Portland Community College | Portland, Oregon

Updating CCOG's so that teaching material does not overlap other courses in the program.

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.

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.

LENSOMETRY

• 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.

  INTERMEDIATE TONOMETRY

• 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.

RETINOSCOPY

• 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.

• Explain the use of the double spheremethod 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.

REFRACTOMETRY

• 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 rulesto 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 aphakiaand 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 Clipsand explain when/how they are used when over-refracting.

• Define presbyopia and list common symptoms.

• List estimated adds for each agefor each group of presbyopes.

• List the process for checking the patients near rangewith 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.

ADVANCED KERATOMETRY

• 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