Confidential




                       June 2005


                       Handbook
                 for the Approval of
 ...
SECTION 1
The General Optical Council (GOC)
1.1   In the interests of the public and for their protection, optometrists an...
SECTION 2
Requirements for entry to an assessment under Section 8(2A) of the Act
2.1     A Provider must satisfy the Counc...
2.6   Providers should ensure that
      [a] PBL has been a managed process and has been supervised by an
          approp...
SECTION 3 - The Assessment
Learning Outcomes to be assessed
3.1   Providers should ensure that they have clearly defined t...
The Assessment of Practice Based Learning
3.8     Each candidate should present a Portfolio of Practice Evidence to verify...
SECTION 4 – Quality Assurance Mechanisms
4.1   The Provider should indicate how the management of standards and
      qual...
SECTION 5 – Resources
5.1   The Provider presenting the proposal will be required to indicate the
      following informat...
SECTION 6 - Role of GOC Audit.
6.1   The GOC will seek to establish, via a Visit and a written report, that:
      [a]   E...
SECTION 7.           GOC process of decision-making

7.1       Timetable for the approval process
Providers wishing to pro...
APPENDICES



Appendix 1   Statutory Powers of GOC


Appendix 2   Core Competencies for dispensing opticians and
         ...
APPENDIX 1
Statutory Powers
Section 8(2) and (2A) as amended of the Opticians Act will state that any
person who satisfies...
(5) The Council must take into account any advice received from their
Standards Committee and their Education Committee un...
qualifications approved by them, indicating the purposes for which the approval
was granted.n




                        ...
Appendix 2




           GENERAL OPTICAL COUNCIL
 The Revised Core Competencies for Registration as
              DISPENS...
1. Communication Skills

The ability to seek and communicate relevant information from and to patients
in an effective and...
2. Professional Conduct

In fulfilling his/her duty of care a Dispensing Optician must have an
understanding and working k...
3. Refractive Management

An understanding of methods of assessing vision, refraction, binocular status
and visual acuity ...
4. Optical Appliances

The ability to dispense an appropriate optical appliance.

Critical competencies;
4.1 The ability t...
5. Contact Lenses

An understanding of the choice, fitting and management of contact lenses.

Critical Competence
5.1 An u...
6. Low Vision

The management of low vision patients.

Critical competencies
6.1 An understanding of the causes of low vis...
7. Ocular Examination and Technique

An understanding of the technologies used in the examination of the eye and
adnexa.

...
8. Ocular Abnormalities

An understanding of the relevance of ocular disease

Critical competencies

8.1 The ability to re...
GLOSSARY
                             Words and Phrases

Competency Title                         One of the eight compete...
THE GENERAL OPTICAL COUNCIL STAGE 2 CORE COMPETENCIES
                    FOR OPTOMETRY




 The following are the REVISED...
Core Subject 1: Communication Skills

      The ability to communicate effectively with the patient and with
             ...
1 The ability to elicit significant symptoms.
.
2

1 The ability to elicit relevant family history.
.
3

1 The ability to ...
Core Subject 2: Professional Conduct

        An understanding of professional conduct and the
             legal aspects ...
Core Subject 3: Visual Function
 An understanding of, and the ability to assess visual function

  To be achieved within f...
Core Subject 4: Optical Appliances
The ability to prescribe and to dispense appropriate optical appliances

     To be ach...
31
Core Subject 5: Ocular Examination
  The ability to perform an examination of the eye and related
                        ...
To be achieved within second quarter

5 The ability to use a contact tonometer to measure intraocular pressure
. and analy...
Core Subject 6: Ocular Abnormalities
         The ability to identify and manage ocular abnormalities

       To be achiev...
6.18   The ability to manage patients presenting with sight- threatening eye
       disease.

6.19   An ability to recogni...
Core Subject 7: Contact Lenses
              The ability to manage patients with contact lenses

        To be achieved wi...
Core Subject 8: Binocular Vision
    The ability to assess and manage patients with anomalies
                        of b...
GLOSSARY
                   Words and Phrases

Competency Title            One of the eight competencies areas
           ...
Appendix 3




      2000
 THE CORE CURRICULUM
  FOR UNDERGRADUATE
TRAINING IN OPTOMETRY




    General Optical Council
 ...
FOREWORD


The Core Curriculum is designed to assist both the Panel of Visitors of the
General Optical Council and the ind...
INTRODUCTION

BASIC SCIENCE

Basic Science is the fundamental knowledge and understanding of the scientific
principles upo...
Optometrists should have an understanding of ocular disease and
      trauma which will enable them to apply their knowled...
EXPANDED IN APPENDIX I
                             BASIC SCIENCE
Human Biology
Detail as to the depth of knowledge requir...
c.    Neuroanatomy
      1.   Spinal cord
      2.   Autonomic nervous system
      3.   Medulla
      4.   Pons
      5. ...
3.      Fatty acid synthesis
            4.      Sterol synthesis
      5.      Membrane biochemistry
f.    Molecular Biol...
5.    Disease states, transmission, pathogenic mechanisms, symptoms,
            diagnosis and immunity of infections by v...
h.   Anti-inflammatory agents
     1      Steroids
     2.     Non-steroids
i.   Major drugs acting on the central nervous...
EXPANDED IN APPENDIX II

                               BASIC SCIENCE

Theoretical Optics
Details as to the depth of knowl...
BASIC SCIENCE
Physiological Optics
Details as to the depth of knowledge required may be found by
consulting Appendix II

S...
CLINICAL SCIENCE
Ophthalmic Optics

Section 1

a.    Physical characteristics of ophthalmic lenses
      1.     Geometry o...
e.    Frame Materials: Physical characteristics and physiological compatibility
f.    Specification and nomenclature of fr...
CLINICAL SCIENCE

Ocular /Visual Biology

Section 1. Anatomy of the Eye, Ocular Adnexa and Visual Pathway
a.    Orbit
    ...
h.   Lacrimal system
     1      Lacrimal gland (structure, innervation, blood supply)
     2.     Accessory lacrima gland...
l.   Iris
     1.     Gross landmarks, zones
     2.     Diameter
     3.     Colouration (factors controlling)
     4.   ...
r.   Vitreous
     1.     Volume
     2.     Shape
     3.     Attachments to retina and lens (ultrastructure)
     4.    ...
Section 2.         Ocular and Visual Pathway Development

a.    Orbit
      1.     Development of bones of orbit (closure ...
k.   Ciliary body
     1.      Tissue origin (mesoderm, neural crest)
     2.      Development of pars ciliaris retinae (e...
Section 3.     Ocular Physiology/Neurophysioiogy

a.    Circulation
      1.     Haemodynamic patterns (resistance, transm...
f.   Aqueous
     1.     Functions of aqueous
     2.     Volume, osmolarity, viscosity
     3.     Formation (ultrafiltra...
m.   Visual pathway
     1.     Function of lateral geniculate body
     2.     Receptive fields of cells in lateral genic...
CLINICAL SCIENCE

Systemic Conditions

Section 1.   General Pathology

a.    Inflammation and repair
      1.     Vascular...
i.   Respiratory system
     1.     Chronic obstructive pulmonary disease (COPD) and emphysema
     2.     Infectious dise...
o.    Nutritional disorders
      1.      Malabsorption
      2.      Alcoholism
      3.      Vitamin deficiencies
      ...
CLINCIAL SCIENCE

Ocular Disease and Trauma

Section 1.   Ocular Pharmacology

a.    General Principles
      1.      Fact...
c.    Pathophysiology, diagnosis, management options, and prognosis
      a)    Epidemiology, history and symptom inventor...
13.   Basic interpretation of special studies (ECG, ERG, VER,
      intravenous fluorescein angiography, ultrasound)
14.  ...
CLINICAL SCIENCE
Refractive/Oculomotor /Sensory Integrative Conditions

