Visit 1 Flashcards

Question

my day lens technology

Answer 1

Aquaform® Technology, which provides a unique balance of high oxygen permeability, high water content and optimum modulus for a soft and flexible lens

Answer 2

aquaform technology abberation neutrailsing technology

Answer 3

- Polyhexanide (PHMB) – disinfectant / preservative - Sodium hyaluronate – helps stabilise tear film, reduce friction between lens and ocular surface - Sodium chloride – tonicity, maintains ideal CL salt solution of 0.9% (too low – cornea swells, too high, cornea drys) - Sodium phosphates – buffer to ensure neutral pH to match tear film - Poloxamer – surfactant used to clean lenses - EDTA – chelating agent, prevents lens deposits (i.e. calcium) / enhances action of preservatives

Answer 4

ICON most similar to bausch and lomb materials

Answer 5

Fluorosilicone acrylate? it has a hydrophillic coating which helps with wetability and lubricity

Answer 6

 Lenses into baskets, rinse each lens in the holder for 5 seconds with peroxide solution, fill the lens case up with solution to the marked line, place lens holder inside of case and close cap, solution will bubble – ensure lenses upright and fully immersed. Allow lenses to soak for at least 6 hours. to insert lenses need to rinse with saline first

Answer 7

1. Wash your hands 2. Rub both sides of the lenses carefully with 4 drops of cleaner (Step 1) in the palm of your hand for 20 seconds 3. Rinse both sides of the lens with a saline solution 4. Soak your lenses for 4 hours with the conditioning solution (step 2) 5. Add a drop of conditioner to the lens for extra cushioning and insert into your eye. 6. Rinse your lens case with a sterile disinfecting solution and then wipe dry with a clean tissue. Avoid air-drying. Boston 2 Step Cleaning and Conditioning System Ingredients: Boston Advance Cleaner (Step 1) * Alkyl ether sulfate – Surfactant to remove contaminants from the lens surface * Ethoxylated alkyl phenol – Alcohol to remove bacteria from the lens surface * Quaternary phosopholipids, Titanium Dioxide and silica gel – aids to physically scrub off proteins and deposits when rubbing Boston Advance Conditioning Solution (Step 2) wetting and cushioning agents: * cellulosic viscosifier * polyvinyl alcohol * polyethylene glycol

Answer 8

- Polyhexanide – disinfectant/preservative - EDTA – chelating agent - Sodium phosphates - buffer - Poloxamer – surfactant, clean lenses - Sodium chloride – tonicity minimum 4 hours soak

Answer 9

steepen the base curve

Answer 10

flatten the base curve

Answer 11

 Homonymous hemianopia – stroke  Bitemporal hemianopia – pituitary tumour  Tunnel vision - Retinitis pigmentosa  Severe AMD

Answer 12

normal blood pressure is between 90/60 mmHg and 120/80 mmHg

Answer 13

4–7 mmol/L before eating

Answer 14

bitemporal hemaniopia

Answer 15

* Central scotoma e.g. AMD * Monocular visual loss e.g. CRAO or CRVO, RD, optic neuritis or atrophy or end stage glaucoma * Homonymous hemianopia e.g. middle cerebral artery occlusion * Homonymous inferior quadrantopia e.g. parietal stroke or tumour * Homonymous superior quadrantopia e.g. temporal stroke or tumour * Homonymous hemianopia with macular sparring e.g. posterior cerebral artery occlusion * Enlarged blind spots – due to papilloedema as well as glaucoma

Answer 16

Central target: Yellow light in the bowl's centre * Small diamond: For patients who cannot see the central target such as those with macular degeneration. The patient looks into the centre of the four lights * Large diamond: For patients who cannot see the above two

Answer 17

 Insulin - may cause hypoglycaemia which causes dizzy spells; in rare cases may cause presbyopia when first starting treatment due to shifting fluids which affect the lens; generally stabilises o Novorapid – ingredient insulin aspart, fast-acting and works rapidly to normalise blood sugar levels, begins working after 10-20mins, lasts 3-5 hours o Levemir – ingredient insulin detemir long acting, subcutaneous injection only, up to 24-hour duration of action

Answer 18

 Metformin (biguanide) (T2) – dry eye and increase risk of angle closure  Gliclazide – lens changes, refractive error shifts

Answer 19

offers indemnity insurance for optometrists and dispensing opticians that covers claims arising from allegations of negligence

Answer 20

* Regulator for the optical professions in the UK * Responsible for setting standards for optoms, DOs, optical students and optical businesses * This is set out in the Standards Framework, which makes clear that the standards should always be the first point of reference to registrants

Answer 21

 Act of parliament which governs the control of medicines for human use and veterinary use, which includes the manufacture and supply of medications  Regulates use & supply of drugs/what diagnostic drugs are available, PoM/P/GSL, IP vs Entry  Entry lvl optoms, sell/supply the following o All GSL/P meds provided it is the course of professional practice

