Certified Paraoptometric Review Course

CPO

Provision

The Self Study Course for Paraoptometric Assistants and Technicians, Self Assessment Examination, and the AOA PS CPO Review Course are not prerequisites for taking the paraoptometric certification examination given by the Commission on Paraoptometric Certification (CPC). Using these study materials and/or taking the CPO Review course does not guarantee passing the paraoptometric certification examination given by the CPC. Attending the CPO Review Course is not a substitute for studying for the paraoptometric certification examination given by the CPC. This course is designed to review previously acquired knowledge.

This review course is not intended to be a substitute for responsible study and preparation for the CPO test.

Copyright© 2010 by The American Optometric AssociationAll rights reserved.No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher.

Certified Paraoptometric

A person who has attained national recognition via certification by demonstrating an understanding of the concepts used in optometric care. The CPO has demonstrated competence by a didactic examination and is on-the-job trained.

Basic Science (29%)

Anatomy

External Eye Structures

EyelidsLacrimal Gland

Lacrimal DuctNasolacrimal Duct

ConjunctivaPalpebralBulbarFornix

Anatomy Lacrimal Lacrimal

GlandGland

Excretory Excretory DuctsDucts

Superior Superior PunctumPunctum

Inferior Inferior PunctumPunctum

Inferior Inferior CanaliculusCanaliculus

Nasolacrimal Nasolacrimal DuctDuct

Lacrimal SacLacrimal Sac

Nasal Nasal CavityCavity

Superior Superior CanaliculusCanaliculus

Graphic courtesy of National Eye Institute, National Institutes of Health (NEI)

Anatomy

CorneaAnterior chamberIris

PupilCrystalline lens

AccommodationCiliary Muscle

Graphic courtesy of National Eye Institute, National Institutes of Health (NEI)

Anatomy

Graphic courtesy of National Eye Institute, National Institutes of Health (NEI)

Anatomy

Posterior chamberVitreous humorRetina

MaculaFovea Centralis

Choroid

Graphic courtesy of National Eye Institute, National Institutes of Health

Fovea

Graphic courtesy of National Eye Institute, National Institutes of Health

The center of the macula and gives the sharpest vision

Anatomy

FundusOptic NerveOptic DiscExtraocular Muscles

Graphic courtesy of National Eye Institute, National Institutes of Health

Extraocular Muscles

Medial Rectus

Lateral Rectus

Superior Rectus

Lateral

Rectus

Inferior Rectus

Inferior Oblique

Inferior Oblique

Superior Oblique

Superior Oblique Trochle

a

Muscle Direction of eye movement

Superior Rectus Upwards and inwards

Inferior Rectus Downwards and outwards

Internal (medial) Rectus Inwards

External (lateral) Rectus Outward

Superior Oblique Downwards and inwards

Inferior Oblique Upwards and outwards

Extraocular Muscles

Common Eye Disorders

Accommodation Cataract

Aphakia & Pseudophakia Glaucoma Keratoconus Macular Degeneration Diabetic Retinophathy Floaters

Cataract

Image courtesy of Eyemaginations

Cataract

Anatomy of an eye with a cataract

Image courtesy of Eyemaginations

Normal Vision

A scene as it might be viewed by a person with cataract.

Graphic courtesy of National Eye Institute, National Institutes of Health (NEI)

Glaucoma

Graphic courtesy of National Eye Institute, National Institutes of Health

Kertaconus

Images courtesy of Eyemaginations

Macular Degeneration

Graphic courtesy of National Eye Institute, National Institutes of Health (NEI)Image courtesy EYEmaginations

Diabetic Retinopathy

Image courtesy of Eyemaginations

Retinal Detachment

Images courtesy of Eyemaginations

Floaters

Images courtesy of Eyemaginations

Common Eye Disorders

Blepharitis Conjunctivitis Subconjunctival hemorrhage Pinguecula Hordeolum Chalazion

Blepharitis

Image courtesy of Eyemaginations

Conjunctivitis

Image courtesy of Eyemaginations

Subconjunctival Hemorrhage

Images courtesy of Eyemaginations

Pinguecula

Images courtesy of Eyemaginations

Ptygerium

Images courtesy of Eyemaginations

Hordeolum (Sty)

Images courtesy of Eyemaginations

Chalazion

Image courtesy of Eyemaginations

Chalazion

Image courtesy of Eyemaginations

Prefixes, Suffixes, Root Words

Prefixes Suffixes Root words - pages 44 - 45 Direction terms O.D. - O.S. - O.U.

