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MAJLIS OPTIK MALAYSIA KEMENTERIAN KESIHATAN MALAYSIA
MODUL KURSUS KANTA LEKAP UNTUK JURUOPTIK BERDAFTAR
PEPERIKSAAN KANTA LEKAP DI BAWAH SEKSYEN 30(5) AKTA OPTIK 1991 (FORMAT PEPERIKSAAN TEORI DAN AMALI)
KANDUNGAN
1. Pengenalan (Introduction)
2. Objektif Kursus (Course objectives) & Hasil (Outcome)
3. Skop Kursus dan Penilaian (Scope Of The Course And Evaluation)
Lampiran 1
4. Borang Peperiksaan Preliminari (Preliminary Examination)
Lampiran 2
5. Borang Pemasangan Cubaan (Trial Fitting Form)
Lampiran 3
6. Borang Prosedur Pemeriksaan Pesakit Kanta Lekap (Examination Procedures For Contact Lens Patient)
Lampiran 4
MALAYSIAN OPTICAL COUNCIL MINISTRY OF HEALTH
CONTACT LENS COURSE FOR REGISTERED OPTICIANS
(KURSUS KANTA LEKAP BAGI JURUOPTIK BERDAFTAR)
1. INTRODUCTION
Registered Opticians have over the years been applying for permits to prescribe
contact lens as part of their practice. Their training and experience however
varies from practitioner to practitioner and it is difficult to monitor the quality of the
service provided. Hospital data shows that the incidence of contact lens related
ocular complications is significant and is a course for concern. Whilst the move is
to change the practice to allow only appropriately trained practitioner to prescribe
contact lens it is imperative upon the Malaysian Optical Council to ensure that
the remaining registered opticians who are eligible by law to prescribe contact
lens are properly trained.
It is recommended that prior to assessment the relevant professional bodies
conduct a course on contact lens that entails the prescribing, fitting, dispensing
and performing an aftercare examination of contact lens wearers for their
members.
Upon completion of the course the opticians will be invited to appear before the
Optic Council Evaluation Committee for an assessment of their competency in
contact lens practice.
2. COURSE OBJECTIVE
To prepare registered opticians eligible by law to prescribe, fit and dispense
contact lens safely
SPECIFIC OBJECTIVES:
2.1. To provide theoretical knowledge on the basic anatomy and physiology of
the eye with special reference to the eyelids, conjunctiva, cornea and the
tear film.
2.2. To provide basic knowledge on the disorders of the eyelids, conjunctiva,
cornea and the tear film and their recognition.
2.3. To provide basic knowledge on the optics of contact lens, types of
contact lens and indications for their use.
2.4. To provide the necessary knowledge on the proper prescribing, fitting,
dispensing and aftercare in contact lens practice.
2.5. To provide the necessary knowledge enabling contact lens practitioners
to detect common contact lens associated problems during an aftercare
examination and subsequent management (including early referral) of the
problem.
2.6. To provide knowledge on the setting up of a proper and safe contact lens
practice.
SPECIFIC OBJECTIVE 1
To provide theoretical knowledge on the basic anatomy and physiology of the
eye with special reference to the eyelids, conjunctiva, cornea and the tear
film.
Targets – Basic understanding of :
1. Anatomy of the eyelids, conjunctiva, cornea and the tear film.
2. Physiology of the eyelids, conjunctiva, cornea and the tear film.
SPECIFIC OBJECTIVE 2
To provide basic knowledge on the disorders of the eyelids, conjunctiva,
cornea and the tear film and their recognition.
Targets –
1. Basic understanding of common disorders affecting the eyelids,
conjunctiva, cornea and the tear film.
2. Demonstrate the ability to distinguish the difference between the
normal and abnormal structure of the eye.
3. Demonstrate the ability to recognise common disorders affecting the
eyelids, conjunctiva, cornea and the tear film.
