# Certified Paraoptometric Assistant Review Course CPOA.

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Certified Paraoptometric Assistant Review Course CPOA

American Optometric Association Paraoptometric Section Ophthalmic Optics & Dispensing (20%)

American Optometric Association Paraoptometric Section Prescriptions  Components  Sphere, cylinder, axis  Add power  Prism  Prism base direction  Ordering

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

American Optometric Association Paraoptometric Section Prescriptions: Optical Cross Optical Cross Example + 3.00 + 5.00 Plus cylinder notation: +3.00 +2.00 x 090 Minus cylinder notation: +5.00 -2.00 x 180 Hint: The sphere is “married” to the axis; the cylinder is the distance between the numbers on the cross

American Optometric Association Paraoptometric Section Prescriptions: Transposition Transposition Combine the sphere and cylinder power mathematically Change the sign of the cylinder Change the axis by 90 degrees Hint: When combining positive and negative numbers, think in terms of money. Example: -2.00 combined with +0.50 If you are \$2.00 “in the hole” and you deposit \$0.50, what is your balance? Answer: \$1.50 “in the hole”, or -1.50.

American Optometric Association Paraoptometric Section Prescriptions: Transposition -1.00 +2.00 X 160 +1.25 -0.75 x 030 Plano +1.00 x 090 +1.00 -2.00 x 070 +0.50 +0.75 x 120 +1.00 -1.00 x 180 Transposition Examples

American Optometric Association Paraoptometric Section Prescriptions: Decentration Decentration calculations Eye size plus distance between lenses minus patient’s PD divided by 2.

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

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

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

American Optometric Association Paraoptometric Section Prescriptions: Prentice’s Formula Prentice’s Prism Formula – if the patient is not looking through the optical center of the lens that has power, they are looking through prism Optical CenterInduced Prism

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

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

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

American Optometric Association Paraoptometric Section Prescriptions: Focal Length Calculations Formula: f (in meters) = 1/D Focal length in meters (f) = 1 / D (reciprocal of power in diopters) Example: The focal length of 2.00 D lens: f = 1 / 2.00 D f =.5 meter

American Optometric Association Paraoptometric Section Prescriptions: Light Rays Rays move from left to right Converging Rays Diverging Rays

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

American Optometric Association Paraoptometric Section Prescription: Prism Displaces light Light bends toward base, Image displaced toward apex

American Optometric Association Paraoptometric Section Lenses: Convex & Concave Plus lenses – prisms stacked base to base Minus lenses – prisms stacked apex to apex

American Optometric Association Paraoptometric Section Lenses: Forms Biconvex  Equiconvex  Planoconvex  Biconcave Equiconcave Planoconcave  Meniscus Plus Minus

American Optometric Association Paraoptometric Section Lenses: Index of Refraction Definition: A comparison, or ratio, of the speed of light in air to the speed of light in another medium Values  Speed of light in air: 186,000 mps  Air= 1.00  Water= 1.33

American Optometric Association Paraoptometric Section Lenses: Index of Refraction Index of refraction (n)= Speed of light in air/speed of light in material

American Optometric Association Paraoptometric Section Lens Materials: Glass Crown glassIR: 1.52 Flint glassIR: 1.65 Hi-Index glassIR: 1.9 Advantages: More scratch resistant, clearer optics Disadvantages: Heavier, less impact resistant

American Optometric Association Paraoptometric Section Lens Materials: Plastic CR-39IR: 1.49 Hi-Index plasticIR: 1.54-1.60 Advantages: Lighter weight, more impact resistant compared to glass, easily tinted Disadvantages: More prone to scratches, less ultra-violet (UV) protection on untreated lens

American Optometric Association Paraoptometric Section Lens Materials: Polycarbonate PolycarbonateIR: 1.54-1.60 Advantages: Lighter weight, more impact resistant compared to plastic, naturally filters UV light. Disadvantages: More prone to scratches, chromatic aberration