Which is which?

OD – oculus dexter, right eye OS – oculus sinister, left eye OU – oculus uniter, both eyes

Rootword blephar eyelid chrom color conjuctiv conjunctiva cor,core,pupil pupil corne,kera cornea dipl two, couble irid, iri irsi ocul, ophthalm eye orth straight opt vision papill optic nerve head path disease phot light retin retina scler sclera ton tension, pressure

Prefix

A, an without Ab away Ad to,toward Aniso different Bi two Di two Ex away from, out of Hyper excessive, above, over Hypo under, below Intra within Para beside, beyond, around Retro backward Sub under, below

Suffix

ectomy cutting out ia diseased or abnormal itis inflammation meter measurer ologist one who studies or practices ology study of oma tumor, swelling osis vision condition pathy disease scope instrument use for exam al, ic, ous pertaining to

Directionality

Anterior Posterior Superior Inferior Medial Lateral

Cataract Surgery

Opening the lens

Phacoemulsification

IOL in capsule bag

Image courtesy of Eyemaginations

Intraocular Lenses

Iris Fixated

Posterior Chamber

Image courtesy of Eyemaginations

Ocular Pharmacology

Diagnostic agentsTherapeutic agents

Graphic courtesy of National Eye Institute, National Institutes of Health (NEI)

Ocular Pharmacology

Mydriatic- dilates the pupil Miotic- constricts the pupil Cycloplegic- paralyzes the ciliary muscle Dyes or Stains- adhere to damaged or diseased cells of the cornea and conjunctiva

Clinical Principals and Procedures

(37%)

The Eye Examination

Case historyDemographic informationChief complaintReview of systems (eye and general health)

The Eye Examination

Visual acuity is how well the eye can see form and detail.

Snellen FractionTest distanceDistance at which letter is

standardized to be read

Image courtesy of Mary Dunn, CPOT

The Eye Examination

KeratometryMeasures the

curvature of the cornea

Response from the patient not needed to perform = objective test

Image courtesy of Mary Dunn, CPOT

The Eye Examination

RetinoscopyAuto-refractor

Subjective RefractionPhoropter

The Eye Examination

OphthalmoscopyPupil dilationDirectBinocular indirect

Non-Contact Tonometer

The Eye Examination

Binocular VisionVisual FieldBiomicroscopy

Slit Lamp

Image courtesy of Mary Dunn, CPOT

Visual Fields Analyzer

Visual Field Analyzer

Corneal Topography

Measurement of the

curvature of the

anterior cornea

surface.

Optical Coherence Tomography (OCT)

Used to obtain cross-sectional retinal images

Image courtesy of R. Reed, OD

Refractive Status

EmmetropiaAmetropia

Myopia Hyperopia Astigmatism Presbyopia

Emmetropic Eye

Images courtesy of Eyemaginations

Myopic Eye

Image courtesy of R. Johnson, CPOT

Hyperopic Eye

Image courtesy of R. Johnson, CPOT

Astigmatism

Images courtesy of Eyemaginations

Presbyopia

Image courtesy of AOA

Accommodation

Focusing from far to near Focusing from near to far

Crystalline lensCilary BodyZonules

Contact Lenses

Soft contact lenses Rigid contact lenses Care & handling Patient education

Images courtesy of EYEmaginations

Contact Lenses

Soft Contact Lenses

Rigid Contact Lenses

Contact Lenses

Contact Lenses

ParametersBase curve radiusLens powerOverall diameterOptical zone diameterPeripheral curvesEdge & center thicknessTintOrdering

Contact Lens Design

Overall Diameter Overall Diameter (OAD)(OAD)

Optical Optical Zone OZZone OZ

Secondary Curve Secondary Curve (SC)(SC)Peripheral Peripheral

Curve (PC)Curve (PC)

Secondary Secondary Curve Width Curve Width

(SCW)(SCW)Peripheral

Curve Curve Width (PCW)(PCW)

Ordering

CONTACT LENS ORDER FORM

Patient Name: J ohn DoeSpecifications Ordered Specifications VerifiedDate 2/23/01 Date

O.D. O.S. O.D. O.S.B.C.R 7.89 7.81 B.C.R

S.C.R./W 8.90 / .3 8.80 / .3 S.C.R./W

I.C.R./W I.C.R./W

P.C.R./W 110.9 / .3 10.8 / .3 P.C.R./W

O.Z.D. 8.0 8.0 O.Z.D.

