practicals Flashcards
hand held magnifier
Design features
Simple
Single plus powered lens
maybe illuminated
available from 1.8x to 12. 5x mag
Suitable for patients with AMD high refractive errors
hand held magnifier
benefits and limitations
Convenient for Short term use
Common psychologically acceptable
Compact / lightweight
flexible task distance
Requires Steady hand
still requires training
Subject to aberrations when used
binoculary due to oblique gaze
higher power = more aberrations and Smaller fov
hand held Mag
advice On use
Hold with most Convex Surface facing PX
place an page move away until image is clear
keep page flat
wear distance Spec’s or near if working within focal length
steady eye strategy move page underneath magnifier
Reduce eye may distance to increase fov
Good illumination,angle Poise lamp directly onto page
Stand magnifier
Design features
Simple magnifier
Has cuff to set lens at the correct working distance
Internally illuminated
may be available as one head or with or with interchangable heads
Available 2x to 12.5x
Cx with AMD
Stand magnifier
Benefits and limitations
Easy to maintain correct working distance
stand may hold in place allowing hands free
Internally illuminated Providing adequate lighting
fixed focus - a specific Pair of Spectacles maybe required
Bulky due to illumination component
stand magnifier
Advice on use
place directly onto Page and should be in focus
use required spectacles
keep page flat (use a clipboard)
Ensure batteries are replaced regularly as adequate Illumination is essential
use steady eye strategy keep mag still and move paper right to left
Bar magnifier
Design features
Simple loupe magnifier
Single plus Powered lens
May have line to aid tracking
may have darker edges to aid contrast
Acrylic / Perspex
can sit directly onto page
Available 1.1 x to 2x
Bar Magnifier
Benefits and Limitations
simple to use
no dexterity issues
maintain binocular vision at normal Working distance
Requires a flat firm Surface
Narrow Field of View
Bar Magnifier
Advice on use
Position Horizontally
direct onto reading material
use line to guide position
use near Spec’s
when not in use place in case
keep out of direct Sunlight
Pocket magnifier
Design features
simple magnifier
single plus Powered lens
lens folds in Protective case
Pocket size
Available 2.5x to 20x mag
Suitable for AMD and high refractive Powers
Pocket magnifier
Benefit’s and limitations
Small Portable and discreet
light weight
psychologically,cosmetically acceptable
cheap
Small fov
not suitable for Prolonged use
steady hand required
Pocket Magnifier
Advice on use
Hold on material and bring away until focused
use distance Spec’s
Bring closer to eye to improve fov
Short tasks only
good illumination angle Poise lamp directly onto Page
Prismatic Readers
Design features
High powered Reading Specs
incorporated base IN Prism to aid convergence
usually 1/2 eye design
for near vision
General Rule 1 prism base in for 1.00D of Add over plus 3.00D
available up to +10.00D 12 Prism in
Prismatic Readers
Benefits and Limitations
Allow maintenance of binocular vision for near tasks when using adds for Patients with Convergence problems
1/2 eye design allows distance vision over top
hands free
Short working Distance- may be difficult to maintain
Heavy
Unattractive
Prismatic Readers
Advice on use
wear for Specific near tasks only
close WD start away from face and move closer until clear
use good illumination angle poise lamp directly onto page
Spectacle Mounted telescope ( binocular)
Design features
Galilean System
Positive objective and negative eye piece
may have adjustable focus
Patients RX maybe glazed into housing spectacles or incorporated into eye Piece
may be permantly fused or clip on
Spectacle Mounted telescope ( binocular)
Benefit and limitations
can be used for distance and near ( adjustable focus)
Hands free
maintenance of binocular vision
High magnification
Good depth of field
Psychologically unacceptable due to appearance
Heavy / bulky
Accurate centration is essential
Requires extensive training for effective use ( 6 weeks)
small fov
Spectacle Mounted telescope ( binocular)
Advice on use
use for specfic tasks
Can adjust focus depending on working distance of task this should be demonstrated
Do not walk around in them static use only
Requires good illumination
monocular hand held telescope
Design features
keplerian Or Galilean
hand held monocular
adjustable focus
may clip into Spectacle frame
Suitable Cx AMDand Central field loss
Reverse Systems can be used for Patients with RP,DR,glaucoma
monocular hand held telescope
Benefits and limitations
Hand held
Small Portable
adjustable focus for Range of WD
Can clip onto spectacles - hands free
high magnification available
steady hand
Dexterity required
only good for stationary objects
cannot Compensate for high Rx
monocular
not Suitable for long time use
Monocular hand held telescope
Advice on use
Adjust eyepiece to focus demonstrate WD if needed
specific Spot tasks as monocular use
