

en

t 13

• Diseasesofthevitreousandretina:vascularanomalies;inflammatoryconditions; retinal detachment; degeneration and dystrophies; laser and cryotherapy treatment; developmental conditions; trauma and foreign bodies; optometric involvement

• Macula:degenerationanddystrophies;toxicconditions;treatment


• Neuro-ophthalmology:reviewofanatomy,physiology,andretinotopicvisualfieldorganization;symptomsandinvestigativetechniquesof visual field loss: signs and symptoms of optic nerve disease; differential diagnosis of ophthalmoplegia; papillary pathway and tests; papillary anomalies; differential diagnosis of papillary defects; neural problems involving visual pathway

Clinical Optometry

• Casehistorytakingandsymptomatology:roleofthecasehistoryin the consultation; questioning techniques and question types; what comprises a case history; recording the history; symptomatology – an overview of symptoms found with various forms of ocular problems (refractive, binocular, organic)

• Evaluationofnormalandabnormalpupilresponsesandiriscolour;investigation of confrontation visual fields and screening for central field


• Retinoscopy:spotandstreakretinoscopy–staticmethods;retinoscopyinastigmatism;nearpointretinoscopy–theMohindratechnique;dynamic methods

• Keratometry:clinicalapplicationinrefraction

• Auxiliaryrefractivetechniques:principles,methodsandapplications of autorefraction, photorefraction and laser refraction

• Subjectiverefraction:monocularsubjectiverefraction;principlesandmethods; duochrome tests

• Slitlampbiomicroscopy:methodsandpracticeofilluminationandobservation; appearances of normal ocular tissues; clinical applications of biomicroscopy; use of vital stains

• Clinicalusesofdiagnosticdrugs:clinicalapplicationsofophthalmicdiagnostic drugs – indications, contraindications and precautions for use; evaluation of effectiveness of various preparations


• Directophthalmoscopy:basicaspects;appearanceofthenormalfundus and its variations; ophthalmoscopic signs of ocular disease; clinical practice of ophthalmoscopy

• Indirectophthalmoscopy:principlesofindirectophthalmoscopy;mononocular indirect and binocular indirect opthalmoscopy – instrumentation and clinical procedures; appearance of the normal fundus; abnormal changes; clinical applications of techniques

Specialized Care 44

Elem

en

t 13


• Gonioscopy:principlesofmethods;typesofgoniolenses,theirmethodsof application; appearance of the anterior angle by gonioscopy; abnormal signs in the anterior angle; three-mirror retinal evaluation


• Macularfunctions:varioustechniquestoassesstheintegrityandfunctionality of the macula, Amsler grid, photostress test, neutral-density filter test, colour comparison test and brightness comparison test

• Contrastsensitivityfunction:theoryandclinicaluseofcontrastsensitivityfunction, contrast sensitivity function curve, commercially available contrast sensitivity charts and systems; clinical significance and interpretations of contrast sensitivity function

• Photo-documentation:methodsofocularphotography–anterioreyeand fundus

• Inter-andintra-professionalcommunication:discussionon handling inter- and intra-professional relationships; communicating information amongst professionals; writing referral letters


• Lowvision:visualimpairmentdefined;examinationofthelowvisionpatient; optical aspects of low vision aids; prescription techniques of low vision aids; management of low vision patients; recent research

• Visualimpairmentdefined:legal,medicalandsocialdefinitions;prevalence and incidence; causes of visual impairment

• Examinationofthelowvisionpatient:visualacuityassessment;clinicalexpectations of visual acuity; refraction and the refractive correction; other investigations including visual field and contrast sensitivity

• Magnificationandlowvisionaids:principlesofmagnification;opticalprinciples of magnifiers and telescopic aids; types of low vision aids available; clinical assessment of low vision aids; training and applications of low vision aids

• Managinglowvisionpatients:multi-disciplinaryapproach;rehabilitationservices; the optometrist in the multi-disciplinary team

• Lowvisionservices;currentservices;futureplanningandprojection

• Recentresearch:clinicalapplicationsofrecentresearchintolowvisioncauses and management

Specialized Care 45

Assess and provide care for the geriatric patient

Requirement

• Abilityto

– Understandthevisualfunction,physiologicalandanatomicalchanges with age

– Deliverappropriatecarethatconsidersdisabilities

– Select appropriate equipment for domiciliary visits


Anatomy


Physiology


Microbiology



• AsperFoundationPathologyofDiseaseinElementOne




Ocular Physiology


Optics


Ocular Disease


• Conditionsoftheorbitandorbitalstructures:anomalies;signsandsymptoms of infection and inflammatory conditions; signs and symptoms of orbital trauma and tumours

