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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.