4. Demonstrate the ability to perform specific techniques to assess tear
film function and corneal integrity. .e.g.: use of flourescein in the
assessment of tear film stability, Schirmer test, and diagnosis of
corneal abrasion.
SPECIFIC OBJECTIVE 3
To provide basic knowledge on the optics of contact lens, types of contact
lens and indications for their use and contact lens solutions.
Targets :
1. Basic understanding of contact lens optics
2. Acquired knowledge of the types of lens available in the market and
their indication for use.
3. Acquired knowledge on contact lens solutions and the proper care of
contact lenses
SPECIFIC OBJECTIVE 4
To provide the necessary knowledge on the proper prescribing, fitting,
dispensing and aftercare in contact lens practice.
Target: Competence in the performance/testing of :
1. Use the ophthalmic appliances associated with contact lens practice
e.g. keratometry and slit lamp biomicroscopy
2. Preparation/placement/removal of diagnostic contact lenses from the
eyes (include RGP, soft lenses and special design lenses like toric
lenses)
3. Assessment of optimal fit of contact lenses on the eyes and their
optical correction
4. Identifying normal physiological responses and abnormal corneal and
lid responses to contact lens wear
5. Identifying abnormal tear stability changes as results of lens wear
6. Use of different solutions for contact lens maintenance
7. Differential diagnosis for contact lens related eye problems
SPECIFIC OBJECTIVE 5
To provide knowledge on the setting up of proper and safe contact lens
practice.
Targets :
1. Demonstrate understanding of a proper contact lens practice that is
safe to practitioner and patients by having appropriate appliances such
as keratometer, slit lamp biomicroscope and diagnostic lenses for trial.
2. Demonstrate understanding on the level of hygiene required for proper
maintenance of contact lenses for office and patients use.
3. Acquired knowledge on a proper recording/recalling system for contact
lens patient.
3. OUTCOME
At the end of the course, participants would have:
3.1. Acquired knowledge basic anatomy and physiology of the eye in
particular the corneas and tears.
3.2. Acquire the necessary knowledge and skills to diagnose common
disorder affecting the anterior segment of the eye.
3.3. Acquired skills in the proper prescribing and fitting of contact lenses.
3.4. Acquired skills in the detection and management of contact lens
associated problem.
3.5. Be able to set up a proper contact lens practice and carry out contact
lenses examination and dispensing in a professional manner.
MALAYSIAN OPTICAL COUNCIL MINISTRY OF HEALTH MALAYSIA
LAMPIRAN 1
SCOPE OF CONTACT LENS COURSE AND EVALUATION 1.1 Background
A. Basic Anatomy & Physiology of the eye.
i) Cornea ii) Conjunctiva iii) Eyelids iv) Tear film
B. Physical properties of Contact lens Material
i) Lens type (Hard, RGP, Soft, and Silicone) ii) Lens design iii) Oxygen permeability iv) Water content v) Oxygen transmissibility vi) Durability vii) Deposits & scratch resistance viii)Rigidity & flexibility
1.2. Instrumentation
Type of instrument required in Contact Lens Fitting
i) Slit Lamp ii) Keratometer iii) Radiuscope
1.3. Consulting room procedures and equipment
i) Hygienic procedures to avoid cross-infection. ii) Decontamination and disinfecting of trial lenses.
1.4. Preliminary considerations and examination.
i) Discussion with patient ii) Indications and contraindications iii) Advantages and disadvantages of Contact Lens compared with
spectacles
iv) External eye examination v) Assessment of tears & lids characteristics vi) Patient Suitability for lens types (base on diagnosis) vii) Advantages and disadvantages of lens type.