Section 1.   Human Development

             a.   ...
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June 2005.doc.doc

  1. 1. Confidential June 2005 Handbook for the Approval of Schemes of Assessment for the Registration of Overseas qualified Dispensing Opticians and Optometrists
  2. 2. SECTION 1 The General Optical Council (GOC) 1.1 In the interests of the public and for their protection, optometrists and dispensing opticians who practise in the United Kingdom are regulated by the GOC: [a] to promote and enforce high standards of education, training and conduct and good business practice in optics, so as to ensure an adequate and safe standard of eye care, and [b] to provide for the accountability of the practitioner providing that eyecare by registration of those suitably qualified as optometrists and dispensing opticians. 1.2 The Opticians Act 1989 provides the legal framework within which the GOC operates (see Appendix 1). The GOC has submitted to the UK Government a number of wide ranging changes to the 1989 Act to modernise the way it regulates the UK optical professions. It is expected that the changes to the Act will be in force by April 2005. Any reference to Sections of the Act in this Handbook will be references to the new text of the Act post April 2005. The reader should bear in mind that the final text of the amended Act is not yet finalised. Therefore the final text should be checked once the legislative changes have been accepted by the UK Government. 1.3 The Act as amended will require the GOC to ensure that a Provider of a Scheme of Assessment has a robust mechanism for ensuring that candidates have reached a suitable level of attainment before they may be admitted to the Scheme. 1.4 In accrediting a Scheme of Assessment the GOC will wish to ensure that appropriate mechanisms for the accreditation [a] of prior learning are in place; and [b] of the assessment processes themselves. This Handbook in context 1.5 This Handbook will guide: [a] Providers in the design and delivery of their Schemes for the UK Registration of overseas qualified dispensing opticians and optometrists to satisfy Section 8(2) and 8(2A) of the Act; [b] GOC Visitors in their audit of the Schemes; [c] Officers of Council in their preparation for visits and for the writing and presentation of formal written reports. Competency Framework 1.6 The GOC has defined the standards for entry to the Registers of dispensing opticians and optometrists in the form of competency statements. The competency framework is given at Appendix 2. The GOC would need to be satisfied that in a Scheme for the Registration of overseas-qualified opticians/optometrists, an assessment referred to in Section 8(2A) adequately tests each candidate’s achievement of the competencies defined by the GOC. 2
  3. 3. SECTION 2 Requirements for entry to an assessment under Section 8(2A) of the Act 2.1 A Provider must satisfy the Council that appropriate mechanisms exist within the Scheme to ensure that candidates to an assessment referred to under Section 8(2A) of the Act: [a] possess a qualification in optometry or ophthalmic dispensing which is similar to those granted in the United Kingdom under Section 8(1) of the Act. The recommended core curricula for dispensing opticians and optometrists are listed at Appendix 3 and Appendix 4 respectively; [b] can provide evidence of a right to practise as an optometrist or dispensing optician (as the case may be) in the country of initial qualification; [c ] have adequate practical experience in optometry and ophthalmic dispensing as practised in the United Kingdom; [d] have demonstrated their proficiency in the use of the English Language by achieving a score of at least 7 at the academic level in the International English Language Testing System (IELTS). Additionally, no individual sections scores are to be less than 6, except for ‘Speaking’ where the minimum is 7. Test centre contact details (as known at the date of publication of the Handbook) can be found at Appendix 5. 2.2 Scheme Providers must ensue that [a] to [e] above are satisfied for each candidate before a candidate is permitted to sit the examination listed in Section 8(2A) of the Act. It would be expected that a mechanism is in place to ensure that the above is effectively implemented. This would usually be accomplished with a mechanism for the accreditation for prior learning (APL). Accreditation for Prior Learning (APL) 2.3 The GOC expects that requirements for entry to an assessment under Section 8(2A) of the Act are flexible, and Scheme Providers will be required to have in place robust systems for the accreditation of prior (or experiential) learning (APEL), so that candidates to the examination are fit for that purpose. 2.4 The Provider should show in detail the procedures for such ’assessment of prior learning’, for example through records of achievement documents, portfolios, and clinical records. Practice-based Learning 2.5 Providers must demonstrate to the satisfaction of the GOC the mechanisms employed in the Scheme to ensure that every candidate presenting for assessment has adequate practical experience in ophthalmic dispensing or optometry as appropriate as practised in the United Kingdom. 3
  4. 4. 2.6 Providers should ensure that [a] PBL has been a managed process and has been supervised by an appropriately qualified professional [b] learning outcomes were set for the PBL prior to the candidate’s commencement of the PBL [c] the setting of the learning in the PBL is appropriate; [d] appropriate measures are in place to ensure that the supervisors selected are appropriate for the task; [e] supervisors have received appropriate induction training; [f] PBL has been structured to ensure that each candidate is exposed to sufficient numbers of patients presenting with the conditions that he or she will manage in an ophthalmic dispensing or optometric setting (as appropriate) in the UK. In addition, the candidate should be exposed to a range of conditions so as to develop differential diagnostic skills. Confirmation of eligibility criteria for entry to the form of assessment under Section 8(2A) of the Act. 2.7 Scheme Providers should demonstrate the mechanisms used to satisfactorily demonstrate to the GOC that candidates to the assessment have satisfied the entry criteria defined in Paragraph 2.1 [a] to [e] of this Handbook: Duration and academic level of training: [a] It is recognised that candidates to the assessment will possess varying base-line experience, which will reflect the amount of training required to meet the stated learning outcomes. A variety of course delivery methods could be used e.g. face-to-face didactic, distance or e-learning, however the delivery must be appropriate for each of the stated learning outcomes. For Dispensing Opticians [b] Training courses should be at academic level 2. And should be at a minimum of the equivalent of 2 years full time study followed by as minimum of 240 days supervised learning in practice (or equivalent part-time study). For Optometrists, [c] Training courses should be at academic level 3 and should be at a minimum of the equivalent of 3 years full time study followed by as minimum of 12 months supervised learning in practice (or equivalent part-time study). Learning in Practice should include time spent in the Hospital Eye Service or Specialist General Practice under the supervision of a designated optometrist or registered medical practitioner. 4
  5. 5. SECTION 3 - The Assessment Learning Outcomes to be assessed 3.1 Providers should ensure that they have clearly defined the learning outcomes to be assessed, which should equate closely with the GOC entry standard competences for UK registered dispensing opticians or optometrist (as appropriate). 3.2 Visitors will observe & scrutinise documentary evidence in coming to judgements on [a] appropriateness of assessment methods to test the learning outcomes; [b] effectiveness of assessment arrangements [c] intended and actual trainee achievement Assessment: 3.3 Providers should demonstrate how the achievement of ALL learning outcomes from ALL GOC competences are assessed, including elements which are weighted for criticality. 3.4 Assessment strategies must be made explicit, in particular the criteria for pass/fail and the details of the marking scheme. Assessment should examine the theory and practice of ophthalmic dispensing or optometry (as appropriate). Assessment methods 3.5 The Provider should indicate how the chosen methods of assessment are appropriate for the measurement of each learning outcome. This should involve a managed process (formative/summative) with clear criteria for each assessment point with evidence presented to the GOC to indicate how this criterion has been met. 3.6 The learning outcomes should be assessed by a variety of methods to test knowledge, skills and a reflective approach to the continued professional development of ophthalmic dispensing or optometry (as appropriate). 3.7 The assessment mechanisms should be suitable for the competency they are designed to test, and could include: written examinations, Practical assessments; Objective Structured Clinical Examinations (OSCE), Visual Identification and Management of Ophthalmological Conditions (VIMOC), or Case Scenarios. It is expected that there will be a viva based on a Portfolio of Practice Evidence seen during the period of clinical training (see Sections 3.8 & 3.9 for Practice Based Learning). This should be performed by two examiners with relevant backgrounds (specifically, dispensing opticians or optometrists), who have been adequately trained and who are registered as dispensing opticians/optometrists in the UK. During the viva examiners are free to ask about the management of conditions not covered in the portfolio, but within the syllabus and competency range. 5
  6. 6. The Assessment of Practice Based Learning 3.8 Each candidate should present a Portfolio of Practice Evidence to verify that learning outcomes have been achieved. The portfolio should include: [a] A log of all patients seen, signed by the supervisor, with an indication of the actual involvement of the candidate in each patient episode. [b] Full information regarding each patient’s clinical presentation, management and follow-up. [c] A reading log as evidence of the literature that has been used by the candidate to inform his or her understanding of practice. [d] Critical reflection by the candidate upon his or her own performance, showing evidence of personal and professional development. [e] A summary sheet showing where in the portfolio the evidence for the achievement of learning outcomes can be found. 3.9 The Portfolio of Practice Evidence should be submitted to the examiners prior to the assessment and will contribute to the final assessment. 6
