certificate in contact lens practice · achievement of the certificate in contact lens practice...

Association of British Dispensing Opticians

Certificate inContact Lens Practice

Conditions of AdmissionSyllabus AssessmentRequirements

QCA Level 6

Sept 2017 revised ABDO Certificate in Contact Lens Practice_Layout 1 21/09/2017 15:13

Sept 2017 revised ABDO Certificate in Contact Lens Practice_Layout 1 21/09/2017 15:13 Page 18

FOREWORD

Students should be aware that the contact lens examinations lead to a post-graduate qualification and so requirea more mature approach to their preparation. In addition to course textbooks and notes, students will be requiredto demonstrate current and in-depth knowledge and skills in the field of contact lens practice.

The Certificate in Contact Lens Practice examinations are designed to assess the General Optical Council ContactLens Specialty Core Competencies as follows –• Full theoretical knowledge of contact lens practice• Practical knowledge of contact lens practice

Achievement of the Certificate in Contact Lens Practice permits the use of the qualification – FBDO CL

The successful candidate may practice unsupervised – see the Contact Lens section of the ABDO Advice andGuidance [www.abdo.org.uk] and the GOC Contact Lens Qualification Rules(1988) modified in 2005

Holders of the Certificate in Contact Lens Practice are encouraged to attain the Diploma in Advanced ContactLens Practice which permits the use of the qualification – FBDO(Hons)CL [see separate syllabus]

CONDITIONS OF ADMISSION

• The candidate must satisfy the Association’s Academic Board that they have undertaken a suitable recognised course of training in preparation for the examinations.

• The candidate holds either the Level 6 Dispensing Diploma of the Association or a appropriate qualification of a recognised examining body in Ophthalmic Optics and is currently registered with the General Optical Council. The decision of the Association’s Academic Board is final.

• To participate in the Certificate in Contact Lens Practice practical examination, the candidate must have undertaken a minimum of 224 hours practical contact lens experience under the supervision of an ABDO approved supervisor and at an ABDO approved practice [see Registration of Supervisor and Practice] and is required to be in regular contact lens practice, prior to any attempt to the contact lens practical examination.

SUPERVISION OF CONTACT LENS TRAINING OF DISPENSING OPTICIANS

The Association requires that the supervisor must be on the premises during the practical experience sessions, aware that contact lens consultations are being undertaken and so placed that they are able to intervene in the procedure.

The fitting and aftercare of contact lenses by a qualified, registered Dispensing Optician under supervision may not begin until they have commenced a recognised contact lens training course, that is the Contact Lens Course at ABDO College or the Day Release Contact Lens Courses at Bradford College and City & Islington College. In addition, the Primary Supervisor must be registered with the ABDO Examinations & Registration department

Supervisors may not be responsible for more than one contact lens trainee at the same stage of training. If a trainee has been referred to retake one or more sections of the ABDO Contact Lens Certificate Examination then the supervisor may also supervise a second trainee who is at a different level, on the understanding that:• the legal requirements for the close personal supervision for contact lens fitting by either trainee is complied with

at all times• the needs of the new trainee for advice and guidance are not neglected

Students may not practice under supervision for an indefinite period. Theory examinations should be attemptedwithin two years of course completion. Evidence of formal revision will be required if a period longer than 2 years


occurs between completion of the training course and the theory examinations and between the theory and the practical examinations. The practical examination may not be attempted prior to the theory examinations and should be attempted within two years of theory examinations. The Primary Supervisor and practice must be on the current register of ABDO approved supervisors and practices throughout attempts of the practical examination. and should remain so until the TCLO has been awarded the qualification and been admitted to the GOC Contact Lens Specialty Register.

Registration of Supervisor and Practice

The ABDO requires a contact lens student to gain practical experience under the supervisor and at a practice approved by and registered with the Association s amination Registration e artment The Primary supervisor must be registered with the ABDO at the commencement of the trainee’s practical experience. Application for continued approval of the Primary Supervisor and Practice must take place in the period between 12 and 6 months prior to the sitting of the practical examination. [see Important Dates below]

If appropiate ( that is a Contact Lens Optician or an Optometrist who has been qualified more than 2 years is available and willing ) and if the TCLO has been involved in contact lens practical experiance for a minimum of 6 months AND has accrued a minimum of 150 hours personal clinical experience, a Supporting Supervisor may be registered with the Association and may be involved in the trainee’s supervision for up to 33% of the trainee’s clinical time.