1.5. Contact Lens Fitting Protocol
i) Refraction ii) Measurement of ocular dimensions (keratometer, corneal & pupil
size) iii) Trial fitting; Lens Selection
a. Base Curve b. Lens Diameter (HVID +2mm SCL, HVID-2mm RGP) c. (iii)Centre thickness d. (iv)Water content e. (v) Lens type (spherical/toric) f. Back Vertex Power (BVP)
iv) Fitting Assessment for soft lenses & rigid gas permeable lenses. Able to identify loose, tight, flat or steep fitting using:
a. Slit lamp b. Fluorescein dye pattern for RGP
v) Documentation & specification of contact lens after fitting of contact lens
1.6. Contact lens dispensing/delivery to patient
i) Information of the lens care regimen ii) Type of solutions & disinfecting regimen for different types of contact
lenses & components of solutions e.g. preservatives iii) Insertion & removal technique iv) Information on adaptation v) Information on suggested wearing schedule vi) Information on signs of complication vii) Advice on contact lens wear: Do’s & Don’ts viii) After care visit schedule
1.7. Aftercare
i) Initial discussion/investigate problems & complaints ii) Visual acuity and over-refraction iii) Slit lamp examination iv) Assessment of contact lens fitting v) Assess contact lens condition vi) Review method of insertion & removal vii) Review lens care regimen
1.8 Contact lens wear problems & solutions:
i) Skill to differentiate between contact lens and non contact lens emergencies
ii) Management of non contact lens emergencies e.g. deposits on contact lenses, discomfort
iii) Identify cases that need referral to ophthalmologists iv) Common contact lenses associated problem
II. PRACTICAL
1. Scope
i) Assessment of Rigid Gas Permeable Contact Lens ii) Assessment of Soft Contact Lens iii) Soft Contact Lens Aftercare examination iv) Rigid Gas Permeable Lens Aftercare examination v) Skills in anterior segment examination - Keratometry and Slit-Lamp
biomicroscopy.
III. EVALUATION FORMAT
Enclose is a copy of Evaluation Format which has been endorsed by the Council.
LAMPIRAN 2
PEPERIKSAAN KANTA LEKAP
MAJLIS OPTIK MALAYSIA
SEKSYEN 30
PEPERIKSAAN PRELIMINARI (PRELIMINARY EXAMINATION)
Nama pesakit____________________________________ Tarikh ____________
Tarikh lahir ______________ No rekod ____________
SIMPTOM UTAMA : (CHIEF SYMPTOM)
RIWAYAT OKULAR: (OCULAR HISTORY)
KESIHATAN UMUM/PENGUBATAN: (GENERAL HEALTH/MEDICATION)
UJIAN ENTRANS (ENTRANCE TEST)
Ujian
penglihatan (Vision test)
MATA KANAN (RIGHT EYE)
Lubang pin: (pinhole)
MATA KIRI (LEFT EYE)
Lubang pin:
(pinhole)
Tanpa bantu (unaided)
Dibantu (aided)
Tanpa bantu (unaided)
Dibantu (aided)
Jauh (distance)
Dekat (near)
Jauh (distance)
Dekat (near)
Jauh (distance)
Dekat (near)
Jauh (distance)
Dekat (near)
Ujian
Hirschberg (Hirschberg
test)
Ujian
katup (cover test)
Reaksi
pupil (pupil
reaction)
Rx cermin
mata (spectacles Rx)
PEMERHATIAN UMUM (GENERAL OBSERVATION)
PEMERIKSAAN LUAR MATA (EXTERNAL EYES EXAMINATION)
PEMERIKSAAN BIOMIKROSKOP (BIOMICROSCOPY EXAMINATION)
KELOPAK MATA &
KONJUNKTIVA (EYELIDS & CONJUNCTIVA)
AIR MATA PRA KORNEA (PRECORNEAL TEAR)
KORNEA (CORNEA)
KANTA KRISTALIN (CRYSTALLINE LENS)
CAMBER ANTERIOR (ANTERIOR CHAMBER)
IRIS (IRIS)
UJIAN VAN HERICK (VAN HERRICK TEST )
PEMERIKSAAN REFRAKSI (REFRACTION EXAMINATION)
KERATOMETRI (KERATOMETRY)
K1:
K2:
K1:
K2:
RETINOSKOPI (RETINOSCOPY)
VA
VA
REFRAKSI SUBJEKTIF (SUBJECTIVE REFRACTION)
VA
VA
AMPLITUD AKOMODASI (ACCOMMODATIVE AMPLITUDE)
