Certified Paraoptometric Assistant Review Course CPOA

1. Certified Paraoptometric Assistant Review Course CPOA

2. Ophthalmic Optics & Dispensing(20%)

3. Prescriptions Components Sphere, cylinder, axis Add power Prism Prism base direction Ordering

4. Prescriptions: Optical Cross Optical cross is a diagram that denotes the dioptric power in the two principal meridians of a lens. Hint: Think of the value of the numbers as they are read off of the lensmeter wheel.

5. Prescriptions: Optical Cross Optical Cross Example

6. Prescriptions: Transposition Transposition Combine the sphere and cylinder power mathematically Change the sign of the cylinder Change the axis by 90 degrees

7. Prescriptions: Transposition -1.00 +2.00 X 160 +1.25 -0.75 x 030 Plano +1.00 x 090 +1.00 -2.00 x 070 +0.50 +0.75 x 120 +1.00 -1.00 x 180

8. Prescriptions: Decentration Decentration calculations Eye size plus distance between lenses minus patient’s PD divided by 2.

9. Prescriptions: Vertex Power Vertex Distance- distance between the ophthalmic lens and the front of the patient’s eye Effective Power- change in the prescription when the distance varies from the normally refracted 13.5mm distance to where the patient wears the RX. Concerned with high Rx’s (-/+ 4.00)

10. Prescriptions: Vertex Power Vertex distance and effective power Lenses gain minus or lose plus power as they are moved closer to the eye. Conversely lenses gain plus or lose minus as they are moved away from the eye.

11. Prescriptions: Verification Instruments used to Verify Rx Lensmeter Lens power and axis location Presence, amount and direction of prism Geneva Lens Clock Base curve Colmascope or Polariscope Progressive add markings Calipers Lens thickness

12. Prescriptions: Prentice’s Formula Prentice’s Prism Formula – if the patient is not looking through the optical center of the lens that has power, they are looking through prism

13. Prescriptions: Prentice’s Formula Prentice’s Prism Formula Prism = Power x Decentration in cm Prism = lens power (in diopters) multiplied by d in cm (Where d = amount the patient PD varies from the major reference point in cm) EX: -4.00(power) x .5cm (decentration in cm) = 2 prism diopters

14. Prescription: Law of Reflection Law of Reflection: Angle of incidence=angle of reflection Hint: In other words, when light strikes a surface, it will be reflected at an angle equal to the angle of the incoming light.

15. Prescriptions: Snell’s Law Snell’s Law of Refraction Light traveling from air into denser material is bent toward the normal Light traveling from denser material into air is bent away from the normal Light striking material perpendicular to surface does NOT bend Normal = line perpendicular to the surface of mirror or lens drawn at the point of contact with the light ray, angles are measured from this line to the light ray

16. Prescriptions: Focal Length Calculations Formula: f (in meters) = 1/D Focal length in meters (f) = 1 / D (reciprocal of power in diopters)

17. Prescriptions: Light Rays Rays move from left to right Converging Rays Diverging Rays

18. Prescription: Prism Prescribed when the two eyes do not align properly Can be induced when the optical centers of the lenses do not line up with the patient’s PD Prentice’s Rule- used to calculate induced prism

19. Prescription: Prism Displaces light Light bends toward base, Image displaced toward apex

20. Lenses: Convex & Concave Plus lenses –prisms stacked base to base Minus lenses – prisms stacked apex to apex

21. Lenses: Forms Biconvex Equiconvex Planoconvex Biconcave Equiconcave Planoconcave Meniscus Plus Minus

22. Lenses: Index of Refraction Definition: A comparison, or ratio, of the speed of light in air to the speed of light in another medium Values Speed of light in air: 186,000 mps Air= 1.00 Water= 1.33

23. Lenses: Index of Refraction Index of refraction (n)= Speed of light in air/speed of light in material

28. Lenses: Coatings Scratch Resistant Anti-Reflective Ultra-Violet Mirror

29. Lenses: Tints #1- lightest Transmission 65-80% (greatest) #2 45-60% #3- darkest Transmission 15-40% (least) Polarized Photochromatic Glass and plastic