  7. 7. SECTION 4 – Quality Assurance Mechanisms 4.1 The Provider should indicate how the management of standards and quality is implemented. 4.2 Visitors will assess: [a] the setting of quality and standards, and measures to maintain/enhance quality; [b] What quality assurance mechanisms are used to ascertain that all the learning outcomes are achieved? For example, use of external assessors. [c] systems regarding the approval/review of examiners and the suitability of APL [d] robustness/security of decision-making processes (e.g. Monitoring and evaluation of APL, external inputs, overall scheme management) 4.3 Feedback procedures to inform reviews. Information will be required on: [a] the use of quantitative data/qualitative feedback [b] the methods adopted in obtaining views of all stakeholders [c] external examiner reports 4.4 Candidate achievement and progression. Information will be required on: [a] statistics on summative achievement [b] analysis of performance across all sections [c] evaluation of progression and achievement rates [d] judgement on “fitness to practise”. 4.5 Personal development opportunities. Information will be required on: [a] the opportunities and take up rates for examiners [b] the opportunities for examiners/other assessment personnel and how these are reviewed [c] data on provider’s own internal review of the effectiveness of the scheme and future plans 4.6 Quality enhancement mechanisms [a] How is the provider planning to maintain standards and to improve the quality of provision in the future? 4.7 The candidate support services available. Regulations 4.8 Details of Assessment and Examination and Appeals Regulations should be provided. 7
  8. 8. SECTION 5 – Resources 5.1 The Provider presenting the proposal will be required to indicate the following information in order for Visitors to determine whether the resource available will support the effective delivery of the assessment requirements: 5.2 Projected number of participants in the assessment procedures 5.3 Adequately trained administrative and Examining Personnel: Staffing available to deliver the assessment with details of CVs 5.4 Accommodation Plans, the nature of the assessment environment and information technology support 5.5 Equipment 8
  9. 9. SECTION 6 - Role of GOC Audit. 6.1 The GOC will seek to establish, via a Visit and a written report, that: [a] Entry requirements to the assessment process are appropriately considered by the Scheme Provider so that the GOC can be confident that all candidates satisfy the requirement of Section 8(2) of the Opticians Act 1989 (as amended); [b] learning outcomes for the assessment are clearly expressed and equate closely with GOC competences; [c] that assessments measure the achievement of competencies appropriately and adequately as defined by Section 12(1) of the Opticians Act 1989 (as amended); [d] communication to ALL interested parties is effective; [e] quality assurance measures are in place; and [f] resources are sufficient to the need. 9
  10. 10. SECTION 7. GOC process of decision-making 7.1 Timetable for the approval process Providers wishing to provide Schemes should in the first instance, write to the GOC indicating their broad intention. At this stage, or later, they should present a document which encapsulates the requirements of this Handbook. The GOC will then trigger the necessary accreditation procedures 7.2 Documentation required from proposers Providers are required to present proposals in the strict sequence indicated in Sections 2, 3, 4 and 5 of this Handbook. 7.3 Requirement for visiting Providers After receipt of appropriate documentation, Officers will arrange for a group of Visitors to give initial consideration to the proposals and decide whether further information is required or whether an accreditation event can be arranged. It is envisaged that this will require a Visit to the Provider assessment events. 7.4 The panel – constitution The accreditation panel will consist of a Lay Chair and dispensing optician visitors, optometrist visitors and an ophthalmologist along with an Officer of the GOC. 7.5 Length of period of accreditation Initially envisaged a maximum of 2 years. 7.6 Form and nature of written report At the end of the Visit the Chair will indicate verbally the conclusions of the Visitors, if possible and this will be followed with a brief written report confirming the Visit conclusions and any conditions. The report will be presented to the GOC’s Education Committee and Council as a series of recommendations for approval. 10
  11. 11. APPENDICES Appendix 1 Statutory Powers of GOC Appendix 2 Core Competencies for dispensing opticians and optometrists Appendix 3 Core Curriculum for training of UK optometrists Appendix 4 Core Curriculum for training of UK dispensing opticians Appendix 5 IELTS Test Centre contact details (as known to the GOC at date of publication or this Handbook or the latest review date for the Handbook) 11
  12. 12. APPENDIX 1 Statutory Powers Section 8(2) and (2A) as amended of the Opticians Act will state that any person who satisfies the Council- (2) Subject to subsection (2A), a person shall be entitled to have his name in the appropriate register if he satisfies the Council that he— (a) holds a qualification as an optometrist or as a dispensing optician granted outside the United Kingdom; (b) has had adequate practical experience in the work of an optometrist or a dispensing optician; (c) holds a qualification approved by the Council under section 12(7) (b) below; and (d) is a fit person to practise as an optometrist or dispensing optician. (2A) The Council may determine in any particular case or class of case to which paragraph (2) above applies that before being entitled to be registered in the appropriate register, a person must obtain such qualification, approved in accordance with section 12(7)(b) below, as they consider appropriate. r Sections 12 of the Act as amended will state as follows: SEducation and Training 12.—(1) The Council shall from time to time establish— (a) the competencies which a person must be able to demonstrate in order to be granted a qualification as an optometrist or dispensing optician; and (b) the content and the standard of education and training (including practical experience) required for the purposes of achieving those competencies. (2) The Council must consult and seek advice from– (a) its Standards Committee before establishing the competencies specified in subsection (1)(a) above; (b) its Education Committee before establishing the requirements specified in subsection (1)(b) above. (3) The competencies and requirements established under subsection (1) above shall be published by the Council from time to time in such form as appears to the Council to be appropriate. (4) The Standards Committee and the Education Committee— (a) must respectively keep under review the competencies and requirements established under subsection (1) above; and (b) must each advise the Council if they consider changes are necessary. 12
  13. 13. (5) The Council must take into account any advice received from their Standards Committee and their Education Committee under subsection (4) above and must, if the Council consider it appropriate to do so, establish and publish revised competencies or requirements. (6) The Council must ensure that those establishments approved by the Council under subsection (7)(a) below who are engaged in the education, training or assessment of optometrists or dispensing opticians are notified of — (a) the competencies and requirements established under subsection (1) above; and (b) the requirements for the approval of any form of assessment under subsection (7)(b) below. (7) The Council may approve— (a) establishments where the instruction given to persons receiving education or training as optometrists or as dispensing opticians appears to the Council to be such as to provide them with adequate knowledge and skills to achieve the competencies for the practice of their profession; (b) the granting of a qualification as an optometrist or dispensing optician to candidates following success in an examination or other form of assessment which in the Council’s opinion indicates that the candidate has attained all the competencies for the time being established under subsection (1)(a) above ; and (c) any test of a candidate’s competency in or knowledge of the English language carried out by an educational establishment on candidates seeking entry to courses for optometrists or dispensing opticians offered by that establishment. (8) If— (a) an establishment referred to in subsection (7)(a) above is outside the United Kingdom; or (b) a qualification referred to in subsection (7)(b) above is granted by an establishment which is outside the United Kingdom the Council may, before determining whether to give their approval, commission others to advise and report on the suitability of the establishment or qualification. (9) The council may also approve— (a) establishments which provide only some of the education or training; or (b) qualifications which meet only some of the requirements, needed to achieve the competencies referred to in subsection (1)(a) above. (10) The Council must from time to time publish, in such form (including electronic form) as they consider appropriate, a list of establishments and 13
  14. 14. qualifications approved by them, indicating the purposes for which the approval was granted.n 14
  15. 15. Appendix 2 GENERAL OPTICAL COUNCIL The Revised Core Competencies for Registration as DISPENSING OPTICIAN (Ophthalmic Dispensing Profession) APPROVED BY THE GENERAL OPTICAL COUNCIL ON 1 JULY 2004 15
  16. 16. 1. Communication Skills The ability to seek and communicate relevant information from and to patients in an effective and appropriate manner. Critical competencies: 1.1 The ability to communicate effectively with the patient, taking into account his/her physical, emotional, intellectual and cultural background, and to take accurate history from patients with a range of ophthalmic problems and needs. 1.2 The ability to deal effectively with patient concerns and complaints. Applied Knowledge and skills: 1.3 An understanding of the importance and significance of family history, signs and symptoms including a recognition of the importance of the patient’s health status, medication, work, sports, lifestyle and special skills. 1.4 The development of the key skills of listening to patients and explaining and discussing with them ophthalmic matters, taking into account relevant individual characteristics. 1.5 The ability to understand patients’ fears, anxieties and concerns about their visual welfare in the eye examination and its outcome. 1.6 The ability to discuss with the patient an understanding of systemic disease and its ocular impact, its treatment and the possible ocular side effects of medication. 1.7 The ability to understand the patient’s expectations and aspirations and managing situations where these cannot be met. 1.8 The ability to recognise cultural diversity, and to communicate with patients who have poor or non-verbal communication skills, or those who are confused, reticent or misled. 16
  17. 17. 2. Professional Conduct In fulfilling his/her duty of care a Dispensing Optician must have an understanding and working knowledge of the relevant legislation and civil laws, as well as codes of conduct and professional guidance to be able to care for, respect and protect the rights, dignity, privacy and confidentiality of patients. Critical competencies 2.1 The demonstration of the ability to manage a patient’s care in a safe, ethical and confidential environment. 2.2 The demonstration of the ability to keep clear, accurate and contemporaneous patient records, which record all relevant findings and decisions made. Applied Knowledge and Skills 2.3 Have an understanding and working knowledge of health care delivery systems to be able to demonstrate an ability to care for patients who have additional clinical or social needs. 2.4 Demonstrate the ability to interpret and respond appropriately to patient records and other relevant information. Demonstrate the ability to work within a multi-disciplinary team and within the guidelines and codes set of the profession. 2.5 Demonstrate an understanding of the importance of their legal and ethical responsibilities in relation to the publication, advertising and broadcasting information of services, facilities and goods. 2.6 Demonstrate the ability to act with probity in professional practice. This includes: keeping clear, accurate and contemporaneous records of financial transactions relating to fees and vouchers and other financial information; the provision of information about payment of fees by all means and other costs relevant to patients needs and wants; a knowledge and understanding of professional guidance in relation to conflicts of interest. 2.7 Demonstrate an understanding of the importance of Health and Safety issues in the workplace, for themselves as employees and for patients. 17
