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WORLD COUNCIL OF OPTOMETRY Curricular Support Elements for an Optometry Programme www.worldoptometry.org CONTENTS Introduction 3 The Patient Examination 4 – Background – Element 1 – Element 2 – Element 3 – Element 4 – Element 5 – Element 6 – Element 7 – Element 8 5 6 12 15 18 20 23 24 26 Patient Management 29 – Element 9 – Element 10 General Health Assessment – Element 11 Specialized Care – Element 12 – Element 13 – Element 14 Professional Responsibilites – Element 15 30 32 35 36 38 39 42 45 48 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 2 INTRODUCTION 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. World Council of Optometry 3 THE PATIENT EXAMINATION BACKGROUND Formulate an examination plan Requirement • S electproceduresthatwillacquirevitalinformationfordiagnosis and management based on the patient history • S electsuitabletestsandprocedurestothepatient’sabilities and condition • U seaproblembased(subjective,objective,assessment,plan“SOAP”)/ scientific approach to gather data relevant to the patient’s problems • C onsiderrelevantinvestigationsnotnecessarilyassociatedwiththe patient’s history • Reviewandanalyzedataforconsistency • Formulateoneormorediagnoses • C onsidermanagementoptionsanddetermineappropriate management plans for each of the diagnoses • Communicatewiththepatientregardingexaminationoutcome • Includethepatientinmanagementdecisions • Reviewmanagementoutcomes The Patient Examination 5 ELEMENT 1 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 • C onceptualapproachestobehaviouralstudies–humanbehaviour investigations: behavioural; psychoanalytical; humanistic; cognitive and biological paradigms • P sychologicalfunctioning:perception;learning;motivation;emotions; stress and coping; health and illness behaviours • C ommunicationandinterpersonalskills:developmentof communication and interpersonal skills The Patient Examination 6 Element 1 Anatomy • Structureofthehumanbodywithrespecttoregionalanatomy • Functionsofthehumanbodywithrespecttosystemicanatomy • S ystemicandregionalanatomyintegrationwithrespectto medical imaging • Thehumanbodyandanatomicalterminology • Skin(integumentarysystem) • Skeletalsystem • Muscularsystem • Nervoussystem • Specialsenses • Cardiovascularsystem • Respiratorysystem • Blood,lymphaticandimmunesystem • Digestivesystem • Renal(urinary)system • Endocrinesystem • Reproductivesystem Cell Biology and Biochemistry • Fundamentalconceptsinbiochemistry • F unctionalsystemswithinanorganism,wherecellsfunctionasbasic building blocks • Rolesofbiologicalmoleculesinlivingsystems • Interactionsbetweenbiochemicalpathwaysinanorganism • C ellstructuresandfunctionoforganellesandthecellasanentity: 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 • C ellcyclesanddevelopmentofcellspecificityineukaryotes,cell cycle and cells in early stage of development, determination and differentiation of cells in higher eukaryotes, and important roles of stem cells • Introductiontoimportantmethodsincellbiology:microscopyand histological methods, cell fractionation and analysis of subcellular components, cytochemical techniques, autoradiography and radioisotope labelling techniques • S tructure,propertiesandfunctionsofmoleculesoflife:water, carbohydrates, lipids, proteins and vitamins, vision biochemistry and its relation to Vitamin A • G eneinformationexpression:geneticinformationcode; transcription; translation The Patient Examination 7 Element 1 • E nzymes:natureandmodeofactionofenzymes,regulationand importanceinbiologicalsystems,isoenzymesandcoenzymes, enzymekinetics • C atabolismandgenerationofenergy:bioenergeticprinciples, glycolysis, citric acid cycle, hexose monophosphate shunt, electronic transport, oxidation of fat, proteolysis, deaminations, fate of carbon skeleton, urea cycle • B iosynthesisandutilizationofenergy:gluconeogenesis,glycogenesis, biosynthesis of lipids, amino acids and proteins Physiology • N ormalfunctioningofthehumanbodywithemphasisonmode of mechanisms • Integrativenatureoftheoperationofdifferentbodysystemsin health and illness • Functionsofphysiologicalsystemsinnormalbodymaintenance • T issuetypesandorganization:classificationoftissues,histological structureandfunctionoftissues;generalorganizationofthehuman body in relation to organs and systems • N ervoussystem:classification,structure,functionandpropertiesof neurons and synapses; basic anatomy and divisions of the nervous system; roles of the central and autonomic nervous systems; receptors andchemicaltransmissionatnerve-nerveandnerve-musclejunctions; neurotransmitters;organizationandfunctionofthesensorysystemfor both general and special senses; control of body movement • E ndocrinesystem:definitionofhormone,endocrineglands; physiologicalfunctionsofmajortypesofhormones;general mechanisms of hormone actions for water soluble and insoluble hormones; structure of pituitary gland and hypothalamus and regulations of hormone release • C ardiovascularsystem:structureandfunctionoftheheartandblood vessels; control of cardiac functions; function of the systemic and pulmonary circulation; haemodynamics; components and properties of blood; structure and function of the lymphatic system • R espiratorysystem:organizationandstructureoftherespiratorysystem; ventilation and lung mechanics; exchange of gases in alveoli and tissues; transport of blood gases; chemical control of ventilation • D igestivesystem:structureofthedigestivesystem;digestionand absorption; 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 • M otorsystem:maincomponentsoftheskeletonbasicjointanatomy; principles of muscle arrangements, mechanisms of muscle contraction • R eproductivesystem:generalprinciplesofgametogenesis;male reproductive physiology; female reproductive physiology; female sex cycle; pregnancy • R enalsystem:organizationoftheurinogenitalsystem;structureofa typical nephron; basic renal processes; regulation of sodium and water balance; regulation of potassium, calcium and hydrogen ions The Patient Examination 8 Element 1 Foundation of Disease • P rincipleofdiseases: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 • D iseasetopicsinlocalareas:prevalenceofdiseaseinthelocal area, mode of disease pattern, causes, mechanisms, effects and complications • A cuteinflammationandpneumonia;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 • P harmacokinetic–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 • P harmacodynamic–absorptionanddistributionofpharmaceuticals (factors affecting absorption and distribution of pharmaceuticals): pH-partition theory, physio-chemical properties of drugs; host factors • B iotransformationofpharmaceuticals:phasesofmetabolism of pharmaceuticals, factors affecting metabolism of pharmaceuticals, prodrugs • E liminationofpharmaceuticals:degradationofpharmaceuticals, systems involved in elimination and excretion of pharmaceuticals, routes of elimination, factors affecting elimination of pharmaceuticals • M odesofactionofpharmaceuticals:extracellular,intracellular,receptor and rate theories in the mechanism of action of pharmaceuticals • O cularsideeffectsofsystemicallyadministeredpharmaceutical 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 The Patient Examination 9 Element 1 Optometry Curriculum – topics to cover Clinical Optometry (with focus on theory) • Interpretingbackgroundinformationcollectedfrompatientsinprimary eye care • P rinciplesandevaluationofocularhealthassessmentproceduresand optometric investigations • Applyingoptometricinvestigations • C omprehensivepatienthistorytaking,devisingaworkinghypothesis and formulating tests to evaluate clinical symptoms • Proceduresforassessmentsselected • Caseanalysis – Diagnosis – Management – Patient training – Patient education – Follow-up • P rofessionalresponsibilityandcommitmentinprimaryeyecareinthe community in diagnosis and treatment • Integratingandsynthesizingclinicalfindings/informationfordiagnosis and