Registration of a supervisor and practice involves –• Application to ABDO for initial registration as soon as practical experience begins.• Application for a practice visit [during which the Competency 5.2 assessment occurs], to reach ABDO

Examinations & Registration Department at the latest by –31 July (for Winter examinations) or 31 January(for Summer examinations)

• Inspection by an ABDO Visitor of the practice and its facilities and a meeting with the supervisor and thestudent.

• Visitor Report to ABDO• Confirmation by ABDO of registration status

Approval is given for a three-year period. The supervisor and the practice are given approval separately.

Conditional approval may be given if the matter of concern may be resolved before the examination.

If a practice and supervisor are not approved, the candidate will unable be to participate in the practical examination until the matter is resolved.

ASSESSMENTS INFORMATION

Examinations Structure

The Certificate in Contact Lens Practice examination consists of written, practical and oral work. There are three theoretical papers of two hours each, as detailed in the main body of the syllabus. The pass mark for each paper is 60%.

o com etencies are assesse uring the ractice isit an the remain er uring the ractical e amination The practical and oral elements of the examination extend over one day and total five hours. The pass mark is 60%in each section

Examination and Marking Notes

General

If the candidate presents themselves on the day of the examination, they are deemed to be fit and well. If any adjustments or considerations are required to be actioned, these must be communicated in advance on the relevant forms, to the Examinations Department.]

Candidates may attempt each theory paper and the sections of the practical examination, a maximum of four times. After three attempts, the Association will require the candidate to provide evidence of a further recognised course of sustained study [theory examinations] or a formal revision course [practical examination]. If a trainee has

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failed any theory or practical examination after four attempts, they would be required to either cease contact lens training or if appropriate, all successes to date would be considered null and void and they would begin a full formal theory training course again and would sit the full theory and practical examinations again.

There is a 7 year limit on the use of partial examination success towards the Certificate in Contact Lens Practice qualification. If a theory examination or a section of the practical examination was achieved more than 7 years previously, it would be necessary for the candidate to retake that element before the Certificate in Contact Lens Practice can be awarded.

It should be noted that the four attempts rule is applied to any attempt of the theory and practical examinations whether before or after the 7 year rule takes effect.

CL Theory Examinations

Any script with borderline marks is reviewed by the External Moderator for that unit before the results are presented to the Examinations Board.

If a candidate is unsuccessful they may request a report. A fee is charged for the report. Requests for a report will not be accepted more than 28 days after the issue of the results.

CL Practical Examination

All sections must be taken at the first attempt of the practical examination.

The pass mark is 60% in each section

If a candidate is unsuccessful, a report is issued with the results indicating the areas requiring special attention/study.

A minimum of 2 / 3 examiners will examine each candidate. Any borderline marks are reviewed on the day of the practical examination by the examiners involved and the supervising examiner of the day.

Important Dates

SUMMER SESSION 31 January

1st March

31 May

Early June

July

WINTER SESSION 31 July

1st October

30 November

Final date for applications for Practice Visit and in-practice Competency 5.2 assessment to be with ABDO Examinations & Registrations Department.

Final date for completed Examination application forms to be with ABDO Examinations Department.

Final date for Practical Examination Case Records to be with ABDO Examinations Department.

Theory Examinations held over 2 days

Practical Examinations held at the ABDO National Resource Centre, BirminghamThe examination sections total 5 hours but breaks are built into the time

Final date for applications for Practice Visit and in-practice Competency 5.2 assessment to be with ABDO Examinations & Registrations Department.

Final date for completed Examination application forms to be with ABDO Examinations Department.

Final date for Practical Examination Case Records to be with ABDO Examinations Department.

Early December Theory Examinations held over 2 days

January Practical Examinations held at the ABDO National Resource Centre, BirminghamThe examination sections total 5 hours but breaks are built into the time


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Assessment Table: GOC Core Competencies for the Speciality of Contact Lens Practice(for full text including Indicators see GOC website)

1. Communication

The ability to communicateeffectively with the patient andany other appropriate personinvolved in the care of thepatient, with English being theprimary language ofcommunication

1.1.1 Obtains relevant history andinformation relating to general health,medication, family history, work, lifestyleand personal requirements.