  18. 18. 3. Refractive Management An understanding of methods of assessing vision, refraction, binocular status and visual acuity in all patients. Critical competence 3.1 An understanding of refractive prescribing and management decisions. Applied Knowledge and Skills 3.2 A knowledge and understanding of the use of ocular diagnostic drugs to aid refraction. 3.3 An understanding of the methods of refracting children, a knowledge and understanding of cycloplegic drugs and their effects, and an understanding of prescribing and management decisions. 3.4 An understanding of the refraction of patients with reduced visual acuity. 3.5 An understanding of the investigation and management of patients presenting with heterophoria, heterotropia and amblyopia based anomalies of binocular vision, including the relevance of history and the recognition of any clinical symptoms. 3.6 An understanding of the objective and subjective tests necessary to investigate binocular status. 3.7 An understanding of likely management options including: vision training, refractive correction, modified refractive correction and prismatic correction, related to the prescribing of the appliance. 3.8 An understanding of the investigation and management of patients presenting with incommitant deviations, including the recognition of symptoms and referral advice. 3.9 An awareness of the special examination needs of patients with learning and other disabilities. 3.10 An awareness of the diagnostic methods for patients with field defects. 18
  19. 19. 4. Optical Appliances The ability to dispense an appropriate optical appliance. Critical competencies; 4.1 The ability to interpret and dispense a prescription using appropriate lenses and facial and frame measurements. 4.2 The ability to advise on and dispense appropriate spectacle frame types and materials and lens forms and materials. 4.3 The ability to dispense optical low vision aids 4.4 The ability to relate the development of a child’s facial anatomy to the fitting of optical appliances. Applied Knowledge and Skills 4.5 The ability to identify anomalies in a prescription and implement the appropriate course of action 4.6 The ability to measure and verify optical appliances including the replication of existing spectacles, taking into account relevant standards where applicable. 4.7 The ability to match the form, type and positioning of lenses to meet all the patient’s needs and requirements. 4.8 Demonstrate a knowledge of personal eye protection regulations and relevant standards, and the ability to appropriately advise patients on occupational visual requirements. 4.9 The ability to recommend and dispense special optical appliances. 4.10 Demonstrate a knowledge of frame and lens manufacturing and the application of special lens treatments. 4.11 The ability to identify current and obsolete frame materials and consider their properties when handling, adjusting, repairing and dispensing. 19
  20. 20. 5. Contact Lenses An understanding of the choice, fitting and management of contact lenses. Critical Competence 5.1 An understanding of the symptoms and signs of serious contact lens complications. Applied Knowledge and Skills 5.2 An understanding of contact lens types and materials, their benefits and disadvantages, and their most appropriate applications. 5.3 An understanding of the initial contact lens selection and fitting of RGP and soft contact lens patients. 5.4 A knowledge of the different methods of contact lens removal and the ability to remove the lens in an emergency, if feasible and the ability to discuss the use of care regimes . 5.5 An understanding of both the aftercare of patients wearing RGP and soft contact lenses and the management of any complications. 20
  21. 21. 6. Low Vision The management of low vision patients. Critical competencies 6.1 An understanding of the causes of low vision and their effects on vision. 6.2 The ability to assess a patient with low vision. 6.3 The ability to advise on the use of and dispense appropriate low vision aids. Applied knowledge and skills 6.4 The ability to consider the effectiveness of current refraction of patients with low visual acuity and to refer back where appropriate. 6.5 An understanding of the assessment of visual function, including the use of logMAR and other specialist charts, and the effects of illumination, contrast and glare. 6.6 An understanding of the assessment of the visual field of patients with reduced vision. 6.7 An understanding of binocular vision in relation to low vision appliances. 6.8 A knowledge of the relevance of optical low vision aids and of common types of non-optical low vision aid. 6.9 The ability to advise low vision patients on illumination, glare and contrast. 6.10 The ability to advise patients about their impairment and its consequences. 6.11 An understanding of the need for multi- and inter-disciplinary approaches to low vision care. 6.12 The ability to refer low vision patients to other agencies where appropriate. 6.13 After-care management of low vision patients. 21
  22. 22. 7. Ocular Examination and Technique An understanding of the technologies used in the examination of the eye and adnexa. Critical competence 7.1 An understanding of the purpose and use of the instruments used in the examination of the eye and adnexa, and the implications of results. Applied knowledge and skills 7.2 An understanding of the examination of the external eye and anterior segment by use of the slit lamp. 7.3 An understanding of the appropriate ocular diagnostic drugs to aid ocular examination and investigation. 7.4 An understanding of the examination of the fundus using either a direct or indirect ophthalmoscope. 7.5 An understanding of the methods of assessment of colour vision. 7.6 An understanding of methods of assessment of corneal shape and integrity. 7.7 An understanding of the instruments involved in visual field analysis and of the results. 7.8 An understanding of the use of a tonometer and of the results. 22
  23. 23. 8. Ocular Abnormalities An understanding of the relevance of ocular disease Critical competencies 8.1 The ability to recognise conditions and symptoms requiring referral and/or emergency referral and the demonstration of the ability to take appropriate action. Applied knowledge and Skills 8.2 The ability to identify common diseases of the external eye and adnexa. 8.3 An understanding of symptoms associated with internal eye disease. 8.4 An understanding of the clinical treatment of a range of significant ocular diseases/disorders and conditions. 8.5 An understanding of the clinical treatment of a range of systemic diseases with ocular manifestations and adverse ocular reactions to medication. 8.6 An understanding of the implications of the manifestations of eye disease. 8.7 The ability to recognise and deal with ocular emergencies. 23
  24. 24. GLOSSARY Words and Phrases Competency Title One of the eight competencies areas identified by the GOC Stem Statement An over-arching statement which explains and expands the competency title. Critical Competency Competencies Those competencies which a candidate must demonstrate before entry to the Opticians Register. Foundation Knowledge & Skills Refers to knowledge and skills which are required to be achieved by students in order to prepare for achievement of applied knowledge and skills. Note: Foundation Knowledge and Skills are given in outline form reflecting aspects of the current curriculum. It would be for the training institutions to interpret and determine the extent to which these are taught, bearing in mind the necessity to have sufficient learning time to achieve the applied knowledge and skills. Applied Knowledge & Skills Refers to knowledge and skills which are required to be achieved by students in order to be able to meet the required relevant critical competencies. Ability to.. Being able to .....and/or permitted to under current legislation Understanding To comprehend, to perceive the meaning of but not necessarily having the ability to do it..... Communication All forms of inter-personal communication ‘written forms’ ‘asking’ ‘listening’ ‘explaining’ ‘discussing’. Ophthalmic Includes all disciplines within optics Special Optical Appliances An optical appliances with or without the means of correcting a refractive error for medical, vocational or any other specified purpose. 24
  25. 25. THE GENERAL OPTICAL COUNCIL STAGE 2 CORE COMPETENCIES FOR OPTOMETRY The following are the REVISED competencies for registration as an optometrist APPROVED BY THE GENERAL OPTICAL COUNCIL ON 1 JULY 2004 Achievement of ALL the Core Competencies must be demonstrated at some stage during the period of the scheme The GOC has placed the competencies in to three categories for assessment purposes: High assessment competencies – in bold Medium assessment competencies – in italics Standard assessment competencies – in standard type 25
  26. 26. Core Subject 1: Communication Skills The ability to communicate effectively with the patient and with professional colleagues To be achieved within first quarter 1.1 The ability to take an accurate history from patients with a range of optometric conditions. 26
  27. 27. 1 The ability to elicit significant symptoms. . 2 1 The ability to elicit relevant family history. . 3 1 The ability to elicit issues pertaining to the patient’s general health, . medication, work, sports, lifestyle and special needs. 4 To be achieved within second quarter 1 The ability to impart to patients an explanation of their physiological or . pathological eye condition. 5 1 An ability to understand a patient’s fears, anxieties and concerns about . their visual welfare, the eye examination and its outcome. 6 1 The ability to discuss with a patient the importance of systemic disease . and its ocular impact, its treatment and the possible ocular side effects of 7 medication. 1 An ability to understand the patient’s expectations and aspirations and . manage empathetically situations where these cannot be met. 8 To be achieved by qualifying examination 1 The ability to communicate with patients who have poor, or non-verbal, . communication skills, or those who are confused, reticent or who might 9 mislead. 1 The ability to communicate bad news to patients in an empathetic and . understandable way. 1 0 27
  28. 28. Core Subject 2: Professional Conduct An understanding of professional conduct and the legal aspects of professional practice To be achieved within first quarter 2 The ability to manage patients in a safe, ethical and confidential fashion. 2 The ability to create and to keep clear, accurate and contemporaneous patient records. 2 The ability to interpret and respond appropriately to existing records. To be achieved within second quarter 2 The ability to make a judgement regarding referral and an understanding of referral pathways. To be achieved by qualifying examination 2 The ability to demonstrate an understanding of the legal, professional and ethical obligations of a registered optometrist. 28