management plans • Professionalattitude,ethics,andcareinperformingclinicalassessment • Inter-andintra-professionalcommunication:handlinginter-and intra-professional relationships; skill of communicating information amongst professionals; writing referral letters Optometry Clinic (with focus on clinical competency) • C aseanalysis:extractingrelevantinformationandformulatingtentative approaches of investigation based on a patient’s presented history • A pplyingclinicalprocedures:performingadditionalclinicalprocedures as required in the management of patients • P atientexamination:performingfullvisionexaminationsonpatients in the Optometry Clinic • A ccurateassessmentanddiagnosisofvisualperformanceandocular characteristics • E ffectivecommunicationwithpatientsandotherprofessionals: presentation of symptoms; critical analysis of clinical findings; proposed plan of action • Hospitalvisits • E thicalandprofessionalclinicaloptometrypractise;understanding of the optometrist’s role in the healthcare system • Diversityofclinicalfacilitiesineyecareservices • E ffectivevisualandocularproblemsidentificationinaclinicalfacility and relevant information collection pertinent to problems • P rovisionofvisioncareandtreatment:opticaltreatments;ophthalmic pharmaceutical agent prescriptions; vision therapy; referrals The Patient Examination 10 Element 1 Case Conference • Organizingandanalyzinginformationrelatedtoagivencase • Identifyingrelevant/importantandirrelevant/lessimportantelements of a case • R ecognizingdifferentapproachesthatcouldbetakenandoutcomes that may result • Integratinginformationfromdifferentsubjectareasandfromone’sown experience in making appropriate decisions regarding patient care • D evelopingappropriatemanagementplansandstrategiesforcoping with unusual cases or clinical entities • Critiquingpatientcaredecisionsmadebyoneself,orbyothers • C ommunicatingimportantelementsofacasetoprofessional colleagues in writing and verbally The Patient Examination 11 ELEMENT 2 Assess the anterior ocular adnexa for their structure, health and functional ability Requirement • A ssessandevaluatewithmacro-observation,slitlampbiomicroscopy, loupe, palpation, lid eversion, photography, and use of diagnostic pharmaceuticals – – – – – – – Conjunctiva Lids Lashes Puncta Meibomianglands Lacrimal glands Skin lesions near the eye Enabling Sciences – topics to cover Anatomy • AsperAnatomyinElementOne Cell Biology and Biochemistry • AsperCellBiologyandBiochemistryinElementOne Physiology • AsperPhysiologyinElementOne Microbiology • M icrobiologyprinciples:anaidtodiagnosis;specimensrequired for diagnosis; characteristics of commonly found microorganisms; differences between bacteria, fungi and viruses • Structuresandpropertiesofmicroorganisms • P athogens:sitesandsourcesofinfection;propertiesofmicroorganisms that cause disease; differentiation of commensals from pathogens • P arasitism:relationshipbetweenhostandparasiteandbetweenthe characteristics of microorganisms and their mode of parasitism • S preadofmicroorganism: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 • C hemotherapeutics:principlesanduseofcommonlyusedantibiotics; mutation and adaption of bacteria to antibiotics • C areofopticalinstruments:methodsofstorage;propertiesanduse of microbiocides • S terilization:principlesofsterilizationanddisinfectionandtheagents commonly used; methods of use of those agents and reasons for their choice; monitoring of the effectiveness of these procedures Foundation of Disease • AsperFoundationofDiseaseinElementOne The Patient Examination 12 Element 2 Optometry Curriculum – topics to cover Anatomy for Optometry • E mbryologyoftheeye:sequenceofeventsinthedevelopmentofthe eye and its appendages in the human foetus • Theocularadnexa:eyelids,lacrimalglandsandteardrainagesystem • V asculatureintheeye,orbitandadnexa;arterialsupplyandvenous drainage; origins and destinations • Relationshipsandfunctionsbetweenstructuresinthevisualsystem Ocular Physiology • O riginandfunctionsoftears,tearfilmandtheirimportanceinrelation to ocular health • T earphysiology: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;functionsofeyelidglandsand secretory cells Ocular Disease • A nteriorsegment:congenitalanomaliesoftheanteriorsegment; infection, inflammatory and toxic conditions; degenerative and dystrophicconditions;differentialdiagnosisofredeye;conjunctival problems, optometric management • S ignsandsymptomsofprimaryandsecondaryeyediseasesinvolving the anterior segment encountered in clinical practice • D iseasesofeyelidsandthelacrimalsystem:signsandsymptomsof inflammation, trauma, tumour and degeneration; differential diagnosis of congenital anomalies; optometric action Clinical Optometry • Thepreliminaryexamination:goalsofperformingpreliminarytests • S litlampbiomicroscopy:methodsandpracticeofillumination andobservation;recognizeappearancesofnormaloculartissues; clinical applications of biomicroscopy; use of vital stains • C linicalusesofdifferentkindsofdiagnosticpharmaceuticalagents: clinical applications of ophthalmic diagnostic agents – indications, contraindications and precautions for use; and evaluation of effectiveness of various preparations • Photo-documentation:methodsofocularphotography–anterioreye • A rterialbloodpressureandintra-ocularpressuremeasurementand interpretation for ocular health evaluation • Clinicaldatasamplingandanalysisforocularhealthdiagnosis • C linicalfindings/informationintegrationandsynthesisfor diagnosis and management plans The Patient Examination 13 Element 2 Ocular Pharmacology • P reservatives:preservativecommonlyusedinophthalmic preparations, physio-chemical and antimicrobial properties, side effects and interactions • F actorsaffectingpenetrationofpharmaceuticalsintheeye: physical-chemical properties of pharmaceuticals, drainage system of the eye, vasculature of the eye • A spectsofophthalmicpharmaceuticals,formsandmethods of administration: dosage forms, principal requirements of ophthalmic preparations, factors affecting efficacy and stability of ophthalmic preparations • T opicalanaesthetics:mechanismsofaction,types,biotransformation, and their side effects • S tainingagents:stainingpropertiesoffluorescein,lassaminegreen and rose bengal, and side effects • A nti-allergicandanti-inflammatoryagentsandtheirresponse cascades: types and classification of pharmaceuticals, modes of action, conditions under which they are to be used, side effects and precautions in use • C linicaluseofvasoconstrictors,antihistamines,mastcellstabilizers, corticosteroid, and non-steroidal anti-inflammatory pharmaceuticals for different ocular problems • A nti-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 • T reatmentofdryeye:lubricants,artificialtears,punctalocclusion and oral supplements • S ystemicsideeffectsofocularpharmaceuticalagents:ocular absorption 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 • T herapeutictreatmentforanterioreyedisorders:conditionsaffecting thelids,adnexa,andconjunctiva,andthelacrimalapparatus • D evelopmentofmanagementstrategiesfordifferentoculardiseases: via case studies and computer assisted learning • C ardio-PulmonaryResuscitation(CPR):recognitionofsignsand symptomsofaheartattack;howtoprovideCPRuntilmedicalhelp arrives; 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 The Patient Examination 14 ELEMENT 3 Assess the anterior segment for their structure, health and functional ability Requirement • A ssessandevaluatewithvitaldyesanddiagnosticpharmaceuticals, 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 Enabling Sciences – topics to cover Anatomy • AsperAnatomyinElementOne Cell Biology and Biochemistry • AsperCellBiologyandBiochemistryinElementOne Physiology • AsperPhysiologyinElementOne Microbiology • AsperMicrobiologyinElementTwo Foundation of Disease • AsperFoundationofDiseaseinElementOne The Patient Examination 15 Element 3 Optometry Curriculum – topics to cover Anatomy for Optometry • N