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Certified Paraoptometric Review Course
CPO
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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.
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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.
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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.
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Basic Science (29%)
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Anatomy
External Eye Structures
EyelidsLacrimal Gland
Lacrimal DuctNasolacrimal Duct
ConjunctivaPalpebralBulbarFornix
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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)
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Anatomy
CorneaAnterior chamberIris
PupilCrystalline lens
AccommodationCiliary Muscle
Graphic courtesy of National Eye Institute, National Institutes of Health (NEI)
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Anatomy
Graphic courtesy of National Eye Institute, National Institutes of Health (NEI)
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Anatomy
Posterior chamberVitreous humorRetina
MaculaFovea Centralis
Choroid
Graphic courtesy of National Eye Institute, National Institutes of Health
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Fovea
Graphic courtesy of National Eye Institute, National Institutes of Health
The center of the macula and gives the sharpest vision
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Anatomy
FundusOptic NerveOptic DiscExtraocular Muscles
Graphic courtesy of National Eye Institute, National Institutes of Health
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Extraocular Muscles
Medial Rectus
Lateral Rectus
Superior Rectus
Lateral
Rectus
Inferior Rectus
Inferior Oblique
Inferior Oblique
Superior Oblique
Superior Oblique Trochle
a
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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
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Common Eye Disorders
Accommodation Cataract
Aphakia & Pseudophakia Glaucoma Keratoconus Macular Degeneration Diabetic Retinophathy Floaters
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Cataract
Image courtesy of Eyemaginations
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Cataract
Anatomy of an eye with a cataract
Image courtesy of Eyemaginations
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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)
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Glaucoma
Graphic courtesy of National Eye Institute, National Institutes of Health
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Kertaconus
Images courtesy of Eyemaginations
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Macular Degeneration
Graphic courtesy of National Eye Institute, National Institutes of Health (NEI)Image courtesy EYEmaginations
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Diabetic Retinopathy
Image courtesy of Eyemaginations
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Retinal Detachment
Images courtesy of Eyemaginations
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Floaters
Images courtesy of Eyemaginations
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Common Eye Disorders
Blepharitis Conjunctivitis Subconjunctival hemorrhage Pinguecula Hordeolum Chalazion
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Blepharitis
Image courtesy of Eyemaginations
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Conjunctivitis
Image courtesy of Eyemaginations
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Subconjunctival Hemorrhage
Images courtesy of Eyemaginations
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Pinguecula
Images courtesy of Eyemaginations
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Ptygerium
Images courtesy of Eyemaginations
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Hordeolum (Sty)
Images courtesy of Eyemaginations
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Chalazion
Image courtesy of Eyemaginations
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Chalazion
Image courtesy of Eyemaginations
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Prefixes, Suffixes, Root Words
Prefixes Suffixes Root words - pages 44 - 45 Direction terms O.D. - O.S. - O.U.
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Which is which?
OD – oculus dexter, right eye OS – oculus sinister, left eye OU – oculus uniter, both eyes
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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
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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
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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
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Directionality
Anterior Posterior Superior Inferior Medial Lateral
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Cataract Surgery
Opening the lens
Phacoemulsification
IOL in capsule bag
Image courtesy of Eyemaginations
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Intraocular Lenses
Iris Fixated
Posterior Chamber
Image courtesy of Eyemaginations
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Ocular Pharmacology
Diagnostic agentsTherapeutic agents
Graphic courtesy of National Eye Institute, National Institutes of Health (NEI)
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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
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Clinical Principals and Procedures
(37%)
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The Eye Examination
Case historyDemographic informationChief complaintReview of systems (eye and general health)
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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
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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
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The Eye Examination
RetinoscopyAuto-refractor
Subjective RefractionPhoropter
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The Eye Examination
OphthalmoscopyPupil dilationDirectBinocular indirect
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Non-Contact Tonometer
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The Eye Examination
Binocular VisionVisual FieldBiomicroscopy
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Slit Lamp
Image courtesy of Mary Dunn, CPOT
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Visual Fields Analyzer
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Visual Field Analyzer
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Corneal Topography
Measurement of the
curvature of the
anterior cornea
surface.