  29. 29. Core Subject 3: Visual Function An understanding of, and the ability to assess visual function To be achieved within first quarter 3 The ability to refract a range of patients with common optometric . problems by appropriate objective and subjective means. 1 3 The ability to make appropriate prescribing and management decisions . based on the refractive and oculomotor status. 2 3 The ability to use appropriate ocular diagnostic drugs to aid . refraction. 3 To be achieved within second quarter 3 The ability to assess children’s visual function using appropriate . techniques. 4 3 The ability to assess patients with impaired visual function. . 5 3 The ability to advise visually impaired patients about their impairment, . disability or handicap. 6 3 The ability to assess a patient's colour vision and to determine whether it . achieves the standards required by various vocational groups. 7 To be achieved by qualifying examination 3 An understanding of the special examination needs of patients with . learning and other disabilities. 8 3 An understanding of the special examination needs of patients with . severe visual field defects. 9 29
  30. 30. Core Subject 4: Optical Appliances The ability to prescribe and to dispense appropriate optical appliances To be achieved within first quarter 4 The ability to advise on and to dispense the most suitable form of optical . correction taking into account durability, comfort, cosmetic appearance 1 and lifestyle. 4 The ability to measure and verify optical appliances, taking into account . relevant standards. 2 To be achieved within second quarter 4 The ability to advise on the use of, and to dispense simple low vision . aids including: hand and stand magnifiers, typoscopes and hand held 3 telescopes. 4 The ability to advise on the use of and to dispense complex spectacle . lens forms, including: multifocals, high corrections, and their application 4 to specific patient needs. 4 An understanding of prismatic effect, and the manipulation of lens form . and setting to obtain the desired control of prismatic effects. 5 To be achieved by qualifying examination 4 An understanding of eye protection regulations, and relevant standards, . and the ability to advise on occupational visual requirements. 6 4 The ability to prescribe and dispense spectacles for vocational use. . 7 4 An understanding of the application of complex low vision aids e.g. . spectacle-mounted telescopes, CCTV. 8 4 The ability to manage non-tolerance cases. . 9 30
  31. 31. 31
  32. 32. Core Subject 5: Ocular Examination The ability to perform an examination of the eye and related structures To be achieved within first quarter 5 The ability to use instruments in ocular examination and to understand . the implications of the findings in terms of subsequent examination 1 techniques. 5 The ability to assess the external eye and adnexa. . 2 5 The ability to assess the tear film. . 3 5 The ability to assess pupil reactions. . 4 5 The ability to use a slit lamp. . 5 5 The ability to use diagnostic drugs to aid ocular examination. . 6 5 The ability to examine fundi using direct and indirect techniques. . 7 5 The ability to use instruments to measure corneal curvature. . 8 5.9 The ability to investigate visual fields and to analyse and interpret the part results. 32
  33. 33. To be achieved within second quarter 5 The ability to use a contact tonometer to measure intraocular pressure . and analyse and interpret the results. 1 0 5 The ability to make an assessment of the fundus in the presence of . media opacities. 1 1 5 The ability to use a slit lamp to detect anterior chamber signs of ocular . inflammation. 1 2 5 The ability to assess visual fields of patients with reduced visual acuity. . 1 3 To be achieved by qualifying examination 5 Demonstrate an understanding of techniques for assessment of vision in . infants. 1 4 5 An understanding of the assessment of visual function, including the use . of specialist charts for distance and near vision, and the effects of 1 lighting, contrast and glare. 5 33
  34. 34. Core Subject 6: Ocular Abnormalities The ability to identify and manage ocular abnormalities To be achieved within first quarter 6.1 The ability to interpret and investigate the presenting symptoms of the patient. 6.2 The ability to develop a management plan for the investigation of the patient 6.3 The ability to identify external pathology and offer appropriate advice to patients not needing referral, 6.4 An understanding of risk factors for common ocular conditions. 6.5 The ability to recognise common ocular abnormalities and to refer when appropriate. To be achieved within second quarter 6.6 The ability to manage a patient presenting with a red eye. 6.7 The ability to manage a patient presenting with reduced vision. 6.8 The ability to identify abnormal colour vision and to appreciate its significance. 6.9 The ability to manage a patient presenting with cataract. 6.10 The ability to evaluate glaucoma risk factors, to detect glaucoma and refer accordingly. 6.11 The ability to manage a patient presenting with macular degeneration. 6.12 The ability to recognise, evaluate and manage diabetic eye disease and refer accordingly. 6.13 The ability to evaluate and manage a patient presenting with symptoms suggestive of retinal detachment. 6.14 An understanding of the treatment of a range of common ocular diseases. 6.15 The ability to recognise ocular manifestations of systemic disease. To be achieved by qualifying examination 6.16 An understanding of the role of optometrists in shared care schemes. 6.17 The ability to assess symptoms and signs of neurological significance. 34
  35. 35. 6.18 The ability to manage patients presenting with sight- threatening eye disease. 6.19 An ability to recognise adverse ocular reactions to medication. 35
  36. 36. Core Subject 7: Contact Lenses The ability to manage patients with contact lenses To be achieved within first quarter 7 The ability to insert and remove contact lenses and instruct patients in . these procedures. 1 7 The ability to fit soft contact lenses. . 2 7 The ability to manage the aftercare of patients wearing soft contact . lenses 3 7 The ability to advise on contact lens materials and care regimes . 4 To be achieved within second quarter 7.5 The ability to manage the aftercare of patients wearing rigid gas permeable contact lens. 7 The ability to fit rigid gas permeable contact lenses. . 6 To be achieved by qualifying examination 7 An understanding of, and the ability to fit contact lenses to patients with . astigmatism. 7 7 An understanding of the techniques used in fitting contact lenses and to . advise patients requiring complex visual correction. 8 36
  37. 37. Core Subject 8: Binocular Vision The ability to assess and manage patients with anomalies of binocular vision To be achieved within first quarter 8 The ability to assess binocular status using objective and subjective tests. 8 An understanding of the management of a patient with an anomaly of binocular vision. 8 The ability to investigate and manage adult patients presenting with heterophoria. To be achieved within second quarter 8 The ability to manage an adult patient with heterotropia 8 The ability to manage children at risk of developing an anomaly of binocular vision. To be achieved by qualifying examination 8 The ability to manage children presenting with an anomaly of binocular vision. 8 The ability to manage a patient presenting with an incomitant deviation. 37
  38. 38. GLOSSARY Words and Phrases Competency Title One of the eight competencies areas identified by the GOC Stem Statement An over-arching statement which explains and expands the competency title. Ability to.. Being able to .....and/or permitted to under current legislation Understanding To comprehend, to perceive the meaning of but not necessarily having the ability to do it..... Communication All forms of inter-personal communication ‘written forms’ ‘asking’ ‘listening’ ‘explaining’ ‘discussing’. Manage Encompasses all aspects of patient management including advice, reassurance, treatment and referral as appropriate. CCTV Closed-circuit Television – a television system in which signals are transmitted from the television camera to the receivers by cables or telephone links 38
  39. 39. Appendix 3 2000 THE CORE CURRICULUM FOR UNDERGRADUATE TRAINING IN OPTOMETRY General Optical Council 41 Harley Street London W1G 8DJ Tel: 020-7580-3898 Fax: 020-7436-3525 Email: GOC@optical.org 39
  40. 40. FOREWORD The Core Curriculum is designed to assist both the Panel of Visitors of the General Optical Council and the individual training institutions. It is recognised that this is a core curriculum and that individual training institutions will both teach beyond the curriculum and place varying emphasis on different parts of the curriculum according to the differing experience and expertise of the academic staff. Nevertheless it provides Visitors with a framework on which to base their judgement of the appropriateness of the curricula when visiting an institution. In areas such as Basic Science where there are less differences of opinion and less new knowledge more detail has been given than in clinical areas where opinions may differ and a great deal of new knowledge is manifested every year. 40
  41. 41. INTRODUCTION BASIC SCIENCE Basic Science is the fundamental knowledge and understanding of the scientific principles upon which optometric practice is built and has been drawn up so that subsequent mastery of clinical content, both systemic and ocular, evolves providing a basis for life-long learning in optometry. (a) Human Biology Optometrists should possess a knowledge of the scientific principles of the biomedical sciences, which are applied in the recognition and management of systemic conditions that can present to them by patients seeking primary eye care; and in the prevention, detection/diagnosis and management of ocular diseases. (b) Theoretical, and Physiological Optics Optometrists should possess a knowledge of the scientific principles of theoretical and physiological optics which are applied in the prevention, diagnosis, treatment and management of refractive, oculomotor and sensory integrative conditions which can present to them by patients seeking primary eye care. CLINICAL SCIENCE Clinical Science is the application of Basic Science to the prevention, diagnosis/ detection, treatment and management of clinical conditions within the scope of optometric practice. (a) Ophthalmic Optics Optometrists should have an understanding of ophthalmic optics so as to enable them to apply their knowledge of Basic Science. (b) Ocular/Visual Biology Optometrists should possess a knowledge of the scientific principles of ocular/visual biology which are applied in the prevention, diagnosis/detection and management of ocular disease and traumatic conditions that can present to them by patients seeking primary eye care. (c) Systemic Conditions Optometrists should have an understanding of systemic conditions that will enable them to apply their knowledge of Basic Science. The more common systemic conditions with serious ocular complications should be taught in detail and other conditions which are either more rare or have less serious ocular effects should also be covered. (d) Ocular Disease/Trauma 41
