CCOG for OMT 206 Spring 2023
- Course Number:
- OMT 206
- Course Title:
- Diagnostic Procedures I
- Credit Hours:
- Lecture Hours:
- Lecture/Lab Hours:
- Lab Hours:
Intended Outcomes for the course
Upon successful completion students should be able to:
1. Skillfully complete patient workup in a clinical setting.
2. Accurately perform and document the biomicroscopy and visual field examination, retinoscopy and refractometry in the clinical setting.
3. Efficiently and accurately perform applanation tonometry under supervision in a clinical setting.
Outcome Assessment Strategies
At the beginning of the course, the instructor will detail the methods used to evaluate student progress and the criteria for assigning a course grade. The methods may include one or more of the following tools: examinations, quizzes, homework assignments, research papers, laboratory modules, student participation and demonstration of competency.
Course Content (Themes, Concepts, Issues and Skills)
- Demonstrate proficiency in reading glasses: single vision torics, bifocals, trifocals, progressives, and its proper recording in a medical record.
- Demonstrate proficiency in marking the optical center and measuring the PD of glasses.
- Demonstrate measuring glasses with prism using the PCD, and calculating compound prism.
- Discuss the significance of vertex distance.
INTERMEDIATE VISUAL FIELDS
- Review and demonstrate Amsler grid, confrontational fields, tangent screen and automated visual field testing.
- List and describe manual techniques for testing the visual field including tangent screen, and Goldmann perimetry.
- Describe the use of an arc shaped perimeter for DMV fields.
- List automated methods for testing the visual field.
- Define: false positive, false negative, fixation losses and acceptable percentage for a quality field.
- Identify the indication for the following tests with the Humphrey Field Analyzer: Full Threshold vs. SITA Standard vs. SITA Fast. 30-2, 24-2, 10-2, 60-4, Superior 36, Superior 64, Esterman monocular/binocular test.
- Describe the process of the HFA for calculating the trial lens power for the test, and the proper position of trial lenses in the lens holder.
- Demonstrate calibration of the Goldmann perimeter, including both stimulus and background.
- Describe when corrective lenses are required and for which portion of the Goldmann perimetry procedure.
- Demonstrate plotting a peripheral and a central isopter, blind spot, and static check with a Goldmann perimeter.
- Distinguish the difference between static and kinetic field testing.
- Differentiate testing strategies for glaucoma and neurological examinations.
- Describe the procedure for confirming steps with respect for the horizontal or vertical meridian.
- Describe screening of possible malingering patient with tangent screen and expected results.
SLIT LAMP BIOMICROSCOPY
- Describe the history and evolution of the slit lamp biomicroscope.
- Describe two major styles of slit lamps.
- Define coaxial as it relates to the slit lamp.
- Differentiate magnification vs. illumination in isolating pathology with the slit lamp.
- Describe the procedure for properly setting each eyepiece of the slit lamp microscope.
- List 6 direct and 6 indirect forms of illumination with the slit lamp.
- Describe the use and technique for each of the following forms of illumination: diffuse, parallel piped, optical sectioning, tangential, conical beam, specular reflection, proximal illumination, sclerotic scatter, direct retro-illumination from the iris, indirect retro-illumination from the iris, retro-illumination from the fundus and iris transillumination.
- List the different filters available on the slit lamp and their usage.
- Describe the vital dyes and their usage when used with the slit lamp including: Fluorescein, Rose Bengal and Lissamine green.
- Describe when the Seidel test is used and how it is performed, and how it is documented.
- Describe when the Tear Break up Time test is performed and how it is documented.
- Describe accessory lenses available to use with the slit lamp microscope; why and how they should be used.
- Differentiate between direct and indirect gonioscopic lenses.
- Describe basic set-up and of the slit-lamp and basic procedure when scanning the eye.
- Utilize biomicroscopy to perform and document an anterior segment and ocular adnexa examination.
- Identify and document normal slit lamp findings.
- Describe the grading system to document abnormal slit lamp findings.
- Identify common terminology used to describe abnormal slit lamp findings.
- Demonstrate proficiency of estimating the anterior chamber using the Van Herick’s technique.
- Describe the differences in tonometers.
- Outline the advantages and disadvantages of each kind of tonometer.
- Explain how to use each tonometer.
- Decide which instrument to use to accomplish the measurement with greatest accuracy, efficiency, and least amount of discomfort to the patient.
- Discuss proper methods of cleaning and list 3 acceptable methods for disinfecting tonometers.
- Discuss technique for each method of tonometry: non-contact, Tono-Pen, Schiotz, pneumotonometer, hand-held tonometers, MacKay-Marg, I-Care tonometer and Goldmann applanation.
- Describe the proper end point image in Goldmann applanation tonometry.
- Identify the position of the mires (overlapping, separate, uneven, too thick, too thin…) and how it relates to pressure reading.
- Describe interpretation of the measuring dial of a Goldmann applanation tonometer in recording intra-ocular pressure.
- Describe and give the proper abbreviation of the units measured in tonometry.
- Describe the intra-ocular changes during the systole and diastole of the heartbeat.
