FORMAT: NCLE Review Course Part 3 AUDIENCE: Optician, Contact lens Technician LEVEL: Beginner SPEAKER: Robert Russo
Course Description
This two hour NCLE basic review course will cover :
Domain VI Dispensing 10.0% of exam Wearing schedules Care systems Patient handling Domain VII Follow-Up 19.0% of exam Subjective findings Objective findings Assessing or verifying patient’s subjective responses and objective findings to determine if desired results have been attained. Establishing follow-up protocol Identifying normal and abnormal symptoms Maintaining patient records Domain VIII Regulatory 5.0% of exam Administrative Standards Legal NCLE Job Analysis
I. Knowledge of Ocular Anatomy and Physiology A. Adnexa 1. Tear Film a) Pre-corneal film b) Lacrimal lake c) Layers d) Lacrimal glands and function e) Break-up time (BUT) f) Factors affecting tear function 2. Conjunctiva a) Location (bulbar, palpebral) b) Description c) Function d) Adverse effects of contact lens wear 3. Lid structure a) Inferior b) Superior c) Function d) Measurement of palpebral fissure e) Normal blink rate and effect of contact lens usage f) Puncta 4. Fornix a) Location b) Inflammation of 5. Lashes a) Function of b) Appearance of related to (1) Blepharitis (2) Conjunctivitis (3) Other conditions c) Trichiasis 6. Tarsal plates a) Location b) Normal and abnormal appearance related to contact lens wear c) Causes of abnormal tarsal plates appearance d) Actions for abnormal tarsal plates appearance 7. Canthi a) Location b) Description c) Function d) Significance to contact lens wearer B. Anterior Segment 1. Corneal Structure, adverse effects of contact lens wear a) Layers b) Dioptric power c) Size d) Radius of curvature e) Thickness f) Chemical reactions g) Index of refraction h) Metabolism i) Topography j) Dehydration/transparency k) Apical zone l) Vascularization m) Edema n) Limbal zone o) Transitional zone
2. Iris a) Location b) Description c) Function d) Size e) Color f) Significance to contact lens wearer
3. Pupil a) Location b) Description c) Function d) Size e) Shape f) Reaction to light g) Significance to contact lens wearer
4. Sclera a) Location b) Description c) Function d) Significance to contact lens wearer
5. Anterior Chamber a) Location b) Description c) Function d) Fluid e) Significance to contact lens wearer C. Posterior Segment 1. Crystalline lens a) Location b) Function c) Ciliary muscle d) Power
2. Retina a) Location b) Description c) Function d) Significance to contact lens wearer e) Image perception with contact lenses f) Abnormalities
3. Choroid a) Location b) Description c) Function d) Significance to contact lens wearer
4. Posterior chamber a) Location b) Description c) Function d) Fluid e) Significance to contact lens wearer
5. Macula a) Location b) Description c) Function d) Fovea e) Significance to contact lens wearer
II. Knowledge of Ocular Pathology A. Drugs and diseases/viruses affecting contact lens wear 1. Alcohol 2. General medication 3. Recreational drugs 4. Thyroid 5. Sjogren’s Syndrome 6. Diabetes 7. Arthritis 8. HIV B. Contact Lens Related Conditions and Pathology 1. Keratoconus 2. Neovascularization 3. Bullous keratopathy 4. Corneal dystrophies 5. Corneal edema 6. Corneal infiltrates and ulcers 7. Corneal scarring 8. Keratoplasty 9. Corneal surgeries 10. Acanthamoeba keratitis 11. Microbial keratitis 12. Herpes simplex and zoster 13. Pterygium 14. Pinguecula 15. Conjunctivitis 16. GPC 17. Blepharitis 18. Extropion 19. Entropiion 20. Ptosis 21. Iris colobona 22. Aniridia 23. Albinism 24. Nystagmus 25. Exophthalmus 26. Media opacities 27. Motility problems
III. Knowledge of Refractive Errors A. Ametropia 1. Myopia 2. Hyperopia 3. Astigmatism (irregular, against the rule, with the rule, oblique) 4. Presbyopia 5. Anisometropia 6. Aniselkonia 7. Amblyopia 8. Aphakia 9. Pseudophakia B. Optical conditions, terminology and principles of optics as related to contact lenses 1. Refraction 2. Prismatic effects 3. Residual astigmatism 4. Lacrimal lens 5. Accommodation 6. Transposition of prescription 7. Spherical equivalent 8. Sagittal depth 9. Vertex distance IV. Knowledge of Instrumentation A. Ametropia 1. Myopia 2. Hyperopia 3. Astigmatism (irregular, against the rule, with the rule, oblique) 4. Presbyopia 5. Anisometropia 6. Aniselkonia 7. Amblyopia 8. Aphakia 9. Pseudophakia
B. Optical conditions, terminology and principles of optics as related to contact lenses 1. Refraction 2. Prismatic effects 3. Residual astigmatism 4. Lacrimal lens 5. Accommodation 6. Transposition of prescription 7. Spherical equivalent 8. Sagittal depth 9. Vertex distance
V. Knowledge of Instrumentation A. Measurement 1. Keratometer (ophthalmometer) a) Range extension b) Focus c) Location of cylinder axis d) Measurement of horizontal meridian e) Measurement of vertical meridian f) With the rule astigmatism g) Against the rule astigmatism h) Oblique astigmatism i) Mire evaluation
2. Instrument calibration 3. Normal and abnormal findings based on instrument readings and test/evaluation outcomes 4. Schirmer’s tests #1 and #2 5. Tear film break-up time (BUT) 6. Measuring and evaluating corneal curvature (e.g., keratometry, topography) B. Observation 1. Slit lamp (biomicroscope) a) Focus b) Types of illumination/applicability to contact lenses c) Exam of cornea, conjunctiva, tear film and lid structure d) Filters e) Use of fluorescein
2. Exam of cornea, conjunctiva, tear film, and lid structure
3. Fluorescein evaluation procedures (without contact lenses)
4. Rose Bengal evaluation
5. External observations (e.g., lids, pupil, tissues, iris, cornea, conjunctiva, sclera)
C. Lens Modification/Verification 1. Polishes and tools used to alter PPC and IPC a) Polish lenses b) Taper edges
2. Fluorescent tubes used to determine proper blend of bevel of contact lens
3. Radiuscope (optic spherometer) a) Detection of warped contact lenses b) Verification of spherical and toric base curves c) Evaluation of lens surfaces
4. Lensometer (focimeter) a) Power verification (front vertex vs. back vertex) b) Optics evaluation c) Cylinder power and axis location d) Prism
5. Other Instruments a) Thickness gauge b) Diameter gauge c) Overhead light reflection techniques/fluorescent tubes d) Hand loupe or measuring magnifer