Answer 22

 Legislation compiled by parliament which gives the GOC the powers to make orders, rules and regulations in relevant areas  The sections include: GOC, registration and training of opticians, fitness to practice, proceedings and appears, restrictions  We have do heath check as well as refraction

Answer 23

o Increasing age o Gender – some studies have found F>M o Family history o Ethnicity  Japanese > Europeans or North American Caucasians o CCT lower in NTG than POAG o Abnormal vasoregulation  Migraine  Raynaud phenomenon  Systemic hypotension  Diabetes, carotid insufficiency, HBP and hypercoagulability o Obstructive sleep apnoea syndrome o Myopia o Thyroid disease may be more common

Answer 24

destroy some of the ciliary body - reduced aqueous humour prodcued

Answer 25

new passage for drainage flap created in sclera (BLEB)

Answer 26

Laser energy is applied to the drainage tissue in front of the eye (the trabecular meshwork)

Answer 27

inserting two tiny hollow metal tubes (stents) into the trabecular meshwork in the eye - for drainage

Answer 28

a small device that's implanted in the eye during glaucoma surgery to regulate aqueous flow and reduce intraocular pressure (IOP)

Answer 29

* Affects 1-2% of the white population of the UK > 4, increasing to 4-5% in > 80s * Second most common cause of irreversible blindness in the UK (approx. 10% of blind registrations) * Incidence: M=F * Risk factors o High IOP or OHT (asymmetry of  4mmHg also significant) o Increasing age o Ethnicity  Black > white (also Latinos, but this is < Afro-Caribbean)  Black pxs are 4x more likely to develop it o Family history  4x more likely if a sibling has it  2x more likely is a parent has it o Thinner central corneal thickness o Suspicious optic nerve appearance  Large optic disc with increase cupping o High myopia o Diabetes o Vascular disease e.g. HBP, migraine and poor ocular perfusion o Eye surgery or injury o Long term use of steroids (eye drops, pills, inhalers and creams) and the contraceptive pill

Answer 30

simbrinza (bromindine and brindolamide)

Answer 31

o Diabetes duration (most important risk factor)  DR rarely develops within 5 years of onset or before puberty  Duration is a stronger predictor for proliferative disease than for maculopathy o Poor diabetic control  Type 1 appear to obtain greater benefit from good control than type 2  The higher a person’s blood sugar level, the greater the risk of developing DR o HBP  Very common in type 2  CVD and previous stroke are also predictive of HBP o Nephropathy  Associated with worsening of DR o Gestational diabetes  Pregnant women with gestational diabetes are at a higher risk of developing DR at a rapid rate o Other factors  Smoking  Obesity  Cataract surgery  Hyperlipidaemia  Anaemia

Answer 32

o Increasing age (>60) o Ethnicity  More common in Caucasians than Black or African-Americans o Family history  3-4x more likely with 1st degree relative o Smoking  Doubles the risk o Uncontrolled HBP and high cholesterol o Dietary factors  High fat and alcohol intake and obesity increases the risk o Sunlight exposure o Other factors  Cataract surgery  Blue iris colour  Female gender (may be due to the fact that women live longer)

Answer 33

o Increasing age (common in > 60s) o Family history o Smoking o Heavy alcohol use o Obesity o HBP o Too much sun exposure (UVB) o Ethnicity – Caucasians > Afro-Caribbean > Asians > Europeans o Long-term corticosteroid use o Diabetes

Answer 34

* Myopic shift can be easily fixed with updating px refraction o This may help at the start, but may come a time when a stronger rx may not help improve VA * Optimisation of reading light o Bright reading lamp over left shoulder * Reduction of glare (px may experience this at night, and see halos around lights) o Brimmed hat o Anti-reflection coating/MAR * UV protection o Reactions, sunglasses and polarising lenses (cut down glare even more) * Stop smoking o This will reduce the rate at which the cataract develops, possible referral to GP or pharmacist for cessation info

Answer 35

 Phacoemulsification is the current technique which uses ultrasound technology  Corneal incision is made, the top of the capsule is removed (capsulorrhexis), phaco of the lens nucleus where lens is broke down into small pieces and removed, irrigation and aspiration, insertion of IOL into capsular bag  Monofocals and torics are available on NHS

Answer 36

⦁ In 2010, a clinical accord was agreed between GPs, ophthalmologists and optoms to enable optoms to undertake the management and treatment of the pxs with: ⦁ Anterior uveitis ⦁ HSK ⦁ Marginal keratitis ⦁ Corneal FB, which requires removal with a needle and/or alger brush ⦁ To undertake this extra service, community optoms have to undertake accredited training and following strict protocols ⦁ Community optoms receive an additional fee for carrying out these services Grampian eye health network – allows optoms to undertake management of anterior uveitis, HSK, marginal keratitis, corneal FB with removal – community optoms need to undertake strict training and follow guidelines