American Optometric Association Paraoptometric Section Lens Materials: Trivex™ Trivex ™IR: 1.53 Advantages: Lightest material available; less distortion; as impact resistant as polycarbonite, highly resistant to cracking around holes when used in drill mount frames; quality optics; natural UV protection. Disadvantages: Cannot be tinted darker than #2

American Optometric Association Paraoptometric Section Lenses: Coatings Scratch Resistant Anti-Reflective Ultra-Violet Mirror

American Optometric Association Paraoptometric Section Lenses: Tints #1- lightest Transmission 65-80% (greatest) #2 45-60% #3- darkest Transmission 15-40% (least) Polarized Photochromatic Glass and plastic

American Optometric Association Paraoptometric Section Frame Types Styles Materials

American Optometric Association Paraoptometric Section Multifocals Basic types and styles Add and Intermediate powers Jump (prism)

American Optometric Association Paraoptometric Section Frames: Multifocal Placement Trifocal Seg HeightBifocal Seg Height

American Optometric Association Paraoptometric Section Frames: Parts & Verification Verification Eyewire size Bridge Temple length

American Optometric Association Paraoptometric Section Dispensing -Frame Alignment Front- Xing Coplanar Face form - positive and negative Nose pads - frontal, splay, vertical

American Optometric Association Paraoptometric Section Dispensing Fitting Standard alignment Adjustment Pliers Pad angling Needle nose Round-Flat jawed Angling

American Optometric Association Paraoptometric Section Common Frame Adjustment Problems - Vertex Distance Increase vertex- bend both end pieces in Decrease vertex- bend both end pieces out Increasing vertex distance effectively raises multifocal height and vise versa

American Optometric Association Paraoptometric Section Changing Height or Vertex Distance Move pad arms up will raise height of frame Move pad arms down will lower height of frame Lengthening pad arms will increase vertex distance Shortening pad arms will decrease vertex distance

American Optometric Association Paraoptometric Section Adjustment Problem Unequal Vertex Distance Unequal temple spread Decrease temple spread on side that is closer (In - In) Increase temple spread on side that is farther from face (out - out) Unequal temple tension and bends behind ears

American Optometric Association Paraoptometric Section Adjustment Problems Crooked Frames One eyewire higher: bend the temple up on that side to lower One eyewire lower: bend the temple down on that side to raise

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

American Optometric Association Paraoptometric Section Basic Procedures (20%)

American Optometric Association Paraoptometric Section Interpupillary Distance Measurement Distance and near PD measuring ruler Pupillometer Monocular PD measurement 1234567 1st measurement 60 mm 1234567 2nd measurement 64 mm

American Optometric Association Paraoptometric Section Near Point of Convergence Measure of the ability of both eyes to work together Blur/Break/Recovery Measured in centimeters from the bridge of the nose to the point of blur/break

American Optometric Association Paraoptometric Section Near Point of Accommodation Ability of the eyes to focus at near Binocular measurement Amplitude of accommodation Binocular or monocular measurement Distance measured in cm

American Optometric Association Paraoptometric Section Extra-Ocular Muscle Testing Pursuits Movement of the eyes while following a moving target Saccades Jumping movements from one target to another

American Optometric Association Paraoptometric Section Cover Test Assess heterophoria and heterotropia Two separate tests - unilateral and alternate Tests are performed at distance and near Unilateral test is performed first

American Optometric Association Paraoptometric Section Unilateral Cover Test Determines heterophoria or heterotropia Heterophoria=tendency Heterotropia=constant Determines frequency (constant or intermittent) Unilateral or alternating

American Optometric Association Paraoptometric Section Alternating Cover Test Determines the direction and magnitude of the tropia or phoria Eso-in Exo-out Hyper-up Hypo-down Hyper EsoExo Hypo

American Optometric Association Paraoptometric Section Eye Dominancy Eye preference Eye used for monocular viewing or sighting Testing methods Reasons for recording Monovision contact lenses