  42. 42. Optometrists should have an understanding of ocular disease and trauma which will enable them to apply their knowledge of Basic Science to their responsibilities in the prevention, diagnosis/detection and management of ocular pathological conditions that can present to them by patients seeking primary eye care. (e) Refractive/Oculomotor /Sensory Integrative Conditions Optometrists should have an understanding of refractive/oculomotor/sensory integrative conditions which will enable them to apply their knowledge of Basic Science to the prevention, diagnosis, treatment and management of such conditions as may present to them by patients seeking primary eye care. PATIENT CARE AND HEALTH CARE DELIVERY SYSTEMS Optometrists should have an understanding of public health, which will enable them to apply their knowledge to the identification of society’s health needs. 42
  43. 43. EXPANDED IN APPENDIX I BASIC SCIENCE Human Biology Detail as to the depth of knowledge required may be found by consulting Appendix I Section 1. Gross Anatomy a. Head and neck b. Thorax c. Abdomen/pelvis d. Systemic circulation of blood and lymph Section 2. Histology a. Tissues 1. Cell 2. Epithelium 3. Glands 4. Connective tissue 5. Muscle 6. Blood 7. Nerve 8. Receptors 9. Blood vessels b. Organs 1. Integumentary system 2. Heart 3. Respiratory system 4. Gastrointestinal system 5. Renal system c. Histogenesis 1. Epithelium 2. Connective tissue 3. Muscle Section 3. Neuroscience a. Neurohistology 1. Histogenesis in the nervous system 2. Degeneration and regeneration in the nervous system b. Electrophysiology of the nerve cell 1. Basis of resting potential (ionic balance, transport mechanisms) 2. Basis of action potential (ionic balance) 3. Action potential conduction 4. Synapses, classification, transmission 5. Membrane physiology receptors, membrane channels 6. Inhibitory and excitatory postsynaptic potentials (including concepts of spatial and temporal summation) 7. Strength - duration curve 43
  44. 44. c. Neuroanatomy 1. Spinal cord 2. Autonomic nervous system 3. Medulla 4. Pons 5. Midbrain 6. Diencephalon 7. Cerebrum 8. Cerebellum 9. Blood supply 10. Functional systems (e.g., visual, auditory, somesthetic, limbic) d. Neurophysiology 1. Integration of nerve signals (synaptic processes, reflexes, feedback, adaptation and habituation) 2. Sensory coding (receptor potentials, uni- and multi-modal units, receptive fields) 3. Somatosensory system (transmission of tactile, proprioceptive, temperature and pain sensations) 4. Auditory system (functions of middle ear and cochlea, central auditory mechanisms) 5. Vestibular system (function of vestibular apparatus, brainstem mechanisms of vestibulo-ocular and postural reflexes) 6. Motor pathways (spinal reflexes, muscle spindles, control of movement by the motor cortex, the cerebellum, the basal ganglia and brainstem structures) 7. Autonomic nervous system (including function of adrenal medulla and central regulation of visceral function) 8. Significance of evoked potentials, CT and PET scanning and MRI Section 4. General Biochemistry a. Cellular biochemistry b. Proteins 1. Structure and Types 2. Mechanism of Enzyme action c. Bioenergetics and energy storage d. Carbohydrate biochemistry 1. Structure and function 2. Glycolysis 3. TCA cycle 4. Pentose monophosphate shunt 5. Gluconeogenesis 6 Glycogen synthesis, storage and utilization 7 Oxidative phosphorylation 8 Mitochondrial structure 9 Electron transport/pH coupling e. Lipid biochemistry 1 Structure and function 2. Fatty acid degradation/beta oxidation 44
  45. 45. 3. Fatty acid synthesis 4. Sterol synthesis 5. Membrane biochemistry f. Molecular Biology 1. DNA structure and function 2. RNA structure and function 3. DNA replication 4. Protein synthesis g. Biochemistry of specialised tissues 1. Hormones and growth factors 2. Muscle 3. Immune system 4. Liver 5. Nerves 6. Eye h. Nutrition 1. Digestion of proteins, carbohydrates and lipids 2. Essential amino acids 3. Vitamins 4. Minerals Section 5. General Physiology/Neurophysiology a. Cellular functions b. Respiration c. Gastrointestinal activity d. Muscle e. Body fluids f. Renal system and body fluids g. Circulatory system h. Endocrine system Section 6. General Microbiology a. Bacteriology 1. Eucaryotic vs. procaryotic cells 2. Bacterial cell structures and cell wall morphology 3. Physiological processes of bacterial growth 4. Genetic mechanisms of bacteria 5. Normal body flora 6. Disease states, transmission, pathogenic mechanisms, symptoms, diagnosis and immunity of infections by 7. Laboratory isolation, culture and identification of bacteria 8. Procedures for antibiotic susceptibility testing 9. Quality control sterilisation and disinfection b. Virology 1. Virus particle chemistry and morphology 2. Classification scheme for viruses 3. Genetic mechanisms of viruses 4. Viral replication in host cells 45
  46. 46. 5. Disease states, transmission, pathogenic mechanisms, symptoms, diagnosis and immunity of infections by viruses c. Mycology 1. Biology of fungi 2. Disease states, transmission, pathogenic mechanisms, symptoms, diagnosis and immunity of infections by 3. Parasitology 4. Disease states, life cycles, transmission, pathogenic mechanisms, symptoms, diagnosis and immunity of infections by protozoans, trematodes, cestodes, nematodes and arthropods. Section 7. General Immunology a. Antigens (chemistry and origin) b. Antibodies c. Antigen-antibody interactions d. Complement chemistry, function, and pathways e. Cytokines (origin and function) f. Non-specific immunity g. Specific immunity h. Hypersensitivity responses i. Transplantation immunology j. Immunological tolerance k. Autoimmunity Section 8. General Pharmacology a. General Principles of pharmacology and toxicity 1. Pharmacodynamics 2. Pharmacokinetics b. Autonomic and/or neuromuscular junction drugs 1. Neurohumoural transmission: autonomic and somatic motor nervous systems 2. Adrenergic agonists 3. Adrenergic antagonists 4. Cholinergic agonists 5. Cholinergic antagonists 6. Ganglionic agonists and antagonists 7. Neuromuscular transmission agonists and antagonists c. Autocoid agonists and antagonists d. Drugs affecting the respiratory system 1. Bronchodilators 2. Mast cell stabilizers 3. Mucolytics e. Gastrointestinal agents f. Chemotherapeutic agents 1. Antimicrobial agents 2. Antiviral agents 3. Antineoplastic agents g. Immunopharmacological agents 46
  47. 47. h. Anti-inflammatory agents 1 Steroids 2. Non-steroids i. Major drugs acting on the central nervous system 1. Neurotransmitters 2. Opioid and non-opioid analgesics 3. Sedative hypnotics 4. Anxiolytics 5. Antipsychotics 6. Antiparkinsonians 7. Antidepressants 8. Anticonvulsants 9. Skeletal muscle relaxants j. Local anaesthetics k. Major drugs acting on the endocrine system 1. Adenohypophyseal hormones 2. Thyroid and antithyroid drugs 3. Insulin and synthetic antidiabetics 4. Oestrogens, progestins and androgens l. Major cardiovascular drugs 1. Antihypertensives 2. Agents used to treat CHF (inotropic agents, vasodilators) 3. Antiarrhythmics 4. Antianginal agents 5. Anticoagulants and thrombolytics 6. Antihyperlipidemic agents m. Major drugs acting on the kidneys 1. Diuretics 2. Uricosuric agents n. Common over-the-counter drugs 1. Vitamins and minerals o. Toxicology p. Drug use and metabolism in pregnancy and breast feeding 47
  48. 48. EXPANDED IN APPENDIX II BASIC SCIENCE Theoretical Optics Details as to the depth of knowledge required may be found by consulting Appendix II Section 1 Geometrical Optics a. Refraction at single plane or spherical surfaces. b. Thin lenses c. Thick lenses d. Aberrations e. Stops, pupillae and ports f. Spherocylindrical lenses g. Thin prisms h. Mirrors i. Ophthalmic and optical instruments Section 2. Physical Optics a. Wave optics b. Interaction of light and matter c. Polarisation d. Image Quality 48
  49. 49. BASIC SCIENCE Physiological Optics Details as to the depth of knowledge required may be found by consulting Appendix II Section 1. Ocular Physiology/Neurophysiology a. Visual pathway Section 2 Visual Optics a. Schematic eye models b. Dioptrics of the eye c. Entoptic phenomena d. Quality of the retinal image e. Radiation and the eye Section 3. Visual Perception a. Colour perception b. Space perception c. Form perception d. Light perception e. Motion perception f. Temporal perception Section 4. Psychophysical Methodology a. Basic psychophysical methods and theory b. Psychophysical scaling methods and theory c. Signal detection methods and theory 49
  50. 50. CLINICAL SCIENCE Ophthalmic Optics Section 1 a. Physical characteristics of ophthalmic lenses 1. Geometry of lens surfaces (Spherical, cylindrical, toric, aspheric) 2. Base curves (form of lenses) 3. Lens thickness (centre, edge, gradients, isothickness curves) 4. Specification of lens size and shape 5. Materials (index of refraction, dispersion, hardness, specific density) b. Optical characteristics of ophthalmic lenses 1. Locations of and relationships between the optic axis, optical centre, geometric centre, and major reference points 2. Principles of corrected curve lens design 3. Verification of lens prescriptions (focimeter, lens measure, and hand neutralisation) 4. Writing and transposing lens prescriptions 5. Effect of lens tilt (spheres and spherocylinders about a principal meridian) 6. Effective power variations 7. Focimetry c. Ophthalmic prisms and prismatic effects of lenses 1. Thickness differences across a prism 2. Prismatic effects in the periphery of a lens (spheres, spherocylinders) 3. Decentration (prism form decentration, decentering to obtain prism, interpupillary distance) 4. Correction of vertical prism effect a) Slab off (front, back, top, bottom, reverse) b) Double slab off c) Dissimilar segments d) Compensated R Segments e) Prism segments f) Multiple corrections g) Contact lenses h) Fresnel prisms i) Fresnel adds d. Multifocal lenses 1. Types (fused, solid, progressive power and blended lenses) 2. Methods of producing add power 3. Segment centre location 4. Differential prismatic effect and jump 5. Total displacement, horizontal and vertical imbalance 6. Placement of distance and multifocal optical centre 7. Optical and physical characteristics of segments (design and calculations, progressive adds, aberrations, surface characteristics) 8. Specifying multifocal height, size, shape and location of segment 50
  51. 51. e. Frame Materials: Physical characteristics and physiological compatibility f. Specification and nomenclature of frames g. Optical and frame consideration of high powered lenses: spheric, aspheric, and high index materials h. Spectacle magnification 1. Shape and power factors 2. Iseikonic lens design i. Methods of remedying reflections and ghost images j. Absorptive lenses 1. Specification of lens tints and absorptive coatings (including spectral transmission curves) 2. Characteristics of photochromic lenses 3. Relationship between lens thickness and spectral transmission 4. Special occupational requirements k. Impact resistance 1. Degrees of resistance of ophthalmic lens materials 2. Methods of rendering materials impact resistant 3. Methods of verifying impact resistance 4. Performance of materials upon impact and after impact 5. Specifications of occupational safety lenses l. Optical tolerances and physical requirements of ophthalmic lenses and frame materials (International and European Standards) Section 2 Spectacle Applications a. Treatment and management of refractive/oculomotor/sensory interactive conditions using spectacle lenses 1. Ametropic spectacle lens prescriptions 2. Lens problems of aberrations, weight, thickness, limits of field, ghost images, magnification, jump and displacement 3. Frame and lens design, including types of single vision and multiple focal lenses of multi-focals, optical centres, and frame specifications 4. Evaluation of lenses and frames, via focimeter, lens gauge, and observation, for optical centre positioning, power, and other specifications of design 5. Fitting and adjusting frames 6. Patient advice associated with the dispensing of prescriptions for different ametropias 51
