Download Review Questions - Lynn`s Lecture Help

Certified Paraoptometric
Review Course
CPO
Lynn Lawrence, CPOT
Be thankful for your job!
Disclaimer…not sanction by
CPC

Disclaimer: This review course does
not prepare you for the national
examination, what it does is review
key areas from the most current test
outline. To properly prepare for a
national examination you should allow
yourself ample time to fully review all
the areas being tested
Objectives

Provide a 3 hour review of
– Discuss practice management
– Thoroughly review anatomy
– Clarify terminology used in review
– Explain the equipment used in review
– Discuss primary diseases
– Review test procedures

Give a 25 question review test
Eyecare Specialists and
Ancillary Personnel
(2%)
The Four “O’s”




Optometrist…state over sight
Ophthalmologist…surgeon
Optician…makes the glasses
Ophthalmic Medical Personnel
– Optometry technicians
– Ophthalmology technicians
Roles of a Paraoptometric




Collect patient data
Administer tests of visual capabilities
Assist in managing the office
Assist in primary patient care
examination and treatment
– Contact lenses
– Low vision
– Vision therapy
– Optical Dispensing
Practice Management
(10%)
Practice Management

Telephone Techniques…when/how
messages

Appointments…when is the best time to
book?

Record Filing Systems…which the best?
– Alphabetical
– Numerical

Recalls…which is the best method?
“Triage” use to categorize

Emergency
– Must be evaluated immediately

Urgent
– 12-24 hours

Routine
– Next available appointment
Triage Questions






What problem are you having? (chief complaint)
How long has it been going on?
(onset/duration)
Is it getting worse? (severity)
Does it affect your vision? (associated
symptoms)
Does anything make it better? (modifying
factors)
Which of these is most important?
Practice Management continued





Fee Presentation
Collections
Third Party Payments…also know as?
Receipts
Explanation of charges
When do you apologize for your fees?
HIPAA

What is HIPAA?
– Health Information Portability &
Accountability Act
– Took effect April 14, 2003
How long are you required to keep patient records?
HIPAA – continued
Use and Disclosure
 Use
– The sharing, employment, application,
utilization, examination or analysis of
Protected Health Information (PHI) within
the covered entity

Disclosure
– The sharing or release of PHI in any
manner outside the covered entity
HIPAA – continued

Office Responsibilities
– Establish and maintain procedures consistent with
the Privacy Act
– Prepare and publish notice of the existence and
character of those systems consistent with
guidance by GSA
– Establish reasonable administrative, technical, and
physical safeguards
– Maintain an account system of all disclosures for
six years
– Permit individuals to have access to personal
records
– Permit individuals to request records amendments
HIPAA – continued

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
HIPAA – continued

Considerations Prior to Disclosure
–
–
–
–
–
–
–
–
Patient notification before release
Mutually agreed upon alternative communications
Mutually agreed upon authorizations
Potential or serious threat or imminent danger to
patient or public
Authority of requestor
Minimum amount of information necessary for
purpose
Can information be de-identified
Documentation of release
HIPAA – continued

Requirements for Document
– Date of disclosure
– Name, address, and identity of requestor
– Brief description of PHI disclosed
– Brief statement of the purpose of the
disclosure that reasonably informs the
individual of basis for disclosure or copy
of written request
– Verified identity of requestor
Anatomy
(15%)

7 Layers of the
eyelids
1. Skin-thinnest layer
2. Subcutaneous
connective tissue
3. Striated Muscle
4. Sub-muscular
connective tissue
5. Tarsal plate or fibrous
layer
6. Smooth muscle
7. Conjunctiva
(Bulbar/Palpebral)
Eyelid
Lipid Secretion: Meibomian
Glands
(WC Posey, Diseases of the Eye, 1902)

Transillumination of
meibomian glands
The lipid layer restricts evaporation to 5-10% of tear flow
– Also helps lubricate
(Transillumination image from Dry Eye and Ocular Surface Disorders, 2004)
Tear Film Layers
oil
snot
aqueous
Healthy Tears….gee whiz slide
A complex mixture of
proteins, mucins, and
electrolytes coated by
a lipid layer
• Antimicrobial proteins
• Growth factors &
suppressors of
inflammation
• Soluble mucin helps
stabilize tear film
• Electrolytes for proper
osmolarity (295-300)
– pH slightly alkaline (7.4)
This is not testable, info only
Conjunctiva