Answer 37

⦁ The LENS scheme was introduced in Lanarkshire in 2010 with the purpose of attempting to reduce demand in the Ophthalmology Acute Eye Casualty Clinic ⦁ The scheme involves pxs receiving treatment for a number of conditions and follow-up appointments with their community optom, who have undergone robust training ⦁ This means pxs can be seen in the community rather than being referred to secondary care e.g. red/sore eyes, reduced vision etc. ⦁ Px satisfaction rates for the service have been high ⦁ Optoms provide this service under the current GOD supplementary fee structure access to low potency steroids & aciclovir

Answer 38

⦁ Post-operative cataract assessment ⦁ Pxs who have received uncomplicated cataract surgery are assessed 4-6 weeks post-op by their local optom ⦁ This apt. is arranged prior to the px being discharged from HES and helps to up skill optoms ⦁ One-stop cataract facility (SCI gateway) ⦁ If px wants cataract surgery and optom feels they require it, optom can refer HES for ‘one-stop’ service appointment ⦁ Forward referral form to GP, hospital and px – px is given info booklet about appointment details ⦁ Px sees ophthalmologist and px told risks/complications ⦁ If px happy with this, then no initial consultation is required from the ophthalmologist and surgery can take place ⦁ Two-stop cataract facility ⦁ Px gets initial appointment to check if they want cataract surgery by consultant ⦁ Biometry, HBP and fundus/OCT is carried out at this first apt too ⦁ If they are happy to have surgery then this takes place at the 2nd visit ⦁ Low Vision services ⦁ Optometry practices provide LV services/assessments and aids to pxs funded by the NHS board ⦁ Hospital Contact lenses ⦁ Complex fitting, therapeutic and cosmetic CLs are fitted in the community

Answer 39

⦁ National system that integrates primary and secondary care systems using familiar yet highly secure internet technology ⦁ Gives options for specific referrals ⦁ General ⦁ Glaucoma ⦁ Orthoptics ⦁ Cataract ⦁ Wet AMD ⦁ Can refer to primary care (GPs) or secondary care (HES)

Answer 40

protect person data stored about individuals on computers/paper filling systems 1. Data must be secure 2. Must be used in a way that is adequate, relevant, and not excessive 3. Kept for no longer than necessary 4. Data stored must be kept accurate & up-to-date 5. Data obtained and processed lawfully 6. Processed within data subject rights 7. Must be obtained and specified for lawful purposes 8. Not transferred to countries without adequate data protection laws

Answer 41

 This is a conditions where the amount of sugar (glucose) in the blood is too high because the body can’t use it properly. This is usually caused by your body not having enough insulin or having poor insulin which does not work properly. Insulin is the chemical that helps your body absorb sugar

Answer 42

 England & wales legislation – applies to everyone involved in the care, treatment and support of people aged 16 or over who are unable to make some or all decisions themselves  Scotlands equivalent is adults within capacity o Any action must benefit the px and be necessary o Wishes of person considered o Options should be least restrictive o Other relevant people must be consulted before decision is made o Person must be encouraged to use skills and develop new skills where possible

Answer 43

e.g. Latanoprost (Xalatan)  Increase uveoscleral outflow by ciliary muscle relaxation

Answer 44

e.g. timolol,  Decrease aqueous production

Answer 45

3. Carbonic anhydrase inhibitor e.g. brizonolamide (azopt)  Decrease aqueous production

Answer 46

4. Alpha 2 agonist e.g. brimonidine tartrate (alphagan)  Decrease production & increase outflow

Answer 47

Race – far eastern and Indian Asians Refraction – hypermetropic Short axial length – narrow AC Age >40 – AC becomes narrow as lens becomes thicker Gender – females Family history – genetic factors are important but poorly defined

Answer 48

High blood pressure (hypertension) is a condition where the pressure of the blood inside the arteries is higher than it should be, and so the heart has to work harder than normal to pump blood around the body The consequences of uncontrolled HBP can be severe i.e. loss of vision due to a blockage in the blood supply to the retina or optic nerve, loss of peripheral vision due to stroke or episodes of vision loss which come and go. The condition can be improved by lifestyle changes such as improving diet, avoiding excess alcohol consumption, stopping smoking and increasing exercise, as well as medications such as beta-blockers, calcium channel blockers and vaso-dilators.

Answer 49

Beta blocker - Propranolol = dry eye ACE inhibitors - Lisinopril & ramipril = may cause ciliary body oedema which leads to reduced accommodation and angle closure Calcium channel blockers – losartan

Answer 50

Consent to store data must be unambiguous – tick box for consent on arrival As px’s have the right to decide how their info is controlled – ask about contact preferences on arrival Confirm details on arrival as we have an obligation to ensure data is accurate and correct Pxs have right to access their own info so can book time out of diary to discuss records as it must be in a test room, not shop floor; also gives evidence that you have spent time with px

Answer 51

Hidden information cannot be accessed without specific knowledge e.g. password No information should be left visible to the public i.e. screens turned off/no paperwork Regular testing of technology instore Test room only accessible by optoms – log out computers on shop floor after use