ervesupplytotheeye,orbitandadnexa:motor,sensoryand autonomic nerve supply Ocular Physiology • T hecornea:functions,itsdifferentlayersandthecommonconditions that affect the cornea and vision, metabolism and maintenance of transparency • M echanismofaqueoushumourformation,itsfunctionandcomposition and relate the understandings to intraocular pressure (IOP) and ocular pathophysiology • T heintraocularpressure:itsorigin,rangeanddistributioninthe population; measurement; diurnal variations • T hepupil:factorscontrollingpupilsize;relationshipbetweenpupilsize and visual function Ocular Disease • S ignsandsymptomsofprimaryandsecondaryeyediseasesinvolving the anterior segment encountered in clinical practice • Diseasesofthescleraanduvealtract • Laboratorytestsappropriateforaidingdiseasediagnosis • A nteriorsegment:congenitalanomaliesoftheanteriorsegment; infection, inflammatory and toxic conditions; degenerative and dystrophic conditions; differential diagnosis of red eye; corneal problems; optometric management • O cularinjuryandtrauma–definition:ocularfirstaid;optometric management • C onditionsrequiringimmediatereferral:recognitionand necessary action • R efractivesurgery:differenttechniquesinrefractivesurgery; pre-operative optometric examination; complications and management of post-refractive surgery The Patient Examination 16 Element 3 Clinical Optometry • Theevaluationofnormalandabnormalpupilresponsesandiriscolour • Pathologicalchangesinanteriorangle • Intraocularpressuresandtonometry:measurementofintraocular pressure; applanation and indentation tonometry; non-contact tonometry; clinical applications of tonometry in practice • G onioscopy: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 • E lectrophysiology:principlesandapplicationsofvisual electrophysiological techniques in optometric practice • U ltrasonographyandotherimagingtechniques:principlesand applications of A-scan, B-scan and ultrasound pachymetry in clinical optometric practice • Keratometry:clinicalapplicationinrefraction • S phygmomanometry:principleandmethodofsphygmomanometry; applications in optometric practice; ophthalmodynamometry – theory and application in optometric practice Ocular Pharmacology • T herapeutictreatmentforanterioreyedisorders:conditionsaffecting the cornea, and the sclera • A utonomicnervoussystem,innervationoftheeye,neuronaltransmitters in 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 • M iotics:parasympathomimetic,sympatholytic,anti-cholinesterases, and their side effects • C ycloplegicsandmydriatics:anticholinergicscycloplegicagents; direct and indirect acting sympathomimetic and anticholinergic mydriatic agents, and their side effects • P harmacologicalmanagementofpre-andpost-refractive surgery patients Visual Science • M easurementofocularcomponents:methodologyandtechniques of ocular measurements including ultrasonography, keratometry and pachometry; frequency of distribution of ocular component dimensions The Patient Examination 17 ELEMENT 4 Assess the ocular media for their structure, health and functional ability Requirement • A ssessandevaluatewithdirectandindirectophthalmoscopy, retinoscopy, photography, diagnostic pharmaceuticals, slit lamp biomicroscopy and ultrasound – Ocular lens – Lens implant – Lens capsule Enabling Sciences – topics to cover Anatomy • AsperAnatomyinElementOne Cell Biology and Biochemistry • AsperCellBiologyandBiochemistryinElementOne Physiology • AsperPhysiologyinElementOne Microbiology • AsperMicrobiologyinElementTwo Foundation of Disease • AsperFoundationofDiseaseinElementOne Optometry Curriculum – topics to cover Anatomy for Optometry • S tructuresandmediawithintheeyeball:adetailedstudyofthe different layers of the eyeball, their structures and functions Ocular Physiology • T hecrystallinelens:metabolismandfunctionsinrelationtovision, the formation of cataract • A ccommodation:itsfunction,causesandcontrol;thenatureand causes of presbyopia in terms of the malfunction of accommodation Ocular Disease • C rystallinelensandcataract:differentialdiagnosisoflenticular anomalies; signs and symptoms of cataract; senile cataract; secondary cataract; complications and management; optometric management The Patient Examination 18 Element 4 Clinical Optometry • R etinoscopy:spotandstreakretinoscopy–staticmethods;retinoscopy inastigmatism;nearpointretinoscopy–Mohindratechnique;dynamic methods;variationsofdynamicretinoscopy–MEMretinoscopy, chromoretinoscopy • D irectophthalmoscopy:basicaspects;appearanceofthenormal fundus 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 • O cularsideeffectsofsystemicallyadministeredpharmaceuticalagents: 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 • C linicaluseandsideeffectsofcorticosteroidpharmaceuticalsfor different ocular problems • M iotics:parasympathomimetic,sympatholytic,anti-cholinesterases, and their side effects • C ycloplegicsandmydriatics:anticholinergicscycloplegicagents; direct and indirect acting sympathomimetic and anticholinergic mydriatic agents, and their side effects Visual Science • O pticsoftheeye:opticalpropertiesofdifferentocularstructures; different schematic eye models • O ptometers:opticsandprinciplesofthesimpleoptometer,Badal’s optometer, Young’s optometer, retinoscopy • A ccommodation:relationshipbetweenstimulusandresponse; mechanism and properties of accommodation; spectacles and ocular accommodation • E ffectsofdifferentradiationstotheeyeandeffectsofocular aberrations on vision • Importanceoflightinvisionandorganisms Optometry Specialties • A phakiaandpseudophakos:advantagesanddisadvantagesof aphakic corrections; types of aphakic corrections; problems of the newly corrected aphake; the pseudophakic eye post-operatively; types of pseudophakic correction; complications of pseudophakos The Patient Examination 19 ELEMENT 5 Assess the posterior segment for their structure, health and functional ability Requirement • A ssessandevaluatewithdirectandindirectophthalmoscopy,slitlamp biomicroscopy 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 Enabling Sciences – topics to cover Anatomy • AsperAnatomyinElementOne Cell Biology and Biochemistry • AsperCellBiologyandBiochemistryinElementOne Physiology • AsperPhysiologyinElementOne Microbiology • AsperMicrobiologyinElementTwo Foundation of Disease • AsperFoundationofDiseaseinElementOne Optometry Curriculum – topics to cover Anatomy for Optometry • T heorbit:theboneswhichmakeuptheorbitandthevariousfossae and canals in the orbit • T hevisualpathway:locationandanatomicalnatureofstructures comprising the visual pathway; arrangement of nerve fibres from retina to visual cortex; implications of this arrangement on binocularity and visual fields Ocular Physiology • T hevitreoushumour:itsproduction,composition,metabolism, and functions • T heretina:metabolismandfunctionsofthevariouslayers; phototransduction mechanism; and relationship of retinal functions with various vegetative functions of other ocular structures • P hotochemistryofvision:visualpigments;chemicalnatureofrhodopsin; responses to light The Patient Examination 20 Element 5 Ocular Disease • C onditionsoftheorbitandorbitalstructures:congenitaland developmental anomalies; signs and symptoms of infection and inflammatory conditions; sings and symptoms of orbital trauma and tumours • Proptosis:conditionsaffectingtheeyesandocularadnexa • C linicalaspectsofultrasound,CT(computerizedtomography)and MRI(magneticresonanceimaging):investigativetechniques,clinical application for diagnosis of ocular disease • G laucoma:definitionandincidence;reviewofaqueousphysiology and angle anatomy; signs and symptoms, investigative techniques; secondary glaucoma; criteria for referral • D iseasesofthevitreousandretina:vascularanomalies;inflammatory conditions; retinal detachment; degeneration and dystrophies; laser and cryotherapy treatment; congenital and developmental conditions; trauma and foreign bodies; optometric involvement • M