TAMBAHAN DEKAT (NEAR ADDITION)
____________________
SASARAN(TARGET):
____________ @________ cm
______________________
SASARAN(TARGET):
____________ @________ cm
PENILAIAN BINOKULAR (BINOCULAR ASSESSMENT)
UJIAN KATUP (COVER TEST)
JAUH: (DISTANCE) DEKAT: (NEAR)
FORIA JAUH (DISTANCE
PHORIA)
HORIZONTAL:
VERTIKAL:
RADAS(APPARATUS):
FORIA
DEKAT (NEAR PHORIA)
HORIZONTAL:
VERTIKAL:
RADAS(APPARATUS):
NISBAH
AC/A (AC/A RATIO)
RX AKHIR (FINAL RX)
MATA KANAN (RIGHT EYE)
VA MATA KIRI
(LEFT EYE)
VA
CALON(CANDIDATE)
NAMA :____________________________
T/TANGAN:____________________________
TARIKH :____________________________
PEMERIKSA(EXAMINER)
NAMA :___________________________
T/TANGAN:___________________________
TARIKH :___________________________
BORANG PEMASANGAN CUBAAN (TRIAL FITTING FORM)
NAMA:_____________________TARIKH:_________PEMERIKSA:_______________ (NAME) (DATE) (EXAMINER)
PEMBOLEHUBAH
PENILAIAN
(ASSESSMENT VARIABLES)
BOZR
ALIGNMENT ALIGNMENT
Mata (Eye) Kanan (Right) Kiri (Left)
Bacaan Keratometri (Keratometry reading)
_____D@____ _____D@____
Low K radius________mm
_____D@____ _____D@____
Low K radius___ _____mm
Rx cermin mata (Spectacles Rx)
_____DS______DC x______
______DS_____DC x______
HVID
_________mm
________mm
Pemeriksaan mata
asas (Baseline Eye Check)
Konjunktiva (Conjunctiva)
Slightly red staining
Kornea (Cornea)
(clear) (staining)
Konjunktiva (Conjunctiva)
(clear) (staining)
Kornea (Cornea)
(clear) (staining)
Kanta cubaan
(Trial Lens):
__________________
Bahan(Material):
__________________
BOZR __________mm
Kuasa(Power) __________mm
Diameter kanta __________mm (Lens diameter)
BOZR __________mm
Kuasa(Power) __________mm
Diameter kanta __________mm (Lens diameter)
Penilaian Pemasangan Kanta (Lens Fit Assessment)
Sentrasi (Centration)
Horizontal __________mm
(nasal/temporal)
Vertikal __________mm
(superior/inferior)
Horizontal __________mm
(nasal/temporal)
Vertikal __________mm
(superior/inferior)
Pergerakan dengan
kelip mata (Movement with Blink)
mm
mm
Pergerakan Movement
lancar tersekat-sekat
(smooth) (jerky)
putaran apeks(apical rotation)
lancar tersekat-sekat
(smooth) (jerky)
putaran apeks(apical rotation)
Laju pergerakan (Speed of Movement)
cepat(fast) sederhana(average)
perlahan(slow)
cepat(fast) sederhana(average)
perlahan(slow)
Kestabilan (Stability)
Jika tidak, sila terangkan
(If no, please explain)
ya (yes) tidak(no) Jika tidak, sila terangkan
(If no, please explain)
ya(yes) tidak(no)
LAMPIRAN 3
Corak floresin pusat
(Central Fluorescein
Pattern)
takung(pooling) optimum
(optimum)
sentuh(touch)
takung(pooling) optimum
(optimum)
sentuh(touch)
Corak floresin
tengah-periferi Mid-peripheral Fluorescein
Pattern)
takung(pooling) optimum
(optimum)
sentuhan tipis(narrow touch)
takung(pooling) optimum
(optimum)
sentuhan tipis(narrow touch)
Kelegaan pinggir
kanta (Edge Clearance)
rendah(low) sederhana(average)
tinggi (high)
rendah(low) sederhana(average)
tinggi(high)
Kelas pemasangan (Fit Classification)
longgar(flat) ketat(steep)
optimum(optimum)
terima(accept) tolak(reject)
longgar(flat) ketat(steep)
optimum(optimum)
terima(accept) tolak(reject)
Refraksi dengan kanta
lekap(Over refraction)
________DS VA________
________DS VA________
Rx kanta lekap akhir (Final Rx)
________DS_______DCx_______
VA_______
________DS_______DCx_______
VA_______
Jika ditolak, apakah
tindakan seterusnya
untuk mendapatkan
pemasangan yang
optimum? (If rejected, what can be
improved?)
