What is the government agency that protects the privacy of patients?
"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.
4. Respect for others
When taking a call from a patient for the optometrist, what should be attached to the message?
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?
determining the priority of the patients complaints
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?
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.
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?
Name the seven bones that form the orbit.
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?
What is the measurement for the palpebral fissures? (the space between the eyelids)
A condition in which the lids are so tightly closed they cannot be opened.
Drooping of the upper lid.
An inward turning of the lids, causing eyelashes to scratch the eye.
The eyelid turns outward due to loss of elasticity of lid tissue.
What is the muscle responsible for eyelid closure?
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.
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
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?
What is the function of the cornea?
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.
3. inadequate tear film oxygen content
List the layers of the cornea.
a condition in which the cornea thins and bulges forward
what is the term used to describe the "white of the eye"?
What is subconjunctival hemorrhage?
pooling of blood between the conjunctiva and episclera
What muscle causes the pupil to constrict in bright light?
What muscle is responsible for opening the pupil in dark conditions?
Describe two major functions of the ciliary body.
1. produce aqueous humor
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?
What is the type of drug used to paralyze accommodation?
loss of focusing ability that relates to the aging process
What two structures does the choroid lie between?
What part of the retina is used when reading an eye chart?
How many layers comprises the retina?
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)
cloudiness of the lens
At what point do the fibers from the nasal retina of each eye cross in the visual pathway?
What type of visual field defect will be present if damage occurs to the chiasm?
List the 6 EOM's
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?
what is the average total power, front and back, of the cornea?
How many diopters does the corneal curvature measure on the keratometer?
What is the average power of the crystalline lens?
Describe the relationship of the crytalline lens' ability to accommodate to the natural process of aging.
Amplitude of accommodation decrease with age
A condition of an unequal refractive state of the two eyes.
A difference in image size caused by the refractive status of the two eyes.
Parallel light rays are refracted by the unaided eye to focus on the retina
Reduced visual acuity not correctable by refractive means
Parallel light ras form two images in different meridians.
Parallel light rays focus in front of the retina.
Refractive condition in which parallel rays of light do not focus on the retina.
Parallel light rays focus behind the retina
Absence of the crystalline lens of the eye
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?
List four types of astigmatism.
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?
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?
What is the common term for amblyopia?
describe what a light ray will do when it strikes a surface at 90 degrees.
A 1.00 D lens will refract light rays to a focus of _______ from the lens.
Which of the following lens powers has the shortest focal length?
What is the term for the pointed tip of a prism?
Light rays passing through a prism will be bent toward the apex or the base?
what unit of measurement is prism power measured by?
A 1 diopter prism will displace an image ____ cm for every ____ m of distance.
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
both surfaces are concave
both surfaces are convex
Define plano convex
one plano surface, the other surface convex
Define Plano concave
one plano surface, the other surface concave
one concave surface, the other surface convex
which lens type is mostly used in phthalmic perscriptions?
A spherocylindrical lens has two powers located how many degrees apart?
transpose the following RX into a minus cylinder perscription...
What is the spherical equivalent for...
what rule states...induced prism is equal to the lens power multiplied by the displacement in centimeters
How does the optical lab avoid induced prism?
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
What three characteristics must be considered in the design of an ophthalmic lens?
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.
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?
What factors must be considered in order to dispense the thinnest lens possible?
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.
What type of PD is measured when fitting progressive addition lenses?
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?
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?
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?
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?
If both sets of lines making up the target sharply focus at the same time, the lens being neutralized is what type of lens?
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?
The cylinder lines will focus at a more _______ power reading than the sphere lines when neutralizing a lens in minus cylinder.
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?
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?
An imprtant factor in measuring lenses with an automated lensometer is keeping the lens _____ against the lens stop.
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?
Of the following which should be measured first when verifying vertical lens positioning, or measuring the amount of vertical prism in the spectacle?
When tapping a glass lens with your fingernail, the sound will be ____ than the _____ sound of a plastic lens.
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.
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.
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.
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.
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.
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?
Use of interpupillary distance rule to verify that the frame is even is know as what?
The glasses are being pushed off the nose because the temples are pressing too tightly.
Frame Adjustment-widen the endpiece angles
One eyewire is closer to the face than the other.
Frame Adjustment-Equalize the endpience bends
The frame slides down the nose.
Frame Adjustment-Form the temple bend to a 45-degree angle at the top of the ear.
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?
What type of plier is used for guard arm and endpiece bends?
What type of plier is used to place tiny screws in hard to reach places?
What type of pliers bends plastic and metal without marring the finish?
List three nosepad angles that correspond to the slope of the nose
The angle that gthe frame front makes when the temple is viewed from the side is known as what?
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?
List three physical attributes of a child that can make frame fitting a challenge.
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?
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.
The first number or numerator of the Snellen notation represents what?
In metric notation, 6/15 is the same as what?
What is the properly calibration height of the 20/200 letter on the Snellen chart for a testing distance of 13 feet?
Near vision acuities should be measured at a distance of what?
In an examination room shorter than 20ft, what can be used to create an optical 20 foot distance?
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?
What is the most common of all color defects?
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?
The systolic pressure reflects the amount of force on the artery walls when the heart does what?
The keratometer measures approximatley how many mm of the central cornea?
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.
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?
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?
The fundus contains the ______, _______, and the _________.
What type of ultrasonography is used to determine the length of the eyeball.
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.
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?
True or False? Every patient tested should have a nonseeing area in his/her field of vision.
Evaluation of the visual field with a moving target is called what?
Confrontation testing should be performed at what test distance?
A tangeant sceen visual field performed at 1 meter measures how many degrees of the visual field?
Define Goldman Bowl Perimeter
Fixation is monitored with a viewing telescope
Tests the central visual field
patients can use this at home to monitor progressive changes
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.