• Proptosis:conditionsaffectingtheeyesandocularadnexae

• Diseasesofthevitreousandretina:vascularanomalies;inflammatoryconditions; retinal detachment; degenerations; optometric involvement

• Macula:degenerations;toxicconditions;treatment


ELEMEN

T 14

Specialized Care 46

Elem

en

t 14

Clinical Optometry


• Retinoscopy:spotandstreakretinoscopy–staticmethods;retinoscopyinastigmatism;nearpointretinoscopy–theMohindratechnique;dynamic methods

• Auxiliaryrefractivetechniques:principles,methodsandapplicationsofautorefraction, photorefraction and laser refraction

• Subjectiverefraction:monocularsubjectiverefraction;principlesandmethods;binocularsubjectiverefraction;nearsubjectiverefraction

• Accommodationandpresbyopia:comfortablenearvision;theamplitude of accommodation – methods of measurement, effects of age; crossed-cylinder tests of accommodation; relative ranges of accommodation; accommodative facility test; determination of the presbyopic addition

• Slitlampbiomicroscopy:methodsandpracticeofilluminationandobservation; appearances of normal ocular tissues; clinical applications of biomicroscopy; use of vital stains

• Clinicalusesofdiagnosticdrugs:clinicalapplicationsofophthalmicdiagnostic drugs – indications, contraindications and precautions for use; evaluation of effectiveness of various preparations


• Directophthalmoscopy:basicaspects;appearanceofnormalfundusand its variations; an introduction to the ophthalmoscopic signs of ocular disease; clinical practice of ophthalmoscopy

• Indirectophthalmoscopy:principlesofindirectophthalmoscopy;mononocular indirect and binocular indirect opthalmoscopy – instrumentation and clinical procedures; appearance of normal fundus; abnormal changes; clinical applications of techniques


• Gonioscopy:principlesofmethods;typesofgonio-lenses,methodsofapplication; appearance of anterior angle by gonioscopy; abnormal signs in the anterior angle; three-mirror retinal evaluation


• Macularfunctions:varioustechniquestoassesstheintegrityandfunctionality of the macula, use of Amsler grid, photostress test, neutral-density filter test, colour comparison test and brightness comparison test

• Contrastsensitivityfunction:theoryandclinicaluseofcontrast sensitivity function, contrast sensitivity function curve, commercially available contrast sensitivity charts and systems; clinical significance and interpretations of contrast sensitivity function

Specialized Care 47

Elem

en

t 14

• Casehistorytakingandsymptomatology:roleofthecasehistory in the consultation; questioning techniques and question types; what comprises a case history; recording the history; symptomatology – an overview of symptoms found with various forms of ocular problems (refractive, binocular, organic)

• AdvancedOptometricInvestigation:principlesandclinicalapplicationsofnewoptometricinstruments;suchasNerveFibreAnalyzer(NFA);Orbscansystem;IOLMasterandOpticalCoherenceTomography(OCT)

• Prescriptiondecisions:aetiologyofrefractiveerrorsandtheinfluence of etiological theories on the refractive prescription and monitoring the refraction; relating the prescription to the occupational and other needs of the patient


• Geriatricoptometry:anatomicandphysiologicalchangewithage;changes in visual functions with age; examining the aging patient; aphakia and pseudophakos; housebound or bedridden patient

• Anatomicandphysiologicalchangewithage:changesinocularstructure with particular reference to retina and lens; development of cataract and age-related maculopathy; clinical implications of age related changes

• Changesinvisualfunctionswithage:effectsuponvisualacuity,colourvision, adaptation, contrast sensitivity, visual field; changes in binocularity

• Examiningtheagingpatient:effectsofcommonsystemicandoculardisease; aims and goals of examination; amendments to routine to account for change in visual function

• Thehouseboundorbedriddenpatient:optometricexamination;role of the optometrist in institutional care; domiciliary visits

PROFESSIONAL RESPONSIBILITIES

Professional Responsibilities 49

Continued professional and practice based-learning and development of the optometrist so that modern, evidence-based care can be provided

Requirement

• Developmentofknowledge,clinicalexpertiseandskills

• Ethicalpractisevalues

• Professionalpatientmanagement

• Practicemanagement

• Legalunderstanding

• Professionalroleincommunity


Applied Statistics and Research Methodology

• Referencejournalpapersandliterature:locating,critiquing,citing,reviewing and referencing