An epithelial membrane which
covers the anterior sclera and
continues to the back surfaces
of the lids to form a
conjunctival sac
Has blood vessels which can
burst and cause
subconjunctival hemorrhage
Three parts
– Bulbar
– Palpebral
– Fornix - where bulbar and
palpebral meet
Adnexa: Orbital Bones

7 Orbital Bones
–
–
–
–
–
–
–
Maxilla
Frontal
Zygomatic
Ethmoid
Lacrimal
Palatine
Sphenoid
Which bone is the weakest?
Sphenoid
Ethmoid
Palatine
Maxilla
Adnexa: Extraocular
Muscles

4 Rectus Muscles
– Superior
– Inferior
– Lateral
– Medial
Adnexa: Extraocular
Muscles

2 Oblique Muscles
– Superior
– Inferior
Lipid Secretion: Meibomian
Glands
What eye is this?
Transillumination of
meibomian glands
(WC Posey, Diseases of the Eye, 1902)
How does the lipid layer aid in contact lens wear?
(Transillumination image from Dry Eye and Ocular Surface Disorders, 2004)
Adnexa: Lacrimal System
Lacrimal gland
Superior punctum
Superior canaliculus
Lacrimal sac
Excretory
ducts
Inferior punctum
Inferior canaliculus
Nasolacrimal duct
Nasal
cavity
Anatomy and Physiology
of the Eyeball
3 Layers
 Fibrous Layer
*Cornea
*Sclera

Vascular Layer
*Choroid
*Ciliary body
*Iris

Nerve Layer
*Retina
*Macula
*Optic nerve
What function does each layer have?
Anterior Segment…where is it






Cornea
Conjunctiva
– Palpebral
– Bulbar
Anterior chamber
Iris
– Pupil
Crystalline lens
– Accommodation
Ciliary Body
– Muscle/Processes
Graphic courtesy of National Eye Institute,
National Institute of Health
Posterior Segment



Vitreous humor
Choroid
Retina
– Macula
– Fovea Centralis
How many layers are in the retina?
Retina
Posterior Segment:
Macula/Fovea

Function
– Central vision
– Color vision
What is the purpose for rods and cones?
Posterior Segment-Optic
Nerve

Optic Disc
– Correlates with the physiological blind spot

Optic Nerve
– Cranial nerve # 2
What type of vision is in the
Optic nerve head?
The Eye Examination
(17%)
Case History
■
■
■
■
■
Chief Complaint…critical for insurance
filing!
■ Reason for visit-recorded in patient’s own
words
History of present illness
■ Detailed information on chief complaint
Medical/ocular history (Dx)
Family History (FHx)
Social history (age-appropriate)
■ Alcohol? Smoke? Occupation? Live alone?
Ocular History

Rule out specific ocular
problems and conditions,
such as:
– Glaucoma
– Cataracts
– Keratoconus
Match the diseases to the structure…
Medications
Name
 Amount taken
 Frequency
 Prescribed for
 Prescribed by
 Illegal drugs too!

Why is illegal drug use important?
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.
How would you document a patient that can only see the big “E” at 10 feet?
Visual Acuity


Test of macular
function
Snellen fraction
– Numerator-# of ft.
away from viewed
letter
– Denominator-# of
ft. a person with
“normal” vision
could see the letter
What is optical infinity?
Accommodation vs Acuity


Accommodation is the ability of the to
focus from a distance to near and vice
versa
Acuity is the ability of the eye to see
fine detail
Keratometry

Keratometer
– Measures the
curvature of the
cornea
– Response from the
patient not needed
to perform =
objective test
Measures how much of the cornea?
Manual Keratometry
End Point
Starting Point
+
+
++
Prize slide
Clearly explain these instruments and what they function they perform?
Refraction

Objective Refraction
– Retinoscopy
– Auto-refractor

Subjective Refraction
– Phoropter
– Patient needed
What is the difference between subjective
and objective refractions?
Ophthalmoscopy



Evaluates the
posterior segment
Patient must be
dilated
Types of
ophthalmoscopy
Indirect
Ophthalmoscope
– Indirect…on head