30. Frame Types Styles Materials

31. Multifocals Basic types and styles Add and Intermediate powers Jump (prism)

32. Frames: Multifocal Placement

33. Frames: Parts & Verification Verification Eyewire size Bridge Temple length

34. Dispensing -Frame Alignment Front- Xing Coplanar Face form - positive and negative Nose pads - frontal, splay, vertical

35. Dispensing Fitting Standard alignment Adjustment Pliers Pad angling Needle nose Round-Flat jawed Angling

36. Common Frame Adjustment Problems - Vertex Distance Increase vertex- bend both end pieces in Decrease vertex- bend both end pieces out Increasing vertex distance effectively raises multifocal height and vise versa

37. Changing Height or Vertex Distance Move pad arms up will raise height of frame Move pad arms down will lower height of frame Lengthening pad arms will increase vertex distance Shortening pad arms will decrease vertex distance

38. Adjustment Problem Unequal Vertex Distance Unequal temple spread Decrease temple spread on side that is closer (In - In) Increase temple spread on side that is farther from face (out - out) Unequal temple tension and bends behind ears

39. Adjustment ProblemsCrooked Frames One eyewire higher: bend the temple up on that side to lower One eyewire lower: bend the temple down on that side to raise

40. Frame Adjustment - Pantoscopic Angle Increase panto - bend both temples down Decrease panto - bend both temples up Increasing panto will raise the frame front height on the face; however, it will effectively lower the multifocal and vice versa

41. Basic Procedures(20%)

42. Interpupillary Distance Measurement Distance and near PD measuring ruler Pupillometer Monocular PD measurement

43. Near Point of Convergence Measure of the ability of both eyes to work together Blur/Break/Recovery Measured in centimeters from the bridge of the nose to the point of blur/break

44. Near Point of Accommodation Ability of the eyes to focus at near Binocular measurement Amplitude of accommodation Binocular or monocular measurement Distance measured in cm

45. Extra-Ocular Muscle Testing Pursuits Movement of the eyes while following a moving target Saccades Jumping movements from one target to another

46. Cover Test Assess heterophoria and heterotropia Two separate tests - unilateral and alternate Tests are performed at distance and near Unilateral test is performed first

47. Unilateral Cover Test Determines heterophoria or heterotropia Heterophoria=tendency Heterotropia=constant Determines frequency (constant or intermittent) Unilateral or alternating

48. Alternating Cover Test Determines the direction and magnitude of the tropia or phoria Eso-in Exo-out Hyper-up Hypo-down

49. Eye Dominancy Eye preference Eye used for monocular viewing or sighting Testing methods Reasons for recording Monovision contact lenses

50. Fusion/Suppression Fusion Blending of 2 images, one from each eye Suppression Subconscious inhibition of an eye’s retinal image Associated with strabismus

51. Pupillary Responses Assure that the sensory pathway is working Direct and consensual responses to light Response to accommodation

52. Pupillary Response: Recording Example #1 P= pupils are E= equal R= round R= react to L= light and A= accommodation -/+RAPD (relative afferent pupillary defect

53. Confrontation Fields Screening for gross visual field defects Comparison of examiners visual field (known) to the patient’s (unknown)

54. Case History Chief Complaint Reason for visit-recorded in patient’s own words History of present illness Detailed information on chief complaint Medical/ocular history Family History Social history (age-appropriate) Alcohol? Smoke? Occupation? Live alone?

55. Ocular Symptoms Ask open ended questions Itching Burning Tearing Redness Irritation Blurred vision Other symptoms

56. Ocular History Rule out specific ocular problems or conditions Surgery Injury Vision training Eye medications Refractive history

57. Ocular History Rule out specific ocular problems and conditions, such as: Glaucoma Cataracts Keratoconus

58.  Refractive History Past history of corrective lenses Current corrective wear Age of correction State of correction Quality of vision

59. General Health History Rule out specific health problems Current health status Diabetes High blood pressure Heart disease Other

60. Medications Name Quantity Frequency Prescribed for Does the patient take the medication as directed?

61. Allergies Medications True allergies vs. side effects Environmental How does patient gain relief?

62. Confidentiality What is HIPAA? Health Information Portability & Accountability Act Minimum Necessary Principle Requires office to take reasonable steps to limit the use or disclosure of, and request for, PHI to the minimum necessary to accomplish intended purpose

63. Visual Acuity: Snellen Fraction Numerator Represents the testing distance in feet or meters 20/_____; 6/______ Denominator Represents the distance at which the letter subtends a 5-minute angle of arc in distance or meters. Also referred to as the letter size.

