What is the government agency that protects the privacy of patients?
HIPAA
"To keep the visual welfare of the patient uppermost at all times" is a statement from the AOA...
Code of Ethics
List the four elements of telephone courtesy.
1. Politeness
2. Kindness
3. Consideration
4. Respect for others
When taking a call from a patient for the optometrist, what should be attached to the message?
Patient Record
How do you treat a caller who is "shopping" for prices?
think of the caller as a potential patient
What should you do when scheduling a patient appointment?
offer two different appointment times
tell a new patient to arrive early to complete paperwork
Loss of vision, severe pain in the eye, and flashing lights are complaints that should be handled as what category of triage?
Emergency
Define Triage.
determining the priority of the patients complaints
Define Recall
the use of a letter, card, e-mail, or phone call to notify a patient of a need to schedule an appointment
what is the simplest and most widely used method of filing?
alphabetical
What is the reason for close monitoring when ordering solutions and drugs?
if order too many, may expire before use
Define Accounts Payable.
Money which a company owes to vendors for products and services purchased on credit .
Define Accounts Receivable.
Money which is owed to a company by a customer for products and services provided on credit
What is money used mostly for postage due and small amounts of office supplies.
Petty Cash
When is the best time to discuss payment policies with a patient?
at the time of the first exam
Explain the difference between vision care and medical insurance coverage.
-vision care should be billed for routine eye exams, refractions and glasses
-Medical insurance should be billed if a patinet has a medical diagnosis, such as glaucoma, cataracts, or eye injury
Define Consultation Letter
a letter sent to another health care provider concerning a patient who is being referred
When medical records are requested, what must be signed by the patient or guardian if under 18 yrs old?
Records Release
Name the seven bones that form the orbit.
Sphenoid
Ethmoid
Lacrimal
Frontal
Maxilla
Palatine
Zygomatic
List the three basic functions of the eyelids.
1. Protect the eye
2. Replenish and spread tear film evenly across the surface fo the eye
3. Regulate the amount of tear fluid in the eyes.
What is rapid forceful closre of the eyelids that protects the eye from foreign bodies and excessive light called?
Reflex blinking
What is the measurement for the palpebral fissures? (the space between the eyelids)
10 mm
Define Blepharospasm.
A condition in which the lids are so tightly closed they cannot be opened.
Define Ptosis.
Drooping of the upper lid.
Define Entropion.
An inward turning of the lids, causing eyelashes to scratch the eye.
Define Ectropion.
The eyelid turns outward due to loss of elasticity of lid tissue.
What is the muscle responsible for eyelid closure?
Obicularis Oculi
What muscle is responsible for eyelid retraction?
levator palpebrae superioris
What causes internal hordeolum?
blockage of the Meibomian glands
What is the conjunctiva?
mucous membrane that covers the inside of the eyelids and the outside of the glode.
Define Conjuntivitis.
Inflammation of the conjunctiva
Define Goblet Cells.
Cells that produce mucus to aid in the stability of tear film.
Define Glands of Krause and Wolfring.
glands that produce the watery layer of the tear film in the conjunction with the lacrimal gland.
located in palpebral conjunctiva
produces about 5% of aqueous layer of tears
Define Glands of Zeiss.
Glands that produce oil to protect the eyelashes from drying out and becoming brittle.
Define Glands of Moll.
Sweat glands found in the lid margin
controls body temperature around the eyes.
Name the three layers of tear film.
1. Oily Layer-secreted by Meibomian glands
2. Watery Layer- produced by lacrimal glands, moistens and coats anterior surface of eye, washes dust and debris to help prevent scratches on the cornea
3. Mucin Layer- secreted by conjunctiva, coats outer layer of eyeball, acts as lubricant and vehicle to help watery layer adhere to or wet the eyeball.
List four functions of the lacrimal system.
1. Provide a smooth, optically clear corneal surface
2. Wash away debris and cellular waste
3. transport oxygen to the cornea
4. inhibit growth of bacteria
List in order the flow of tears through the lacrimal apparatus.
1. Lacrimal Gland
2. Lacrimal Ducts
3. Conjunctival Sac
4. Puncta
5. Canaliculi
6. Lacrimal Sac
7. Nasolacrimal Duct
Function of the Lacrimal Gland.
95% of aqueous layer of tears
located under frontal bone at upper and outer angle
Function of the Lacrimal Ducts.