Less magnified,
wider view
– Direct…in hand

More magnified,
narrower view
Direct Ophthalmoscope
Biomicroscopy
Commonly called “Slit
Lamp”
– Evaluates the anterior
segment of the eye
(cornea to lens)
– Evaluates intraocular
pressure by attachment of
a Goldmann applanation
tonometer
Tonometry

Goldmann Applanation
– Mounted on slit lamp
– Requires anesthesia and fluorescein dye

Tonopen®
– Portable
– Requires anesthesia

Non-contact (air-puff)
– Easy to use
– No anesthesia required
Fundus Photography
Terms




Fundus – interior posterior surface of the
eyeball
Posterior Pole – refers to the retina between
the optic nerve and macular area
Arcades – normal pattern of retinal blood
vessels as they leave the optic nerve head
and arch around the macula
Cup-to-Disc ratio – numerical expression
indicating percentage of disc occupied by
the optic cup
Fundus Photography
Terms



Exudates – protein or fatty fluid that leaks from
blood vessels into retinal tissue (hard is less
fluid, more dense) (soft fluffy looking also
called cotton wool spots)
Cotton Wool Spots – fluffy looking white
deposits resembling small tufts of cotton
within the retinal nerve fiber layer that
represent small patched of retina that have
lost their blood supply from vessel obstruction
Nevus – mole small and flat usually pigmented
area, benign tumor made of specific cells
called nevus cells found in skin and eye tissue
Fundus Photography
Examples
Normal
Papilledema
Fluorescein Angiography
Lasered Diabetic Retinopathy
Optical Coherence
Tomography (OCT)
What is this machine used for?
Corneal Topography
 Measurement
of the
curvature of the
anterior corneal
surface.
Pachymetry

A Pachymeter
determines thickness of
the cornea by use of
ultrasound
– Refractive surgery
– Glaucoma diagnosis
How might IOP pressure be impacted by
The thickness of a cornea?
Optical Coherence
Tomography (OCT)


A laser-based, non-contact, non-invasive imaging
technique that is capable of obtaining high
resolution images of the retina and its components.
Clinically useful in visualization of:
– Macula holes
– Macula edema
– Age-related Macula Degeneration
– Epiretinal membranes
– Central serous chorioretinopathy
Tomography Advantages

Non-contact, non-invasive scan
obtained in one second

Shows living histology with
minimal discomfort to the patient

No injections of exposure to
painful high-intensity light

Increased patient comfort and
safety, reduced photophobia
Visual Field

What is a visual field?
– The area of space visible to the eye

What is a scotoma?
– Blind spot

What is used to measure a visual field?
– Perimetry
Refractive Status
(12%)
Refractive Errors





Myopia
Hyperopia
Astigmatism
Presbyopia
Amblyopia
Emmetropia vs. Ametropia

Emmetropia
– No refractive error
– Rays of light focus on the retina

Ametropia
– An optical error
– Corrected by glasses, contact lens or
refractive surgery
Emmetropic Eye
Emma is a perfect woman
Myopia


Also called “Nearsighted”
Axial myopia
– Eye is too long
– Rays of light fall in front of retina

Index myopia
– Diabetes/cataracts

Corrected by a concave, or minus lens
Myopic Eye
Myopia




A refractive condition
where parallel light
rays focus in front of
the retina when the
eye is at rest
Termed
nearsightedness
Patient may have
20/20 vision at near,
but distance vision will
be reduced
Corrected with minus
lenses
Hyperopia


Also called “Farsighted”
Axial length of the eye is too short
– Rays of light fall virtually behind the
retina


Affected by accommodation
Corrected by a convex, or plus lens
Hyperopic Eye
Hyperopia




A refractive condition
where parallel light
rays focus behind the
retina when the eye is
at rest
Termed farsightedness
Patient may have
20/20 vision at
distance and near
Corrected with plus
lenses
Astigmatism

Corneal Astigmatism
– 2 different points of focus
– Cornea is “football-shaped”
– Corrected by cylinder at a specific axis

Lenticular Astigmatism
– Crystalline lens

Irregular Astigmatism
– Cannot be corrected by a lens
Keratoconus
 Corneal trauma