acula:congenitalandinheritedconditions;degenerationand dystrophies; toxic conditions; treatment • O cularsignsofsystemicdiseases:signsandsymptoms;optometric management • N euro-ophthalmology:reviewofanatomy,physiology,andretinotopic visualfieldorganization;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 • F undusbiomicroscopy:contactfunduslens;theHrubyandVolklenses and their principles and applications in clinical practice; fundus appearance with biomicroscopy • V isualfieldsandvisualfieldtests:Bjerrumscreen;visualfieldscreeners; principles and practice; perimetry – static and kinetic perimetry; automated perimetry; detection of visual field defects • M acularfunctions:varioustechniquestoassesstheintegrityand functionality of the macula, Amsler grid, photostress test, neutral-density filter test, colour comparison test and brightness comparison test • Pathologicalfunduschanges • C olourvisionandcolourvisiontests:clinicalassessmentofcolourvision; applications of colour vision tests; congenital vs. acquired colour vision defects; clinical manifestations of acquired colour vision defects • A dvancedOptometricInvestigation–principlesandclinical applicationsofnewoptometricinstruments:NerveFibreAnalyzer(NFA); Orbscansystem;IOLMasterandOpticalCoherenceTomography(OCT) The Patient Examination 21 Element 5 Ocular Pharmacology • M edicaltreatmentofglaucoma:typesandclassificationofindividual groups of pharmaceuticals for glaucoma treatment, modes of action, conditions under which they are to be used, side effects and precautions in use Visual Science • A natomyofthevisualpathway:nervefibredistributionintheretina, optic nerve, optic chiasma and optic pathway; visual and synaptic relations in the midbrain and cerebrum • L ightandthevisualsystem:introductiontophotometry;lightasa physiological stimulus, characteristics of light, representation of visual stimulus on the retina, brightness sensation; circadianism and vision, effect of melatonin on the retina • R etinalintegrationofvisualinformation:convergentproperties of retinal signals in the retina; integration of visual information in the retina in relation to control of retinal sensitivities, wavelength andspatial/spectralsampling • E lectrophysiologyofthevisualsystem:physiologicalbasisofERG,EOG, andVERtostructuredandunstructuredstimuli;knowledgeofmultifocal technique in visual electrophysiology • N euralorganizationofthevisualsysteminthebrain: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 • C odinginthevisualsystem:conceptandorganizationofreceptive fields, edge detection, spatial frequency tuning, neural channels, signal and noise • P sychophysicsofmeasurement:frequencyofseeing,signal detectiontheoryROCcurves,visualthreshold,signalandnoise, criterion-dependent and criterion-dependent methods in vision research • C olourvision:spectralsensitivity,wavelengthdiscrimination,colour matching, colour contrast, defective colour perception, classical and recent theories of colour vision, design of colour vision tests • V isualperception:sensationandperception,theoriesof perception, perception of space, form and motion, constancies, factors affecting perception The Patient Examination 22 ELEMENT 6 Assess the sensory visual function and integrity of the visual pathway Requirement • A ssessandevaluatecontrastsensitivityfunction,glare,optokinetic nystagmus, pinhole vision, binocular vision – Visual acuity • A ssessandevaluatewithconfrontation,kineticandstaticscreening and threshold, short wavelength automated perimetry (SWAP) and frequencydoublingtechnology(FDT) – Visual fields Optometry Curriculum – topics to cover Anatomy for Optometry • AsperAnatomyforOptometryinElementsTwotoFive Ocular Physiology • R eflexarcs:thenervouspathwayofvariousocularreflexesincluding pupillary, accommodation and convergence; eye movements Ocular Disease • Decreaseinvisualacuityofacuteandchroniconsets Clinical Optometry • HabitualVAanditssignificance • C ontrastsensitivityfunction:theoryandclinicaluseofcontrastsensitivity function, contrast sensitivity function curve, commercially available contrast sensitivity charts and systems; clinical significance and interpretations of contrast sensitivity function • V isualfieldsandvisualfieldtests:Bjerrumscreen;visualfieldscreeners; principles and practice; perimetry – static and kinetic perimetry; automated perimetry; detection of visual field defects Visual Science • V isualacuity:limitationsforvisualresolution;introductionofvisual acuity measurement; design of visual acuity chart; factors affecting visual acuity • Spatialvision:spatialresolution,spatialcontrastsensitivity,hyperacuities • T emporalvision:temporalresolutionandflicker,deLangecurve, spatio-temporal characteristics of vision • A ssessmentofvisualacuity: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 • O culartransmissionandaberrations:transmissionandabsorption spectra of the media components; their effects on vision; aberrations of lens systems as applied to the eye; effects of these upon vision • E ntopticphenomena:physiologicalvisualsensationsandtheircause and effects The Patient Examination 23 ELEMENT 7 Assess the refractive status Requirement • Assessandevaluate – Spherical ametropia – Astigmatism – Presbyopia Enabling Sciences – topics to cover Mathematics • Applyingmathematicalreasoningforanalysisofdifferentproblems • E xtendingknowledgeofmathematicaltechniquesandadapting known solutions to different situations arising in optics • D evelopingandextrapolatingmathematicalconceptsinsynthesizing and solving Optics problems • Resolvingmathematicalprobleminoptometryrelatedtopics • Basicmathematics:trigonometry,complexnumbers,simplematrices • D ifferentialcalculus:differentiationfromthefirstprinciples,ratesof change, differentiation of algebraic, trigonometric, logarithmic and exponential functions, differentiation of inverse functions and implicit functions,Leibniz’stheorem,geometricandphysicalapplications • Integralcalculus:definiteandindefiniteintegrals,techniquesof integration, reduction formulas, applications of integrations Optometry Curriculum – topics to cover Anatomy for Optometry • AsperAnatomyforOptometryinElementsTwotoFive Ocular Physiology • AsperOcularPhysiologyinElementsTwotoSix Ocular Disease • Decreaseinvisualacuityofacuteandchroniconsets Clinical Optometry • O culartransmissionandaberrations:transmissionandabsorption spectra of the media components; their effects on vision; aberrations of lens systems as applied to the eye; effects of these upon vision • A uxiliaryrefractivetechniques:principles,methodsandapplications of autorefraction, photorefraction and laser refraction • S ubjectiverefraction:monocularsubjectiverefraction;principles and methods – fogging techniques, fan and block techniques, Jackson’scrossedcylinder;monocularrefractiveendpoints–+1.00D blur,duochrometests;binocularequalizationmethods–infinity balance,prismatictechniques;binocularsubjectiverefraction;near subjectiverefraction The Patient Examination 24 Element 7 • Refractiveerrortypesandsubnormalvisualacuitycaseidentification • Opticalmanagementofametropia • A ppropriateprescriptioncorrectionperrefractiveandnon-refractive conditions and management plan • A ccommodationandpresbyopia:comfortablenearvision;amplitude of accommodation – methods of measurement, effects of age; crossedcylinder tests of accommodation; relative ranges of accommodation; accommodative facility test; determination of the presbyopic addition Optics • Physicalandgeometricaloptics • Identifyingandresolvingopticalproblems • O pticalinstrumentation:stops,pupilsandwindows;cameras,simple magnifiers and eyepieces, microscopes, and telescopes • O pticsofthicklensesandlenssystems:Gaussianoptics–reflection and refraction at plane and spherical surfaces; cardinal points of thick lenses and lens systems; image forming systems; matrix method • P roductionandmeasurementoflight: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 • L ensaberrations:dispersivepowerofopticalmaterials;achromatic