64. Visual Acuity:Techniques for Testing Monocular and binocular With and without Rx Distance and near Pinhole acuity Testing errors

65. Types of Acuity Charts Snellen Metric (Bailey-Lovie) Low Vision Charts Illiterate Charts Landolt “C” or rings Tumbling “E” Lighthouse charts

66. Color Vision Types of color vision tests Pseudoisochromatic plates (PIP) Farnsworth D-15 Farnsworth 100 hue Nagel Anomaloscope

73. Color Vision Classification Trichromatism Normal color vision Protanope Red deficiency Deuteranope Green deficiency Tritanope Blue-yellow deficiency

74. Color Vision:Method for Testing Monocular vs. Binocular Test distance 75 cm (30 inches) Illumination Macbeth daylight lamp Illuminant C lamp

75. Stereopsis Highest degree of depth perception Purpose of test Types of stereo tests Titmus stereo fly Randot Reindeer

76. Stereo Testing:Method for Testing Illumination Testing distance 40 cm (16 inches) Patient wears habitual Rx for near Recording- in seconds of arc

77. Exam Equipment Retinoscope Ophthalmoscope Biomicroscope (Slit lamp) Phoropter Keratometer Fundus Camera Optical Coherence Tomographer (OCT)

78. Special Procedures (17%)

79. Contact Lenses Verification Fitting Theories Modification

80. Contact Lenses - Related Ocular Problems GPC Keratitis Abrasion Pseudomonas Acanthoamoeba

81. Contact Lenses Gas Permeable Lenses Overall Diameter Optical Zone Diameter Back Vertex Power Base Curve Radius Peripheral Curves Edge and Center Thickness

82. Contact Lenses Gas Permeable Materials Silicone Acrylate Fluoro- Silicone Acrylate Rigid Polymethylmethacrylate-PMMA \

83. Soft Lens Good initial comfort Variable wearing time Occasional wear Ability to enhance or change eye color Stability in sports Gas Permeable Clear, sharp vision Long-term comfort Stability/durability Ease of care Good ocular health Corrects small and large amounts of astigmatism

84. Daily wear Flexible wear Extended wear

85. Soft lens care systems clean rinse disinfect & store protein removal Gas Permeable care systems clean rinse disinfect & store protein removal

86. Blurred Vision – Soft Contact Lenses Residual astigmatism Switched lenses Inverted lens Coated lens Dry lens Poor fit Wrong prescription

87. Non-wetting lens surface Switched lenses Warped lens Poor optical quality Coated lens Poor fit Wrong prescription

88. Soft Lenses Tear Poor edge Dryness Poor fit Dirty lens Gas Permeable Poor wetting surface Poor blend Bad edge

89. Adverse reaction to solutions Uncomfortable edge Wrong solutions used on lenses Foreign body Excessive movement Improper application

90. Contact Lenses Wearing Schedules Soft lenses- 4-6 hours plus 2 each day to full time wear Gas Permeable lenses- 4 hours plus 1-2 each day to full time wear

91. Contact Lenses Verification Lensometer- measures the vertex power Radiuscope- measures the base curve Hand Magnifier- measures the overall diameter (OAD), optic zone (OZ), peripheral curve widths (PCW, SCW) V-Gauge or Slot Gauge- measures the overall diameter (OAD)

92. Instrumentation-RGP

93. Special Lens Designs and Uses Ballast Truncation Tints Toric Bifocal

94. Tonometry Applanation Indentation Risk factors for glaucoma Diurnal variation

95. Tonometry Measurement of Intraocular Pressure (IOP) Tonometer Indentation- Schiotz Applanation- Goldmann; Tonopen Non Contact