Astigmatism
Astigmatism
Astigmatism



A refractive condition
where different meridians
of the eye have different
powers
Corrected by lenses
which incorporate
cylinder power
Usually due to different
curvatures of the cornea
Presbyopia



Natural aging of the crystalline lens
Affects accommodation
Corrected by additional plus power at
near
– Bifocal
– Trifocal
– Progressive
– Reading glasses
Presbyopia


A condition in which
lost elasticity of the
lens leads to the
inability to
accommodate
Age related
condition
What age does presbyopia begin?
Accommodation
The Ophthalmic Prescription
(9%)
The Ophthalmic
Prescription

Components of a
lens prescription
– Sphere, cylinder,
axis
– +2.00 -1.00 x 095
– Add power
– Prism

Lensometer
– Used to measure
lens components
Unit of Measurement

Diopter - unit of measure for optical
lenses.
– Based on fact that a 1 diopter lens will focus
parallel light at 1 meter.
1 Diopter Focus Light at 1
Meter
1 Meter
+1D
-1D
Ophthalmic Lenses
(5%)
Refraction

Definition
– Altering of the
pathway of light
from its original
direction as a result
of passing obliquely
from one medium to
another of different
density
– Pivoting or bending
of light rays
Light


Visible wavelengths extend from 400740 nanometers (nm), 400nm being
violet and 740nm being red.
A change of wavelength is perceived
as color change.
400
500
600
700
Light

Light travels in a vacuum at 186,000
mps and in various other transparent
media at slower speeds. It is this
characteristic of light, traveling at
different speeds in different media,
that causes the bending or refraction
of light, for example, light travels at
77,000 mps in diamond and 120,000
mps in crown glass
Deviation



Bending of light
Image deviates towards the Apex
Light is deviated towards the base
Apex
Base
Prescriptions: Light Rays
Rays move from left to right
Converging Rays
Diverging Rays
Light always deviates toward the base
of a prism
Prescription: Prism
Displaces light
Light bends toward base,
Image displaced toward apex

General Lens Forms
PLUS
MINUS
PLANO
Convergent
Divergent
Zero
Thicker in the
middle
Produces a
real focus
Thinner in the
middle
Produces a
virtual focus
Equal
thickness
No change
Lens Types

Types of Lenses
– Single vision
– Spherical
– Planocylindrical
– Spherocylindrical
– Multifocal
Bifocal
 Trifocal
 Progressive addition

Lens Materials

Lens Materials
–
–
–
–
–
Glass
Plastic (CR-39)
Polycarbonate
High index
Trivex ™
Bifocal Lenses
Bifocal Lenses (FT-28, D-28)
Trifocal Lenses
(Executive)
7mm
17mm
28mm
Progressive Lenses
Progressive Addition Lenses
Distant Viewing Zone
Near Viewing
Zone
Intermediate
Viewing Zone
Aberration Zones
Ophthalmic Dispensing
(8%)
Lenses




Plus- Lens that is thicker in the center than at the edges,
adding optical power to incoming light rays. Corrects
farsightedness
Minus- Lens that is thicker at the edges than in the center,
increasing divergence of incoming light ray. Corrects
nearsightedness
Cylindrical- Lens that produces a different refractive power in
each meridian; used for correcting ocular astigmatism.
Prism
- Power = Deviation in cm/distance- Wedge-shaped,
transparent medium that bends light rays toward its base.
Does not focus
Lenses cont…





Prism and decentration
Multifocals
Lens Types
- Crown glass – heavy, scratch resistant
- CR-39 – thicker, scratch easily
hard resin
Polycarbonate –thinner, safest
High Index – thinnest, lacks strength
Frame Anatomy

Frame Anatomy
– Frame front




Eyewire
Bridge
Hinge
Nosepads
– Temples
Frame Size and
Measurements
Boxing System
DB
L
ED
B
A
Frame Materials

Frame Materials
– Plastic
– Metal
Frame Selection

Frame Selection
– Frame fit is most important
– Frame width equal face width
– Longer face, deeper the frame can be
– Bridge fit important
– Temples need to be long enough for a
proper bend
– Cosmetic concerns
Pupillary Distance
1
2
3
4
5
6
7
1st measurement 60 mm
1
2
3
4
5
6
7
2nd measurement 64 mm
Pupillometer
Seg Height
Bifocal Seg Height
Trifocal Seg Height
Frame Adjustments