Moves tears from eye into canaliculi by blinking
6-12 per eye
Function of the Conjunctival Sac.
collect and flow tears nasally toward medial canthus
located inferior fornix
Function of the Puncta.
small openings in nasal aspect of upper/lower lid margins
tears drawn from surface of the eye through puncta to canaliculi
Function of the Canaliculi.
small tubes that carry tears from puncta to lacrimal sac
Function of the Lacrimal Sac
collection point for tears
Function of the Nasolacrimal Duct.
carries tears into nasal sinuses, drain into throat
What are the fluids or "humors" that help maintain the shape of the eye?
aqueous
vitreous
What is the function of the cornea?
refract light
Where does the cornea receive oxygen and nutrients from?
the fluid in front and behind it
conjunctival blood vessels
List three conditions that could cause corneal neovascularization.
1. edema
2. inlfammation
3. inadequate tear film oxygen content
List the layers of the cornea.
Epithelium
Bowman's Membrane
Stroma
Descemet's Membrane
Endothelium
Define Keratoconus.
a condition in which the cornea thins and bulges forward
what is the term used to describe the "white of the eye"?
Sclera
What is subconjunctival hemorrhage?
pooling of blood between the conjunctiva and episclera
What muscle causes the pupil to constrict in bright light?
sphincter muscle
What muscle is responsible for opening the pupil in dark conditions?
dilator muscle
Describe two major functions of the ciliary body.
1. produce aqueous humor
2. accommodation
What is the diagnosis for when the optic nerve damage is present because the rate of aqueous drainage is not equal to the production of aqueous?
Glaucoma
What is the type of drug used to paralyze accommodation?
cycloplegic
Define presbyopia.
loss of focusing ability that relates to the aging process
What two structures does the choroid lie between?
sclera
retina
What part of the retina is used when reading an eye chart?
macula
How many layers comprises the retina?
10
Explain the reason viewing color is more difficult in dim illumination.
Cones, which are responsible for color discrimination, are stimulated by light.
Describe the function of the eye's crystalline lens.
allows for accommodation (focusing on near objects)
Define Cataract.
cloudiness of the lens
At what point do the fibers from the nasal retina of each eye cross in the visual pathway?
chiasm
What type of visual field defect will be present if damage occurs to the chiasm?
bitemporal hemianopsia
List the 6 EOM's
Medial Rectus
Lateral Rectus
Superior Rectus
Inferior Rectus
Superior Oblique
Inferior Oblique
Define Convergence
an eye movement in which both eyes move toward the nose
What is optical infinity?
at a distance of 20 feet, or 6 meters, light rays are virtually parallel
What two factors influence the path of a light ray as it passes through a transparent medium?
Angle of incidence
index of refraction
what is the speed of light in a vacuum?
186,000 miles per second
through what type of glass will light travel the slowest?
flint glass because it has an index of refraction of 1.65
List some common facts about convex lenses.
-can be referred to as plus lenses
-it is thinner on the edges and thicker in the middle
-it causes light rays to converge
List some common facts about concave lenses.
-concave lenses minifies objects
-can be referred to as minus lenses
-it is thicker on the edges and thinner in the middle
-it causes light rays to diverge
What is the focal length of a 5 diopter lense?
20 cm
what is the average total power, front and back, of the cornea?
42.00 D
How many diopters does the corneal curvature measure on the keratometer?
44.00 D
What is the average power of the crystalline lens?
+18.00 D
Describe the relationship of the crytalline lens' ability to accommodate to the natural process of aging.
Amplitude of accommodation decrease with age
Define Anisometropia.
A condition of an unequal refractive state of the two eyes.
Define Aniseikonia.
A difference in image size caused by the refractive status of the two eyes.
Define Emmetropia
Parallel light rays are refracted by the unaided eye to focus on the retina
Define Amblyopia
Reduced visual acuity not correctable by refractive means
Define Astigmatism
Parallel light ras form two images in different meridians.
Define Myopia
Parallel light rays focus in front of the retina.
Define Ametropia
Refractive condition in which parallel rays of light do not focus on the retina.
Define Hyperopia
Parallel light rays focus behind the retina
Define Aphakia
Absence of the crystalline lens of the eye
Define Presbyopia
A reduced ability to accommodate that occurs normally with age.
What is acceptable treatment for physiologic myopia?
Minus lenses or contact lenses
Concave spectacle or contact lenses
contacts that steepen the cornea
Based on the average, non-accommodating eye with 60 D, a hyperopic eye with an optical power of 58.00 D would most likey be perscribed a spectacle lens with how much diopters of power?
+2.00 D
List four types of astigmatism.
