Certified Paraoptometric. Certified Paraoptometric Review Part II. Certified Paraoptometric

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1 Certified Paraoptometric Review Part II Stacie Layne Virden, O.D. Therapeutic Optometrist Glaucoma Specialist Certified Paraoptometric Certified Paraoptometric Certified Paraoptometric Exam Abbreviated CPO A person who has attained national recognition via certification by demonstrating an understanding of the concepts used in optometric care The CPO has demonstrated competence by a didactic examination and is on-the the-job trained. How To Study Become interactive with material flash cards* notes tape record notes study groups Study environment floral scented candles or potpourri facilitates learning (strange but true) wake up your body, wake up your mind - walk, sit on edge of chair Certified Paraoptometric Exam Certified Paraoptometric Exam How To Study Study pace - preview material, study, break, review Do not study for more than 2 hours at a time Use travel time to study - use tapes Test Taking Tips Get plenty of rest the night before - important in this meeting environment. Arrive a little early for test- look for test room today. A little anxiety is OK - it makes us perform better. Know the time limit and be aware of time throughout the test. Manage your time. Read the directions carefully. Make sure you know how to enter items on score sheet. 1

2 Certified Paraoptometric Exam Certified Paraoptometric Exam Test Taking Tips Realize there may be questions you do not know the answer to. There should not be many, but we tend to dwell on them. Your first impression for an answer is usually the best. Memory dump - at beginning of test write down the facts you want to remember. Make a mark at the margin on questions you want to return to. Multiple Choice Questions Essentially are true/false questions arranged in groups. Only one alternative is totally correct. Eliminate obvious false choices. Of remainder, pick the alternative that answers most fully all aspects of the question. Only change your first answer if you have a very good reason - i.e. read questions incorrectly. A Little Anxiety Is Okay Triage Triage First point of contact between patient and health care provider Staff s s primary duty is to determine if the patient has a true emergency If so, how does it compare with what is already happening in the office, and how soon can we get the patient in for care? Triage QUESTIONS TO ASK What kind of problem are you having? How long has it been going on? (onset/duration) Is it getting worse? (severity) Does it affect your vision? (associated symptoms) Does anything make it better? (relief) 2

3 What is? Health Information Portability & Accountability Act Defines penalties for healthcare providers who allow breaches to patients protected health information Penalties increase significantly Spring 2010 HIPPA Regulations (Federal Law) State Laws may also exist DoD Guidance (Military) also exist Accounting of disclosures only applies to events after April 14, 2003 Use and Disclosure Use: the sharing, employment, application, utilization, examination or analysis of Protected Health Information (PHI) within the covered entity Disclosure: the sharing or release of PHI in any manner outside the covered entity Required Disclosures When the individual patient requests it To secretary of HHS to determine compliance Office Privacy Act Responsibilities Establish and maintain procedures consistent with the Privacy Act Prepare and publish notice of the existence and character of those systems consistent with guidance by GSA Establish reasonable administrative, technical, and physical safeguards Maintain an account system of all disclosures for six years Permit individuals to have access to personal records Permit individuals to request records amendments 3

4 Privacy Rule This rule overlaps Privacy Act of 1974 Individuals have the right to receive an accounting of disclosures of PHI made by your office with the exceptions of: Treatment Payment Healthcare Operations Accounting must include disclosures made in the past six years of request date 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 Implementing Standards Identify those in your office who need access to PHI to do their job Front Desk Doctor s s Assistant CL tech Optician Insurance billing OK, EVERYONE! Implementing Standards Further identify anyone outside the office who may need access Ophthalmic Lens Lab Soft Lens Manufacturer Gas Perm Lens Manufacturer Frame Manufacturer Insurance Companies Implementing Standards Create policies and procedures for routine disclosures to achieve purpose of disclosure Limit the PHI disclosed by developing criteria Review requests on an individual basis against criteria Considerations Prior to Disclosure Patient notification before release Mutually agreed upon alternative communications Mutually agreed upon authorizations Potential or serious threat or imminent danger to patient or public Authority of requestor Minimum amount of information necessary for purpose Can information be de-identified Documentation of release 4

5 Requirements for Disclosure Request Documents Date of disclosure Name, address, and identity of requestor Brief description of PHI to be disclosed Brief statement of the purpose of the disclosure that reasonably informs the individual of basis for disclosure or copy of written request Verified identity of requestor Elements of Valid Authorizations Description of used/disclosed information Name of person authorized to make request Name of person to whom the requested use or disclosure An expiration date Signature of patient and date Statement that information may be subject to re-disclosure by the recipient, therefore, no longer protected under HIPPA Verification of requesting party Authorization must be written in plain English Prefixes, Suffixes, Root Words Prefixes, Suffixes, and Root Words Prefixes Suffixes Root words Direction terms O.D. - O.S. - O.U. The Ophthalmic Prescription Diopter The Ophthalmic Prescription Unit of measure for optical lenses. Based on physics that proves that a 1 diopter lens will focus parallel light at 1 meter. Can be measured for plus lenses for farsightedness, or for minus lenses for nearsightedeness 5