Basic Frame Adjustments
– Fitting triangle
– Frame height
– Vertex distance
– Face form
– Pantoscopic angle
– Retroscopic angle
– Temple adjustment
Basic Adjustments
Fitting Triangle
Pantoscopic Angle
Correct
4 mm
17 degree
tilt
Optical
center
Wrong
Optical
center
Ordering
Jones Optical
5209 South Penn
Oklahoma City, OK 73109
638-7889
Patient
SPH
Jane Doe
CYL
AXIS
OD
DEC
In
+1.00 - 0.25
2/23/01
Date
PRISM
PLASTIC
GLASS
Out
90
1/2 Δ BU
SV
FDA Tested
RND
EXEC
ST 28
LENT
TRIFOCAL
OS
+1.00 - 1.00 95
Seg
Ht.
Width Insert
A
D +2.00 20
D
+2.00 20
Set
F.P.D.
F
R
A
M
E
S
A
28
1/2 Δ BD
Total Pup
Dist
R
R
Dist
Near
L
L
66
62
Lens Shape
B
ED
LOC UNCUT
OTHER
Edge
Rimless
Grove
Drill
Metal
ZYL
Size BDG Temp
Style
Color
58
16
145 Safilo
Gray
Titanium 109 OT30
ACCT:
REMARK
SUPPLY
TRAY#
Colour
PINK
1
2
3
GREEN
1
2
3
GRAY
1
2
3
BROWN
1
2
3
OTHER:
1
2
3
GRADIENT TO
 Lite
RX LENS
MISC
TAX
TOTAL
DATE
INVOICE
$
 Clear
Polarizing lens


A lens that transmits all light rays in one
meridian, and eliminates all light rays in
the meridian 90 degrees away
Light reflected off a surface is partially
polarized
Elements of an Rx
– Abbreviations - the following is a
listing of accepted abbreviations:
 O.D.
= right eye
 O.S. = left eye
 O.U. = both eyes
 + = convex, plus
 - = concave, minus
Contact Lenses
(8%)
Contact Lenses




Soft contact lenses
Rigid contact lenses
Care & handling
Patient education
Success with a contact lens candidate begins with what?
Contact Lens Parameters

Parameters
– Base curve radius
– Lens power
– Overall diameter
– Optical zone diameter
– Peripheral curves
– Edge & center thickness
Contact Lens Design
Overall Diameter (OAD)
Optical Zone
OZ
Secondary Curve (SC)
Peripheral Curve
(PC)
Secondary Curve
Width (SCW)
Peripheral Curve
Width (PCW)
Contact Lens Design
Center Thickness (CT)
Base Curve (BC)
Edge
Shape
Secondary Curve (SC)
Optical Zone
(OZ)
Peripheral Curve (PC)
Overall Diameter
(OZ)
What type of contact lens has correction for astigmatism?
Tri-Curve Contact Lens
Design
PCW
SCW
JUNCTION
JUNCTION
OAD
OZ
SCW
PCW
OAD = Overall Diameter
PCW = Peripheral Curve Width
OZ = Optical Zone
SCW = Secondary Curve Width
JUNCTION
JUNCTION
Ordering
CONTACT LENS ORDER FORM
Patient Name:
John Doe
Specifications Ordered
Date 2/23/01
O.D.
B.C.R
7.89
S.C.R./W 8.90 /.3
I.C.R./W
P.C.R./W 110.9 /.3
O.Z.D.
8.0
Dia
9.2
Power
- 2.50
C.T.
.16
Blend
Med
Tint
Blue
Dot O.D.

Additional Information
 Accepted
 Rejected
Reason for return/reorder
Specifications Verified
Date
O.S.
7.81
8.80 /.3
10.8 /.3
8.0
9.2
- 2.50
.16
Med
Blue
O.D.
B.C.R
S.C.R./W
I.C.R./W
P.C.R./W
O.Z.D.
Dia
Power
C.T.
Blend
Tint
Verified by
 Returned for Credit
Date Returned
O.S.
TORIC
What is a high water contact lens?
Types of Contact Lenses
Soft Contact Lenses
Rigid Contact Lenses
What are advantages and disadvantages of soft and rigid contact lens?
TRAUMATIC IRIDECTOMY
What is used to measure the power of a contact lens?
COLOR
What is used to measure the base curve of a contact?
SPORT TINT


Amber—tracking fast
moving balls
(baseball, soccer,
tennis, football)
Grey-green—decrease
sun glare (golf,
running)
Safety First!