American Optometric Association Paraoptometric Section Fusion/Suppression Fusion Blending of 2 images, one from each eye Suppression Subconscious inhibition of an eye’s retinal image Associated with strabismus

American Optometric Association Paraoptometric Section Pupillary Responses Assure that the sensory pathway is working Direct and consensual responses to light Response to accommodation

American Optometric Association Paraoptometric Section Pupillary Response: Recording Example #1 P= pupils are E= equal R= round R= react to L= light and A= accommodation -/+RAPD (relative afferent pupillary defect Example #2: 5mm/4mm 2+ (reaction time) R & R (round & reactive) -/+ RAPD (also called Marcus Gunn pupil)

American Optometric Association Paraoptometric Section Confrontation Fields Screening for gross visual field defects Comparison of examiners visual field (known) to the patient’s (unknown)

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

American Optometric Association Paraoptometric Section Ocular Symptoms Ask open ended questions Itching Burning Tearing Redness Irritation Blurred vision Other symptoms

American Optometric Association Paraoptometric Section Ocular History Rule out specific ocular problems or conditions Surgery Injury Vision training Eye medications Refractive history

American Optometric Association Paraoptometric Section Ocular History Rule out specific ocular problems and conditions, such as: Glaucoma Cataracts Keratoconus

American Optometric Association Paraoptometric Section Refractive History Refractive History Past history of corrective lenses Current corrective wear Age of correction State of correction Quality of vision

American Optometric Association Paraoptometric Section General Health History Rule out specific health problems Current health status Diabetes High blood pressure Heart disease Other

American Optometric Association Paraoptometric Section Medications Name Quantity Frequency Prescribed for Does the patient take the medication as directed?

American Optometric Association Paraoptometric Section Allergies Medications True allergies vs. side effects Environmental How does patient gain relief?

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

American Optometric Association Paraoptometric Section 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.

American Optometric Association Paraoptometric Section Visual Acuity: Techniques for Testing Monocular and binocular With and without Rx Distance and near Pinhole acuity Testing errors

American Optometric Association Paraoptometric Section Types of Acuity Charts Snellen Metric (Bailey-Lovie) Low Vision Charts Illiterate Charts Landolt “C” or rings Tumbling “E” Lighthouse charts

American Optometric Association Paraoptometric Section Color Vision  Types of color vision tests Pseudoisochromatic plates (PIP) Farnsworth D-15 Farnsworth 100 hue Nagel Anomaloscope

American Optometric Association Paraoptometric Section Pseudoisochromatic Plates (PIP’s)   Ishihara   14, 24, or 38 plates   Plate #1 can be read by anyone, even those with color defects

American Optometric Association Paraoptometric Section Pseudoisochromatic Plates (PIP’s)   Hardy-Rand Ritter (HRR)   Screening test to separate those with defective color vision from those with normal color vision   Classifies the type of defect   Indicates the extent of the defect (mild, medium, strong)

American Optometric Association Paraoptometric Section Farnsworth Dichotomous (D15)   Used to separate medium and strong color defect vs. normal TRITAN PROTAN DEUTAN REFERENCE CAP 1 2 34 5 6 7 8 9 10 1112 13 14 15

American Optometric Association Paraoptometric Section Patient color disk selection is shown in color, test results are plotted and diagnosis is recommended.

American Optometric Association Paraoptometric Section Farnsworth 100 Hue Test   93 Colored Discs   Tray   Scoring Template   Calculates a numerical score

American Optometric Association Paraoptometric Section Anomaloscope HMC Anomaloscope controlled by optional keypad and LCD display The software provides capability for data analysis and display.