use with dominant eye
Hold steady may require elbow Support
Do not move around when using
Spectacle mounted magnification unit
Design features
used for crafts / models
Plus powered lens mounted or clipped onto Spec’s
Cx own Rx may be glazed into housing Spectacles
maybe binocular or monocular
Available - up to 3x binocular
7x monocular
Spectacle mounted magnification unit
Benefits and Limitations
Good fov achieved due to minimal eye mag distance
Coatings and tints available in carrier lens
Binocular vision maybe maintained
Hands free available
Range options available
maybe psychologically unacceptable - appearance
Short Working distance - difficult to Maintain
Accurate Centration - essential
Poor illumination - extra essential
Spectacle mounted magnification unit
Advice on use
Hold Page away and bring closer until clear
use for Specific tasks
Do not walk around when wearing
Maxx TV / coil TV unit
Maxx event - TV
Maxx near
Design features
Galilean telescope System
Positive object and negative eye piece
adjustable focus for room distance use frosted objective lens
eliminates reflections
2x mag
adjustable to compensate for up to 3.00D
Ametropia
Maxx TV / coil TV unit
Maxx event - TV
Maxx near
Benefits and Limitations
Simple and economic solution for room distance
can be used for distance and some intermediate ( room distance use)
hands free
Heavy and relatively uncomfortable for long periods of Wear
Requires dexterity for adjustment
cannot compensate a high RX but available as clip on
Maxx TV / coil TV unit
Maxx event - TV
Maxx near
Advice on use
use for specific tasks (TV)
Demonstrate adjustment of Working Distance
Do not walk around when wearing
sheet magnifier
Design features
fresnel lens
multiple concentric rings providing magnification
Some may have foldable stand for Support
Available in low magnification powers of 2x - 3x
sheet magnifier
Benefits and limitations
large Fov due to size of magnifier and low power
Cosmetically acceptable
Inexpensive
light easily portable
only available in low mag
Posture Sometime difficult to maintain- needs to be Parallel
optically poor - due to aberations
sheet mag
advice on use
Hold on page
move away until clear
use with near vision Specs - often be working within focal length
can be used for eccentric Viewing
keep page flat
Good Illumination angle poise lamp directly onto page
chest magnifier
Design features
low magnification plus Powered lens
Bracket and neck Strap to support against chest
may have Smaller High mag Segment
1.5 x - 2 x mag
up to 6x mag
chest magnifier
Benefits and Limitations
Constantly Supported at appropriate working distance
Hands free
low magnification means less aberrations
wider fov
Inexpensive
chest magnifier
Advice on use
Position close to eye to boost fov + magnification ol wearing reading Specs
Mark an neck Strap where appropriate fitting is
use while Seated
may need additional lighting angle poise
can be used for reading if only low mag is required
steady eye strategy
Hyperocular
(one lens)
Design features
Spectacle mounted magnification
single high Powered plus lenticular lens
the other lens to be occluded/ frosted / CX own Rx
A available up to 12 x magnification
Hyperocular
(one lens)
Benefits and limitations
Psychologically acceptable as looks Similar to normal Spec’s
Able to incorporate prescription into lenses
Hands free
large fov due to short eye mag distance
short WD maybe hard to maintain
monocular only
Requires good illumination due to short WD
.Hyperocular
(one lens)
Advice on use
Hold page in front of dominant eye and bring closer until Clear
use for specific Tasks
Do not walk around when Wearing
good lighting angle poise
Tinted over Specs
Design features
Plano tinted / filter lenses
wrap around design to shield disabling glare
Specific filters to absorb certain wavelengths
Blue light blocking ( 47Onm + less)
FL - 41 Rose filter
Px with gluacoma,retinitis pigmentosa,ARMD,Photosensitivity
Tinted over Spec’s
Benefits and Limitations
Lightweight
use over own Spec’s
many filter options
wrap around - Shields glare
psychologically acceptable- like large Sunnies
Bulky
unattractive
only benefit in day time
May restrict driving
Tinted over Spec’s
wear over existing Spec’s
wear in bright conditions or if light a problem
Do not wear for driving due to contrast filter
Diving mask
Diving and Snorkelling
Design features
silicone Cupping and head strap to create a water tight fit including over nose
tiltable to allow clearing of water
glazeable Insert to full RX
Diving mask
Diving and Snorkelling
Dispensing and fitting requirements
fit close not too tight
CD and vertical heights
Record vertex
Rinse trap water air dry
Skiing goggles Design features
Snow
Skiing
Snowboarding
Ski Jumping
bobsleigh
Snow boarding
Single shield
wrap style to protect debris + UV
Glazeable insert
Polycarbonate /Trivex
100% Uv Protection
Mirror coating
Skiing goggles
Dispensing + fitting requirements
Polycarbonate or trivex for safety