1. mixed
2. simple
3. compound
4. irregular
what role does accommodation play in hyperopia?
a hyperopic person may not realize a visual problem exists because of the eye's ability to accommodate
What type of surgery is NOT a treatment for refractive error?
CRT
What is a disadvantage of reading glasses?
distance objects will be blurry when viewed through reading glasses
What lenses provide clear distance, near and intermediate vision?
Trifocals
What is the common term for amblyopia?
"lazy eye"
describe what a light ray will do when it strikes a surface at 90 degrees.
slow down
A 1.00 D lens will refract light rays to a focus of _______ from the lens.
1 meter
Which of the following lens powers has the shortest focal length?
2.00
3.00
1.50
1.00
3.00
What is the term for the pointed tip of a prism?
Apex
Light rays passing through a prism will be bent toward the apex or the base?
base
what unit of measurement is prism power measured by?
prism diopters
A 1 diopter prism will displace an image ____ cm for every ____ m of distance.
1 cm
1 m
describe the difference between a spherical lens and a cylindrical lens.
a spherical lens deviates rays of light in the same direction.
a cylindrical lens deviates rays of light in more than one direction
Define Biconcave.
both surfaces are concave
Define Biconvex
both surfaces are convex
Define plano convex
one plano surface, the other surface convex
Define Plano concave
one plano surface, the other surface concave
Define Meniscus
one concave surface, the other surface convex
which lens type is mostly used in phthalmic perscriptions?
Meniscus
A spherocylindrical lens has two powers located how many degrees apart?
90 degrees
transpose the following RX into a minus cylinder perscription...
-4.00+1.25x135
-2.75-1.25x045
What is the spherical equivalent for...
-2.00-1.00x100
-2.50
what rule states...induced prism is equal to the lens power multiplied by the displacement in centimeters
Prentice's Rule
How does the optical lab avoid induced prism?
decentration
What decentration is required if a frame PD is 60 mm and the patient's PD is 58mm?
2 mm each lens
What is the total near power for the following Rx?
+2.00-1.00x100 Add +2.50
+4.50-1.00x100
What three characteristics must be considered in the design of an ophthalmic lens?
thickness
chromatic aberration
weight
What is the manufacturing standard for glass lenses according to the American National Standards Institue (ANSI)?
the lens must be heat or chemically tempered
List three advantages of CR-39 lenses over glass lenses.
lighter
do not fog as easily
tinting is more uniform and can be manipulated
produce less glare and internal reflections
improve visual performance
List three advantages of CR-39 lenses over glass lenses.
Glass lenses do not scratch as easily
thinner because the index of refraction is high
they do not warp as easily as CR-39
why is polycarbonate a good choice of lens material for children and monocular patients?
polycarbonate is more impact resistant than crown glass and CR-39
What is the material used to make high-index plastic lenses?
Polyurethane
What factors must be considered in order to dispense the thinnest lens possible?
frame size
lens material
aspheric design
center thickness
What is the ANSI Standard for drop-ball testing in dress eyewear?
lenses must withstand the impact of a 5/8-inch steel ball dropped from a height of 50 inches.
What is the ANSI Standard ofr drop-ball testing for industrial safety glasses?
Lenses must withstand the impact of a 1-inch steel ball dropped from a height of 50 inches.
Name two methods of treating glass lenses for impact resistance.
heat tempering
chemical tempring
What type of PD is measured when fitting progressive addition lenses?
monocular
What is an identifying factor of an executive or Franklin bifocal?
A large ridge that runs across the entire width of the lens
what is the most likely intermediate power if the near power is +3.00?
+1.50
What types of patients might require a balanced lens?
a patient with a prosthetic eye
a patient who is blind in one eye from advanced glaucoma
What type of patient might require a Fresnel Press-On lens?
an aphakic patient who has had surgery on one eye only
If the distance PD is 64 and the near PD is 60, what is the seg inset?
2 mm
Describe a gradient tint.
A gradient tint lightens toward the bottom of the lens.
When focusing the eyepiece of a lensometer, why is it important to stop turning the eyepiece when a sharp focus is first obtained?
turning the eyepiece past the point of focus could cause accommodation.
If the lensometer is in proper calibration, and the eyepiece is properly focused, the target will come into a sharp focus without a lens present at what setting?
zero
When the lensometer was calibrated, the target focused sharply at +0.25 and was blurred at zero. You are neutralizing a lens and have a reading of +1.00 on the lensometer. How would you record this reading?