American Optometric Association Paraoptometric Section Color Vision Classification Trichromatism Normal color vision Protanope Red deficiency Deuteranope Green deficiency Tritanope Blue-yellow deficiency

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

American Optometric Association Paraoptometric Section Stereopsis Highest degree of depth perception Purpose of test Types of stereo tests  Titmus stereo fly  Randot  Reindeer

American Optometric Association Paraoptometric Section Stereo Testing: Method for Testing Illumination Testing distance 40 cm (16 inches) Patient wears habitual Rx for near Recording- in seconds of arc

American Optometric Association Paraoptometric Section Exam Equipment Retinoscope Ophthalmoscope Biomicroscope (Slit lamp) Phoropter Keratometer Fundus Camera Optical Coherence Tomographer (OCT)

American Optometric Association Paraoptometric Section Special Procedures (17%)

American Optometric Association Paraoptometric Section Contact Lenses Verification Fitting Theories Modification

American Optometric Association Paraoptometric Section Contact Lenses - Related Ocular Problems GPC Keratitis Abrasion Pseudomonas Acanthoamoeba

American Optometric Association Paraoptometric Section Contact Lenses Gas Permeable Lenses Overall Diameter Optical Zone Diameter Back Vertex Power Base Curve Radius Peripheral Curves Edge and Center Thickness

American Optometric Association Paraoptometric Section Contact Lenses Gas Permeable Materials Silicone Acrylate Fluoro- Silicone Acrylate Rigid Polymethylmethacrylate-PMMA \

American Optometric Association Paraoptometric Section Soft Lens  Good initial comfort  Variable wearing time  Occasional wear  Ability to enhance or change eye color  Stability in sports Gas Permeable Clear, sharp vision Long-term comfort Stability/durability Ease of care Good ocular health Corrects small and large amounts of astigmatism Comparison of Soft and GP Lens Advantages

American Optometric Association Paraoptometric Section Daily wear Flexible wear Extended Extended wear Contact Lens Wearing Modalities

American Optometric Association Paraoptometric Section Soft lens care systems clean rinse disinfect & store protein removal Gas Permeable care systems clean rinse disinfect & store protein removal Lens Care Regimens

American Optometric Association Paraoptometric Section Blurred Vision – Soft Contact Lenses Residual astigmatism Switched lenses Inverted lens Coated lens Dry lens Poor fit Wrong prescription

American Optometric Association Paraoptometric Section Non-wetting lens surface Switched lenses Warped lens Poor optical quality Coated lens Poor fit Wrong prescription Blurred Vision – Gas Permeable

American Optometric Association Paraoptometric Section Soft Lenses Tear Poor edge Dryness Poor fit Dirty lens Gas Permeable Poor wetting surface Poor blend Bad edge Poor Lens Comfort

American Optometric Association Paraoptometric Section Adverse reaction to solutions Uncomfortable edge Wrong solutions used on lenses Foreign body Excessive movement Improper application Redness

American Optometric Association Paraoptometric Section Contact Lenses Wearing Schedules Soft lenses- 4-6 hours plus 2 each day to full time wear Gas Permeable lenses- 4 hours plus 1-2 each day to full time wear

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

American Optometric Association Paraoptometric Section Instrumentation-RGP

Special Lens Designs and Uses Ballast Truncation Tints Toric Bifocal

American Optometric Association Paraoptometric Section Tonometry Applanation Indentation Risk factors for glaucoma Diurnal variation

American Optometric Association Paraoptometric Section Tonometry Measurement of Intraocular Pressure (IOP) Tonometer Indentation- Schiotz Applanation- Goldmann; Tonopen Non Contact

American Optometric Association Paraoptometric Section Tonometry Indentation (Schiotz) Applanation (Goldmann)

American Optometric Association Paraoptometric Section SPECIALTY TESTING Keratometry Measurement of corneal curvature Vertical and horizontal meridians Measures a 3mm area of central cornea Keratometers; Ophthalmometers Mires; plus and minus signs

American Optometric Association Paraoptometric Section Clinical Procedures Keratometry Corneal astigmatism With-the-rule/Against-the-rule Oblique Regular or irregular Javal’s Rule

American Optometric Association Paraoptometric Section Manual Keratometry + + Starting Point End Point + +