measure CD ‘s and heights
Adjustable headstrap for secure fit
Avoid lens Spray due to mirror coat
Swimming goggles
Design features
Available as Plano modular or full RX
Silicone Cups + head strap water tight
flat form lenses ( Plano front surface)
choice of bridge Size
Tints available
Maximum depth of 1. 5 m
not used for diving
Swimming goggles
Dispensing / fitting Requirements
Modular Rx = Sphere + 1 / 2 cyl
Available In 0.50D steps
check VA’S with trail frame
fit close but not too tight as can cause pinching and Increase Ocular pressure
Bridge width can alter horizontal OC /Position
Rinse in tap water air dry
Aquaviz - Design features
Swimming
Surfing
kayaking
windsurfing
rafting
Canoeing
Paddle boarding
wider field of View than Swimming goggles
Available with glazeable Insert full Rx
Tintable Inserts available
Silicone cups and head stone for water tight fitting
max depthof 1.5m not used for diving
Aquaviz
Dispensing / fitting requirements
fit close but not too tight
measure CD and vertical height
Record Vertex distance
Rinse in tapwater + air dry
shooting Spec’s
Design features
Designed for monvision non- dominant eye will be occluded
Adjustable horizontal positions of lens and occluder
Adjustable vertical positions from bridge
Adjustable apertures for depth of field
adjustable angle of side
Curled Sides forSecure fit
shooting Spec’s
Dispensing/ Fitting requirements
Dispense dominant eye
position lens and occluder before measuring CD
Dispense trivex/ Polycarb
tints or filters maybe
measure CD’s + vertical heights
Record vertex distance
Adjust Pantoscoptic angle worn depending on posture
cycling Spec’s
Design features
wrap around Protection of debris
high base curve
maybe glazable insert
straight sides
adjustable nose pads
Range of tints
interchangeable Shields maybe an option
cycling Spec’s
Dispensing + fitting requirements
may need to dispense high base curve
Trivex/ Polycarbonate
Tints as required consider road Safety
Head Strap for Secure fittings
measure CD + vertical heights
Record vertex distance
Consider face form angle and Panto angle worn
Snooker Spectacles
Design features
Snooker
Pool
billiards
bowls
large frame
increased fov
low crest to provide high fit
adjustable Joints to Induce retroscopic tilt
thin metal frame
Supra / rimless
Snooker spectacles
Dispensing / fitting Requirements
non - Aspheric SV lens
measure horizontal + vertical CD’s
mark pupil Centre in full retro + full Panto tilt place OC in middle
MAR Or photochromic tint as appropriate
Record Vertex distance
football,Rugby Judo, lacross,Ice hockey
design features
Silicone bumpers on bridge + templesto increase Impact
Bevel built up on back surface causing lenses to fall forwards on Impact
nylon frame
Air vents to Prevent steaming
Adjustable head strap
football,Rugby Judo, lacross,Ice hockey
Dispensing/ fitting requirements
Polycarbonate or trivex lenses for Safety
Demonstrates use of head Strap fit Securely
maybe tinted or photochromic for outdoor Sports
measures CD and heights
Record Vertex distance
clip on magnifier
Design features
Simple high Powered plus lens
Available up to 3x binocular
7x monocular
clip over Own Spec’s
Hands free for Occupational,vocational use
flip up when not needed
Some have extendable vertex distance
clip on magnifier
Dispensing / fitting requirements
magnification required - acuity achieved / acuity desired
ef N8 / N4 = 2x
clip over bridge on Cx can Spec’s
Adjustable vertex distance - Increased field of view
Demonstrate Working distance
clip on magnifier
Advice on use
Wear for Specific tasks
Hold task away from face + bring closer until clear
close working distance
Good illumination required
angle poise lamp directly over task
flip up when not required
fresnel Prism
Design features
Temp Prism
made of Upvc
consists of multiple Parallell Prism
1mm thick
available up to 30 Prism dioptres
fresnel Prism
Dispensing / fitting requirements
check Prism base direction
Apply underwater to remove air bubbles
Apply to back Surface of lens
check VA’S for Suitability for driving ect as can reduce VA by 2 Snellen lines
fresnel Prism
advice on use
wear as advised by orthoptist / Optometrists
Do not attempt to clean or rub back Surface
Can reapply if needed
monocle
Design features
Single lens held in gallery
Gallery gripped by Orbicolaris Oculi muscle
Gallery holds lens away from globe
neck cord to Prevent loss
monocle
Dispensing / fitting requirements
Dispense to dominant eye
Dispense best Vision Sphere
Glaze with trivex for safety
Glaze flat form lens
Glaze oC at Centre of aperture
Ensure Cx has enough muscular Control to hold in place
can be used for distance / Correction
monocle
Advice on use
use with dominant eye
use for specific tasks
Do not use for prolonged tasks
keep on neckCord to prevent loss
Half eye Spec’s
Design features
Shallow lens covering lower Portion of orbit
wide distance between Pad centres
long LTB to allow C x to sit on end of nose
ideal for emmetropic Presbyopes and CL wearers
Half eye spec’s
