Opinto-opas

Objective

Students are able to describe different mechanisms of action for drugs and understand the basics of the pharmacokinetics. They are able to name the main categories of drugs and their characteristics. Students have the basic knowledge on ocular drugs and their use, mechanisms of action and possible side effects. They can apply their knowledge to the use of diagnostic drugs as optometrists.
Students can describe the most common eye diseases, their signs, symptoms and treatments. After completing an external and internal examination of the eye, students can detect the most common eye diseases and refer their customers for further examination or treatment. Students can provide First Aid for general and ocular injuries. Students are able to describe the benefits, disadvantages and risk factors of various refractive surgery techniques.
After completing the course, students can measure the visual fields and examine the posterior retina using ophthalmoscopic techniques. They can explain the principles of direct and indirect ophthalmoscopy and visual field examination equipment, as well as identify physiological and acceptable measurement tolerances. Students are able to use diagnostic drugs in their examinations appropriately and safely.

Content

Mechanisms of action of drugs, pharmacokinetics and drug safety; drugs affecting the peripheral and central nervous system, circulatory and respiratory systems; drugs affecting fluid and electrolyte balance, metabolism and gastrointestinal tract; vitamins and hormones; drugs used in endocrinology; antimicrobial and antiparasitic drugs; allergy drugs; chemotherapy and immunopharmacology; administering routes of ocular drugs and local drug absorption through the cornea. Drugs affecting the sympathetic and parasympathetic nervous system; hyperosmotic drugs, products for dry eyes; antihistamines, anti-inflammatory drugs; dyes; local anaesthestetics; glaucoma drugs; antibiotics and sulpha-antibiotics, antiviral and antifungal drugs; ocular side effects of systemic drugs. Diseases of the anterior and posterior segments of the eye and its adjoining structures, ocular motility disorders, abnormal pupil reactions, optic nerve disorders, and visual field defects. Toxic reactions in the eye, ocular manifestations of systemic diseases, headaches. First Aid in ocular injuries, various refractive surgery techniques. Direct and indirect ophthalmoscopy, fundus imaging, quantitative perimetry, applanation tonometry, cyclorefraction, principle of the gonioscopy, diagnostic drugs in eye examinations.

Location and time

Ensiavun harjoitustunnit toteutuvat Myllypuron kampuksella lukujärjestyksen mukaisesti.

Materials

Books
- Lääketieteellinen farmakologia ja toksikologia (A Finnish textbook of medical pharmacology and toxicology); Olavi Pelkonen, Heikki Ruskoaho, Jukka Hakkola, Risto Huupponen, Ewen MacDonald, Eeva Moilanen, Markku Pasanen, Mika Scheinin, Kirsi Vähäkangas (ed.); 4th edition 2014; EAN/product number: 9789516562646.
- Clinical Ocular Pharmacology, 5th Edition by Jimmy D. Bartlett OD DOS ScD (Author), Siret D. Jaanus PhD LHD (Author), Butterworth Heinemann Elsevier, 2008, ISBN-13: 978-0750675765 ISBN-10: 0750675764.
- Atlas Of Clinical Ophthalmology, 3rd Edition by David J. Spalton FRCS FRCP FRCOphth (Author), Roger A. Hitchings FRCOphth (Author), Paul Hunter FRCP FRCOphth (Author), Gower Medical Publishing Ltd, London England, ISBN-13: 978-0323036566 ISBN-10: 0323036562.
- Roy and Fraunfelder's Current Ocular Therapy 6th Edition, F. Hampton Roy (Author), Frederick Fraunfelder (Author), Saunders, 30th November 2007, ISBN: 9781437721126.
- Silmätautien käsikirja (A Finnish textbook of clinical manual of ophthalmology); Matti Seppänen, Juha Holopainen, Kai Kaarniranta, Niko Setälä, Hannu Uusitalo (ed.); 1th Edition 2018, Duodecim, ISBN: 978-951-656-422-0.
Käypähoito suositukset (national guidelines): Glaucoma, diabetic retinopathy, cataract.

Teaching methods

Lectures
Practical sessions
Laboratory instructions /Workshop
Guided assignments

Exam schedules

Anterior segment, ocular first aid: written examination 26.3.2021. Retake 1:9.4.2021. Retake 2: 3.5.2021
Posterior segment: written examination 13.4.2021. Retake 1: 18.5.2021. Retake 2:3.6.2021.
Pharmacology: written examination 19.2.2021 Retake 1: 5.3.2020. Retake 2: x.x.2020

Student workload

Pharmacology 4 ECTS
Ophthalmology: anterior segment 3 ECTS
Ophthalmology: posterior segment 4 ECTS
Clinical techniques including practicals 3.5 ECTS
First aid 0.5 ECTS