  52. 52. CLINICAL SCIENCE Ocular /Visual Biology Section 1. Anatomy of the Eye, Ocular Adnexa and Visual Pathway a. Orbit 1. Contents (extraocular muscles, nerves, blood vessels, fat compartments, fascia) 2. Anatomical relationships among orbital structures 3. Bones of the orbit 4. Foramina and openings of the orbit (location, contents) b. Extraocular muscles 1 Nomenclature 2. Origins 3. Insertions 4. Innervation, blood supply 5. Relationship to other orbital structures c. Blood supply 1 Branches of internal and external carotid arteries related to the orbit, eyelid and upper face 2. Branches of the internal and external jugular veins 3. Dural sinuses d. Ocular and orbital nerves 1 Cranial nerve I, III, IV, V, VI, VII (intracranial and extracranial course, branches, functions, tissue innervated) 2. Parasympathetic nerves (course, branches. tissue innervated) 3. Sympathetic nerves (course, branches, tissue innervated) e. Eyelid 1 Anatomic boundaries 2. Layers 3. Muscles (actions) 4. Glands (secretions, functions) 5. Blood supply drainage, lymphatic drainage 6. Innervation f. Eyebrow (structure and function) g. Conjunctiva 1. Location 2. Composition (layers, cell types, glands) 3. Relationship with tarsal plate, extraocular muscles, sclera, Tenon's capsule, cornea 4. Blood supply and venous drainage, lymphatic drainage 5. Innervation 6. Plica semilunaris (composition) 7. Caruncle (composition) 52
  53. 53. h. Lacrimal system 1 Lacrimal gland (structure, innervation, blood supply) 2. Accessory lacrima glands (location, function) 3. Distribution of tears (role of eyelids) 4. Drainage of tears, nasolacrimal duct (cellular lining), lacrimal papillae (location), lacrimal puncta, canaliculli (relationship to Horner’s Muscle); lacrimal sac (relationship to medial palpebral ligament, Horner’s muscle, orbicularis oculi, septum orbitale) 5. Lacrimal fossa (bony structure) 6. Nasolacrimal canal (bony composition, relationship to maxillary sinus) i. Cornea 1 Normal dimensions including diameter, radii of curvature (anterior and posterior) and thickness (central and peripheral) 2. Temperature 3. Epithelium (histology and ultrastructure) 4. Basal lamina (relationship to epithelium) 5. Bowman's layer (relationship to basal lamina and epithelium) 6. Stroma (composition, ultrastructure) 7. Descemet's membrane (relationship to stroma and endothelium) 8. Endothelium (composition, ultrastructure) 9. Innervation 10. Healing j. Sclera 1. Size 2. Radius of curvature 3. Thickness 4. Colour 5. Relationship to conjunctiva, Tenon's capsule, suprachoroidal space 6. Emissaria (contents, location) 7. Composition 8. Lamina cribrosa (structure) k. Anterior chamber and angle 1. Shape and volume 2. Boundaries 3. Diameter and depth 4. Trabecular meshwork (components, ultrastructure) 5. Juxtacanalicular tissue (components, ultrastructure) 6. Schlemm's canal (location, size, ultrastructure of wall, afferent and efferent connections) 7. Scleral spur (composition, location) 8. Schwalbe's ring (composition, location) 53
  54. 54. l. Iris 1. Gross landmarks, zones 2. Diameter 3. Colouration (factors controlling) 4. Anterior border (composition, ultrastructure) 5. Stroma (composition) 6. Sphincter muscle (type, composition, innervation) 7. Anterior epithelium (ultrastructure) 8. Dilator muscle (type, composition, innervation) 9. Posterior epithelium (relationship to lens, anterior epithelium, pupil margin) 10. Blood supply, venous drainage 11. Innervation m. Pupil 1. Size 2. Location n. Posterior chamber 1. Size and volume 2. Boundaries o. Ciliary body 1. Gross morphology 2. Dimensions 3. Relationship to sclera, anterior chamber, iris, posterior chamber, lens and retina 4. Pars plana (location, components) 5. Pars plicata (location, components) 6. Stroma (components) 7. Ciliary muscle (components, origin, insertion, action, innervation) 8. Pigmented epithelium (basal lamina, ultrastructure) 9. Non-pigmented epithelium (basal lamina, ultrastructure, relationship to pigmented epithelium) 10. Blood supply and venous drainage 11. Innervation p. Lens, zonule 1. Zonule 2. Location of lens 3. Epithelium (capsule, ultrastructure) 4. Cortex (composition of lens fibres, ultrastructure) 5. Nuclei (various names and locations) 6. Sutures (location) q. Choroid 1. Extent 2. Thickness 3. Relationship to lamina fusca of sclera 4. Choriocapillaris (ultrastructure, type of capillaries) 5. Stroma (composition) 6. Blood supply 7. Venous drainage 8. Innervation 9. Bruch's membrane (location, composition) 54
  55. 55. r. Vitreous 1. Volume 2. Shape 3. Attachments to retina and lens (ultrastructure) 4. Patellar fossa (location) 5. Anterior hyaloid (location) 6. Posterior hyaloid (location) 7. Cortex (composition) 8. Hyaloid canal (location, origin) s. Retina 1. Layers (components of each, ultrastructure) 2. Relationship between retinal pigment epithelium and Bruch's Membrane 3. Relationship between retinal pigment epithelium and photoreceptor outer segments 4. Synaptic connections within retina 5. Glial cells (name, location, function) 6. Blood supply 7. Anatomical areas (location, size, composition) of area centralis, parafovea, fovea, foveola, macula lutea, ora serrata (ultrastructure) t. Optic nerve 1. Surface features 2. Prelaminar portion (composition, blood supply) 3. Laminar portion (composition, blood supply) 4. Retrolaminar portion (composition, blood supply) 5. Central retinal artery and vein (location) 6. Optic disc/cup u. Visual pathway 1 Localisation of retinal fibres along visual pathway, optic nerve, chiasm (crossing), optic tract, lateral geniculate body, optic radiations. visual cortex 2. Layers of lateral geniculate body (afferent, efferent) 3. Layers of visual cortex, areas 4. Blood supply 5. Anatomy related to visual pathology 55
  56. 56. Section 2. Ocular and Visual Pathway Development a. Orbit 1. Development of bones of orbit (closure of sutures) 2. Abnormalities (faulty development of facial bones) b. Extraocular muscles 1. Condensation of mesenchyme (bilateral condensation) 2. Motor innervation development 3. Insertion of extraocular primordia into anterior sclera 4. Late development c. Eyelid 1. Tissue origin 2. Lid folds 3. Fusion of eyelid 4. Ectodermal derivatives (skin, glands, conjunctiva) 5. Mesodermal derivatives (tarsus, orbital septum, orbicularis oculi, aponeurosis of levator, smooth muscle) d. Conjunctiva 1. Ectodermal specialization forming conjunctiva and glands e. Lacrimal apparatus 1. Tissue origin of lacrimal glands (main, accessory) 2. Appearance of tearing and weeping (reflexes) 3. Tissue origin of lacrimal and nasal passages f. Cornea 1. Inductive mechanisms 2. Ectodermal components (epithelium, primary stroma) 3. Mesenchymal components (waves) 4. Corneal nerve development (origin) 5. Factors affecting corneal size, curvature, transparency g. Sclera 1. Inductive mechanisms 2. Tissue origin 3. Comparison with cornea h. Anterior chamber and angle 1. Creation of anatomical space 2. Factors that promote growth of anterior chamber 3. Creation of angle (atrophy theory, cleavage theory, reorganisation theory, rarefaction theory) 4. Differentiation of Canal of Schlemm, sclera spur, trabecular meshwork 5. Endothelial membrane i. Iris/Pupil 1. Development of iris stroma (anterior leaf, posterior leaf) 2. Development of pars iridica retinae (epithelial layer) 3. Development of dilator and sphincter muscles 4. Pupillary membrane (atrophy) 5. Cilio-iridic circulation j. Posterior chamber 56
  57. 57. k. Ciliary body 1. Tissue origin (mesoderm, neural crest) 2. Development of pars ciliaris retinae (epithelial layers) 3. Development of ciliary processes, ciliary muscles, ciliary vessels l. Lens zonules 1. Zonule development 2. Tissue induction and interaction (effect on development of vitreous, iris, cornea, retina) 3. Mechanism of lens fibre orientation 4. Stages of lens vesicle development (lens placode, lens pit, lens vesicles) 5. Stages of lens fibre development 6. Developmental nuclei (embryonic, foetal, infantile) 7. Zones of development of lens epithelium m. Choroid 1. Tissue origin (paraxial mesoderm, neural crest cells) 2. Development of choroidal vasculature (3 stages) 3. Development of Bruch's membrane n. Vitreous 1. Primary vitreous (hyaloid canal, tissue origin, tissue characteristics) 2. Secondary vitreous (tissue origin, tissue characteristics) 3. Tertiary vitreous (tissue origin, tissue characteristics) o. Retina 1. Development of optic cup 2. Analogies between development of retina and central nervous system 3. Foetal fissure (formation, function, fusion) 4. Retinal differentiation (Stages I, II, III, proliferation, migration, differentiation) 5. Macular differentiation 6. Retinal circulation development (hyaloid system, central retinal artery/vein) 7. Postnatal events p. Optic nerve and visual pathway 1. Developmental stages of lower visual pathway, before lateral geniculate body (differences between crossed and uncrossed fibres) 2. Myelination of the visual pathway (lower visual pathways vs. upper visual pathway) 3. Relationship between development of upper visual pathway and central vision. 57
  58. 58. Section 3. Ocular Physiology/Neurophysioiogy a. Circulation 1. Haemodynamic patterns (resistance, transmural pressure, flow rate, critical closing pressures) 2. Autoregulation 3. Autonomic nervous system control 4. Unique environment of the eye (high extravascular pressure) 5. Uveal blood flow: choroid, ciliary body, iris (unique characteristics of each, functions of each) 6. Retinal blood flow (unique characteristics, dual supply, functions) b. Eyelids 1. Normal closure of eyelids (forced, spontaneous) 2. Blink reflexes (spontaneous, menace, auditory, touch, dazzle) 3. Role of eyelids in production, distribution and drainage of tears 4. Protective functions of eyelids c Tears 1. Functions of tears (optical, antimicrobial, nutritional, etc.) 2. Composition of tears (layer theories) 3. Function of each layer of tears 4. Source of each layer of tears 5. Basic tear secretion (variation with age, gender, medication etc.) 6. Reflex tear secretion 7. Tear film stability 8. Rheology of tears d. Cornea 1. Physical characteristics (water content, protein content, cells, resistance to trauma) 2. Permeability characteristics of various layers 3. Metabolic characteristics of various layers 4. Theories of corneal transparency 5. Factors influencing corneal thickness/hydration (osmolarity of tears, integrity of epithelium and endothelium, epithelial and endothelial pumps) 6. Physiological parameters necessary to maintain corneal integrity (oxygen level, glucose level, pH, etc.) 7. Epithelial regeneration (normal and response to trauma) 8. Physiological characteristics of corneal nerves 9. Ageing changes of the cornea e. Intraocular pressure 1. Mean pressure 2. Diurnal variation 3. Factors controlling aqueous production (capillary pressure, active transport) 4. Factors controlling aqueous outflow (IOP, episcleral venous pressure) 5. Nervous system regulation of IOP 6. Systemic factors influencing IOP (blood osmolarity, body position, blood pH, blood pressure) 58