Dispensing / fitting requirements
adjust for lower frame fitting
Record near CD at Specified WD
Glaze OC appropriately high
Record vertex distance
Half eye Spec’s
Advice on use
sit low on nose to allow distance Vision over the top
Wear for Specific tasks ( intermediate /near ) only
Remove Spectacle to walk around
View distance objects over frame
Recumbent / belay Spectacles
Design features
Prism and Mirrors mounted into frame to deviate light by 90°
Prism displace Image
mirrors reflect image
can be worn over current Spec’s
Silicone nose pads
adjustable Sides for Snug fit
Recumbent / belay Spectacles
Dispensing / Fitting requirements
Ideal for bedbound cx/ with Stoop/ climbling
fit Snug to avoid Slipping down due to heavy prism
may require head strap
fit low and shallow to allow Cx to look of top if needed
Some tiltable may need to secure in optimum Position
Recumbent / belay Spectacles
advice on use
wear to view object below Or above
wear with specs if required
Take care if wearing while moving
look over the top to see directly in front
Patient should try before Purchase
Surgeon Spec’s
Design features
Spec mounted telescope
Galilean telescope unit
adjustable focus
used by Surgeons / dentists
Surgeon’s Spec’s
Dispensing / Fitting Requirements
must accurately measure CD’S
measure working Distance and CD’ S with frame in place
Some units adjustable focus
may need to secure at appropriate focus
Some allow Cx Rx to be glazed into Carrier
Surgeon’s Spec’s
Advice on use
Demonstrate working distance
wear for Specific tasks
do not move around when wearing
Requires Good Illumination angle poise lamp directly onto task
Safety Spec’s
Design features
large frame with side Shields
maybe wrap to Protect from debris
Impact resistant
marked to confirm with BSEn 166/167
kite mark
Safety Spec’s
Dispensing/ fitting requirements
Ensure fit close for adequate Protection from debris
frame and lenses Specified by safety officer
adjustments maybe made in practice but not repairs the Spec’s must be Sent to manufacturer
Safety Spec’s
advice on use
wear for designated tasks (keep at work)
Do not remove side shields / Interfere with device
clean as Specified by manufacturer
Trigeminal Spec’s
Design features
large frame with side Shields
Not BSEN marked
maybe tinted
may have curled Sides for close secure fit
Trigeminal spec’s
Dispensing / fitting requirements
Dispensed to patients with paralysis of trigeminal nerve
curl sides for close Secure fit
Tint’s to reduce photophobia
side Shields to Prevent debris as lack of Corneal Sensitivity
Ptosis prop/ Lundi loop
Design features
prop / loop tend to back plane,
Upper rim of Spectacle frame
Aims to lift upper lid to keep pupil clear for adequate vision
ideal for Patients with Ptosis
Ptosis prop/ Lundi loop
Dispensing / fitting requirements
Select suitable frame that fits in line with Cx brow
Select appropriate material - if metal good quality coated
Pre adjust before measuring
measure distance from back of frame to orbit
can be Silicone covered as hypoallergenic
Silicone nose pads if necessary to prevent Slipping
Ptosis prop/ Lundi loop
advice on use
use artifical tears ( lack at blinking)
Ensure prop / loop is fitting comfortable
Replace Silicone covers if Perishing
flip up Spec’s
Design features
flip attached to top Rim of frame
2 Seperate Sets ofglazed lenses
Range of Prescription tint combinations available
flip up Spec’s
Dispensing / fitting requirements
ideal for occupational use
identify patient requirements task analysis
Rembember to glaze add /negative add only in flip up lens
measure cd with frame on
can dispense tints to flip up lenses
Flip up Spectacles
advice on use
Wear for Specific tasks
flip up lenses when not in use
make up specs Double + Single
design features
Double
Spectacle lenses glazed to SV RX
lenses can flip down when not in use
flip attached to lower rim
Single
Single positive lens
lens can be rotated to sit in front of either eye
flip attached to bridge
make up spec’s Double+ single
Dispensing/ fitting requirements
Double
Glazed to fill SV RX
measure CDwith frame in place
ideal for hyperopes for Application of make up
I & R contacts
Single
ideal for hyperopes makeup+ cl
Glaze to Best vision Sphere
measure CD with Frame on use binocular measurement
make up spec’s Single+ double
advice on use
Double
Demonstrate use and movement of lenses
flip down lens to apply makeup/ cL
wear only for Specific tasks
Do not drive when wearing
Single
Demonstrate use and movement of lenses
wear for specific tasks
No driving
-Reversible spectacles
Design features
Spec’s with 360° hinges
can be wom either way round
number of RX combinations available
curl Sides for Secure fit
Reversible spectacles
Dispensing / fitting requirements
dispensed to patent with monocular vision
Dispense trivex lenses for Safety
Measure distance and near CD with Frame on face
Reversible spectacles
advice on use
Demonstrate how to flip when changing task
wear withappropriate lens in front of dominant / functioning eye