Further information

In case a student has a decision on special support arrangements affecting the course the student needs to contact the teacher in charge right after enrollment period.
Part of the teaching may be conducted in English.
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Detailed content, practical work:
The basic skill and knowledge is acquired to examine the peripheral retina using a 20-30D lens with direct ophthalmoscope. The students are also introduced the headband BIO technique. Basic skill is ensured in pachymetry and in Goldmann applanation, and “air puff” non-contact - tonometers, ICARE-tonometer is used routinely.
The students dilate each other with Tropicamide when practicing cyclo-refraction by examining fellow students. Dilation with Tropicamide is also used in most BIO practicals.
Clinical use, Instrumentation, Clinical procedure and Clinical implications of the following:
Cycloplegic subjective and objective techniques
Tonometry (GAT, ICare, Tonopen)
Direct ophthalmoscopy
Monocular indirect ophthalmoscopy
Binocular Indirect ophthalmoscopy
Gonioscopy (theory only)
Fundus biomicroscopy
Quantitative perimetry
Cornea thickness examination

Detailed content, theory:
PHARMACOLOGY
Contents
SECTION I - selected topics of general and ocular pharmacology:
• The basic aspects of pharmacology in medicine
• Mechanisms of action of drugs: pharmacodynamics and pharmacokinetics
• Structure of the human nervous system
• Neurotransmitters of human autonomous nervous system
• Receptors of human autonomous nervous system
• The pharmacological effects of neuro transmitters in human autonomous nervous systems
• Drugs affecting the autonomous nervous system
• Local transmitters - histamine
• Drugs affecting the central nervous system - treatment of mental disorders
• Local anesthetics
• Fundamental concepts in ocular pharmacology: ocular anatomy and physiology affecting the delivery and the absorption of ophthalmic drugs
• Basic concepts of ocular drugs in clinical practice: ocular hypotensive drugs, anti-infective drugs, anti-inflammatory drugs, anti-allergy drugs and decongestants, preparations for dry eye and ocular surface diseases, dyes, drugs for retinal diseases.
• Ocular adverse drug reactions to systemic medications (use of the literature “search engine” developed by Metropolia)
SECTION II - Ocular drugs in Clinical Practice (focus in diagnostic drugs):
• Ocular tissue structures and ophthalmic drug delivery
• Local anesthetics
• Mydriatics and mydriolytics
• Cycloplegics
• Cycloplegic refraction
• Use of dyes in optometric practice
• Treatment of dry eye disease in optometric practice
• Pharmaceutical and regulatory aspects of ophthalmic drug administration
• Legal aspects of drug utilization
SECTION III - Pharmacology seminars (special topics in current ocular therapy):
• Pre- and postoperative care of cataract patient
• Treatment options in different forms of age related macular degeneration
• Treatment options in glaucoma
• Optic neuritis and its treatment
• Medical treatment in systemic hypertension
• Diabetes mellitus and its medical treatment
• Medical treatment in coronary heart diseases
• Treatment options in metabolic disorders
• Allergic eye disease and its medical treatment
• Medical treatment of ocular infections
• Different forms of migraine and they medical treatment
• Chemotherapy of ocular tumors
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OPHTHALMOLOGY: ANTERIOR SEGMENT DISEASES
Contents
Ocular adnexa
• enophthalmos, exophthalmos, proptosis
• preceptal cellulitis
• orbital cellulitis
• tenonitis
• orbital pseudotumour
• granulomatosis with polyangiitis (GPA), (Wegener's g.)
• Graves disease
• dermoid cyst
• hemangioma
• lacrimal gland tumors
• orbital lymphoma
• rhabdomyosarcoma
Lids
• ectropium, entropium
• ptosis
• lagophthalmos
• epicanthus
• dermatochalasis
• blepharochalasis
• trichiasis
• distichiasis
• blepharoclonus
• blepharospasm
• hordeolum
• chalazion
• meibomianitis
• blepharitis acute and chronic
• herpes varicella zoster (shingles), h. simplex
• allergic dermatitis
• xanthelasma
• hemangioma ( Sturge-Weber)
• basal cell carcinoma
• squamous cell carcinoma
• adenocarcinoma
• melanoma
Tears
• tear film structure and function
• tear secretion
• Sjogren syndrome (primary/ secondary)
• dry eye (definition, aetiology, classification/grading, tests, management DEWS II)
• punctal plugs
Lacrimal system
• dacryoadenitis acute and chronic
• lacrimal gland tumors
• congenital dacryostenosis
• dacryocystitis acute and chronic
Conjunctiva
• hyperemia
• subconjunctival sugillation
• conjunctivitis acute and chronic
• conjunctivitis bacterial, viral, allergic (atopic, chronic, vernalis)
• ophthalmia neonatorum
• inclusion conjunctivitis, conjunctivitis trachomatosa
• conjunctivitis epidemica
• papillary conjunctivitis
• degenerations (pinguecula, pterygium)
• tumors (dermoids, naevus, melanoma, carcinoma)
Cornea
• layers
• transparency
• infections (bacterial, viral, fungal, acanthamoeba)
• degenerations (arcus senilis, arcus lipoides, pterygium, bandkeratopathy)
• map-dot fingerprint-dystrophy (epithelial basement membrane dystrophy)
• stromal dystrophies (granular, macular, lattice)
• Fuch’s endotherial dystrophy
• keratoconus
Sclera (anterior)
• episcleritis
• scleritis (anterior)
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OPHTHALMOLOGY: POSTERIOR SEGMENT DISEASES
Contents
SECTION I: The Uveal Tract
• Embryology
• Uveal structures
• Coloboma of the uvea
• Types of Uveitis in anterior, intermediate, and posterior segments
• Choroidal nevi
• Choroidal melanoma
SECTION II: Crystalline Lens
• Embryology
• Anatomy
• Physiology
• Metabolism
• Types of cataracts: congenital, infantile, juvenile, and adult
• Cataracts caused by trauma, infection and inflammation, metabolic disorders, genetic disorders
• Surgical treatment of cataracts
• Complications of cataract surgery
• After cataract
SECTION III: Vitreous and Vitreo-Retinal Disorders
• Anatomy of the vitreous
• Aging of the vitreous
• Vitreous detachment
• Asteroid hyalosis
• Vitreous hemorrhage
• Anatomy of the vitreous and retina
• Modern ophthalmoscopy and imaging techniques in detection of vitreo-retinal disorders
• Types of retinal detachment: rhegmatogenous, traction, and exudative
• Differential diagnosis of retinal detachments
• Retinoschisis
• Macular hole
• Macular pucker
SECTION IV: Retina
• Anatomy of the retina
• Blood supply of the retina
• Physical signs of retinal disease
• Changes in retinal pigment epithelium
• Retinal dystrophies
• Retinopathia centralis serosa
• Macular degenerations
• Senile macular degeneration
• Myopic macular degeneration
• Vascular diseases: arterial occlusions, venous occlusions, retinal infections, retinal vascular anomalies
SECTION V: The Optic Nerve and disc
• The normal optic disc and nerve
• Blood supply of the optic nerve
• Physical signs of optic nerve disorders
• Congenital anomalies and pseudopapilloedema
• Refractive anomalies
• The pathologically swollen disc
• Papillitis
• Ischemic papillopathy
• Glaucoma affecting the optic disc
• Tumors of the optic disc
SECTION VI: Systemic disease and the eye
• Metabolic disorder and the ocular findings
• Systemic hypertension and hypertensive retinopathy
• Diabetes mellitus and diabetic retinopathy
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REFRACTIVE SURGERY
Munnerlyn's formula
Referrals
- Absolute and relative general health contraindications
- Absolute and relative ocular health contraindications
Pre-operative assessment
-History and symptoms
-Vision assessment
Treatment options
- Surface ablation: Photorefractive Keratectomy (PRK) and Laser epithelial keratomileusis (LASEK)
- Laser in-situ keratomileusis (LASIK)
- Small Incision Lenticule Extraction (SMILE)
- Clear lens extraction and intraocular lens (IOL) implant
---Phacic intraocular lens implant
---Implantable contact lens (ICL)
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GENERAL FIRST AID
Details will be given during the sessions.
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OCULAR EMERGENCIES
OPHTHALMIC EMERGENCIES
Contents
Ocular trauma
• foreign body (corneal/conjunctival/intraorbital)
• corneal abrasion
• penetrating ocular injury, ruptured globe
• blunt trauma, blow-out fracture
• swollen lids
• chemical injuries
• radiation damage
• burns
• conjunctival and lid lacerations
Urgent referrals