96. Tonometry

97. SPECIALTY TESTING Keratometry Measurement of corneal curvature Vertical and horizontal meridians Measures a 3mm area of central cornea Keratometers; Ophthalmometers Mires; plus and minus signs

98. Clinical ProceduresKeratometry Corneal astigmatism With-the-rule/Against-the-rule Oblique Regular or irregular Javal’s Rule

99. Manual Keratometry

100. Recording K Readings O.D. 42.50 @ 175; 43.50 @ 085 O.S. 43.00 @ 005; 43.75 @ 095 O.D. -1.00 x 175/O.S. -0.75 x 005

101. Ophthalmic Ultrasonography A-Scan Determines the position and the distance between the structures of the eye (axial length) B-Scan Detects the position and size of abnormalities within the eye

102. Visual Field Testing Importance of patient education Review of visual pathway Classification of defects

103. Classification of Visual Defects

104. Monocular Visual Field Boundaries 60 Degrees superiorly 75 Degrees inferiorly 105 Degrees temporally 60 Degrees nasally

105. Physiological Blind Spot 15 Degrees temporal to fixation Absolute scotoma

106. Types Of Visual Field Testing Confrontation Tangent Screen Amsler Grid Goldmann bowl perimeter Automated

107. Other Visual Field Tests Harrington Flocks screener Arc Perimeter Auto-Plot

108. Visual Field Procedures Test Distance Automated - set Tangent Screen – 1 meter or 2 meters Goldmann Bowl- set Amsler Grid- 28 cm -30 cm Confrontation fields- 2 feet (approx 1 meter)

109. Sphygmomanometry (Blood Pressure Measurement) Incidence of hypertension Systolic The maximum pressure in the artery Diastolic The lowest pressure in the artery

110. What Influences Blood Pressure? Activity (or lack of…) Temperature Diet Emotional state Posture Physical state Drugs

111. How Is The Test Performed? Wrap the blood pressure cuff around the upper arm about 1 inch above the bend of the elbow Place the earpiece of the stethoscope into your ears Place the head of the stethoscope over the brachial artery Make sure that the valve is closed on the cuff.

112. How Is The Test Performed? Inflate the cuff to approximately 20-30 mmHg (millimeters of mercury) higher than the systolic pressure Open the valve slowly Record the number from the sphygmomanometer when the pulse is first heard This is the systolic pressure

113. How Is The Test Performed? Continue releasing the valve The pulse will disappear Record this number This is the diastolic pressure Release the rest of the air and remove the cuff

114. Normal The “normal” for adults is approximately 120mmHg /between 70-80mmHg Abnormal Mild Hypertension 145-159mmHg/90-104mmHg Severe Hypertension 160mmHg or more/100mmHg or more Hypotension Below normal blood pressure Readings

115. Low Vision Define legally blind 20/200 BCV or less than 200 VF in best eye Microscopes and magnifiers Large Print Materials Training Psychological impact – patient motivation

116. Surgery Refractive PRK LASIK LASEK Cataract Glaucoma Laser

117. Refractive Status of the Eye and Binocularity (13%)

118. Refractive Status Of The Eye

119. Refractive Status Of The Eye

120. Refractive Status Of The Eye

121. Refractive Status Of The Eye

122. Astigmatism Simple- one ray is focused on the retina; the other is focused either in front of (myopic) or behind (hyperopic) Compound- both rays are focused in front of (myopic) or behind (hyperopic) Mixed- one ray is focused in front (myopic) and one ray is focused behind (hyperopic)

123. Presbyopia Reduction in the ability to accommodate Occurs normally with age Reduction in lens elasticity Reduction in strength of the ciliary muscle

124. Refractive vs. Axial Refractive causes of myopia, hyperopia and astigmatism refer to the fact that the “error” lies within the shape of the cornea and/or the lens Axial causes refer to the length of the eyeball itself being the cause of the “error”

125. Refractive Conditions Aphakia Pseudoaphakia Anisometropia Aniseikonia Amblyopia

126. Aphakia Absence of the crystalline lens Cataract Most common cause of surgical removal of the lens Correction Intraocular lens implant (IOL) Contact lenses Spectacle lenses

