67859 study guide cover:Layout 1 21/10/2009 11:18 Page 1 The Ophthalmic Study Guide Study Ophthalmic The In recent years, an increasing variety of professionals have been involved in the care of ophthalmic patients. This study guide, written by a team of specialist ophthalmic practitioners, enables nurses, healthcare assistants and other health professionals to The develop useful, basic ophthalmic knowledge quickly, whether they need it for their day-to-day work or as preparation for taking a higher qualification in ophthalmology. The Ophthalmic Study Guide has a number of helpful features, including red and amber flags to indicate urgent and less urgent symptoms, plentiful diagrams, lists of useful online resources, and simple questions at the end of many of the chapters, which Ophthalmic can be used for self-testing or as a basis for mentors’ questions to their students. There are also ‘To do’ boxes, which allow students to reflect on their own practice and develop good habits of self-assessment and self-directed learning. Study Guide Contents include G Basic anatomy and physiology of the eye G Basic pharmacology Other titles include G Treatment of cataracts G Treatment of glaucomas G Retinal problems G Macular degeneration G Ophthalmic equipment for Nurses and G Basic ophthalmic procedures Health Professionals Ophthalmology Books available from M&K Research Issues in Health Routine Blood Results The ECG Workbook and Social Care Explained 2/e ISBN: 978-1-905539-14-7 • 2008 ISBN: 978-1-905539-20-8 • 2009 ISBN: 978-1-905539-38-3 • 2007 Field/Tillotson/Macfarlane Issues in Ophthalmic Practice: Current and future challenges ISBN: 978-1-905539-17-8 • 2009 The Clinician’s Guide to Nurses and Their Patients: The Management of COPD Chronic Disease Management Informing practice through in Primary and Secondary for Long-term Conditions: psychodynamic insights Care A cognitive–behavioural ISBN: 978-1-905539-31-4 • 2009 ISBN: 978-1-905539-28-4 • 2007 approach ISBN: 978-1-905539-15-4 • 2008 ISBN: 978 1-905539-40-6 Dorothy Field PUBLISHING is an imprint of M&K Update Ltd Julie Tillotson Eye Emergencies: Mandy Macfarlane The practitioner’s guide For books and training courses visit: PUBLISHING ISBN: 978-1-905539-08-6 • 2008 www.mkupdate.co.uk 67859 osg prelims:Layout 1 21/10/2009 11:17 Page i Ophthalmic Study Guide for Nurses and Health Professionals i 67859 osg prelims:Layout 1 21/10/2009 11:17 Page ii Other Ophthalmology books from M&K: Eye Emergencies: The practitioner’s guide ISBN: 978-1-905539-08-6 · 2007 Issues in Ophthalmic Practice: Current and future challenges ISBN: 978-1-905539-17-8 · 2009 Other Health & Social Care books from M&K include: Routine Blood Results Explained 2/e ISBN: 978-1-905539-38-3 · 2008 The ECG Workbook ISBN: 978-1-905539-14-7 · 2008 Arterial Blood Gas Analysis: An easy learning guide ISBN: 978-1-905539-04-8 · 2008 Nurses and Their Patients: Informing practice through psychodynamic insights ISBN: 978-1-905539-31-4 · 2009 The Management of COPD in Primary and Secondary Care ISBN: 978-1-905539-28-4 · 2007 The Clinician’s Guide to Chronic Disease Management for Long Term Conditions: A cognitive-behavioural approach ISBN: 978-1-905539-15-4 · 2008 Identification and Treatment of Alcohol Dependency ISBN: 978-1-905539-16-1 · 2008 Perspectives on Death & Dying ISBN: 978-1-905539-21-5 · 2009 67859 osg prelims:Layout 1 21/10/2009 11:17 Page iii Ophthalmic Study Guide for Nurses and Health Professionals Edited by Dorothy Field Julie Tillotson Mandy Macfarlane 67859 osg prelims:Layout 1 21/10/2009 11:17 Page iv The Ophthalmic Study Guide Dorothy Field, Julie Tillotson and Mandy Macfarlane ISBN: 978-1-905539-40-6 First published 2009 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without either the prior permission of the publishers or a licence permitting restricted copying in the United Kingdom issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London, W1T 4LP. Permissions may be sought directly from M&K Publishing, phone: 01768 773030, fax: 01768 781099 or email: [email protected] Any person who does any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Notice Clinical practice and medical knowledge constantly evolve. Standard safety precautions must be followed, but, as knowledge is broadened by research, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers must check the most current product information provided by the manufacturer of each drug to be administered and verify the dosages and correct administration, as