Tahap keselesaan
pesakit selepas 15
minit (Patient Comfort Rating after
15 minutes)
Selesa (Comfortable)
Tidak selesa (uncomfortable)
Tidak diterima (unacceptable)
Selesa (Comfortable)
Tidak selesa (uncomfortable)
Tidak diterima (unacceptable)
Soalan. Adakah terdapat perbezaan diantara pemasangan kanta mata kanan dan mata kiri?
Nyatakan sebab-sebab bagi jawapan anda. (Question. Is there any difference in lens fit between the right and left eyes? State the reasons for your answer.
Prosedur Pemeriksaan Pesakit Kanta Lekap
(Examination Procedures for Contact lens Patients)
Pesakit (Patient) ______________________________________________________________
Tarikh (Date) _______________________
Sejarah WT hari ini Jam (History WT today) _________________________ (hours)
WT biasa Jam (usual WT) ___________________________ (hours)
Nama kanta (Lens Name)
RE_____________________________
LE__________________________________
Sistem Jagaan (Care System)
_______________________________________________
Pematuhan (compliance) _____________________________________
Enzim (Enzyme)
_______________________________
Kekerapan (how often) _______________________________
Kali terakhir guna (Last used)?
__________________________
Penglihatan
(Vision) Keselesaan
(Comfort)
Masuk / Keluar (Insertion/Removal)
Lain-lain (others)
Usia kanta RE_______bln/th
(Lens age) LE_______bln/th
Aduan utama: (Chief complaint)
Perubahan kesihatan?/ubatan?/alahan? (Change in health?/medication?/allergies) ___________________________________________________________________
Pakai kanta (with lenses on)
RE
LE
Akuiti Visual (Visual acuity)
6/
Near:
6/
Near:
Retinoskopi (retinoscopy)
_________________________
6/
__________________________
6/
Refraksi dengan kanta lekap(Over-Rx)
_________________________
6/
__________________________
6/
Muka depan keratometri (Front Surface keratometry)
K1:____________D @_______
K2:____________D @_______
K1:________________D @ ________
K2:________________D @ ________
Penampilan mire [Mire appearance (SCL)]
Sebelum kelip (Before Blink) ___________________________
Selepas Kelip (After blink) ___________________________
Sebelum kelip (Before blink)____________________________
Selepas Kelip (After blink) ___________________________
Lag
RGP Posisi
Kornea (Cornea)
Posisi
Kornea (Cornea)
SCL
Gaze Tegak Ke depan (Straight Ahead Gaze)
________________________mm
____________________________mm
Gaze Atas (Up Gaze)
________________________mm
____________________________mm
WT=Masa Pakai (Wearing Time); bln = bulan; th = tahun
LAMPIRAN 4
Biomikroskopi (biomicroscopy) Tandakan: takik,koyak,calar,deposit (Indicate: nicks, tears,scratches,deposits)
Kanta (Lens) Kanta (Lens)