Wash your hands!
Procedure must be
safe
Explain procedure
Explain do’s and
don’ts
Insertion and Removal
Techniques

Soft
– Patient comfort

RGP
– More difficult
– Use gravity
Contact Lens Care
Questions





What parameters are needed to order
Contact lens’s?
What is used to measure the base curve
of a contact lens?
What is used to measure the power of a
contact lens?
What is the primary curve of a contact?
What medication is used to view CL’s?
Common Eye Disorders
(6%)
Blepharitis…inflammation of the
lids
Conjunctivitis…inflammation of the
conjunctiva
Why do you get more mucus when the conjunctiva is swollen?
Bacterial Conjunctivitis
Subconjunctival Hemorrhage
Trauma induced
Non-trauma related
Pinguecula…is small like
penguin
Normally at
3 and 9 o’clock
Ptygerium…is large like
pterodactyl
Covers the cornea
Hordeolum…hurts
Chalazion…painless bump
Cataract
Cataract…an opacity of the lens


Eye without
cataract
Eye with cataract
Cataract

Mature cataract
Glaucoma…acute and open
angle




Increased intraocular pressure
Increased cupping (cup to disc ratio)
Decrease in peripheral vision
Optic Nerve Head (ONH) involvement
Kertaconus…corneal thinning
Macular Degeneration
Diabetic Retinopathy
Effects Of Macular
Degeneration
Diabetic Retinopathy


Background
Proliferative
– Neovascularization
Retinal Detachment
Floaters
Why is it that older patients complain more of floaters than younger ones?
Significance



8-10% Males
.4% Females
Green defect occurs most frequently
– This is strange due to the color of money

Who passes the defected gene that causes color deficiencies?
Exam Equipment
Retinoscope
 Ophthalmoscope
 Biomicroscope (Slit lamp)
 Phoropter
 Keratometer
 Fundus Camera
 Optical Coherence
WhichTomographer
one of these can be used during objective refraction?

Pupil Testing




Size
Shape
Response to direct light
Response to indirect (consensual)
light
What is the proper room lighting condition?
Terminology
(4%)
Prefixes




a, an, aniso-without
epi-above
sub-below
Endo -
What is a contextual clue?
Root Words





Kerat-cornea
Blephar-eyelid
Palpebr-eyelid
Cor-pupil
Lacrim-tear
Suffixes





itis-inflammation
al-pertaining to…(palpebral)
metropia-eye measurement
Opia- disease
Edema- swelling
What is papilledema?
Surgery
(2%)
Cataract Surgery

Opening the
lens
Cataract Surgerycontinued


Phacoemulsificati
on
Aphakia
Cataract Surgerycontinued


IOL in capsule
bag
Psuedophakia
Intraocular Lenses
Iris Fixated
Posterior Chamber
Refractive Surgery

Uses laser to reshape the cornea,
resulting in a diminished refractive
error
Types of Refractive
Surgery





PRK-Photo Refractive Keratectomy
LASIK – Laser-Assisted In Situ
Keratomileusis
LASEK – Laser Epithelial Keratomileusis
Epi-LASEK
ALK – Automated Lamellar
Basic Pharmacology
(2%)
Drop Instillation





Clean hands
Explain procedure
Remember safety
Inspect bottle
Check date
What is wrong with this picture?
Diagnostic Drugs

Dilation
– Mydriatic

Neo-Synephrine
– Cycloplegic
Cyclogyl
 Mydriacyl
 Atropine,
 Homatropine
 Scopolomine


Dyes
– Fluorescein…used to evaluate contact lens
– Rose bengal
Therapeutic Drugs






Antibiotics
Antivirals
Antifungals
Glaucoma drops
Steroids
Lubricants
Which medication stops inflammation?
Mydriatic And Miotic
Effects
Which is miotic and which is mydriatic?
Readings

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
Abnormal Blood
Pressures




Systolic greater than 140*
Diastolic greater than 90*
Difference less than 30 between the
Systolic and Diastolic Pressures.*
These are general guidelines and may differ from the guidelines that the
provider you are employed by uses.
What’s Next?