+0.75
If both sets of lines making up the target sharply focus at the same time, the lens being neutralized is what type of lens?
sphere
If the two sets of lines in the target will not come into focus at the same time, the lens being neutralized is what type of lens?
spherocylinder
The cylinder lines will focus at a more _______ power reading than the sphere lines when neutralizing a lens in minus cylinder.
minus
If the spere lines are focused and unbroken at +3.00, axis 090, and the cylinder lines focus at +1.00, how would the prescription be recorded?
+3.00 -2.00 x 090
If the sphere lines are focused and unbroken at -1.00, axis 100, and the cylinder lines focus at -1.50, how would the prescription be recorded?
-1.00 -0.50 x 100
When measuring a lens in minus cylinder, if the cylinder lines focus at a more plus reading than the sphere lines, you should rotate the axis wheel by how many degrees?
090 degrees
If the vertical target lined in the distance prescription focus at -2.00 and the same lines focus at +0.50 in the near segment of the lens, the newar power should be recorded as what?
+2.50
An imprtant factor in measuring lenses with an automated lensometer is keeping the lens _____ against the lens stop.
flat
What must be accounted for when measuring prism?
-the patients PD
-the orientation of the prism
-the location of the lateral PRP or MRP
Define frame eye size, or "A" dimension
the largest horizontal measurment
Define "B" dimension
the largest vertical measurement
Define Distance between lenses or "DBL"
the seperation of the two lenses in a frame at the nasal bevel tips
Define Bridge Size
same as DBL, the seperation of the two lenses in a frame at the nasal bevel tips
of the following which has the least amount of power in the vertical meridian?
+2.00-0.50x180
+1.50-1.00x180
+1.50-1.00x180
Of the following which should be measured first when verifying vertical lens positioning, or measuring the amount of vertical prism in the spectacle?
+2.00-0.50x180
+1.50-1.00x180
+2.00-0.50x180
When tapping a glass lens with your fingernail, the sound will be ____ than the _____ sound of a plastic lens.
sharper, dull
What is a lens clock used for?
measure the surface powers and base curve of the lens
True or False? A polycarbonate lens should be treated with a UV coating to avoid damage to the eye from UV radiation.
False
The lens bevel used most commonly for low power lenses edged to fit into plastic and metal framesis called a what?
standard or V bevel
What does the fitting cross represent in the markings of a progressive lens?
the position of the pupil on the lens
Rule for Proper Fit
the width of the frame from endpiece to endpiece should be approximately equal to the width of the facial bone structure just above the cheek bones.
Purpose
Keeps undue stress from being placed on the endpieces and hinges of the frame.
Rule for Proper Fit
the longer the face, the greater the vertical depth of the frame should be; the shorter the face, the smaller the vertical depth should be.
Purpose
Keeps the frame eyewire from touching the brow or cheek.
Rule for Proper Fit
the bridge of the frame should rest flat on the sides of the nose, evenly distributing the weight of the frame.
Purpose
Reduces red marks and broken skin caused by the misfit of the frame.
Rule for Proper Fit
the temple should extend 40mm behind the top of the ear and follow the contour of the face.
Purpose
Stabilizes the frame, allowing it to be held in place by touching, not pressure.
The temples pressing into the sides of the head can cause what?
the frame to be pushed down toward the end of the nose
To check for X-ing of the bridge, you must view the frame from what position?
the sides and the top
A frame that follows the curve of the face is said to have what form?
face form
Use of interpupillary distance rule to verify that the frame is even is know as what?
vertical alignment
four-point touch
Situation
The glasses are being pushed off the nose because the temples are pressing too tightly.
Frame Adjustment-widen the endpiece angles
Situation
One eyewire is closer to the face than the other.
Frame Adjustment-Equalize the endpience bends
Situation
The frame slides down the nose.
Frame Adjustment-Form the temple bend to a 45-degree angle at the top of the ear.
Situation
One eyewire is higher on the face than the other.
Frame Adjustment-Equalize the temple hinge angles.
What type of plier is used to Change the pantoscopic angle?
Wide-jawed hinge angling
What type of plier is used to Change the angle of the nosepads?
Pad-angling pliers
What type of plier is used for guard arm and endpiece bends?
Round-flat jawed
What type of plier is used to place tiny screws in hard to reach places?
Needle-nose
What type of pliers bends plastic and metal without marring the finish?
Nylon-jawed
List three nosepad angles that correspond to the slope of the nose
front angle
splay angle
vertical angle
The angle that gthe frame front makes when the temple is viewed from the side is known as what?
front angle
Describe the procedure used for adding a mastoid bend to a temple.
heat the temple behind the bend and make a depression in it with your thumb between the bend and temple end.