prisms and lenses; monochromatic aberrations; ray tracing • Wavenatureoflight:Fresnel’slawofreflection;interferometry andapplications;opticalcoating;FresnelandFraunhoferdiffraction; zoneplatesandtheirapplication;resolvingpower;polarizationby reflection;scattering,dichroismandbirefringent;polarizers,applications ofpolarizedlight Ophthalmic Optics and Dispensing • O phthalmiclenspowerandformpresentation:lenspowerandform transposition; writing of prescriptions and lens shapes presentations General and Ocular Pharmacology • AsperGeneralandOcularPharmacologyinElementsOnetoThree Visual Science • E mmetropiaandametropia:definitionofdifferentrefractiveconditions; frequency of distribution of ametropia • R etinalimagesizeandmagnification:effectsofrefractiveerrorson retinalimagesize;spectacleandcontactlenscorrectiononretinal imagesize The Patient Examination 25 ELEMENT 8 Assess the oculomotor and binocular function Requirement • A ssessandevaluatewithprisms,covertest,headtilttest;ocular alignment 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 Enabling Sciences – topics to cover Mathematics • AsperMathematicsinElementSeven Optometry Curriculum – topics to cover Anatomy for Optometry • T heextraocularmuscles:anatomy,functions,nervousand vascular supply Ocular Physiology • AsperOcularPhysiologyinElementsTwotoSix Ocular Disease • Decreaseinvisualacuityofacuteandchroniconsets The Patient Examination 26 Element 8 Clinical Optometry • E ntopticphenomena:physiologicalvisualsensationsandtheircause and effects • Investigationofbinocularity:theoriesandprinciplesofbinocularvisual functions; 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 • H irschbergtestandanglekappatest,theoryandmethodsofthe unilateral and alternate cover tests; assessment of binocular motility; near point of convergence and other evaluations; near point of accommodation; evaluation of ocular dominance • H eadaches:clinicalpresentationsofheadaches;variouscauses of headaches; management of patients with headaches as the chief compliant Optics • AsperOpticsinElementSeven Visual Science • B inocularvisioninhumansandotheranimals:anatomicalandstructural features in different species with binocular vision; levels of binocularity in different species; evolution and environmental adaptation • S ensoryaspectsofbinocularvision:visualprojection;corresponding and disparate retinal points; theoretical and empirical horopters; Panum’s area and fusional space; physiological diplopia; fixation disparity • F usionalresponsesandnearvisioncomplex:fusionalmovement; heterophoria; accommodation, convergence and pupillary action • D epthperceptionandstereopsis:physicalfactorsaidingdepth judgment;stereopsis;theoreticalmodelsforstereopsis • N ormaleyemovements:fixationeyemovement;saccades;pursuit; ductions; versions; vergence • A niseikonia:effectofunequalretinalimagesizeonbinocularvision and space perception • B inocularinteraction:advantagesofbinocularvision;binocular summation and inhibition; theoretical models • D evelopmentofnormalbinocularvision:binoculardevelopmentfrom infancy to adulthood; sensitive period; effect of visual deprivation The Patient Examination 27 Element 8 Clinical Binocular Vision • V isiontherapyconcepts,procedures,andinstrumentation:synotophore, synotiscope, stereoscopes, anaglyphs, physiological diplopia techniques and their applications • H eterophoriaanditsmanagement:aetiologyandclassification;clinical signs 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 • A ccommodationandconvergenceanomalies:accommodationand convergence excess and insufficiciency, investigation and management • Heterotropia:aetiologyandclassification;comitanceandincomitance • S ensoryadaptations:developmentofsensoryadaptationsinstrabismus; amblyopia, eccentric fixation, anomalous correspondence, suppression – clinical signs and investigations • M anagementofcomitantstrabismusandsensoryadaptations: 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 • M anagementofincomitantstrabismus:developmentofmotor adaptations; clinical signs and investigations; indications for referrals; optometric management • N ystagmus:latentandmanifestnystagmus;formsofnystagmus,clinical investigation and significance, optometric management The Patient Examination 28 PATIENT MANAGEMENT ELEMENT 9 Assess suitability of spectacles and prescribe Requirement • Assessandevaluate – – – – – – – Visual requirements: recreational and vocational Magnificationrequirements Prism requirements Dispensingrequirementsandlimitations Anisometropia Aniseikonia Lens design Enabling Sciences – topics to cover Mathematics • AsperMathematicsinElementSeven Optometry Curriculum – topics to cover Clinical Optometry • C asehistorytakingandsymptomatology: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) • P rescriptiondecisions:aetiologyofrefractiveerrorsandtheinfluence of etiological theories on the refractive prescription and monitoring the refraction; relating the prescription to the occupational and other needs of the patient • C linicalcasemanagement:simulatedandrealclinicalcasestobuild up problem solving techniques in case management Optics • AsperOpticsinElementSeven Visual Science • AsperVisualScienceinElementsThreetoEight Patient Management 30 Element 9 Ophthalmic Optics and Dispensing • V ergencemethodofraytracing:theory,methodandapplication of tracing paraxial ray through single and complex lens systems • B asicopticalpropertiesofsinglevisionlenses:opticalproperties of spherical and sphero-cylindrical lenses; principles of focimeter and lens measure • O phthalmiclenspowerandformpresentation:lenspowerandform transposition; writing of prescriptions and lens shapes presentations • O phthalmicprismsandlensdecentration:specificationofophthalmic prisms and interactions of prisms; theory and calculation of prismatic effects on lens decentration • O bliquelycrossedcylinders:effectsandcalculationofcylinderscrossed at any angle • A ccuratetransposition:calculationofexactlensformsforthicklenses, with bi-toric surfaces • L ensmaterialsandtheirfabrication:opticalandphysicalproperties of common ophthalmic lens materials; selection of lens materials; processes of lens making • L enticularandFresnellenses:opticalprinciplesandophthalmicuses oflenticularandFresnellenses • F ramematerialandtypes:meritsofdifferenttypesofspectacleframe materials; frame types and component parts; effects of frame designs on fitting • F rameandfacemeasurement:introductiontospectacleframeand face measurement • Assessinglensimagequality • B ifocalsandtrifocals:principleandterminology,opticalproperties and fitting of bifocals and trifocals with maximum visual efficiency and wearing comfort • M ultifocals:principleandterminology,opticalpropertiesandfittingof multifocals with maximum visual efficiency and wearing comfort • L ensthicknessconsiderationsandcalculation:calculationofthickness in edged lenses • L enseffectivity:effectsofworkingdistanceandvertexdistanceon the prismatic and refractive powers in spectacles • S pectaclelensdesign:principlesandmethodsofophthalmiclens designs; aberration correcting lenses; lens material selection for spectacle prescriptions; safety prescriptions • T intedlenses:radiationandtheeye;ophthalmicusesoftinted/ photochromatic lenses; Polaroid lenses • S pectaclefitting:factorstobeconsideredinlensandframeselections; principlesandpracticalaspectsofspectacleframefitting;adjustments; safety and efficiency; optical and fitting suitability evaluation Optometry Clinic • S pectacleframedispensingandadjustment:fittinganddelivery of spectacles to patients Patient Management 31 ELEMENT 10 Assess contact lens-wear suitability and prescribe Requirement • Assessandevaluate – – – – Contact lens visual requirements Fittingparameters Patient compliance Contact lens performance Enabling Sciences – topics to cover Cell Biology and Biochemistry • AsperCellBiologyandBiochemistryinElementOne Physiology • AsperPhysiologyinElementOne