Today
– Lightly review the material
– Get a good night’s sleep
– Arrive a little early to test

Future
– Look for details about the CPOA test begin studying the Self-Study Course for
Paraoptometric Certification
25 Gun Salute Review


Here are 25 review questions that you
can test your skills with…
No multiple choice answers…do you
know the answer?
Review Questions

What part of the Rx is the cylinder power?
– +1.25 – 0.75 X 130



What is the difference between acuity and
accommodation?
What does Blepharitis mean?
Which encroaches upon the pupil, a
pterygium or pinguecula?
Review




Opia means what?
What is the difference between a tropia and
a phoria?
Avascular means what?
How many extra-ocular muscles are
oblique?
Review Questions

How long do you keep records for HIPAA?

Where do you measure a trifocal height?

What part of the eye regulates light?

What instrument measures the power of a
contact lens?
Review Questions

Identify the name for the parts of the
conjunctiva on the eye and back of the
eyelid

What is the near vision test distance?

In what layer of the eye will the retina be
found?

What is the strongest bone of the bony
orbit?
Review Questions

What in the macula controls the ability to see color?

Which lens is thicker in the center?

What is the most important part of the Hx?

Which lens is the safest?

What is the rating on a high water contact?
Review Questions

What is the difference between a subjective and
objective test?

Where is the anterior chamber and what instrument
do you use to look at it?

When is the best time to schedule an appointment?

What handle held instrument aids in refraction?

Where is your central vision located?
Questions

How often should a EW SCL patient enzyme their
contacts?

“Ex” as in exo means _______ and “es” in “eso”
means ________?

What is the unit of measure for lens power?
How many extra-ocular muscles are there? Name
them if you dare…..

Which lens is designed to be shatter resistant?

Questions




What is the purpose of the fitting
triangle?
Which tonometers require an
anesthetic?
What instrument is used to obtain a
prescription from a contact or
ophthalmic lens?
What is the heaviest lens material?
Questions



What is the difference between
acuity and accommodation?
Spell the scientific name for your
eyelid ______________?
What percentage of water is in a low
water content ______ or high water
content _______ contact lens.
Questions



The person who normally grinds
lenses is called a(n)
_________________?
What is the difference between a
mydriactic and miotic?
What is the definition of the word
“plano”?
Review Questions


The point where the upper and lower eyelids meet
is called?
The blockage of the meibomian gland is called the
___________ when it causes pain, and the
_________ when it does not cause pain?

What is a good tear break up time?

What is amblyopia?
Review Questions

The eyelid will protect your eyes from what?

What main muscles raises the eyelid?

What is the main layer of the eye lid?
Review Questions

What is the difference between visual acuity and
accommodation?

What is decentration?

Name a test performed binocularly?

Through a prism the image deviates which way?
Review Questions

Which is the heaviest lens material?

What is the ora serrata

What comprises the vascular layer?

Name one of two indentation tonometers
Review Questions

What is the speed of light?

What is optical infinity?


What chronic disease is normally associated with
internal bleeding in the eye?
What is conjunctivitis? Another name for it
is?
Review Questions

What is emmetropia?

Papilladema refers to what structure?

What is vertex distance

What are the parts of a standard frame?
I want you to pass life’s test
Good Luck!
The person who makes a success of living is the
one who see his goal steadily and aims for it
unswervingly. That is dedication.
Cecil B. DeMille
(1881 - 1959)
Credits
Individual support:










Al Levin, O.D.
Darrell Grise, O.D.
Mile Brujic O.D.
Billie Taylor
Mary Jameson, CPOT
Kathy Wood, CPOT
Belen Holbrook, CPOA
Emma E. Gomez, CPO
Lynn Lawrence, CPOT
Leah Schneider, NREMT
Industry Support:
 Ziess/Meditec
 Vistakon
 Xalatan
 3D Eye Imaginations
 Google search sites…
Course Evaluation


Thank you
Please take a few moments to
complete the course evaluation.