What will aid in the best cosmetic appearance of a lens?
use of anti-reflective coating
choosing a round lens shape
centering the eye in the center of the frame
What type of nosepad is the best choice for an elderly patient?
silicone
List three physical attributes of a child that can make frame fitting a challenge.
longer eyelashes
underdeveloped nose bridge
head is more round
eyes are closer set
The chief symptom should be recorded how?
In the patient's own words
What is the type of case history that is the easiest to delegate?
checklist
Why should the paraoptometric question the patient family history?
heredity may play a factor in may diseases, such as diabetes and high blood pressure
True or False? When recording patient history, only the positive responses are pertinent.
False
The first number or numerator of the Snellen notation represents what?
testing distance
In metric notation, 6/15 is the same as what?
20/50
What is the properly calibration height of the 20/200 letter on the Snellen chart for a testing distance of 13 feet?
58mm
Near vision acuities should be measured at a distance of what?
40cm
In an examination room shorter than 20ft, what can be used to create an optical 20 foot distance?
mirror system
Why is the color vision testing more effective if performed monocularly?
Acquired color vision defects are often monocular.
What is the most common type of color vision testing?
psuedoisochromatic plates
Define Deuteranomalous.
Green Weakness
Define Tritanomalous
Blue-yellow weakness
Define Protanomalous
Red Weakness
What is the most common of all color defects?
deuteranomalous trichromatism
Name three "near-point" actions of the eye.
accommodation, convergence, pupil constriction
When is the break point or NPC found?
the patient reports either diplopia or one eye loses fixation on the target
What is the test used to determine the presence of a tropia?
cover-uncover test (unilateral cover test)
How much difference in mm is the near PD from the distance PD?
3-5mm less
The systolic pressure reflects the amount of force on the artery walls when the heart does what?
heart beats
The keratometer measures approximatley how many mm of the central cornea?
3mm
The eyepiece of the keratometer should not be moved back and forth when focusing the cross, what will this cause if done?
stimulates the accommodative system, resulting in an incorrect setting
If the horizontal bars of the plus sign are not aligned, what must you do next?
rotate the axis grip
When recording the keratometry reading, the horizontal power reading is taken from the ________side of the instrument and the vertical power reading is taken from the _______side of the instrument.
left, right
True or False? A person with a low or normal pressure reading does not have glaucoma.
False. A person with a low or normal pressure reading could have low-tension glaucoma.
Describe the mire position when the cormea is properly centered and applanated?
the inner edges of the semicircles touch
Which tonometers have the advantage of being portable, fast and comfortable to hold?
Tono-Pen
What instrument is used to test visual acuity under different lighting conditions?
Brightness Acuity Tester
The Potential Acuity Meter is used to determine the potential acuity of a patient who has what occular disease process?
Cataracts
The fundus contains the ______, _______, and the _________.
retina
optic disk
retinal vessels
What type of ultrasonography is used to determine the length of the eyeball.
A-scan
Corneal topography measurements should be performed when?
prior to a refractive procedure such as LASIK.
A pachymeter is used for what?
measure corneal thickness
True or False? In order for GDx or HRT to be performed, the patient must have dilating eyedrops instilled.
False
The extent of monocular visual field measures....
60 degrees superiorly
75 degrees inferiorly
105 degrees temporally
60 degrees nasally
The horizontal and vertical meridians intersect perpendicularly at the center point of fixation, seperating the visual field into what?
four quadrants
True or False? Every patient tested should have a nonseeing area in his/her field of vision.
True
Evaluation of the visual field with a moving target is called what?
kinetic testing
Confrontation testing should be performed at what test distance?
2 feet
A tangeant sceen visual field performed at 1 meter measures how many degrees of the visual field?
30 degrees
Define Goldman Bowl Perimeter
Fixation is monitored with a viewing telescope
Amsler Grid
Tests the central visual field
patients can use this at home to monitor progressive changes
Automated Perimeter
Allows accurate testing of both the central and peripheral visual fields
Describe an Arc Perimeter
Rotatable, semicircular arc of 180 to 200 degrees
Describe Autoplot Tangent Screen
the use of a projected light target that is controlled by a handle on a pantograph
Describe a Tangent Screen
A black or gray matte-finished cloth, such as felt or velvet
Describe Harrington Flocks Screener
Flashes simple abstract patterns of dots and crosses.