1.1.2 Elicits the detail and relevance ofany significant symptoms.

1.1.3 Identifies and respondsappropriately to patients’ fears, anxietiesand concerns about their visual welfare.

1.2.1 Understands the patient’sexpectations and aspirations andmanages situations where these cannotbe met.

1.2.2 Communicates with patients whohave poor or non-verbal communicationskills, or those who are confused, reticentor who might be misled.

1.2.3 Discusses with the patient anunderstanding of systemic disease and itsocular impact, its treatment and thepossible ocular side effects of medication.

1.2.4 Explains to the patient theimplications of their pathological orphysiological eye condition.

1.2.5 Communicates effectively with anyother appropriate person involved in thecare of the patient

1.1 The ability to communicateeffectively with a diverse groupof patients with a range ofoptometric conditions andneeds

1.2 The ability to impartinformation in a manner which isappropriate to the recipient

Background knowledge and the ‘understanding of’ competencies are assessed in the theory examinations and during thepractical examination. The ‘ability to do’ competencies are assessed during the visit to the practice and in the practicalexamination.

Unit Element Criteria

2. Professional ConductThe ability to comply with thelegal, ethical and professionalaspects of practice

2.1 The ability to managepatients in a safe, appropriateand confidential environment

2.1.1 Adheres to Health and Safety issuesin the practice including the ability toimplement appropriate measures forinfection control

2.1.2 Maintains confidentiality in allaspects of patient care

2.1.3 Shows respect for all patients

2.2.1 Is able to manage all patientsincluding those who have additionalclinical or social, needs

2.2 The ability to comply withlegal, professional and ethicalissues relating to practice


2.2.2 Is able to work within a multi-disciplinary team

2.2.3 Is able to work within the law andwithin the codes and guidelines set by theregulator and the profession.

2.2.4 Creates and keeps full, clear,accurate and contemporaneous records.

2.2.5 Interprets and responds to existingrecords


3. Methods of ocularExamination

The ability to perform anexamination of the externaleye and related structures

3.1 The ability to assess theindications and contra-indications to contact lensfittings

3.1.1 Interprets relevant history andinformation obtained from the patient Demonstrates an understanding ofcontraindications to contact lens fittings

3.2.1 Uses instruments to measure thecurvature of the cornea and assess itsregularity

3.2.2 Uses a slit-lamp to assess theexternal eye and related structures

3.2.3 Measures external dimensionsrelevant to contact lens fittings

3.2.4 Assesses the tear film

3.2 The ability to use thetechniques in examination ofthe external eye and relatedstructures and to understandthe implications of the findings

4. Verification and Identification

The ability to assess theaccuracy of the specificationsof contact lenses including theuse of appropriateinstrumentation

4.1 The ability to assess thedimensional measurements ofcontact lenses

4.2 The ability to recognise thedesign features of contactlenses

4.1.1 Selects the appropriate equipmentto measure the relevant parameters

4.1.2 Measures lens parameters to ISOstandards of tolerance

4.2.1 Assesses the lens design anddecides on its definition

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5. Contact Lenses

The ability to manage the fittingand aftercare of patients withcontact lenses

5.1 The ability to select and fitthe most appropriate contactlens for the planned use andclinical needs of the patient

5.2. The ability to instruct thepatient in contact lenshandling, and all aspects oflens wear including careregimes

5.3 The ability to assess theprogress in wear of a contactlens patient

5.4. The ability to investigate,identify and manage anyaftercare issues and to beresponsible for future contactlens management of a patient

5.5. The ability to select and fitthe most appropriate complexlens for the planned use andclinical needs of the patient

5.1.1 Chooses, assesses the fit of andorders soft lenses

5.1.2 Chooses, assesses the fit of andorders rigid lenses

5.2.1 Instructs the patient to handle softlenses and how to wear and care forthem

5.2.2 Instructs the patient to handle rigidlenses and how to wear and care forthem

5.3.1 Carries out a routine aftercareconsultation of a contact lens wearer

5.4.1 Recognises contact lens aftercareissues

5.4.2 Manages contact lens aftercareissues

5.5.1 Chooses and manages the fitting oftoric contact lenses

5.5.2 Chooses and manages thecorrection of presbyopic patients

5.5.3 Understands the conditions whichbenefit from therapeutic and prostheticcontact lenses and manages therapeuticand prosthetic contact lens fittings


CONTACT LENS CERTIFICATE THEORY SYLLABUS

Unit One – Ocular Anatomy, Physiology and Related Pathology (2 Hours)

In each of the following subject areas, there should be an understanding of the aetiology, signs, symptoms,management and contact lens implications of pathological conditions; the examples given are not exhaustive.Consideration should also be given to contact lens induced pathology – eg contact lens associated papillaryconjunctivitis.