American Optometric Association Paraoptometric Section Recording K Readings O.D. 42.50 @ 175; 43.50 @ 085 O.S. 43.00 @ 005; 43.75 @ 095 O.D. -1.00 x 175/O.S. -0.75 x 005

American Optometric Association Paraoptometric Section Ophthalmic Ultrasonography A-Scan Determines the position and the distance between the structures of the eye (axial length) B-Scan Detects the position and size of abnormalities within the eye

American Optometric Association Paraoptometric Section Visual Field Testing Importance of patient education Review of visual pathway Classification of defects

American Optometric Association Paraoptometric Section Classification of Visual Defects Nerve Fiber Layer Optic ChiasmOptic Tract to Visual Cortex Arcuate ScotomaHeteronymous Bitemporal Hemianopsia Homonymous Hemianopsia Paracentral Scotoma Congruent Nasal StepIncongruent

American Optometric Association Paraoptometric Section Monocular Visual Field Boundaries 60 Degrees superiorly 75 Degrees inferiorly 105 Degrees temporally 60 Degrees nasally

American Optometric Association Paraoptometric Section Physiological Blind Spot 15 Degrees temporal to fixation Absolute scotoma

American Optometric Association Paraoptometric Section Types Of Visual Field Testing Confrontation Tangent Screen Amsler Grid Goldmann bowl perimeter Automated

American Optometric Association Paraoptometric Section Other Visual Field Tests Harrington Flocks screener Arc Perimeter Auto-Plot

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

American Optometric Association Paraoptometric Section Sphygmomanometry (Blood Pressure Measurement) Incidence of hypertension Systolic The maximum pressure in the artery Diastolic The lowest pressure in the artery

American Optometric Association Paraoptometric Section What Influences Blood Pressure? Activity (or lack of…) Temperature Diet Emotional state Posture Physical state Drugs

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

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

American Optometric Association Paraoptometric Section How Is The Test Performed? Continue releasing the valve The pulse will disappear Record this number This is the diastolic pressure Release the rest of the air and remove the cuff

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

American Optometric Association Paraoptometric Section Low Vision Define legally blind 20/200 BCV or less than 20 0 VF in best eye Microscopes and magnifiers Large Print Materials Training Psychological impact – patient motivation

American Optometric Association Paraoptometric Section Surgery Refractive PRK LASIK LASEK Cataract Glaucoma Laser

American Optometric Association Paraoptometric Section Refractive Status of the Eye and Binocularity (13%)

American Optometric Association Paraoptometric Section Refractive Status Of The Eye

American Optometric Association Paraoptometric Section Refractive Status Of The Eye

American Optometric Association Paraoptometric Section Refractive Status Of The Eye

American Optometric Association Paraoptometric Section Refractive Status Of The Eye

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

American Optometric Association Paraoptometric Section Presbyopia Reduction in the ability to accommodate Occurs normally with age Reduction in lens elasticity Reduction in strength of the ciliary muscle

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

American Optometric Association Paraoptometric Section Refractive Conditions Aphakia Pseudoaphakia Anisometropia Aniseikonia Amblyopia

American Optometric Association Paraoptometric Section Aphakia Absence of the crystalline lens Cataract Most common cause of surgical removal of the lens Correction Intraocular lens implant (IOL) Contact lenses Spectacle lenses

American Optometric Association Paraoptometric Section Anisometropia Condition of unequal refractive state of the two eyes An- not; iso- same; metric- measure

American Optometric Association Paraoptometric Section Aniseikonia Difference in the size of the two retinal images Inherent and acquired

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

American Optometric Association Paraoptometric Section Types of Refractive Status Conditions Aphakia Anisometropia Aniseikonia Amblyopia

American Optometric Association Paraoptometric Section Basic Ocular Anatomy and Physiology (17%)

American Optometric Association Paraoptometric Section Orbital Bones Orbit Bony socket that contains the eye and most of the accessory organs Six bones Sutures Foramen Sinuses