• Principlesinvolvedinconception,design,conductandcompletion ofresearchprojects

• Researchethics

• Structuringaliteraturereview

• Generatinghypotheses

• Experimentaldesigns

• Describinganddisplayingquantitativeandqualitativedata

• Choosingandusingappropriatestatisticaltools

• Interpretingandreportingstatisticaltestresults

• Howscienceisdone;the“ResearchMethod”andalternativeviews

• Developingskillsforprojectwork

• Plagiarismanditsavoidance;citingsources

• Ethicalissuesinresearch

• Typesofdata;displayingdata;averagesanddispersion;identifyingandhandling outliers

• Introductiontoprobability;characteristicsofnormaldistribution;sampling distribution of mean and standard error; degree of freedom

• Samplesizeconsideration;nullhypothesis;experimentalhypothesis; error in hypothesis testing (type I and type II errors)

• Definitionofpower;oneandtwo-tailedtests;conceptofpvalues

• Parametricandnon-parametrictests;student’sTtest;Wilcoxontest,Mann-Whitneytests,KrustalWallistest;Chi-squaretest

• Principleofindependenceofdata;correlation;researchquestions;experimental and non-experimental designs; random assignment; matched assignment

• Controlgroups;placeboeffect;masking;prospectivevs.retrospective;longitudinal vs. cross-sectional; validity and reliability of data; repeated measures; sensitivity and specificity; false positive and negative

• Populationsandrandomsamples;samplingmethods;random,systematic and stratified sampling; external validity

• Descriptiveresearch;surveysandquestionnaires;interviewtechniques

ELEMEN

T 15


Elem

en

t 15

Project

• Drawingrelevantinformationfromliteraturewithregardto research topics

• Conscientiousandrationalpursuitofaresearchtopic

• Writtenandposterpresentations:logicalandclearinterpretation,presentation and discussion of information and results; demonstration of deep understanding

Psychology in Health Care

• Developmentalissuesacrossthelifespan:majorstagesinhumandevelopment and particular issues that are encountered within these stages


Practice Management

• Startingapractice:modesofpractice;businessplans;businessregistration; location; practice design; business registration and legal requirements

• Marketing:strategiesandplans;consumerbehaviour;marketsegmentation; pricing strategies

• Accountingandtaxation:managingfinances;budgeting(capitalbudget, monthly revenue and expense budget); inventory control; setting up an accounting system; banking; cash flow; estimate payback period of equipment; financial risk and control; taxation and taxation planning

• Managementsystems:patientrecordmanagementsystem;inventory control system

• Financialmanagement:financialreporting;managementreporting

• Managingstaff:motivatingstaff;continuousdevelopment;appraisals

• Estateplanning:goalsandstrategies;investment;MPF


Elem

en

t 15

Community Optometry

• Vision-careprogramme:planning,organizingand conducting a vision-care programme in collaboration withanon-optometricorganization

• Roleofoptometristsinthecommunity:asprimarycareproviders; their role in the prevention and modification of occupational problems

• Visualscreening:developmentofvisualscreeningprogrammes; cost effectiveness of visual screening and its relation to incidence of disease; screening protocols and regimen; visual screeners

• Visualhazardsandocularprotectioninoccupationsandsports:natureandtypesofoccupational/sportseyeinjuriesandtheirprevention;typesandusesofprotectiveeyewear;radiationhazardsinindustryandtheir prevention

• Visualergonomicsandlighting:humanvisualcapabilitiesandanalysisof visual demands in visual tasks, visual requirements for different occupations; visual fatigue and its relation to visual task and visual demand; introduction to basic concepts in lighting design

• Visualdisplayterminal(VDT):thevisualdisplayunit,itsvisualdemands, its related eye problems, their causes and solutions

Professional Studies

• Patientrightissuesandmedicalethico-legalissuesinvolvingtheoptometry profession, and other healthcare professions

• Exploring,evaluatinganddevelopingone’sowncodesandstandards for practice

• Analysisofmedicalethico-legalissues,clinicaldecision-making and problem-solving

• PromotingandadvancingtheOptometryprofession

• Introductiontothelegalsystems

• Biomedicalethics

• Medicalnegligence

• Consent

• Confidentialityandprivacyissues

• CodeofPractice

• Professionalissues

New Technologies

• Curriculumshouldincludeprovisionsforupdatingstudents on new technologies and future developments.

• TopicssuchasOCT,ultrasoundbiomicroscopy,electronic medical records.

* Elements are accompanied by practical and clinical session

World Council of Optometry 42 Craven Street London WC2N 5NG UnitedKingdom

Tel: +44 20 7839 6000 Fax: +44 20 7839 6800 Email: [email protected]

Registeredcharitynumber:1133429

With thanks to the Brien Holden Vision Institute for supplying the images used in this document. www.brienholdenvision.org

worldoptometry.org

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