Microbiology • AsperMicrobiologyinElementTwo Foundation Disease • AsperFoundationPathologyofDiseaseinElementOne Optometry Curriculum – topics to cover Anatomy for Optometry • AsperAnatomyforOptometryinElementsTwotoFive;andEight Ocular Physiology • AsperOcularPhysiologyinElementsTwotoSix Ocular Disease • Decreaseinvisualacuityofacuteandchroniconsets • Managingocularemergencies • Cornealandconjunctivalproblems Clinical Optometry • AsperClinicalOptometryinElementsTwotoThree;andSixtoNine Optics • AsperOpticsinElementTwo Ocular Pharmacology • Pharmacologicalmanagementofcontactlensrelatedproblems Patient Management 32 Element 10 Visual Science • AsperVisualScienceinElementsThreetoEight Contact Lens Practice • C ornealshapeandmeasurements:cornea,cornealshape (topography) and the use of keratometer in contact lens practice; sources of error; contact lens terms • C ornealphysiologyandlenswear:opticalpachometer;introductionto contact lenses, indications and contra-indications for contact lens wear • T earfilmandblinking:effectsofnormalblinkingonlenswear,tear exchange and lens rotation; abnormal blink patterns and their effects; effect of lens wear on the tear film; tear function tests and their significance • P ropertiesofcontactlensmaterials:rigidcontactlensmaterials;oxygen permeability and transmissibility; wettability; water absorption • L ensverification:measuringBOZRandotherradii,diameters,thickness, back vertex power; measuring water content; examining edges and surfaces • Astigmatismandcontactlenses • C ontactlensconsultations:functionsprocedures;preliminary,fitting, aftercare routines (stress on slit lamp examinations) and delivery visits • S oftlenses:lensdesigns;specificindicationsandcontraindications; fitting principles and assessment of fit; effect of altering parameters; optimum fitting • S olutionsandstains:preservativesusedincontactlenssolutions; solutions necessary for care of all types of contact lenses; use of stains in contact lens practice; sodium fluorescein • O pticsofcontactlenses:tear/cornealenssystem;residualastigmatism; magnification and accommodation with contact lenses and their implications;toricRGPs • G aspermeablerigidlenses:objective;specificindicationsand contraindications; trial sets and initial lens selection; fluorescein pattern; assessment of lens fit; over-refraction; effect of altering parameters; optimum fitting criteria • R igidandgaspermeablerigidlensesfittingphilosophiesanddesigns; fluorescein patterns; common fitting techniques; forces acting on the lens/eye • M anagingcontactlenscomplications:contactlensspoilageand preventative measures; ocular and lens deposits • M anagingcontactlens-relatedocularcomplications:signs,symptoms, aetiology, treatment and prognosis; importance of compliance in contactlenswear(usageandcareprocedures);breachesinusage/ careprocedures;waystomaximizecompliance • E xtendedwearlensesanddisposablelenses:patientselectionand management;fittingphilosophies;softversusRGP;management • Cosmeticcontactlenses Patient Management 33 Element 10 • Scleral,hybridandpiggy-backlenses • Contactlensesforprebyopesandkeratoconus • Introductiontoorthokeratology:indicationsandcontraindications, limitations,howortho-Kdiffersfromextendedwear,myopiccontrol withortho-K Contact Lens Clinic • Comprehensivecontactlens-historytaking • Suitabilityofpatientsforcontactlenswear • A ssessinganterioreyeandmeasuringocularparametersrequiredfor contactlensfitting/aftercare • E valuatingandhandlingdifferentlenstypes;identificationofcommon contact lens-related issues • Lensfitting,evaluationanddispensing • Managingpatientandaftercare(routineandproblemsolving) • Legalandethicalissuesrelatedtocontactlenspractice Patient Management 34 GENERAL HEALTH ASSESSMENT ELEMENT 11 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 o o o o Complete blood counts Erythrocytesedimentationrates(ESR) Cholesterol levels Blood glucose measurements 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 General Health Assessment 36 Element 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 Enabling Sciences – topics to cover Anatomy • AsperAnatomyinElementOne Cell Biology and Biochemistry • AsperCellBiologyandBiochemistryinElementOne Physiology • AsperPhysiologyinElementOne Microbiology • AsperMicrobiologyinElementTwo Foundation Disease • AsperFoundationofDiseaseinElementOne Cell Biology and Biochemistry • AsperCellBiologyandBiochemistryinElementOne Physiology • AsperPhysiologyinElementOne General Health Assessment 37 SPECIALIZED CARE ELEMENT 12 Assess and provide care for the paediatric patient Requirement • Understandthedevelopmentandnormsofchilddevelopment • Knowthevisualandrefractivedevelopmentnorms • Understandrelationofvisionandlearning • Beabletoexaminetheinfantandchild • Managementofvisualproblemsintheinfantandchild Enabling Sciences – topics to cover Anatomy • AsperAnatomyinElementOne Physiology • AsperPhysiologyinElementOne Microbiology • AsperMicrobiologyinElementTwo Foundation Disease • AsperFoundationofDiseaseinElementOne Optometry Curriculum – topics to cover Anatomy for Optometry • AsperAnatomyforOptometryinElementsTwotoFive;andEight Ocular Physiology • AsperOcularPhysiologyinElementsTwotoSix Optics • AsperOpticsinElementTwo Ocular Disease • D iseasesoftheeyelidsandthelacrimalsystem:signsandsymptoms of inflammation, trauma, tumour and degeneration; differential diagnosis of congenital anomalies; optometric action • A nteriorsegment:congenitalanomaliesoftheanteriorsegment; infection, inflammatory and toxic conditions; dystrophic conditions; differential diagnosis of red eye; optometric management • C rystallinelensandcataract:differentialdiagnosisoflenticular anomalies; signs of cataract; complications and management; optometric management • O cularinjuryandtrauma–definition:ocularfirstaid;optometric management Specialized Care 39 Element 12 • C onditionsoftheorbitandorbitalstructures:congenitaland developmental anomalies; signs and symptoms of infection and inflammatory conditions; sings and symptoms of orbital trauma and tumours • Proptosis:conditionsaffectingtheeyesandocularadnexae • D iseasesofthevitreousandretina:vascularanomalies;inflammatory conditions; dystrophies; laser and cryotherapy treatment; congenital and developmental conditions; trauma and foreign bodies; optometric involvement • M acula:congenitalandinheritedconditions;dystrophies;toxic conditions; treatment • N euro-ophthalmology:reviewofanatomy,physiology,andretinotopic visualfieldorganization;congenitalpapillaryanomalies • C onditionsrequiringimmediatereferral:recognitionofconditions requiring immediate referral; necessary action Clinical Optometry • Thepreliminaryexamination:goalsofperformingpreliminarytests • H istorytaking;Hirschbergtestandanglekappatest,theoryand methods 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. • A ssessmentofvisualacuity:clinicalmethodsofmeasurement; relationships between refractive error and acuity; effect of amblyopia and abnormal eye conditions on vision • R etinoscopy:spotandstreakretinoscopy–staticmethods;retinoscopy inastigmatism;nearpointretinoscopy–Mohindratechnique;dynamic methods;variationsofdynamicretinoscopy–MEMretinoscopy, chromoretinoscopy • A uxiliaryrefractivetechniques:principles,methodsandapplicationsof autorefraction, photorefraction and laser refraction • Investigationofbinocularity:theoriesandprinciplesofbinocularvisual functions; 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 • D irectophthalmoscopy:basicaspects;appearanceofthenormal fundus 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 • C olourvisionandcolourvisiontests:clinicalassessmentofcolourvision; applications of colour vision tests; congenital vs. acquired colour vision defects; clinical manifestations of acquired colour vision defects Specialized Care 40 Element 12 Optometry Specialties • P aediatricoptometry:visualandrefractivedevelopmentand norms; clinical examination of children; management of visual problems in