American Optometric Association Paraoptometric Section Orbital Bones 1. Frontal bone 2. Ethmoid bone 3. Palatine bone 4. Zygomatic bone 5. Lacrimal bone 6. Maxillary bone

American Optometric Association Paraoptometric Section Anterior Adnexa 1. Upper eyelid 2. Lower eyelid 3. Lateral canthus 4. Medial canthus 5. Caruncle 6. Limbus 7. Iris 8. Pupil 9. Puncta 10. Sclera 11. Plica Semilunaris

American Optometric Association Paraoptometric Section Anterior Adnexa Eyelids Distribute the tear film across the front surface of the eye Protect the eye from light and debris Reflex blinking versus blepharospasm

American Optometric Association Paraoptometric Section Entropion

Ectropion

Ptosis

Adnexa: Lacrimal System Lacrimal gland Excretory ducts Superior punctum Inferior punctum Inferior canaliculus Nasolacrimal duct Lacrimal sac Nasal cavity Superior canaliculus

American Optometric Association Paraoptometric Section Tear Film Layers

American Optometric Association Paraoptometric Section Sclera (Fibrous Tunic) Opaque, white outermost layer of the eye Limbus- junction of the sclera and the cornea

American Optometric Association Paraoptometric Section Cornea & Anterior Chamber

American Optometric Association Paraoptometric Section Cornea First and most powerful refracting medium of the eye 5 Layers Epithelium (anterior) Bowman’s membrane Stroma (middle) Descemet’s membrane Endothelium (posterior)

American Optometric Association Paraoptometric Section Ocular Anatomy & Physiology The Globe/Three Spheres or “Tunics ” Fibrous Vascular Nervous

American Optometric Association Paraoptometric Section Uveal Tract (Vascular Tunic)

American Optometric Association Paraoptometric Section Crystalline Lens Nucleus Cortex Capsule Accommodation Cataract

American Optometric Association Paraoptometric Section Vitreous Gel like substance found in the eye (in the vitreous chamber). Helps to keep the shape of the eye.

American Optometric Association Paraoptometric Section Retina (Nervous Tunic) Macula Fovea Vein Artery Optic Disc Cup

American Optometric Association Paraoptometric Section Ocular Tunics Fibrous Tunic Vascular Tunic/Uveal Tract Neural Tunic CorneaChoroidRetina Macula/fovea Ora Serrata Episclera Sclera Ciliary body, Iris Rods & Cones Optic Nerve

American Optometric Association Paraoptometric Section Extraocular Muscles

American Optometric Association Paraoptometric Section Visual Pathway Optic nerve Optic chiasm Optic tract Lateral geniculate body Optic radiations Occipital lobe

American Optometric Association Paraoptometric Section Conjunctiva Translucent membrane that lines the inner surface of the lids (palpebral) and the outer surface of the globe (bulbar) Fornices- where the palpebral and the bulbar conjunctiva meet

American Optometric Association Paraoptometric Section Conjunctiva

Ocular Pharmacology Diagnostic agents Therapeutic agents

American Optometric Association Paraoptometric Section Ocular Pharmacology Mydriatic- dilates the pupil Miotic- constricts the pupil Cycloplegic- paralyzes the ciliary muscle Dyes or Stains- adhere to damaged or diseased cells of the cornea and conjunctiva

American Optometric Association Paraoptometric Section Ocular Pharmacology Routes of delivery Solutions Suspensions Ointments

American Optometric Association Paraoptometric Section Test Tips

American Optometric Association Paraoptometric Section How To Study Interactive Flash cards Notes Tape record notes Study groups Environment Scented candles Active learning Keep body and mind awake

American Optometric Association Paraoptometric Section Study Pace Study, break, review, preview, and study No more than two hours a one time Use travel time to study Record your notes

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

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

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

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

American Optometric Association Paraoptometric Section 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 Cecil B. DeMille (1881 - 1959)

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