Visit 1

Question 1

Under what principle does keratometry work

Answer 1

Keratometry works on the principle of recording the image size reflected from a known-sized object.
Given the object size and distance from image to object, the radius of curvature of the cornea can be calculated.

Question 2

indications for keratometry

Answer 2

 Contact lens assessments
o provide baseline and aftercare examinations values of corneal curvature and any induced changes
o determining side of astigmatic surface
 RGP lens fitting
 NITBUT
o Distorted mires can indicate poor tear quality
 Monitoring corneal pathology

Question 3

where is the astigmatism here
8.00/7.40
-2.00/-3.00 x 180

Answer 3

o Sphere power is located at the axis (-2 @ 180)
o The sum of sphere & cyl is located at 90 from axis (-5 at 90)
o 3D of corneal astigmatism

Question 4

Types of astigmatism

Answer 4

WTR – vertical meridian stays close to 90 & is steepest (steepest = smallest), flattest at 180
o Smallest number is the vertical
o +ve cyl at 90
o -ve cyl 180
o More common

ATR – horizontal stays close to 180 & is steepest, flattest at 90
o Smallest number is the horizontal
o +ve cyl at 180
o -ve cyl at 90

Oblique – principles not at 180 & 90 - 130-160, 120-150

Irregular – principle meridians not separated by 90

Question 5

Automatic Keratometry

Answer 5

 Two position instruments
 Use servomotors to drive the doubling device until alignment can be assessed optically using light-emitting and detecting diodes
 The machine prints out 3 measures
 Phi 2.4 = central 2.4mm corneal diameter (we use)
 Phi 3.3 = central 3.3mm corneal diameter
 Comparison of the 2 above gives an indication of corneal shape

Question 6

Bausch and Lomb advantages and disadvantages

Measures the 2 meridians at the same time and contains 2 prisms which are adjusted independently

Answer 6

o One position– double images produced side by side at 90 deg from each other
o Variable doubling – object size remains constant, which allows for measurement of TBUT
o Fixed mires
cannot check for irregular astigmatism

Question 7

Javal Schowitz advantages and disadvantages

Answer 7

o Two position - requires rotation about axis to measure each of the principle meridians
o Fixed doubling – the distance between the mires are varied mechanically, when these are lined up, Ks are taken from scale along each meridian in 2 stages. This system only works at certain distance from eye
o Variable mires
- used for irregular astigmatism
-more accurate as longer working distance

Question 8

keratometry common errors

Answer 8

o Failing to maintain mire image focus when attempting superimposition of the mire image
o Not ensuring the px keeps their head against the headrest
o Forgetting to focus the eyepiece
o Not centring the mire image (in centre of cornea)
o Forgetting to calibrate the instrument regularly

Question 9

4.1.2 positioning tolerances

Answer 9

o Heights – within +/-1.00mm of the order
o Horizontal position of the fitting point – within +/-1.00mm
o Alignment marking tilt – no more than 2 degrees from horizontal

Question 10

• BS EN ISO 21987:2017

Answer 10

o Effective from 30th September 2017
o BS = British Standards
o EN = European Nations
ISO = International Organisation for Standardisation (worldwide federation of national standards bodies)

Question 11

prism in varifocals

Answer 11

 There is always prism at the prism reference point due to prism thinning; mainly for cosmetic purposes to ensure same level of thickness in lens despite reading addition
 To check for prism in varifocals
o Measure both lenses at prism reference point
o If there is a difference, then this residual prism gives prism in specs
o Examples
 3BD RE 3BD LE cancels out = no residual
 3BD RE none LE = residual prism of 3BD
o Plus lenses – base up prism should be removed to reduce thickness, therefore if + lens, the prism should be BASE DOWN for prism thinning
o Minus lens – base up prism for thinning

Question 12

focimeter measures what

Answer 12

the lens’s back vertex power

Question 13

prism tolerances - british standards

Answer 13

 1^ vertical
o Generally 1.5-2.5^
 Distance vision - up to 10^ base out, 4^ base in
 Near vision – up to 7^ base out, 7^ base in

Question 14

prism equation

Answer 14

• P = prism P=CF
• C = decentration (cm)
• F = power (D)

Question 15

What is meant by the terms wettability and modulus? What part do they play in contact lens selection and fitting?

Answer 15

Wettability refers to how easily a liquid spreads over the surface of a contact lens

Modulus is a measure of how a material will deform and strain when put under pressure. SiHy has a higher modulus than hydrogel lenses (so hydrogel more comfortable)

Question 16

SiHy VS Hydrogel lenses

Answer 16

Hydrogels have a greater water content and lower modulus so they are more comfortable
Silicone Hydrogels have high oxygen permeability
Silicone hydrogel lenses have a lower risk of dehydrating during the day because of their lower water content

Question 17

difference between DK/t and DK

Answer 17

Dk/t
Oxygen transmissibility, which is a measure of how much oxygen can pass through a contact lens in air.

Dk
Oxygen permeability, which is a measure of how easily oxygen can diffuse through a contact lens material

Question 18

toric contact lenses methods of stabilisation

Answer 18

truncation - section of lens removed at bottom to align w lower lid margin- should help w orientation and stabilisation , usually done on a lens that also has a prism ballast

prism ballast - prism at the bottom of the lens - w gravity the lens stays w the prism at the bottom

peri ballast - lens thinned down superiorly (thickness at inferior ) so uses thickness differences as the stabilizing component, creates a base down prism effect

double slab off - thin zone superiorly and inferiorly, the lid forces (upper and lower) maintain orientation

dynamic stabilization

toric back surface

Question 19

linarial material, water content, Dk/t, Dk/ modulus

Answer 19

material stenfilcon A
Water content 54%
Dk/t 100
Dk (how permeable a lens is to o2) 80
modulus 0.4 MPa

Question 20

minimum amount of O2 for a cl

Answer 20

24: Minimum recommended central oxygen transmissibility level
33: Minimum recommended peripheral oxygen transmissibility level to avoid swelling³

Question 21

DPA (1998) was superseded by the DPA (2018)

what is now included in the law?