127. Anisometropia Condition of unequal refractive state of the two eyes An- not; iso- same; metric- measure

128. Aniseikonia Difference in the size of the two retinal images Inherent and acquired

129. Amblyopia Reduced Visual Acuity No Apparent Cause Not Correctable With Refractive Means Strabismic- Amblyopia Ex Anopsia Abnormal binocularity, resulting in suppression of one eye Refractive Uncorrected refractive error that remains uncorrected for a significant period of time

130. Types of Refractive Status Conditions Aphakia Anisometropia Aniseikonia Amblyopia

131. Basic Ocular Anatomy and Physiology(17%)

132. Orbital Bones Orbit Bony socket that contains the eye and most of the accessory organs Six bones Sutures Foramen Sinuses

133. Orbital Bones Frontal bone Ethmoid bone Palatine bone Zygomatic bone Lacrimal bone Maxillary bone

134. Anterior Adnexa Upper eyelid Lower eyelid Lateral canthus Medial canthus Caruncle Limbus Iris Pupil Puncta Sclera Plica Semilunaris

135. Anterior Adnexa Eyelids Distribute the tear film across the front surface of the eye Protect the eye from light and debris Reflex blinking versus blepharospasm

136. Entropion

137. Ectropion

138. Ptosis

139. Adnexa: Lacrimal System

140. Tear Film Layers

141. Sclera (Fibrous Tunic) Opaque, white outermost layer of the eye Limbus- junction of the sclera and the cornea

142. Cornea & Anterior Chamber

143. Cornea First and most powerful refracting medium of the eye 5 Layers Epithelium (anterior) Bowman’s membrane Stroma (middle) Descemet’s membrane Endothelium (posterior)

144. Ocular Anatomy & Physiology The Globe/Three Spheres or “Tunics” Fibrous Vascular Nervous

145. Uveal Tract (Vascular Tunic)

146. Crystalline Lens Nucleus Cortex Capsule Accommodation Cataract

147. Vitreous Gel like substance found in the eye (in the vitreous chamber). Helps to keep the shape of the eye.

148. Retina (Nervous Tunic)

149. Ocular Tunics

150. Extraocular Muscles

151. Visual Pathway Visual Pathway Optic nerve Optic chiasm Optic tract Lateral geniculate body Optic radiations Occipital lobe

152. Conjunctiva Translucent membrane that lines the inner surface of the lids (palpebral) and the outer surface of the globe (bulbar) Fornices- where the palpebral and the bulbar conjunctiva meet

153. Conjunctiva

154. Ocular Pharmacology Diagnostic agents Therapeutic agents

155. Ocular Pharmacology Mydriatic- dilates the pupil Miotic- constricts the pupil Cycloplegic- paralyzes the ciliary muscle Dyes or Stains- adhere to damaged or diseased cells of the cornea and conjunctiva

156. Ocular Pharmacology Routes of delivery Solutions Suspensions Ointments

157. Test Tips

158. How To Study Interactive Flash cards Notes Tape record notes Study groups Environment Scented candles Active learning Keep body and mind awake

159. Study Pace Study, break, review, preview, and study No more than two hours a one time Use travel time to study Record your notes

160. Before the Test Find the location of test early Don’t arrive too early on the day of the test Build your confidence by reviewing condensed notes Be patient when you are handed the test, your time doesn’t start right away Remain calm

161. Recommended Books “Self Study Course for Optometric Assisting” by AOA Paraoptometric Section “The Ophthalmic Assistant” by Stein & Slatt (8th Edition-Stein, Stein & Freeman) “System for Ophthalmic Dispensing” by Brooks and Borish “Dictionary of Eye Terminology by Cassin & Solomon

162. How to take a Multiple Choice Test Memory dump Answer easy questions first Mark difficult questions, return to them later Multiple choice are T/F question arranged in groups Only one totally correct answer Eliminate obvious false choices Pick the most complete answer

163. More Test Taking Tips Take your time but be aware of the time *The first hour = 50 questions Read all the questions and answers completely Mark your answer sheet carefully Once you mark your answer, don’t go back and change it without good reason

164. Good Luck!