children • R efractivenormsandmeasuringrefractiveerrorininfantsand 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 41 ELEMENT 13 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 • P rescribelowvisiondevicestomeetpatient’svisualand functional requirements • K nowledgeoforganizationsprovidingrehabilitative and low vision services Enabling Sciences – topics to cover Microbiology • AsperMicrobiologyinElementTwo Optometry Curriculum – topics to cover Anatomy for Optometry • AsperAnatomyforOptometryinElementsTwotoFive;andEight Ocular Physiology • AsperOcularPhysiologyinElementsTwotoSix Optics • AsperOpticsinElementTwo Ocular Disease • A nteriorsegment:anomaliesoftheanteriorsegment;infection, inflammatory and toxic conditions; degenerative and dystrophic conditions; differential diagnosis of red eye; optometric management • C rystallinelensandcataract:differentialdiagnosisoflenticular anomalies; signs and symptoms of cataract; senile cataract; secondary cataract; complications and management; optometric management • O cularinjuryandtrauma–definition:ocularfirstaid;optometric management • C onditionsoftheorbitandorbitalstructures:developmentalanomalies; signs and symptoms of infection and inflammatory conditions; signs and symptoms of orbital trauma and tumours • G laucoma:definitionandincidence;reviewofaqueousphysiology and angle anatomy; signs and symptoms, investigative techniques; secondary glaucoma; criteria for referral Specialized Care 42 Element 13 • D iseasesofthevitreousandretina:vascularanomalies;inflammatory conditions; retinal detachment; degeneration and dystrophies; laser and cryotherapy treatment; developmental conditions; trauma and foreign bodies; optometric involvement • Macula:degenerationanddystrophies;toxicconditions;treatment • O cularsignsofsystemicdiseases:signsandsymptoms;optometric management • N euro-ophthalmology:reviewofanatomy,physiology,andretinotopic visualfieldorganization;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 • C asehistorytakingandsymptomatology: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) • E valuationofnormalandabnormalpupilresponsesandiriscolour; investigation of confrontation visual fields and screening for central field • A ssessmentofvisualacuity: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 • R etinoscopy:spotandstreakretinoscopy–staticmethods;retinoscopy inastigmatism;nearpointretinoscopy–theMohindratechnique; dynamic methods • Keratometry:clinicalapplicationinrefraction • A uxiliaryrefractivetechniques:principles,methodsandapplications of autorefraction, photorefraction and laser refraction • S ubjectiverefraction:monocularsubjectiverefraction;principlesand methods; duochrome tests • S litlampbiomicroscopy:methodsandpracticeofilluminationand observation; appearances of normal ocular tissues; clinical applications of biomicroscopy; use of vital stains • C linicalusesofdiagnosticdrugs:clinicalapplicationsofophthalmic diagnostic drugs – indications, contraindications and precautions for use; evaluation of effectiveness of various preparations • Intraocularpressuresandtonometry:measurementofintraocular pressure; applanation and indentation tonometry; non-contact tonometry; clinical applications of tonometry in practice • D irectophthalmoscopy:basicaspects;appearanceofthenormal fundus 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 43 Element 13 • F undusbiomicroscopy:contactfunduslens;theHrubyandVolklenses and their principles and applications in clinical practice; fundus appearance with biomicroscopy • G onioscopy:principlesofmethods;typesofgoniolenses,theirmethods of application; appearance of the anterior angle by gonioscopy; abnormal signs in the anterior angle; three-mirror retinal evaluation • V isualfieldsandvisualfieldtests:Bjerrumscreen;visualfieldscreeners; principles and practice; perimetry – static and kinetic perimetry; automated perimetry; detection of visual field defects • M acularfunctions:varioustechniquestoassesstheintegrityand functionality of the macula, Amsler grid, photostress test, neutral-density filter test, colour comparison test and brightness comparison test • C ontrastsensitivityfunction:theoryandclinicaluseofcontrastsensitivity function, contrast sensitivity function curve, commercially available contrast sensitivity charts and systems; clinical significance and interpretations of contrast sensitivity function • P hoto-documentation:methodsofocularphotography–anterioreye and fundus • Inter-andintra-professionalcommunication:discussionon handling inter- and intra-professional relationships; communicating information amongst professionals; writing referral letters Optometry Specialties • Lowvision:visualimpairmentdefined;examinationofthelowvision patient; optical aspects of low vision aids; prescription techniques of low vision aids; management of low vision patients; recent research • V isualimpairmentdefined:legal,medicalandsocialdefinitions; prevalence and incidence; causes of visual impairment • E xaminationofthelowvisionpatient:visualacuityassessment;clinical expectations of visual acuity; refraction and the refractive correction; other investigations including visual field and contrast sensitivity • M agnificationandlowvisionaids:principlesofmagnification;optical principles of magnifiers and telescopic aids; types of low vision aids available; clinical assessment of low vision aids; training and applications of low vision aids • M anaginglowvisionpatients:multi-disciplinaryapproach;rehabilitation services; the optometrist in the multi-disciplinary team • Lowvisionservices;currentservices;futureplanningandprojection • R ecentresearch:clinicalapplicationsofrecentresearchintolowvision causes and management Specialized Care 44 ELEMENT 14 Assess and provide care for the geriatric patient Requirement • Abilityto – U nderstandthevisualfunction,physiologicalandanatomical changes with age – Deliverappropriatecarethatconsidersdisabilities – Select appropriate equipment for domiciliary visits Enabling Sciences – topics to cover Anatomy • AsperAnatomyinElementOne Physiology • AsperPhysiologyinElementOne Microbiology • AsperMicrobiologyinElementTwo Foundation of Disease • AsperFoundationPathologyofDiseaseinElementOne Optometry Curriculum – topics to cover Anatomy for Optometry • AsperAnatomyforOptometryinElementsTwotoFive;andEight Ocular Physiology • AsperOcularPhysiologyinElementsTwotoSix Optics • AsperOpticsinElementTwo Ocular Disease • C rystallinelensandcataract:differentialdiagnosisoflenticular anomalies; signs and symptoms of cataract; senile cataract; secondary cataract; complications and management; optometric management • C onditionsoftheorbitandorbitalstructures:anomalies;signsand symptoms of infection and inflammatory conditions; signs and symptoms of orbital trauma and tumours • Proptosis:conditionsaffectingtheeyesandocularadnexae • D iseasesofthevitreousandretina:vascularanomalies;inflammatory conditions; retinal detachment; degenerations; optometric involvement • Macula:degenerations;toxicconditions;treatment • O cularsignsofsystemicdiseases:signsandsymptoms;optometric management Specialized Care 45 Element 14 Clinical Optometry • A ssessmentofvisualacuity: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 • R etinoscopy:spotandstreakretinoscopy–staticmethods;retinoscopy inastigmatism;nearpointretinoscopy–theMohindratechnique; dynamic methods • A uxiliaryrefractivetechniques:principles,methodsandapplicationsof autorefraction, photorefraction and laser refraction • S ubjectiverefraction:monocularsubjectiverefraction;principlesand methods;binocularsubjectiverefraction;nearsubjectiverefraction • A ccommodationandpresbyopia:comfortablenearvision;the amplitude 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 • S litlampbiomicroscopy:methodsandpracticeofilluminationand observation; appearances of normal ocular tissues; clinical applications of biomicroscopy; use of vital stains • C