EyelidsAnatomy - Gross anatomy of the upper and lower lids with specific reference to muscles, nerves, vascular and

lymphatic supply

Physiology - Lid functions with reference to the relevant ocular structure

Pathology - Pathological conditions affecting the eyelids eg blepharitis, ptosis, entropion, ectropion, trichiasis,hordeolum and chalazion.

Pre-corneal Tear FilmAnatomy - Structure and detailed composition of component layers, physical properties and dimensionsPhysiology - Functions of each component layer and contribution to corneal nutritionPathology - Manifestation of deficiencies in the component layers and the clinical significance.

Lacrimal SystemAnatomy - Gross anatomy of the lacrimal gland, and other structure involved in the production of the tear film

constituents, and the lacrimal drainage apparatusPhysiology - Mechanisms of tear formation and drainagePathology - Clinical causes of epiphora, acquired defects of tear formation or drainage.

CorneaAnatomy - Gross anatomy and histology of the corneal layers. Topographical features and corneal dimensions.Physiology – Corneal nutrition and respiration. Maintenance of corneal deturgescence. Causes of oedema and

the role of the endothelial pump. Epithelial healing rate. Mechanisms of corneal stainingPathology - Corneal ulcer, keratoconus, corneal dystrophies, neovascularisation, keratitis, infiltrates, dellen.

ScleraAnatomy - Gross anatomy of the component layersPhysiology - Structural arrangement producing opaque tissuePathology - Scleritis and episcleritis.

ConjunctivaAnatomy - Gross anatomy of the component layers with a detailed understanding of how these structures

change topographicallyPhysiology - Role in protection and tear film formationPathology - Viral, bacterial, allergic and fungal conjunctivitis. pinguecula, pterygium, giant papillary

conjunctivitis, keratoconjunctivitis sicca.

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Unit Two – Visual Optics (2 Hours)

Instrumentation and Emerging TechnologyRadiuscope / Keratometer [Formula / Doubling principle] / Placido Disc / Keratoscope / The Wet Cell [for usewith Focimeter] / The Scheiner Disc.

Refractive TechniquesSubjective Refraction - Fan & Block [including fogging method ]/ Cross Cylinder/OptotypesBinocular balancing - Turville infinity balance / Humphriss methodDuochrome Test Theory and practiceOver-refraction and resulting prescription

Trial contact lenses and over-refraction / Addition of obliquely crossed cylindersObjective refraction Theory and practice of retinoscopy / Optometers.

The Optics of the EyeSchematic and reduced eyes Knowledge of constantsAmetropia Axial, refractive / Aphakia / anisometropiaAstigmatism Corneal, lenticular, total, residual, irregular / Classifications of regular astigmatism /

Calculations for toric contact lensesRetinal images Spectacle magnification / Thin and thick lens systems

Relative spectacle magnification / Aniseikonia / Comparisons between spectacleand contact lens corrections.

Accommodation and Convergence Ocular accommodation / Spectacle accommodation /Convergence /Comparisons between spectacle and contact lens corrections.

The Optics of Contact LensesThe liquid lens Liquid lens power [alignment, steep, flat fitting] / Corneal astigmatism / Calculation

of residual astigmatismComputation of contact lens parameters to given prescriptionCalculation of front surface powers and radii / Hydrophilic lenses / Hydration factors / Changes in parameters

during hydrationLens thickness Axial centre thickness and edge thickness / Radial edge thickness of monocurve

and bicurve lensesBifocals and Multifocals Rigid / Hydrophilic / Fused / Solid / Alternating / Simultaneous vision / Calculation of

parameters to required prescription.