New regulations which supplement the EUs General Data Protection Regulat

Answer 21

The new regulates collection, storage and use of personal data more strictly
Under DPA 2018 – right to find out what information the government and organisations store about you, including the right to:
Be informed about how data is being uses
Access to personal data
Have incorrect data updated/correct personal data
Have data erased i.e. the right to be forgotten/prevent further processing
Stop or restrict processing of your data
Data portability
Object to how your data is processed in certain circumstances

Question 22

what does GDPR inlcude

Answer 22

EU regulations relating to the collecting and processing of data

Indication for consent must be unambiguous – tick box
Broader definition of personal data

Includes any potential identifiers, also identification number, location data & IP address

Higher bar for lawful processing
Must fall within 1 or more of the 6 permitted legal justifications

More rights for individuals
Right to be informed, access, rectify and erase data

Restrict processing
Not to be subjected to automated decision making and profiling

Notify of data breaches
Report a breach to information commissioner’s (ICO) office if high risk to individual within 72 hours of breach & notify individual

Penalties to hold businesses more accountable
GDPR regulates data processors and controllers

Data processing: any action performed on that data e.g. collecting, recording, storing, erasing (third party that processes personal data on behalf of the controller)

Data controller – person who decides why/how personal data is processed (any employer/employee)

Stricter rules for sharing data outside the EU
Potential penalties for non-compliance

Question 23

for DR when is anti vegf done and when is photocoagulation done

Answer 23

DR treatment for maculopathy – anti VEGF. Laser for preventative

Question 24

precision one lens technology

Answer 24

PRECISION1® was born from the Water Gradient Technology of DAILIES TOTAL1®, but offered at an affordable price

Question 25

my day lens technology

Answer 25

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

Question 26

opteyes lens technology

Answer 26

aquaform technology
abberation neutrailsing technology

Question 27

soft MPS ingredients

Answer 27

• 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

Question 28

RGP choice in my store and why

Answer 28

ICON most similar to bausch and lomb materials

Question 29

ICON material

Answer 29

Fluorosilicone acrylate?

it has a hydrophillic coating which helps with wetability and lubricity

Question 30

hydrogen peroxide 1 step- coopervision

Answer 30

 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

Question 31

hydrogen peroxide 2 step

Answer 31

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

Question 32

RGP MPS ingredients

Answer 32

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

Question 33

what to do when cls is too loose

Answer 33

steepen the base curve

Question 34

what to do when cls is too tight

Answer 34

flatten the base curve

Question 35

severe VF defects

Answer 35

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

Question 36

normal blood pressure levels

Answer 36

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

Question 37

normal glucose levels

Answer 37

4–7 mmol/L before eating

Question 38

pituitary tumour causes which VF defect

Answer 38

bitemporal hemaniopia

Question 39

severe VF defects

Answer 39

• 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

Question 40

different targets for VFs machine

Answer 40

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

Question 41

insulin meds effect

Answer 41

 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

Question 42

 Metformin and Gliclazide side effects

Answer 42

 Metformin (biguanide) (T2) – dry eye and increase risk of angle closure

 Gliclazide – lens changes, refractive error shifts

Question 43

AOP - what does it do

Answer 43

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

Question 44

GOC

Answer 44

• 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

Question 45

Medical act

Answer 45

 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

Question 46

what does the opticians act do?

Answer 46

 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

Question 47

NTG risk factors

Answer 47

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

Question 48

what does the cyclodiode laser do

Answer 48

destroy some of the ciliary body - reduced aqueous humour prodcued

Question 49

process of GOC compliant

Question 50

trabeculectomy

Answer 50

new passage for drainage
flap created in sclera (BLEB)

Question 51

SLT - selective laser trabecultoplasaty

Answer 51

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

Question 52

MIGS- istent

Answer 52

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

Question 53

ahmed valve

Answer 53

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

Question 54

POAG risk factors

Answer 54

• 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

Question 55

common combination glaucoma drop

Answer 55

simbrinza
(bromindine and brindolamide)

Question 56

DR risk factors

Answer 56

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

Question 57

AMD Risk factors

Answer 57

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)

Question 58

Cataract Risk factors

Answer 58

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

Question 59

catarct management

Answer 59

• 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

Question 60

cataract operation procedure

Answer 60

 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

Question 61

grampian

Answer 61

⦁ 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

Question 62

LENS

Answer 62

⦁ 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

Question 63

ayrshire and arran

Answer 63

⦁ 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

Question 64

SCI gateway

Answer 64

⦁ 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)

Question 65

what is the data protection act?

Answer 65

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

Question 66

explain diabetes

Answer 66

 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

Question 67

mental capacity act

Answer 67

 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

Question 68

1. Prostaglandin analogue

Answer 68

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

Question 69

2. Beta-blocker

Answer 69

e.g. timolol,
 Decrease aqueous production

Question 70

3. Carbonic anhydrase inhibito

Answer 70

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

Question 71

4. Alpha 2 agonist

Answer 71

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

Question 72

PACG risk factors

Answer 72

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

Question 73

HBP explanation to px

Answer 73

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.

Question 74

HBP meds and side effects

Answer 74

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

Question 75

implementing GDPR

Answer 75

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

Question 76

implementing data protection act

Answer 76

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