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Optical Coherence Tomography (OCT)
Used to obtain cross-sectional retinal images
Image courtesy of R. Reed, OD
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Refractive Status
EmmetropiaAmetropia
Myopia Hyperopia Astigmatism Presbyopia
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Emmetropic Eye
Images courtesy of Eyemaginations
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Myopic Eye
Image courtesy of R. Johnson, CPOT
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Hyperopic Eye
Image courtesy of R. Johnson, CPOT
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Astigmatism
Images courtesy of Eyemaginations
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Presbyopia
Image courtesy of AOA
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Accommodation
Focusing from far to near Focusing from near to far
Crystalline lensCilary BodyZonules
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Contact Lenses
Soft contact lenses Rigid contact lenses Care & handling Patient education
Images courtesy of EYEmaginations
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Contact Lenses
Soft Contact Lenses
Rigid Contact Lenses
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Contact Lenses
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Contact Lenses
ParametersBase curve radiusLens powerOverall diameterOptical zone diameterPeripheral curvesEdge & center thicknessTintOrdering
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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)
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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
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Blood Pressure
Sphygmomanometer and stethoscope Systolic Pressure Diastolic pressure Taking blood pressure reading
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Ophthalmic Optics and Dispensing
(22%)
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Ophthalmic Lens Components
ComponentsSphere CylinderAxisAdd powerPrismPrism base direction
- 2.00 - 0.75 x 090 + 2.00
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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
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The Ophthalmic Prescription
- 1 D- 1 D
+ 1 D+ 1 D
1 meter1 meter
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Ophthalmic Lenses
Types of LensesSingle visionSphericalPlanocylindricalSpherocylindricalMultifocal
Bifocal, trifocal, progressive addition
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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
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Ophthalmic Lens Materials
Lens MaterialsGlassPlastic (CR-39)PolycarbonateHigh indexTrivex
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Verification
NeutralizationLensometer- measures
the lens power
Image courtesy Marco
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Frame Anatomy
Frame frontEyewireBridgeHingeNosepads
Temples
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Frame Boxing
Frame size & measurementsBoxing system
“A” dimension“B” dimensionEffective diameterDistance between lenses
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Frame Boxing
Boxing System
B
A
DBL
ED
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Frame Materials
Plastic Metal
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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
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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
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Ophthalmic Dispensing
Pupillary distance measurement Seg height Ordering
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Pupillary Distance
PupillometerPupillometer
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Measuring Segment Heights
Bifocal Seg Height
Trifocal Seg Height
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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
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Basic Frame Adjustments
Fitting triangle Frame height Vertex distance Face form Pantoscopic angle Retroscopic angle Temple adjustment
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Basic Adjustments
Fitting Triangle
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Pantoscopic Angle
4 mm
Optical center
Optical center
Correct
Wrong
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Professional Issues (13%)
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Eyecare Specialists & Ancillary Personnel
Optometrist Ophthalmologist Paraoptometric Ophthalmic Medical Personnel Optician
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Practice Management
Telephone Techniques Appointments Record Filing Systems
AlphabeticalNumerical
Recalls
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Telephone Techiques
Be courteous Be professional
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Making Appointments
Be knowledgeable on the doctor’s time needs
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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?
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Fee Presentation
Present fees in a professional manner Be prepared to explain the fee structure Will this be cash, check, or credit card?
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Collections
Most efficient method isat the time the service is rendered
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Third Party Payments
Be knowledgeable of third party programs in which your office is enrolled
Coverage may beVision CareMajor MedicalBoth
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HIPAA
What is HIPAA?
Health Information Portability & Accountability Act
Applies to disclosure after April 14, 2003 It is the law
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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
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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
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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
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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
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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
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The Test…..
Computer-based Testing
Paper and Pencil Testing
http://www.aoa.org/x8565.xml
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A Little Anxiety Is Ok
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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
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How To Study
Study pace - preview material, study, break, reviewDo not study for more than 2 hours at a
timeUse travel time to study
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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.
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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.
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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.
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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
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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