may wish to mark one side So easy to determine lens
Paediatric frames
Design features
Silicone
No joints/ Screws
Loop end Sides with elastic head Strap
low crest height
Moulds to shape of baby’s face
Hypoallergenic
Paediatric frames
dispensing / fitting Requirements
adjust head Strap to fit comfortably ( underhair line)
Record CD
cover test
trivex for Safety
ordered Surfaced lenses to reduce Centre substance if Plus Powered
not mini bevel - may catch cheeks
May often glaze BVS as easy to wear upside down
Paediatric frames
advice
Explain Importance of continous wear to Parent
call in for regular fitting checks
Return if broke/ damaged
Adaptation time
clean with warm water / Soft cloth
Trifocal measurements
S 7 28
50% Inter + Reading ratio
inter 28×7
Reading 28 x 11mm
Cr39 + Polycarbonate
Trifocal
S8 35
50% IP/ RP ratio
Inter 35 x 8mm
Reading 35×20mm
CR39
Trifocal
S 14 35
50% IP/RP ratio
inter 35×14mm
Reading 35×18mm
Available in CR39
Trifocal
E style
CR39
7mn intermediate depth
50% IP /RP ratio
-ve Rx - flat top - less Jump
Tri focal
Concentric 7×22
CR39
7mm intermediate
22 mm diameter near
50% IP/RP ratio
Also 7×28
Tri focal
wide band 12 x12
CR39
12 mm inter
12mm reading
Occupational Trifocals
Double D Seg
DD 28
Plastic
Segs 14 mm apart
60% IP /RP ratio Or same add Top + bottom
depending on occupation bottom Seg lower limbus
Dispense large frame
Trifocals
ideal for cx requiring wide areas of distance near + intermediate
good for non tol to PPL
when dispensing standard trifocals the Seg top of the intermediate Portion is normally fitted Midway between the pupil Centre and lower limbus
D Dseg - lower limbus
BS for RX
BS/EN 2738
includes powers to two decimal places,vertex distance,specified for powers over combination of + / - 5.00D and no degree Sign
if not written correctly refer to Prescriber
Base curves
Steep Base curve = Centre thickness, distortion,Spec mag + retinal Image will be Increased
Plus power are surfaced on negative Base curves and Minus Powered lenses are Surfaced on positive base Curves
Splitting Prism
Vertical = opposite
Horizontal = Same direction
Anisometropia
difference of 2.00 D or more in Power between 2 eyes
if VA’s are recorded may determine whether this will lead to visual problems Such as vertical Prism and diplopia at near
Aniseikonia
.if the Rx are different and both VA’S are good this may Cause Unequal retinal image size
(x will complain of blurred Vision,headaches,dizziness when wearing Spec’s and viewing distance objects
An ISecikonic maybe dispensed to increase RIS of least Positive eye known as Sized lens
Single vision differential Prismatic effect
occurs when patient looks down through the lens to read
may experience diplopia caused by Anisometropia due to the different amounts of vertical Prism when looking away from the optical Centres of the lens
Solution
Drop Spec’s for near vision tasks
2nd pair of Spec’s with OC lower
slab off Base down from most negative Powered lens
Tilt head down Slightly for near vision
contact lenses
Amblyopia
difference of 2 lines or more in VA between 2 eyes when no reported clinical Problems
Tinted
plastic = dip dyed, Polarised,vacuum coated ( mirror tints) or photochromic
Glass - Vacuum coated Or Solid Or bonded equitint
a lens which is vacuum coated/ dip dyed will not have Same properties as a glass Solid tint -give the most protection as the tint is all the way through the lens
Infra red Radiation ( IR)
not harmful radiation more than 750nm which is troublesome in equatorial regions + industrial welding
Rayban G15 lenses Zeiss umbra = solid glass - ferrous oxide to absorb 100% IR and uv
Thicker lens Colour darker where thicker makes uneven
En 12312
covers plano Sun Spec’s
tints, Filters
Photochromic
A layer of light sensitive photochromic molecules imbibed into top Surface of lens - depth of 150 microns
uv + temp dependent
Polarised
only type of plastic lens to eliminate glare + Uv Protection up to 400 nm
BS 21987
covers lens power and Centration tolerances and the making and supply of the Spectacles
BS / En 166/167
personal eye protection
V value
1.5= 58
1.6 = 42
1.67 as = 33
1.74 as = 31
1.76 as = 30
Glass
1.9 =30
1.8 as =35
1.7= 40
Poly = 1.586 =30
Trivex = 1.53 = 43
Airwear =1.59 = 31
Coloboma
Signs,symptoms,history,treatment, referral
Sign- irregular keyhole shaped pupil,hole lower region of iris, unilateral/bilateral
Symptom-photophobia,reduced va, field loss
History-congenital
Treatment- cosmetic CL opaque to match iris ,large specs uv Protection, photochromic for all light conditions
Referral- manage in practice
Meibomian gland dysfunction
Signs,symptoms,history,treatment, referral
Sign- small lumps along lid margin, red eyes, sometimes crusty appearance
Symptom- discomfort, gritty, itchy,blurred Vision, similar to dry eye
History- dry syndrome and blepharitis
Treatment-massage lids to promote secretion of oils by glands, hot compress, flax seeds, defer CL wear
Referral- GP if need antibiotics