well as contraindications. It is the responsibility of the practitioner, utilising the experience and knowledge of the patient, to determine dosages and the best treatment for each individual patient. Any brands mentioned in this book are as examples only and are not endorsed by the Publisher. Neither the publisher nor the authors assume any liability for any injury and/or damage to persons or property arising from this publication. The Publisher To contact M&K Publishing write to: M&K Update Ltd · The Old Bakery · St. John's Street Keswick · Cumbria CA12 5AS Tel: 01768 773030 · Fax: 01768 781099 [email protected] www.mkupdate.co.uk Designed and typeset in 11pt Usherwood Book by Mary Blood Illustrations by Mary Blood Printed in England by Reed’s Printers, Penrith 67859 osg prelims:Layout 1 21/10/2009 11:17 Page v Contents List of figures vii List of tables viii About the editors ix About the contributors ix Acknowledgements x Preface ix More about this book xiii 1 Information for students and mentors 1 Dorothy Field 2 Basic anatomy and physiology of the eye 7 Dorothy Field 3 Basic refraction 25 Dorothy Field 4 Basic pharmacology 37 Julie Tillotson and Dorothy Field 5 Preoperative cataract information 49 Claire Adams and Dorothy Field 6 Intraoperative management of cataract patients 63 Dorothy Field 7 Postoperative cataract care 73 Claire Adams, Pauline Haley and Dorothy Field 8 The glaucomas, primary open-angle glaucoma and congenital glaucoma 85 Lynn Ring 9 Primary angle-closure glaucoma 101 Lynn Ring 10 The secondary glaucomas 109 Lynn Ring v 67859 osg prelims:Layout 1 21/10/2009 11:17 Page vi 11 Retinal problems 119 Dorothy Field 12 Age-related macular degeneration 133 Dorothy Field and Mandy Macfarlane 13 Ophthalmic equipment 145 Sue Cox 14 Basic ophthalmic procedures 155 Dorothy Field Appendix 1 Record of ophthalmic knowledge and skills development 187 Appendix 2 Glossary of common ophthalmic abbreviations and terms 195 Answers to self tests 203 Index 207 vi 67859 osg prelims:Layout 1 21/10/2009 11:17 Page vii List of figures 2.1 The eye 7 2.2 The eyelid 8 2.3 The tear film 9 2.4 The lacrimal apparatus 11 2.5 The conjunctival fornices 11 2.6 The cornea 12 2.7 Aqueous drainage 16 2.8 The layers of the retina 17 2.9 The optic pathways 19 3.1 Viewing a distant object (top) and viewing a near object (below) 26 3.2 Uncorrected myopia (top) and corrected myopia (below) 27 3.3 Uncorrected hypermetropia (top) and corrected hypermetropia (below) 28 3.4 Corrected astigmatism (top) and uncorrected astigmatism (below) 29 3.5 Lens box and trial frame 31 5.1 A focimeter 55 5.2 The IOL Master 57 13.1 The exophthalmometer 145 13.2 The indirect exophthalmometer 148 13.3 Humphrey field analyser 151 14.1 The Ishihara test (P7) 160 14.2 The modified Amsler grid 162 14.3 Folded Schirmer’s papers 166 14.4 Patient with Schirmer s papers inserted 166 14.5 Schirmer’s papers are removed simultaneously 166 14.6 Measurement of the wetted area of a Sno-strip 166 14.7 Goldman applanation tonometry 168 14.8 The TonoPen 170 14.9 Bandage contact lens ready for insertion 178 14.10 Bandage contact lens applied 179 vii 67859 osg prelims:Layout 1 21/10/2009 11:17 Page viii List of tables 3.1 Optical prescriptions 32 5.1 Age at first spectacles 54 5.2 Checking your readings by comparing biometry readings with spectacle prescriptions 59 7.1 Postoperative examination conducted at the nurses cataract clinic at Bournemouth Eye Unit 79 7.2 Nursing discharge protocol (with permission from Bournemouth Eye Unit) 81 8.1 Glaucoma drugs 93 14.1 Inflammatory cells seen in the slit lamp beam 173 14.2 Grading of aqueous flare seen in the slit lamp beam 173 viii 67859 osg prelims:Layout 1 21/10/2009 11:17 Page ix About the editors Dorothy Field RGN, OND, BSc (Hons), MA, EdD recently retired as Senior Lecturer Practitioner (ophthalmic nursing) at Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust and Bournemouth University. She has worked in ophthalmic departments at Bristol, Glasgow and Dublin before spending 23 years in a range of positions in Bournemouth Eye Unit. She is currently employed by Bournemouth eye unit as a ‘bank’ staff nurse, and is enjoying remaining close to patients and the joys and trials of practice within a busy eye unit. Her most recent publication Eye Emergencies was written with Julie Tillotson and published by M&K Update. Julie Tillotson RGN, OND, BSc (Hons) is currently working as a Nurse Consultant in the Acute Referral Clinic at Bournemouth Eye Unit.