Unit Three – Contact Lens Practice (2 Hours)

InstrumentationThe use of the following instruments related to the assessment and fitting elements of contact lens practice – Slit-lamp / Keratometer / Burton lamp / Tearscope / Topographers

The use of the following instruments related to rigid and soft lens verification – Radiuscope / Focimeter / Soft lensanalyser and alternative methods of soft lens verification / Thickness gauge / V-Gauge / Band magnifier.

Computers and electronics in contact lens practice.


Clinical proceduresPreliminary examination of patients.

Special techniques for detailed inspection of the anterior segment and related ocular adnexa and tears.

Contraindications to contact lens fitting.

Fitting and assessment procedures.

Patient instruction / Methods of hygiene and handling / Wearing procedures / Care of lenses.

Aftercare consultations.

Abnormal ConditionsDetection, symptoms, causes, control and avoidance of contact lens induced abnormal conditions, for rigid, softand scleral lenses.

Emergencies.

Design, materials, manufacture and related terminologyHistory, design and development of contact lenses and contact lens materials.

Related terminology.

Methods of manufacture for rigid, soft and scleral lenses / BS/ISO tolerances.

Construction and dimensions of all types of rigid, (including tricurve, multicurve and aspherical designs) soft andscleral lenses.

Construction and dimensions of bifocal, multifocal and other contact lenses for the management of presbyopia.

Construction and dimensions of rigid and soft torics, reasons for use of different types of torics.

Advantages and disadvantages of designs, materials and methods of manufacture.

Clinical application of all contact lens typesOptical, physiological and pathological indications and contraindications.

Optical, therapeutic, protective, diagnostic and cosmetic use of contact lenses and related ocular conditions

Wearing modalities.

Solutions and drugsDrugs and staining agents used in contact lens practice / Relevant legislation concerning drugs and medicines /Contact lens related side effects of commonly prescribed drugs / Available preparations.

Methods of disinfection / Solutions used in contact lens practice, and their constituents / Maintenance of sterility /Common pathogens.

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Unit Four – CONTACT LENS CERTIFICATE PRACTICAL EXAMINATION

[1] Competency 5.2 AssessmentThe assessment will take place in the six-month period prior to the practical assessment and will occur during the visitto the practice and supervisor which takes place at that time.

The candidate will be required to provide a subject patient to whom they will give practical tuition of lens handingand care of both rigid and soft lenses, in front of the assessor. The tuition will include instructions on care system useand relevant information which would be given to a patient at the collection appointment.

The content of the products involved and any legislative implications would not be addressed in this assessment.

Success in the Competency 5.2 assessment is valid for a maximum of 3 years provided the candidate is in regularcontact lens practice.

Important note. Candidates whose supervisor and practice are currently approved for the period of their practicalexperience and examination, must still – • Complete Primary Supervisor registration form to register the commencement of their personal practical

experience.• Complete an application form for an In-practice assessment and Practice Visit

[2] Contact Lens Certificate Practical Examination

1. Initial Assessment [Practical] (l hour 15 mins)(a)Indications of contact lens fitting.

Legal issuesContra-indications History-takingRoutine observations and external measurements Communication skills.

b) Slit lamp techniques.Adjustment for use.Demonstration of slit- lamp routine. Use of Theories of illumination Communication skills and patient care

c) KeratometryAdjustment for use.Demonstration of routine use. Instrument general principlesInterpretation of results Communication skills and patient care

2. Soft Contact Lens Fitting [Practical] (45 mins)Discussion of range of lenses used in practice. Selection of lens for patient. Write final order.Assessment of lens fit and possible modificationsDiscussion on types, materials, designs and their effects


b). Assessment of Over-RefractionDemonstrate spherical over-refraction (to achieve best vision sphere).Communication skills and patient care

a)

3. RGP Contact Lens Fitting [Practical] (30 mins)Discussion of range of lenses used in practice.Selection of lens for patient. Write order including full back surface parameters of a multicurve lensDiscussion on types, materials, designs and their effectsAssessment of lens fitCommunication skills and patient care

[Viva] (30mins)4. Complex LensesToricsBifocals, multifocals and other forms of contact lenses for presbyopic correction.Lenses for therapeutic and prosthetic use