Blepharitis
Signs,symptoms,history,treatment, referral
Signs- dandruff on eyelashes, swollen inflamed lid margins
Symptoms- discomfort, sore itchy lids, burning sensation, sticky lids
History- scalp disorder, poor lid hygiene,dry eyes
Treatment- improve lid hygiene Sterile wipes , warm eye pads with wheat gem ,defer CL wear
Referral -GP if antibiotics needed
Ectropian
Signs,symptoms,history,treatment, referral
Signs- lower lid rolling outwards, drooping lower lid,conjunctiva becomes red and dry
symptoms- dry eye epihoria,soreness of facial skin
History- possible trauma usually senile, loss of muscle tone or shrinking of scar tissue following surgery
Treatment- surgery, dispense larger frame side Shields
Referral- GP -non urgent
Ectropian
Signs,symptoms,history,treatment, referral
Signs- lower lid rolling outwards, drooping lower lid,conjunctiva becomes red and dry
symptoms- dry eye epihoria,soreness of facial skin
History- possible trauma usually senile, loss of muscle tone or shrinking of scar tissue following surgery
Treatment- surgery, dispense larger frame side Shields
Referral- GP -non urgent
Entropian
Signs,symptoms,history,treatment, referral
Sign- lower lid rolling in, inflammation, corneal scarring
Symptoms-painful, lacrimation, corneal scarring, may lead reduced VA
History- eyelashes abrading cornea
Treatment- Bandage CL, removal of lashes , surgery
Referral- GP
Ptosis
Signs,symptoms,history,treatment, referral
Signs- dropping upper lid
Symptoms- poor VA if eyelid obscures the pupil, no pain, no photophobia
History- paralysis of levator muscle, maybe congenital, senile, or due to a stroke
Treatment-ptosis prop , surgery
Referral GP- non urgent unless sudden onset
Stye(hordeleum externam)
Signs,symptoms,history,treatment, referral
Signs- inflammation, swelling of lid margin
Symptoms- discomfort, no photophobia, no vision loss
History- blockage of tarsal gland causing meibomian cyst, bacterial infection of eyelash follicle - dirty make up brushes
Treatment-hot compress, golden eye ointment, eyelash removal
Referral- manage in practice
Chalazion ( meibomian cyst) ( swelling top eyelid)
Signs,symptoms,history,treatment, referral
Signs-swelling hard and gradually enlarges
Symptoms-generally no pain, as enlarges may cause pressure on cornea causing distortion and blurred Vision, no photophobia
History- swelling of tarsal gland, maybe blockage of duct following infection, if recurrent- blepharitis, or skin conditions
Treatment- may disappear surgical removal through the tarsal conjunctival for long standing lesions
Referral- non urgent- unless abrading cornea
Xanthalasma
Signs,symptoms,history,treatment, referral
Signs-flat yellow lumps of fat on lids
Symptoms- cosmetic appearance, no pain,no photophobia, no vision loss
History- raised cholesterol, possible diabetes
Treatment- removal by laser, reduce fat intake
Referral- GP non urgent GP for cholesterol
Conjunctivitis
Signs,symptoms,history,treatment, referral
Signs- inflamed conjunctiva, blood shot eye, usually both eyes,mucous discharge on lid margin and lashes
Symptoms-lids sticky in morning eyes feel gritty and hot,photophobia
History-previous occurrence, bacterial, viral, allergic
Treatment- cx managed bathe lids, boil pillow case and towels, antibiotic eye drops mayb required, defer CL wear
Referral - Mecs, triage, GP in antibiotic required
Pinguecula
Signs,symptoms,history,treatment, referral
Sign- raised yellow area on the conjunctiva most common in elderly
Symptom- possible irritation with CL, no pain, no photophobia,no vision loss
History-exposure to uv, living in hot/ dry climate, hardening of the Bulbar of the conjunctiva and degeneration of conjunctiva
Treatment- cosmetic appearance
Referral- GP non urgent
Pterygium
Signs,symptoms,history,treatment, referral
Signs- Raised triangular growth on conjunctiva and invades the epithelium, often bilateral
Symptoms - Possible irritation with CL, Reduced VA if encroaches on cornea,no photophobia
History- Living in hot climate excessive uv working in dusty conditions, possible previous occurence
Treatment- surgical removal before pupil invasion
Referral- GP. non urgent
Sub- conjunctivaI Haemorrhage
Signs,symptoms,history,treatment, referral
Signs - Burst blood vessel between conjunction and Tenon’s capsule
Symptoms - Possible discomfort,no pain,no photophobia,no vision loss
History- Exertion, possible previous occurence,high blood pressure
Treatment- none
Referral - GP if recurring - blood pressure checks
Arcus
Signs,symptoms,history,treatment, referral
signs- opaque white/ grey band at periphery of Iris
Symptoms- no pain, no photophobia,no vision loss
History - Raised cholestrol, caused by fat deposited in cornea
Treatment ~ Reduce cholesterol intake
Referral - GP for cholesterol check
Epicanthal folds
Signs,symptoms,history,treatment, referral
Signs- Commonly seen in young children as the bridge of the nose is not fully developed usually bilateral gives the appearance of esotropia