6 The Ophthalmic Prescription The Ophthalmic Prescription 1 meter 1 meter Components of a lens prescription Sphere, cylinder, axis Add power Prism + 1 D Ex x BI, 0.75 BU Sph 2 BI, 0.75 BD D The Ophthalmic Prescription Lensometer Instrument used to measure the power in a lens May be manual or automated Ophthalmic Lenses Ophthalmic Lenses Types of Lenses Ophthalmic Lenses Bifocal Lenses (FT-28, D-28) Trifocal Lenses (Executive) Single vision Spherical Planocylindrical Spherocylindrical Multifocal Bifocal, trifocal, progressive addition 17mm 28mm Distant Viewing Zone Intermediate Viewing Zone 7mm Progressive Addition Lenses Near Viewing Zone Aberration Zones 6

7 Ophthalmic Lenses Lens Materials Glass Plastic (CR-39) Polycarbonate or Trivex High index Frame Anatomy Frame front Eyewire Bridge Hinge Nosepads Temples Frame size & measurements Boxing system A dimension B dimension Effective diameter Distance between lenses Boxing System Frame Materials ED DB L A B Metal Nickel composite Titanium Bendable Metal Precious Metals Plastic Zyl Acetate Technology Materials Carbon Fiber Ceramic Natural Materials Wood Horn / Bone Leather 7

8 Frame Selection Frame Selection Frame fit is most important Frame width equal face width Longer face, deeper the frame can be Bridge fit important Temples need to be long enough for a proper bend Cosmetic concerns Can t t teach taste Basic Facial Shapes Cosmetic Criteria Fitting Shapes Fitting Suggestions Oval Normal May wear most any type Oblong Long Face Deep frame Low temple attachment Contrasting Round Shapes Wide Face Narrow frame Square High temple attachment Base down triangle Inverted Triangle Diamond Erect (basedown triangular face Inverted (base up) triangular face Contrasting Shapes Fit to largest part of lower facial area Dark colors or bolder looks Unobtrusive frame (metal or rimless) Light or medium weight frame Lighter color Round lens shape Delicate characteristics of frame for women Frame Selection Lens Selection Options Pupillary distance measurement OC height Seg height Ordering Pupillary Distance st measurement 60 mm Pupilometer 2nd measurement 64 mm Bifocal Seg Height Trifocal Seg Height 8

9 Jones Optical 5209 South Penn Oklahoma City, OK Patient Jane Doe Date 2/23/01 SPH CYL AXIS PLASTIC DEC PRISM GLASS /2 Δ BU SV FDA Tested /2 Δ BD RND Seg Ht. Width Pup Dist EXEC Insert Total LENT A ST 28 TRIFOCAL D D OTHER Set Lens Shape Edge Colour Rimless Grove PINK 1 F.P.D. A B ED LOC UNCUT Drill Metal GREEN 1 ZYL GRAY 1 F R Size BDG Temp Style Color BROWN 1 A Safilo Gray OTHER: 1 M E GRADIENT TO Lite Titanium 109 OT30 S ACCT: REMARK SUPPLY TRAY# RX LENS $ MISC TAX TOTAL DATE INVOICE Clear Basic Frame Adjustments Fitting triangle Frame height Vertex distance Face form Pantoscopic angle Retroscopic angle Temple adjustment : Pantoscopic Angle Correct 4 mm Optical center Wrong Basic Adjustments: Fitting Triangle Optical center Contact Lenses Contact Lenses Soft contact lenses Rigid contact lenses Care & handling Patient education 9

10 Contact Lenses Contact Lenses Soft Contact Lenses Rigid Contact Lenses Contact Lenses Contact Lens Design Overall Diameter (OAD) Parameters Base curve radius Lens power Overall diameter Optical zone diameter Peripheral curves Edge & center thickness Tint Ordering Optical Zone OZ Secondary Curve (SC) Peripheral Curve (PC) Secondary Curve Width (SCW) Peripheral Curve Width (PCW) Contact Lens Design Tri-Curve Contact Lens Design Center Thickness (CT) PCW SCW JUNCTION JUNCTION Edge Shape Optical Zone (OZ) Base Curve (BC) Secondary Curve (SC) Peripheral Curve (PC) OAD OZ Overall Diameter (OZ) SCW PCW JUNCTION JUNCTION OAD = Overall Diameter OZ = Optical Zone PCW = Peripheral Curve Width SCW = Secondary Curve Width 10