  59. 59. f. Aqueous 1. Functions of aqueous 2. Volume, osmolarity, viscosity 3. Formation (ultrafiltration, active transport) 4. Factors influencing rate of flow 5. Composition 6. Blood aqueous barriers (location, ultrastructure, function) g. Lacrimal apparatus 1. Regulation of basic tear secretion 2. Regulation of reflex tear secretion 3. Distribution of tears 4. Drainage of tears (role of Horner's muscle) h. Pupillary pathways 1. Sympathetic pathway to iris 2. Parasympathetic pathway to iris 3. Functional relationships between pupiliary pathways and central nervous system i. Lens 1. Functions of lens 2. Composition of lens 3. Difference in composition between lens and aqueous 4. Metabolism of lens (various pathways essential to the lens) 5. Types of lens proteins 6. Factors which regulate size and solubility of the lens proteins (Vitamin C, glutathione) 7. Theories of lens transparency 8. Mitotic activity of lens epithelium 9. Ageing changes in composition of the lens j. Choroid 1. Functions of choroid 2. Physiological relationships between choroid and retina k. Vitreous 1. Functions 2. Composition 3. Metabolism 4. Ageing changes in composition 5. Physical characteristics (volume, water content, transparency) l. Retina 1. Composition of disc outer segments 2. Formation of disc outer segments (disc renewal, disc shedding) 3. Composition of visual pigments 4. Formation of visual pigments 5. Stages of visual cycle 6. Photoreceptor electrophysiology (membrane potentials, dark current role of sodium, calcium, etc.) 7. Retinal neurotransmitters 8. Function of bipolar, horizontal, amacrine and ganglion cells (receptive fields) 9. Retinal neural mechanisms of colour vision (spatial, temporal and chromatic) 59
  60. 60. m. Visual pathway 1. Function of lateral geniculate body 2. Receptive fields of cells in lateral geniculate body (relationship to colour vision, binocularity, space perception, etc.) 3. Function of visual cortex 4. Receptive field properties (single cell properties) 5. Functional organisation of visual cortex 6. Physiology of binocular vision 7. Mechanism of feature detection n. Extraocular muscles 1. Visual-vestibular interactions (vestibulo-ocular reflex, optokinetic reflex) 2. Supranuclear control of eye movements. 60
  61. 61. CLINICAL SCIENCE Systemic Conditions Section 1. General Pathology a. Inflammation and repair 1. Vascular and cellular changes in acute inflammation 2. Causes of histological changes in chronic inflammation 3. Causes and features of granulomatous inflammation 4. Resolution of acute and chronic inflammation 5. Events and local factors affecting wound healing and repair 6. Systemic factors affecting the rate of wound healing. b. Immunopathology 1 Types of immunologic injury (mechanisms, cell components) 2. Tissue transplantation and graft rejection (mechanisms) 3. Tumour immunology 4. Monoclonal disorders of the immune system 5. Non-specific mediators (e.g., complement, lymphokines) c. Host defences and responses to infection 1. PMN, macrophage and eosinophil function 2. Chemotaxis. phagocytosis, and bactericidal activity of these cells 3. Role of antibody in phagocytosis and destruction of micro- organisms d. Cellular disease 1. Cell injury (reversible and irreversible) 2. Morphologic changes associated with cell injury or death 3. Apoptosis e. Genetic principles and disorders 1. Cytogenetics (mitosis, miosis, chromosomes) 2. Autosomal dominant inheritance (criteria for recognition) 3. Autosomal recessive inheritance (criteria for recognition) 4. X-linked inheritance (criteria for recognition) 5. Development syndromes (characteristics, genetic basis) 6. Congenital anomalies (characteristics, genetic basis) f. Neoplasia 1. Histogenesis of neoplasms 2. Classification of neoplasms 3. Causes of neoplasms (Viral, chemical, radiation) 4. Differences between benign and malignant tumours 5. Effects of tumour on host, oncogenes, agents g. Integument system 1. Infectious diseases 2. Neoplastic diseases (benign, pre-malignant, and malignant) 3. Pigmented lesions h. Haematopoietic and lymphoid system 1. Disorders of RBC, WBC (non-neoplastic) 2. Neoplastic disorders of WBC-leukemias 3. Non-neoplastic disorders of lymph nodes 4. Neoplastic disorders of lymph nodes 61
  62. 62. i. Respiratory system 1. Chronic obstructive pulmonary disease (COPD) and emphysema 2. Infectious diseases of the lung 3. Neoplastic diseases of the lung 4. Interstitial diseases j. Gastrointestinal system 1. Disorders of the stomach (gastritis, ulcers) 2. Disorders of the intestines and colon (enteritis, colitis) 3. Neoplastic disorders of the gastrointestinal tract k. Cardiovascular haemodynamic disorders 1. Congestion, oedema (causes, characteristics) 2. Shock (classification, causes, complications) 3. Thromboembolism (classification, causes, complications) 4. Systemic hypertension (causes, complications) 5. Arterosclerosis (causes, development, complications) 6. Aneurysms (classification, development, complications) l. Heart disease 1. Coronary artery disease (causes, complications) 2. Hypertensive heart disease (causes, complications) 3. Streptococcal infections and nonsupprative sequelae a. Rheumatic fever (causes, clinical features, pathologic features) b. Glomerular nephritis (causes, clinical features, pathalogic features) c. Endocarditis (causes, clinical features, pathologic feature) 4. Cardiomyopathies (causes. clinical features. pathologic features) m. Endocrine diseases 1. Diabetes (classification. pathology, clinical manifestations) 2. Hyperthyroidism 3. Hypothyroidism 4. Goitres, Graves' disease 5. Hyperparathyroidism 6. Hypoparathyroidism 7. Hyperpituitarism 8. Hypopituitarism 9. Hypercorticism (Cushing's disease) 10. Hypocorticism (Addison's disease) 11. Disorders of adrenal medulla (pheochromocytoma) n. Nervous system and neuromuscular diseases 1. Cerebrovascular disease, stroke 2. Headaches 3. Infectious diseases of the central nervous system 4. Nervous system neoplasms 5. Muscular atrophy, muscular dystrophy 6. Demyelinating diseases 7. Leukocidystrophies, gangliosidoses 8. Alzheimer’s disease 9. Trauma, closed head injuries 62
  63. 63. o. Nutritional disorders 1. Malabsorption 2. Alcoholism 3. Vitamin deficiencies 4. Trace minerals p. Congenital and neonatal anomalies 1. Cerebral palsy 2. Foetal alcohol syndrome Section 2. Congenital/Hereditary Conditions a. Symptoms and signs of common genetic disorders (Down's syndrome, cystic fibrosis, congenital heart disease, and other chromosomal anomalies) b. Symptoms and signs of common congenital disorder (foetal alcohol syndrome, rubella, syphillis, toxoplasmosis) c. Medical laboratory tests and diagnostic imaging Section 3. Epidemiology and Biostatistics a. Epidemiological data 1. Incidence and prevalence 2. Odds ratio 3. Relative risk 4. Indices of health 5. Measures of central tendency and variability b. Screening concepts 1. Sensitivity and specificity 2. Predictive value 3. Yield c. Major epidemiological studies d. Research design 1. Descriptive and experimental studies 2. Case-control studies 3. Cross-sectional studies 4. Cohort studies (prospective and retrospective) e. Morbidity and mortality 1. General morbidity and mortality patterns 2. General distribution of eye and vision disorders 3. Legal blindness (age-specific causes, age-specific rates) 63
  64. 64. CLINCIAL SCIENCE Ocular Disease and Trauma Section 1. Ocular Pharmacology a. General Principles 1. Factors affecting ocular drug bioavailability 2. Routes of ocular drug administration b. Autonomic Drugs 1. Functional concepts and ocular receptor types 2. Ocular cholinergic agents 3. Ocular adrenergic agents c. Local anaesthetics 1. Properties of topical ocular anaesthetics d. Antihistamines e. Anti-inflammatory agents 1. Steriods 2. Non-steriods (including mast cell stabilizers) f. Chemotherapeutic Agents 1. Antimicrobials 2. Antivirals 3. Antifungals g. Dyes 1. Topical diagnostic agents 2. Oral and intravenous agents h. Hyperosmotic agents 1. Topical ocular agents i. Lubricants and tear substitutes j. Preparations used with contact lenses k. Toxicology 1. Ocular effects from topical ocular drug administration 2. Ocular effects from systemic drug administration 3. Systemic effects from ocular drug administration Section 2 Ocular Abnormality a. Epidemiology, history and symptom inventory b. Observation, inspection, recognition of signs, and techniques: 1. Palpation of relevant structures 2. Lid eversion 3. Tonus and strength testing of facial and lid muscles by the third and seventh cranial nerves 4. Tests for integrity of the fifth cranial nerve 5. Testing for facial anhidrosis 6. Sinus evaluation, discharge, fever, etc.) 7. Biomicroscopic appearance of relevant structures in health and disease 8. External photography and documentation 9. Signs and symptoms of related systemic diseases 64
  65. 65. c. Pathophysiology, diagnosis, management options, and prognosis a) Epidemiology, history and symptom inventory b) Pathophysiology, diagnosis, management options, and prognosis a) b) and c) above applied to the following sections: Section 3. Ocular Adnexa Section 4. Conjunctiva Section 5. Cornea Section 6. Sclera/Epsiclera Section 7. Anterior Uvea (Iris and Ciliary Body) Section 8. Pupillary, Accommodative and Refractive Pathology Section 9. Orbit Section 10. Anterior Chamber, Angle Structure and Abnormal IOP Section 11. Lens/Aphakia/Pseudophakia Section 12. Posterior Pole Section 13. Peripheral Fundus/Vitreous Section 14. Optic Nerve Pathology Section 15. Lacrimal System Section 16. Sensory Neuro-Visual Pathology Section 17. Oculoneuropathology a) Epidemiology, history and symptom inventory b) Observation, inspection, recognition of signs, and techniques 1 Direct ophthalmoscopy 2. Indirect ophthalmoscopy 3. Family history 4. Biomicroscopy with fundus lenses 5. Ophthalmodynamometry 6. Colour vision testing 7. Photo-stress testing 8. Amsler grid testing 9. Visual fields 10. Dark adaptometry 11. Contrast sensitivity testing 12. Retinal photography 65
  66. 66. 13. Basic interpretation of special studies (ECG, ERG, VER, intravenous fluorescein angiography, ultrasound) 14. Retinal integrity testing with opaque media 15. Signs and symptoms of related systemic diseases 66
  67. 67. CLINICAL SCIENCE Refractive/Oculomotor /Sensory Integrative Conditions Section 1. Human Development a. Normal vision development in the infant and child 1. Visual acuity 2. Contrast sensitivity 3. Refractive status 4. Colour vision 5. Spectral transmission of the ocular media 6. Light sensitivity 7. Form reproduction and perception b. Normal motor development in the infant and child 1. Gross motor/language developmental milestones 2. Oculomotor system 3. Visual perceptual-motor abilities c. Normal cognitive and social development in the infant and child d. Effects of early environmental restrictions 1. Plasticity of the system 2. Animal models 3. Light and pattern deprivation 4. Monocular and binocular deprivation 5. Refractive error 6. Cataract e. Normal changes in vision with ageing 1. Visual acuity 2. Contrast sensitivity 3. Refractive error 4. Colour vision 5. Spectral transmission of the ocular media 6. Light sensitivity 7. Glare (disability and discomfort) 8. Dark adaptation, glare recovery 9. Visual fields 10. Critical flicker fusion frequency 11. Accommodation and convergence Section 2. Anomalies of Child Development a. Epidemiology; history and signs/symptoms manifest by patients in the age ranges noted b. Clinical characteristics of children who deviate from normal patterns of development, and epidemiology of developmental disorders 1. Mental abilities 2. Sensory abilities (vision and hearing handicaps) 3. Neuromuscular and physical abilities 4. Personal-social behaviours 5. Speech and language abilities 67

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