Symptoms - no symptoms,no pain,no photophobia,no vision loss
History- is still preser adulthood in in oriental Races + downs Syndrome,Careful examination to ensure hetero tropia use pen torch to check reflex
Treatment- Surgery if required
Referral- GP if Surgery if required for cosmetic reasons
D2- Iritis
Signs,symptoms,history,treatment, referral
Signs- Unilateral inflammation of the Iris Irregular Shaped pupil,usually one eye
Symptoms- Acute iritis - Pain, reduced VA,lacrimation and photophobia, Chrome Iritis - very few symptoms
History - Arthritis, aids ,TB
Treatment- mydriatic drops followed by systemic steroids
Referral - urgent A+ E Telephone ahead
D2 Keratitis - ( kera= cornea)
Signs,symptoms,history,treatment, referral
Signs - Red eye Corneal lesion inflamation of Cornea, lacrimation,discharge,Corneal ulcer visible as white Patch on the Cornea,usually are eye
Symptoms - pain, blurred vision,Photophobia,reduced VA if ulcer centrally On Cornea,FB Sensation
History-.Corneal Trauma,CL wearer,Dry elderly,Herpes simplex
Treatment. Antibiotic Drops,steroids and antiviral drops
Referral - urgent to A+ E
D2 Hypopyon
Signs,symptoms,history,treatment, referral
signs - white blood cells deposited in the lower anterior chamber
Symptoms - None,NO Pain/ photophobia /Vision loss
History - linked with bacteria Keratitis (corneal ulcer) in servere or long standing cases hypopyon may be present,may lead to acute secondary glaucoma
Treatment- antibiotics drops or oinment or subconjunctival injections
Referral- Urgent A&E
Hyphaema
Signs,Symptoms,History,Treatment, referral
Signs-Blood in the anterior chamber
Symptoms- Pain, blurred vision, particulary in the crystaline lens is displaced, possible visual field loss if a retinal detachment has occured
History- A blow to the eye or orbital region, caused by fall or struck by blunt object- may lead to 2nd glaucoma
Treatment- Miotics to reduce IOP, surgery maybe needed to remove blood clot or crystaline lens
Referral- Urgent to A&E
malignant melanoma of the Iris-
Signs,Symptoms,History,Treatment, referral
Signs- Darker iris area, may appear thicker and cause distortion of the pupil bleeding may occur causing hyphaema Blood in lower iris)
Symptoms- none unless the tumour blocs the angle of the anterior chamber producing secondary glaucoma
History- Increased uncontrolled growth of melanocytes
commom in over 60’s
Treatment- none if no bleeding/ pupil distortion surgical if enlrgment occurs, removal of tumour, possible enucleation(removal of eye)
Referral- GP urgent
Acute Glaucoma
Signs,Symptoms,History,Treatment, referral
Signs- Red eye cloudy cornea oval shaped pupil
Symptoms- Severve pain, frontal headaches, blurred vision, vomitting due to pain
History- haloes round lights, 4 types, Acue open angle, closed angle congenital. NICE guidlines state if IOPs 34 or more in 1 or both eyes immediate referral to A&E
Treatment- Miotics to reduce IOP NICE guidelines look above
Referral A&E phone ahead & email referral letter
Orbital cellulitis (D2)
Signs,Symptoms,History,Treatment, referral
Signs- Inflammation of the orbital connective tissues, Lids red, swollen, serervly closing, conjuntiva also swollen and inflamed
Symptoms- moderate to servere orbital pain, may be worse with eye movement possible diplopia and reduced VA feverish
History- Bacterial infection spread from infected tooth/sinus
Treatment- immediate HES possible leading to optic neuritis/ meningitis, antibiotics, surgery to drain orbit and infectied sinues
Referral- Urgent to A&E.
Episcleritis- (D2)
Signs,Symptoms,History,Treatment, referral
Signs- inflammed sclera, redness swelling of the surface of the sclera, affecting a diffuse area or a well defined patch near the limbus
Symptoms- slight discomfort, gritty sensation, photophobia
History- commonly affects young people linked with herpeszoster (shingles) or gout
Treatment- often go without treatment reaccurance are common steroid drop maybe used reduce discomfort, Defer CL wear
Referral- GP only (urgent refer if reaccuring)
Scleritis (D2)
Signs,Symptoms,History,Treatment, referral
Signs-Inflammed sclera redness often with bluish tinge and swelling of the deep layers of the sclera
symtoms- Pain affecting the orbital area including the forehead and jaw and eyeball
History- linked with systemic conditions arthritis, herpes zoster, often accompained by uveitis may lead to keratitis, glaucoma and cataract
Treatment- steriod drops systemic and tropical,Defer CL wear
Referral - A&E
Retinoblastoma (D2)
Signs,Symptoms,History,Treatment, referral
Signs- white/yellow appearance to the pupil usually unilateral. rare tumour found affecting young children
Symptoms- reduced VA, rarely noticed unless bilateral, advanced tumours can cause 2ndary glaucoma
History- Nuclear layers in the foetal retina arise from genitic mutation, hereditarry
Treatment- Radiation therapy/ enucleation removal of the eye
Referral- A&E
Tumour- Basal call cacinoma (D2)
Signs,Symptoms,History,Treatment, referral