- Describe the proper rotation of the tonometer prism head for patients with corneal cylinder of more than 3 diopters.
- Demonstrate the process of checking calibration of a Goldmann applanation tonometer in all three measurement ranges.
- Demonstrate checking calibration of TonoPen and proper measurement technique including replacement of OcuFilm tip covers.
- Demonstrate disinfecting each instrument.
- Perform and document applanation tonometry with a tono-pen and Goldmann.
- Describe the procedure for non-contact tonometry.
- Describe the procedure for indentation tonometry.
- Describe Schiotz tonometry including checking of calibration, cleaning and assembly.
- Describe when additional weights are required in measurement with Schiotz tonometers.
- Describe how central corneal thickness relates to measurement of intra-ocular pressure readings.
- Describe how intra-ocular pressure readings are converted for thick or thin corneas.
- List 3 types of patients contraindicated for tonometry.
- Review common glaucoma drops and possible side effects.
- Describe the history and evolution of the retinoscope.
- State and explain the principles of and indications for retinoscopy.
- Describe the mechanism and functioning of the streak retinoscope.
- Describe the various types of behavior of the retinoscopic streak.
- Explain the recording of retinoscopic results and transpose those results into sphero-cylinderical form.
- Perform retinoscopy on the human eye.
- Demonstrate appropriate maintenance of various retinoscopes.
- List at least 3 types of patients for whom retinoscopy is critical because refractometry cannot be performed.
- Describe the proper setup, with both phoropter and trial frames, for performing retinoscopy.
- Describe the reasons for both fogging the fellow eye and having the fellow eye un-occluded during retinoscopy.
- Describe proper sleeve position for both the Copeland type and Welch Allyn types of retinoscopes.
- Describe the purpose of using a working lens or subtracting working distance from the patients retinoscopic findings.
- Review the calculation of the working distance.
- List the steps performed when retinoscoping in plus cylinder.
- Determine the cylinder axis using various phenomena: Thickness, Intensity, Break/Skew phenomenon.
- Confirm the axis using the “straddling the axis” technique.
- Review the use of the double sphere method in retinoscopy, and demonstrate.
- Practice scoping with a sciascopy lens rack and describe its indications.
- List the types of motion observed in patients with emmetropia, myopia, hyperopia and astigmatism.
- List the types of lenses used to neutralize motion in myopes, hyperopes and astigmats.
- Describe a method of confirming that neutrality has been achieved in retinoscopy.
- Describe techniques to avoid reflection/artifacts when scoping.
- Give estimated spherical refractive errors for patients with visual acuities of: 20/80, 20/200, 20/400, and worse than 20/400.
- Explain how keratometry findings can help in finding proper correction of axis in retinoscopy.
- Describe a retinoscopic reflex in patients with high refractive error.
- Differentiate between refraction and refractometry.
- Define emmetropia, ametropia, hyperopia, myopia and astigmatism.
- Describe symptoms of myopes, hyperopes and astigmats.
- Identify all knobs, dials and parts of the phoropter.
- List the five main steps in refractometry.
- List at least 5 rules to use during refractometry.
- Describe the proper use of the Jackson Cross Cylinder in testing both cylinder axis and power (in plus cylinder).
- Describe the 4-Step Test when looking for cylinder power when spheres alone do not correct vision adequately.
- Describe the astigmatic clock and its usage.
- Describe the duochrome test and its usage in preventing over-minusing.
- Describe the principle of binocular balancing and how it is performed.
- Describe the principle of the fogging technique and how it is performed.
- Describe prism dissociation method and how it is performed to balance a refraction.
- Define aphakia and pseudophakia.
- Describe techniques to use with aphakic patients.
- Describe trial frames and loose lenses distinguish how refractometry with these is different than that with a phoropter.
- Define vertex distance and explain when/how it is measured in performing refractometry.
- Define Halberg Clips and explain when/how they are used when over-refracting.
- Define presbyopia and list common symptoms.
- List estimated adds for each age for each group of presbyopes.
- List the process for checking the patients near range with adds in place.
- List three methods of measuring amplitude of accommodation.
- Describe subjective and objective methods of measuring refractive error.
- Explain the refinement technique using a cross cylinder lens.
- Describe the difference between manifest and cycloplegic refractometry and indications.
- List and review mydriatic and cycloplegic drops.
- Describe the history of the keratometer.
- Demonstrate proficiency in reading K’s.
- Identify the benefits of keratometry in contact lens fittings, retinoscopy and refractometry.
- Demonstrate extending the range of the keratometer
- Collect a proper ophthalmic history on a patient with strabismus, amblyopia, new onset of diplopia (due to trauma, CN palsy).
- Describe the tests for sensory fusion: stereo tests, worth 4 dot, haploscopic devices, the red lens test.
- Define NPA and NPC
- Distinguish between ductions, versions and vergences; describe function and anomalies.
- Fusional convergence amplitudes.
- Discuss the significance of primary and secondary deviations.
- Identify 6 cardinal positions of gaze
- Distinguish between a phoria and a tropia
- Properly document ophthalmic deviations
- Describe the following strabismus measuring techniques: Hirschberg, Krimsky, prism and cover, Maddox rod.