linicalusesofdiagnosticdrugs:clinicalapplicationsofophthalmic diagnostic drugs – indications, contraindications and precautions for use; evaluation of effectiveness of various preparations • Intraocularpressuresandtonometry:measurementofintraocular pressure; applanation and indentation tonometry; non-contact tonometry; clinical applications of tonometry in practice • D irectophthalmoscopy:basicaspects;appearanceofnormalfundus and 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 • F undusbiomicroscopy:contactfunduslens;theHrubyandVolklenses and their principles and applications in clinical practice; fundus appearance with biomicroscopy • G onioscopy:principlesofmethods;typesofgonio-lenses,methodsof application; appearance of anterior angle by gonioscopy; abnormal signs in the anterior angle; three-mirror retinal evaluation • V isualfieldsandvisualfieldtests:Bjerrumscreen;visualfieldscreeners; principles and practice; perimetry – static and kinetic perimetry; automated perimetry; detection of visual field defects • M acularfunctions:varioustechniquestoassesstheintegrityand functionality of the macula, use of Amsler grid, photostress test, neutral-density filter test, colour comparison test and brightness comparison test • C ontrastsensitivityfunction:theoryandclinicaluseofcontrast sensitivity function, contrast sensitivity function curve, commercially available contrast sensitivity charts and systems; clinical significance and interpretations of contrast sensitivity function Specialized Care 46 Element 14 • C asehistorytakingandsymptomatology: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) • A dvancedOptometricInvestigation:principlesandclinicalapplications ofnewoptometricinstruments;suchasNerveFibreAnalyzer(NFA); Orbscansystem;IOLMasterandOpticalCoherenceTomography(OCT) • P rescriptiondecisions:aetiologyofrefractiveerrorsandtheinfluence of etiological theories on the refractive prescription and monitoring the refraction; relating the prescription to the occupational and other needs of the patient Optometry Specialties • G eriatricoptometry:anatomicandphysiologicalchangewithage; changes in visual functions with age; examining the aging patient; aphakia and pseudophakos; housebound or bedridden patient • A natomicandphysiologicalchangewithage:changesinocular structure with particular reference to retina and lens; development of cataract and age-related maculopathy; clinical implications of age related changes • C hangesinvisualfunctionswithage:effectsuponvisualacuity,colour vision, adaptation, contrast sensitivity, visual field; changes in binocularity • E xaminingtheagingpatient:effectsofcommonsystemicandocular disease; aims and goals of examination; amendments to routine to account for change in visual function • T hehouseboundorbedriddenpatient:optometricexamination;role of the optometrist in institutional care; domiciliary visits Specialized Care 47 PROFESSIONAL RESPONSIBILITIES ELEMENT 15 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 Enabling Sciences – topics to cover Applied Statistics and Research Methodology • R eferencejournalpapersandliterature:locating,critiquing,citing, reviewing and referencing • P rinciplesinvolvedinconception,design,conductandcompletion ofresearchprojects • Researchethics • Structuringaliteraturereview • Generatinghypotheses • Experimentaldesigns • Describinganddisplayingquantitativeandqualitativedata • Choosingandusingappropriatestatisticaltools • Interpretingandreportingstatisticaltestresults • Howscienceisdone;the“ResearchMethod”andalternativeviews • Developingskillsforprojectwork • Plagiarismanditsavoidance;citingsources • Ethicalissuesinresearch • T ypesofdata;displayingdata;averagesanddispersion;identifyingand handling outliers • Introductiontoprobability;characteristicsofnormaldistribution; sampling distribution of mean and standard error; degree of freedom • S amplesizeconsideration;nullhypothesis;experimentalhypothesis; error in hypothesis testing (type I and type II errors) • Definitionofpower;oneandtwo-tailedtests;conceptofpvalues • P arametricandnon-parametrictests;student’sTtest;Wilcoxontest, Mann-Whitneytests,KrustalWallistest;Chi-squaretest • P rincipleofindependenceofdata;correlation;researchquestions; experimental and non-experimental designs; random assignment; matched assignment • C ontrolgroups;placeboeffect;masking;prospectivevs.retrospective; longitudinal vs. cross-sectional; validity and reliability of data; repeated measures; sensitivity and specificity; false positive and negative • P opulationsandrandomsamples;samplingmethods;random, systematic and stratified sampling; external validity • Descriptiveresearch;surveysandquestionnaires;interviewtechniques Professional Responsibilities 49 Element 15 Project • D rawingrelevantinformationfromliteraturewithregardto research topics • Conscientiousandrationalpursuitofaresearchtopic • W rittenandposterpresentations:logicalandclearinterpretation, presentation and discussion of information and results; demonstration of deep understanding Psychology in Health Care • D evelopmentalissuesacrossthelifespan:majorstagesinhuman development and particular issues that are encountered within these stages Optometry Curriculum – topics to cover Practice Management • S tartingapractice:modesofpractice;businessplans;business registration; location; practice design; business registration and legal requirements • M arketing:strategiesandplans;consumerbehaviour;market segmentation; pricing strategies • A ccountingandtaxation:managingfinances;budgeting(capital budget, 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 • M anagementsystems:patientrecordmanagementsystem;inventory control system • Financialmanagement:financialreporting;managementreporting • Managingstaff:motivatingstaff;continuousdevelopment;appraisals • Estateplanning:goalsandstrategies;investment;MPF Professional Responsibilities 50 Element 15 Community Optometry • V ision-careprogramme:planning,organizingand conducting a vision-care programme in collaboration withanon-optometricorganization • R oleofoptometristsinthecommunity:asprimarycareproviders; their role in the prevention and modification of occupational problems • V isualscreening:developmentofvisualscreeningprogrammes; cost effectiveness of visual screening and its relation to incidence of disease; screening protocols and regimen; visual screeners • V isualhazardsandocularprotectioninoccupationsandsports:nature andtypesofoccupational/sportseyeinjuriesandtheirprevention; typesandusesofprotectiveeyewear;radiationhazardsinindustryand their prevention • V isualergonomicsandlighting:humanvisualcapabilitiesandanalysis of 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 • V isualdisplayterminal(VDT):thevisualdisplayunit,itsvisualdemands, its related eye problems, their causes and solutions Professional Studies • P atientrightissuesandmedicalethico-legalissuesinvolvingthe optometry profession, and other healthcare professions • E xploring,evaluatinganddevelopingone’sowncodesandstandards for practice • A nalysisofmedicalethico-legalissues,clinicaldecision-making and problem-solving • PromotingandadvancingtheOptometryprofession • Introductiontothelegalsystems • Biomedicalethics • Medicalnegligence • Consent • Confidentialityandprivacyissues • CodeofPractice • Professionalissues New Technologies • C urriculumshouldincludeprovisionsforupdatingstudents on new technologies and future developments. • T opicssuchasOCT,ultrasoundbiomicroscopy,electronic medical records. * Elements are accompanied by practical and clinical session Professional Responsibilities 51 World Council of Optometry 42 Craven Street London WC2N 5NG United Kingdom Tel: +44 20 7839 6000 Fax: +44 20 7839 6800 Email:[email protected] worldoptometry.org facebook.com/WorldCouncilOpt twitter.com/WorldCouncilOpt Registered charity number: 1133429 With thanks to the Brien Holden Vision Institute for supplying the images used in this document. www.brienholdenvision.org