Corak Floresin (RGP) [Fluorescein Pattern (RGP)] Tengah (centre) Spara-periferi (mid-periphery)
Pinggir (Edge)
Kanta(lens) Kanta(Lens)
Tanpa Kanta( With Lenses Off)
Kekunci gred(Grade keys): ): 0-tiada (nil) 1-sedikit kesan (trace) 2-sedikit (mild) 3-sederhana (moderate) 4-parah (severe)
PEMERIKSAAN LAMPU CELAH (SLIT LAMP EXAMINATION)
RE LE
Tiada(Absent)
Ada(Present)
Tiada(Absent)
Ada(Present)
Gred(Grade)
0
1
2
3
4 Striae Kornea
(Corneal striae)
Gred(Grade)
0
1
2
3
4
Gred(Grade)
0
1
2
3
4 Edema kornea
(Corneal Oedema)
Gred(Grade)
0
1
2
3
4
Gred(Grade)
0
1
2
3
4 Neovaskularisasi kornea
(Corneal Neovascularization)
Gred(Grade)
0
1
2
3
4
Gred(Grade)
0
1
2
3
4 Staining pukul 3 dan 9
(3 and/or 9 O’clock Staining)
Gred(Grade)
0
1
2
3
4
Gred(Grade)
0
1
2
3
4 Staining Kornea lain
(Other Corneal Staining)
Gred(Grade)
0
1
2
3
4
Gred(Grade)
0
1
2
3
4 Mikrosis epitelia
(Epithelial Microcyst)
Gred(Grade)
0
1
2
3
4
Gred(Grade)
0
1
2
3
4 Kemerahan Limbal (Limbal Injection)
Gred(Grade)
0
1
2
3
4
Gred(Grade)
0
1
2
3
4 Kemerahan Bulbar
(Bulbar Injection)
Gred(Grade)
0
1
2
3
4
Gred(Grade)
0
1
2
3
4 Kemosis
(Chemosis)
Gred(Grade)
0
1
2
3
4
Gred(Grade)
0
1
2
3
4 Keabnormal Konjunctiva Tarsal
(Tarsal Conjunctival Abnormalities)
Gred(Grade)
0
1
2
3
4
Arahan: Jika keabnormalan hadir, tunjukkan sebab dengan tandakan (X) pada kotak yang berkenaan dan catat kedudukannya pada rajah berikut Instruction : If Abnormalities are present, indicate cause (s) by ticking (X)at the appropriate box (es) and note location in diagram below
Ada (present)
Tiada (Absent)
Komen jika ada (Comment if any)
Ada (present)
Tiada (Absent)
Komen jika ada (Comment if any)
1.Blefaritis
(Blepharitis)
2.Infiltrat Kornea
(Corneal Infiltrates)
3.Bebola Musin
(Mucin Ball)
4.Iritis
(Iritis)
5.Ulser Kornea
(Corneal Ulcer)
6.Lain-lain, jelaskan
(GPC, mata kering etc.)
Others, explained
(GPC, dry eye, etc.)
Komen dan Ujian Tambahan (eg Ujian untuk mata kering: BUT, Schirmer)
Comments and Additional Tests (eg. Test for Dry Eye : BUT, Shirmer)
Keratometri (Keratometry)
K1_______________D @_______________
K2_______________D @_______________
K1___________________D @___________
K2___________________D @___________
Retinoskopi (Retinoscopy)
6/
6/
Subjektif (Subjective)
6/
6/
Verifikasi kanta guna radiuskop(pilihan) [Verification of Lenses using radiuscope (Optional)]
Pemeriksaan teliti kanta (Inspection of Lenses)
Ringkasan Penilaian Lawatan [Summary of Visit Assessment (problem)]
Rangka tindakan (Plan)
Panggil semula 3 bulan / 6 bulan / setahun (Recall 3 months/6 months/yearly)
Modifikasi (Modification)
Nama
BOZR
Diameter total
BVP
Lain-lain
Calon: (Candidate)
Pemeriksa: (Examiner)