Dia 9.2 9.2 Dia

Power - 2.50 - 2.50 Power

C.T. .16 .16 C.T.

Blend Med Med Blend

Tint Blue Blue Tint

Dot O.D. Verified byAdditional Information

Accepted Rejected Returned for Credit Date ReturnedReason for return/reorder

Blood Pressure

Sphygmomanometer and stethoscope Systolic Pressure Diastolic pressure Taking blood pressure reading

Ophthalmic Optics and Dispensing

(22%)

Ophthalmic Lens Components

ComponentsSphere CylinderAxisAdd powerPrismPrism base direction

- 2.00 - 0.75 x 090 + 2.00

The Ophthalmic Prescription

Diopter - unit of measure for optical lenses. Based on fact that a 1 diopter lens will focus parallel light at 1 meter.

Plus LensesMinus Lenses

The Ophthalmic Prescription

- 1 D- 1 D

+ 1 D+ 1 D

1 meter1 meter

Ophthalmic Lenses

Types of LensesSingle visionSphericalPlanocylindricalSpherocylindricalMultifocal

Bifocal, trifocal, progressive addition

Ophthalmic Lenses

Trifocal Lenses (Executive)

7mm7mm17mm17mm

28mm28mm

Bifocal Lenses (FT-28, D-28)

Progressive Addition Lenses

Aberration ZonesAberration Zones

Near ViewingNear Viewing

Zone Zone Intermediate Intermediate

Viewing Zone Viewing Zone

Distant Viewing ZoneDistant Viewing Zone

Ophthalmic Lens Materials

Lens MaterialsGlassPlastic (CR-39)PolycarbonateHigh indexTrivex

Verification

NeutralizationLensometer- measures

the lens power

Image courtesy Marco

Frame Anatomy

Frame frontEyewireBridgeHingeNosepads

Temples

Frame Boxing

Frame size & measurementsBoxing system

“A” dimension“B” dimensionEffective diameterDistance between lenses

Frame Boxing

Boxing System

B

A

DBL

ED

Frame Materials

Plastic Metal

Frame Selection

Frame fit is most important Frame width equal face width Longer face, deeper the frame can be Bridge fit important Temples need to be long enough for a proper

bend Cosmetic concerns

Cosmetic Criteria

BasicFacial Shapes

FittingShapes

Fitting Suggestions

Oval Normal May wear most any type

Oblong Long Face

Contrasting

Deep frameLow temple attachment

Round

SquareWide Face Shapes Narrow frame

High temple attachment

Base down triangle

Erect (base- down triangularface

Contrasting

Fit to largest part of lowerfacial areaDark colors or bolderlooks

Inverted Triangle

Diamond

Inverted (base up) triangular face

Shapes Unobtrusive frame (metal or rimless)

Light or medium weight frameLighter color Round lens shape

Delicate characteristics of frame for women

Ophthalmic Dispensing

Pupillary distance measurement Seg height Ordering

Pupillary Distance

PupillometerPupillometer

Measuring Segment Heights

Bifocal Seg Height

Trifocal Seg Height

Ordering

J ones Optical5209 South Penn

Okl ahoma City, OK 73109

638-7889

Patient J a n e Doe Date 2/23/01SPH CYL AXIS DEC PRISM PLASTIC GLASS

OD In Out

+1.00 - 0.25 90 1/2 Δ BU SV FDA TestedOS

+1.00 - 1.00 95 1/2 Δ BD RND

Seg Ht. Width Insert Total Pup Dist EXEC LENTR R Dist Near

+2.00 20ST 28 TRIFOCAL

L L

ADD

+2.00 2028 66 62 OTHER

Set Lens Shape Edge Colour

F.P.D. A B ED LOC UNCUT

Rimless Grove Drill Metal ZYL

Size BDG Temp Style ColorFRAMES

58 16 145 Sa fi loTi ta n i u m 109

Gra yOT30

PINK

GREEN

GRAY

BROWN

OTHER:

GRADIENT TO

1

1

1

1

1

Lite

2

2

2

2

2

3

3

3

3

3

Clear

ACCT: REMARK SUPPLY TRAY#RX LENS $MISCTAXTOTALDATEINVOICE

Basic Frame Adjustments

Fitting triangle Frame height Vertex distance Face form Pantoscopic angle Retroscopic angle Temple adjustment

Basic Adjustments

Fitting Triangle

Pantoscopic Angle

4 mm

Optical center

Optical center

Correct

Wrong

Professional Issues (13%)

Eyecare Specialists & Ancillary Personnel

Optometrist Ophthalmologist Paraoptometric Ophthalmic Medical Personnel Optician

Practice Management

Telephone Techniques Appointments Record Filing Systems

AlphabeticalNumerical

Recalls

Telephone Techiques

Be courteous Be professional

Making Appointments

Be knowledgeable on the doctor’s time needs

Triage

What kind of problem are you having? How long has it been going on?

(onset/duration) Is it getting worse? (severity) Does it affect your vision?

(associated symptoms) Does anything make it better?

(relief)

What’s wrong?

Fee Presentation

Present fees in a professional manner Be prepared to explain the fee structure Will this be cash, check, or credit card?

Collections

Most efficient method isat the time the service is rendered

Third Party Payments

Be knowledgeable of third party programs in which your office is enrolled

Coverage may beVision CareMajor MedicalBoth

HIPAA

What is HIPAA?

Health Information Portability & Accountability Act

Applies to disclosure after April 14, 2003 It is the law

HIPAA

Use and Disclosure Use: the sharing, employment, application,

utilization, examination or analysis of Protected Health Information (PHI) within the covered entity

Disclosure: the sharing or release of PHI in any manner outside the covered entity

HIPAA

HIPAA Privacy Rule This rule overlaps Privacy Act of 1974 Individuals have the right to receive an

accounting of disclosures of PHI made by your office with the exceptions of:TreatmentPaymentHealthcare Operations

Accounting must include disclosures made in the past six years of request date

HIPAA

Minimum Necessary Principle Requires office to take reasonable steps to

limit the use or disclosure of, and request for, PHI to the minimum necessary to accomplish intended purpose

HIPAA

Implementing Standard Identify those in your office who need access to

PHI to do their job Further identify anyone else who may need

access Create policies and procedures for routine

disclosures to achieve purpose of disclosure Limit the PHI disclosed by developing criteria Review request on individual basis against

criteria

HIPAAConsiderations Prior to Disclosure Patient notification before release Mutually agreed upon alternative communications Mutually agreed upon authorizations Potential or serious threat or imminent danger to

patient or public Authority of requestor Minimum amount of information necessary for purpose Can information be de-identified Documentation of release

The Test…..

Computer-based Testing

Paper and Pencil Testing

http://www.aoa.org/x8565.xml

A Little Anxiety Is Ok

How To Study

Become interactive with material

flash cardsnotestape record notesstudy groups

Study environmentfloral scented

candles or potpourri facilitates learning (strange but true)

wake up your body, wake up your mind - walk, sit on edge of chair

How To Study

Study pace - preview material, study, break, reviewDo not study for more than 2 hours at a

timeUse travel time to study

Test Taking Tips

Get plenty of rest the night before - important in this meeting environment.Arrive a little early for test- look for test room today.A little anxiety is OK - it makes us perform better.

Know the time limit and be aware of time throughout the test. Manage your time.Read the directions carefully.

Test Taking Tips

Realize there may be questions you do not know the answer. There should not be many but we tend to remember them.Your first impression for an answer is usually the best.

Memory dump - at beginning of test write down the facts you want to remember.Make a mark at the margin on questions you want to return to.

Multiple Choice Questions

Essentially are true/false questions arranged in groups.Only one alternative is totally correct.Eliminate obvious false choices.Of remainder pick the alternative that

answers most fully all aspects of the question.

Only change your first answer if you have a very good reason - i.e. read questions incorrectly.

What’s Next?

TodayLightly review the materialGet a good night’s sleepArrive a little early to test

FutureLook for details about the CPOA test - begin

studying the Self-Study Course for Paraoptometric Assistants and Technicians

Questions?Study Materials The AOA Paraoptometric Section (PS) may assist with questions concerning PS Membership, staff development, and study materials 800-365-2219 ext. 4108Certification The Commission on Paraoptometric Certification may assist with questions concerning examinations, certification, and re-certification 800-365-2219 ext. 4210