11 Ordering CONTACT LENS ORDER FORM Patient Name: John Doe Specifications Ordered Specifications Verified Date 2/23/01 Date O.D. O.D. O.S. O.S B.C.R B.C.R S.C.R./W 8.90 / /.3 S.C.R./W I.C.R./W I.C.R./W P.C.R./W / /.3 P.C.R./W O.Z.D O.Z.D. Dia Dia Power Power C.T C.T. Blend Med Med Blend Tint Blue Blue Tint Dot O.D. Verified by Additional Information Common Eye Disorders Accepted Rejected Returned for Credit Date Returned Reason for return/reorder Blepharitis Blepharitis Conjunctivitis Bacterial Conjuntivitis 11

12 Subconjuntival Hemorrhage Pinguecula Ptygerium Hordeolum (Sty) Hordeolum (Sty) Chalazion 12

13 Chalazion Chalazion Cataract Cataract Eye with mature cataract Anatomy of an eye with a cataract Normal Vision Vision With A Cataract Blurred Vision Double Vision 13

14 Cataract Cataract Eye without cataract Eye with cataract Cataract Ripe Cataract Cataract Surgery Cataract Surgery continued Opening the lens Phacoemulsification 14

15 Cataract Surgery continued Intraocular Lenses IOL in capsule bag Iris Fixated Posterior Chamber Glaucoma Keratoconus Keratoconus Macular Degeneration 15

16 Effects Of Macular Degeneration Diabetic Retinopathy Diabetic Retinopathy Retinal Detachment Floaters 16

17 Laser Vision Correction Photoablation occurs when specialized light is used to remove tissue This is the basis for all laser vision correcting procedures Broad Beam Lasers use a relatively large beam diameter (from 6.0 to 8.0 millimeters) to ablate the cornea has the shortest procedure time of any laser speed creates less likelihood of overcorrection and decentration - a complication caused by movement of the eye Broad Beam Lasers disadvantage is an increased possibility of center islands - a complication related to ablation surgeons have learned to decrease the incidence of center islands by using several short laser pulses to ablate the cornea instead of one longer one Slit Scanning Lasers use relatively small beams linked to a rotational device with slit holes that can enlarge during surgery, the laser beam scans across these holes to gradually increase the ablation zone uniform beam and potentially smoother ablations characterize slit scanning lasers disadvantages slightly higher risk for decentration slightly greater risk of overcorrection Spot Scanning Lasers have the potential to produce the smoothest ablations use radar technology to track the eye's movement to ensure proper centration Can treat irregular astigmatism and link to topography FLAP PROCEDURES surgeon cuts a flap in the cornea in order to access the underlying tissue LASIK (Laser-Assisted In-Situ Keratomileusis) treats myopia, hyperopia, and astigmatism a flap which includes tissue from the outer three corneal layers is created with a microkeratome,, then an excimer laser is used to remove stromal material LASEK (Laser Epithelial Keratomileusis) cuts flap in the outer layer only for those with flat or thin corneas 17

18 - Procedures FLAP PROCEDURES continued Epi-LASEK surgeon does not use a blade, but uses an epikeratome which separates epithelial layers and creates an epithelial sheet tissue below this is them removed with a laser ALK (Automated Lamellar Keratoplasty) treats high levels of nearsightedness and mild farsightedness in addition to a flap cut with a microkeratome,, more corneal tissue is removed with another pass of the blade to correct power not as predictable as laser procedures OTHER PROCEDURES PRK (Photorefractive Keratectomy) treats myopia, mild to moderate hyperopia, and astigmatism uses an excimer laser to remove tissue directly from the surface of the cornea, thus changing the shape initially more discomfort than with a flap procedure RK (Radial Keratotomy) surgeon makes incisions in a radial spoke-like pattern to flatten the cornea Not as predictable as laser procedures OTHER PROCEDURES AK (Astigmatic Keratotomy) surgeon cuts certain areas that are too steep bulgy in order to make them flatter this procedure can be used in addition to other types of surgery HK (Hexagonal Keratotomy) used with hyperopic in the past discontinued due to high incidence of complications OTHER PROCEDURES Wavefront sensing an emerging diagnostic tool for measuring the refractive error of the eye conventional forms of refraction are limited to measuring the best spherical and cylindrical refraction, but wavefront sensing allows for measurements of other conditions within the cornea that affect a patient's refraction these conditions are called higher order aberrations OTHER PROCEDURES Wavefront sensing uses a simple technique where the patient stares ahead at a field d and focuses on an object as a beam of light is projected into the eye this light is reflected off the back of the eye and back out, then the machine maps where the exiting rays of light land this map is then used to determine what is going on in the eye some machines available today look at nearly 2,000 data points, providing a much more detailed map of the patient's eye. 18

19 What s s Next? Course Evaluation Testing to Earn Certification Most given in testing centers See for more details Live test usually only once each year Generally at Optometry s s Meeting, this year in Orlando Once you Pass Look for details about the CPOA test Begin studying the Self-Study Study Course for Paraoptometric Certification Thank you! Please take a few moments to complete the course evaluation. QUESTIONS? drvirden@wacovision.com website 19