Evaluation scale

0-5

Assessment criteria, satisfactory (1)

The student is able to:

- display learning in professional knowledge and core content in the field
- search information from a variety of sources
- work in various duties in a variety of operating environments
- show that he has achieved the targets for core competence
- display learning in the key safety practices in the field
- act according to ethical principles
- to contribute his learning for the benefit of a group or project

Assessment criteria, good (3)

The student is able to:

- use concepts and knowledge in his field systematically
- find information and assess and use information sources with a critical eye
- apply professional information in professional assignments
- apply professional expertise in various work assignments
- act independently and responsibly in professional contexts
- plan operations with safety in mind
- act according to professional ethics
- act purposefully in working groups and projects

Assessment criteria, excellent (5)

The student is able to:

- use concepts and knowledge in his field professionally
- argue the use of his sources - argue a course of action on the basis of research information or findings
- operate in a range of duties and work situations, also in international contexts
- to act in a way that is customeroriented and displays entrepreneurial spirit
- to act responsibly, taking safety issues into consideration
- argue his choices on the basis of professional ethics
- organise and manage the operation of a group and project

Assessment criteria, approved/failed

The student is able to:

- The student does not know or appreciate knowledge in the field sufficiently
- The student does not know or cannot use concepts in his field properly
- The student's professional level is insufficient
- The student is not acting in accordance with his training and guidance
- The student is not trying to develop himself or his actions
- The student is unconcerned about professional safety or ethical principles
- The student is not motivated by or participating in group or development work

Assessment methods and criteria

Written examination/examinations.
Practicals returned and approved.
To pass the course, the students are expected to attend the lectures and practicals.

Qualifications

Pathology and Clinical Microbiology, Basics of Contact Lens Fitting