Signs Lesion on eyelid or nose,misaligned eyelashes, pearly edge dipped centre , red area, (similar to a pizza)
Symptoms- no pain possible slight discomfort, may come ulcerated
History- Possible previous occurance
Treatment- Surgical treatment
Referral GP further referral to dermatologist for treatment
FB (D2)
Signs,Symptoms,History,Treatment, referral
Signs- red eye, inflammation, lacrimation
symtoms- inflammatory reaction, paun reduced VA, photophobia,blurred vision depentant on trauma
History- Occupational or DIY accident
Treatment - Removal if possible
Referral - Urgent to A&E if embedded or penetrating
Chemical burn (D2)
Signs,Symptoms,History,Treatment, referral
Signs- inflammation, lacrimation
Symptoms- pain & blurred vision, photophobia
History- Occupational accident, DIY accident Acid attack
Treatment- Immediate irrigation, Flush excessivley with saline/water
Referral- Urgent A&E
Trichiasis (D2)
Signs,Symptoms,History,Treatment, referral
Signs- misdirected eyelashes growing inwards, abrading the cornea, inflammation, lacrimation, can result in ulceration of the cornea
Symptoms- pain, reduced VA Caused by eyelashes rubbing
History, Eyelash follicles in an abnomal position, Entropian, blepharitis, congenital
Treatment- lash removal, bandge CL
Referral - G{
Macular Degeneration (D2)
Signs,Symptoms,History,Treatment, referral
signs- No external visible signs, ophthalmoscope shows pale spots in fundus
Symptoms- progressive central vision loss- difficuly reading and near vision tasks, straight lines appear wavy, loss of sharp detail
History- Hereditary- prevalent in females, smokers, poor diet, lacking luteins, eventually the Macular degenerates completley choroidal vessels may become visible
Treatment- WEt AMD antivascular endothelial growth (anti vegf injections into viterous) , Lucentis injections
Referral - WEt AMD clinic -
detached retina (D2)
Signs,Symptoms,History,Treatment, referral
signs- no visible external, ophthalmoscope shows purple grey area on the fundus which appears ripped or folded, retinal blood vessels in this area may appear darker
Symtoms- progressive visual field loss -(curtain) flashes occurs with eye movement, floaters, Reduced VA
History- High myopia exertion, can be caused by aging or cataract surgery
Treament -
Referral - A&E
Acute Glaucoma (D2)
Signs,Symptoms,History,Treatment, referral
signs- Red eye cloudy cornea oval shaped pupil
Symptoms- servere pain int he eye, frontal headaches, blurred vision, vomitting due to pain
History - Haloes round lights- 4 types acute open angle, closed angle congenital NICE guidelines state if IOPS 34 or more in ome or both eyes immediate referral
Treatment -
V Value
1.5
V58
V value
1.6
V42
.V value
1.67 as
V33
.V value
1.74 AS
V31
V value
1.76AS
V30
V value
Poly
1.586
V30
V value
Trivex
1.53
V43-45
V value
Airwear 1.59
V31
V value
Glass
1.9
V30
V value
Glass 1.8AS
V35
V value
1.7
V40
How much are Standard ppl inset
1.5mm to 4mm
State 3 factors that control the inset off ppl
Design Softer design = more inset
Add low add = more inset
Distance rx - minus rx will have more inset that plus rx as myopes converge more
3 Methods plastic tinting
Dip dyed
Vacuum
Polarised
3 methods of glass tinting
Solid
Vacuum coated
Bonded Equi tint
What is a best form lens
A lens designed to eliminate 9r minimalise aberrations and distortions
Name 5 defectsthat are reduced or eliminated by best form lenses
Coma
Oblique astigmatism
Distortion
Curvature
Tca transverse chromatic aberration
Which Image shells should fall on the far point sphere
Tangential and sagittal
Advantages of aspheric lenses
Flatter
Thinner
Lighter
Less speg mag/min
How do aspheric reduce spec mag
Lens is flatter and thinner
Sm = power factor x shape factor
Difference between point focal and percival lenses
Point focal- steeper base curve , therefore thicker
Percival- flatter base curve therefore thinner but more distortion
MTE lenses
Minimum tangential error
Which markings on lenses are permanent
Add (temporal)
Manufacturer logo
Lens design
Material
Index
Base curve
Why is it important to use correct manufacturers template
Distance between f8tting Cross and prism reference point varies between
0,2,4,6mm
Ppl
How is prism calculated what direction
2/3 of add is worked as base down
Jump
Sudden introduction of base down prism as the eye crosses the dividing line
How to calculate jump in round seg
Jump=seg radius cm x add
3 no jump bifocals
E line
Franklin spilt
D40 seg
4 causes of cateract
Senile
Congenital
Trauma
Medication
Excessive UV
How does a MAR coating work
Destructive interference
Reflected light is1/2 wavelength out of phase so reflections cancel
Occupational
Restricted distance
Room distance ziess Rd
Enhanced reader sola access
Restricted distance hoya tact (pupil)
Room distance ziess Rd (pupil)
Enhanced reader sola access (lower limbus)
Cvi
Certificate of visual impairment
High add bifocals
Cr39 round 24
What age do cx start to lose intermediate vision
50-55 years