5. Aftercare Routine and Management [Practical / Viva] (1hr 30 min)a) Aftercare consultation of a contact lens wearer

RoutineFuture actionManagement of legal issuesContent of record cardCommunication skills and patient care

b) Discussion of patient records presented in advance [see Case Records Information]c) Aftercare Management

Signs, symptoms and management of conditions arising from contact lens wearContact lens solutions, stains and ophthalmic pharmaceutical products Legal matters relating to dispensing opticians fitting contact lenses

6. Verification and Identification [Practical] (30 mins )Verification of an RGP lens to enable replicationISO/CEN/BSI standards.Identification of designs of various RGP lens types

PRACTICAL EXAMINATION INFORMATION

Candidates are advised that it is their responsibility to –• Provide (and pay any fee for) a subject for preliminary assessment and the fitting sections

[including if retaking any of those sections]

The subject must not be one of the following – • A qualified or certified Contact Lens Optician• A Dispensing Optician undergoing contact lens training• A qualified or pre-registration OptometristIn the interests of fair assessment, failure to make provision of a subject for Sections 1,2,3 will preventcompletion of the practical examination and issue of results.

• To bring to the examination –• a current Rx for the subject• frequent spherical replacement/disposable soft lenses for use in Section 2,• a pair of rigid lenses ordered for their patient (they should take any appropriate measurements and

empirically order the lenses). The lenses should remain sealed from the manufacturer and should only be opened by the examiner involved in Section 3 [unless soaking prior to use is recommended by the manufacturer]

• A trial frame - and any refraction aids if they wish• Full photocopies of the 10 case records

• Copies of 10 case records selected from the patients fitted during the practical experience period for use in Section 5 must reach ABDO at the latest by November 30 for the Winter sitting or 31 May for the Summer sitting [ see Case Record Information ).

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a)b)c)

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CASE RECORDS INFORMATION

For Section 5 of the ABDO Certificate in Contact Lens Practice examination, candidates are required to present 10case records chosen from the patients fitted during the practical experience period. A number of the case recordswill be discussed in detail with the candidate, including decisions made and actions taken.

The records must reach ABDO by 31st May (Summer Exams) or 30th November (Winter Exams) before the CLpractical examination. They should demonstrate the range and depth of experience of the candidate and arerequired to meet the following criteria – one record shall not apply to more than one of the *categories:

A mix and range of prescriptions –to include myopes and hyperopes of under and over 5 dioptresto include a minimum of one patient demonstrating bifocal/multifocal contact lens management of theirnear vision requirements*.

A mix and range of lens designs and replacement modalities, and a mix and range of lens materials includingsilicone hydrogels –

to include a minimum of three rigid lens patients*to include a minimum of one toric lens patient*

a minimum of two clinical aftercare problems* –to show problems recognised, refitted and improved. These case records do not need to have beenoriginally fitted by the candidate but must meet the minimum aftercare period . The problem must beintolerance to lens wear or a corneal or adnexal issue caused during contact lens wear.

The case records are required to demonstrate that there has been a minimum period of 6 months since the lenseswere issued, to allow appropriate aftercare appointments to take place. Therefore, the case records presentedmust show the initial contact lenses issued, at the latest, by 31st May (for Winter exams) and 30th November (forSummer exams). If the records do not meet these criteria, they will be considered invalid. The reduced number ofrecords therefore presented will reflect in the marks for that section.

The records are not required to be photocopies of the originals as it is appreciated that the practical experiencepractice record format may not demonstrate the candidate’s full potential. However they must be traceable topatients of the TCLO in the practical experience practice.

Candidates must ensure they have taken FULL photocopies of the case records to be used in the examination, priorto dispatch to ABDO.

NB Those re-sitting the case records section of the examination should be aware that if they are re-presenting any oftheir original case records, it will be expected that those case records will show up-to-date aftercare. For example, ifthe candidate indicates that an aftercare consultation should occur in the period between the first and subsequentexamination attempts, the re-submitted case records should show any notes of that and any subsequent visit/s.

Updated - September 2018


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Sept 2017 revised ABDO Certificate in Contact Lens Practice_Layout 1 21/09/2017 15:13 Page 18

ABDO Examinations and Registration,The Old Dairy, Godmersham Park,Godmersham, Canterbury, Kent CT4 7DTTelephone 01227 732 921Fax 01227 733 641Email [email protected] www.abdo.org.uk


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