Opinto-opas

Objective

Knowledge base
Students are able to
• describe the abnormal eye conditions, risk factors and treatment for: (1) orbit, and ocular adnexa, (2) lacrimal system, (3) conjunctiva, (4) cornea, (5) sclera and episclera, (6) anterior uvea (iris and ciliary body), (7) pupillary, accommodative and refractive pathology, (8) anterior chamber, angle structures and IOP, (9) lens, (10) vitreous, (11) choroid, (12) retina (including abnormal ocular conditions affecting its different layers and anatomical landmarks, e.g., macula, fovea, foveolar, mid-periphery, periphery etc.), (13) optic nerve and the optic nerve head, (14) sensory neuro-visual pathology, and (15) oculomotor neuropathology, and (16) systemic diseases affecting the eye, (17) ocular emergency and urgent situations.
• discuss, explain, and undertake examinations and management of patients wanting to undergo or who have undergone refractive surgery. Knowledge, understanding and testing skills should be demonstrated in the areas of (1) patient counselling and (2) pre- and post-operative assessments. Knowledge and understanding should be demonstrated in the (3) different treatment options and (4) postoperative complications.


Clinical/practical base
Students are able to
• detect, describe their findings, and evaluate their significance by the following examination methods: (1) automatic perimeter, (2) contact tonometry (3) contact-pachymetry, (4) gonioscopy, (5) indirect ophthalmoscopy (6) fundus and anterior part imaging including Optical Coherence Tomography (7) dry eye tests (8) slit lamp microscopy
• use diagnostic drugs safely manner

Clinical exam
Students are able to
• use, interpret and explain the findings: Ophthalmoscopy (direct monocular indirect and binocular indirect), pachymetry, microscopy for fundus examination and health assessment, contact tonometry.

Content

Examination techniques:
Evaluation of visual fields with automatic perimeter
•definition and terminology
• factors affecting the retina sensitivity
Static perimeter
•stimulus luminance and sensitivity of the retina
•thresholds
• test strategies (full threshold, fast threshold, screening)
• testing
Goldmannin aplanaatiotonometria
- periaate
Visual field defects and visual pathway
Visual field examination
• glaucoma
• interpretation of the visual field result
• recording
Tonometer
Goldmann Aplanation Tonometry
• the principle
• measurement and use of local anesthesia
• normal values and its meaning
• factors that affect measurements and factors that affect pressure
• recording
Pachymetry
• the principle
• measurement and use of local anesthesia
• normal values and their meaning
• measurement-related issues and relationship to eye pressure
• recording
Evaluation of the anterior chamber and gonioscopy
Lens options and optical principle (Goldmann 3 Mirror Lens and 4 Mirror Lens)
• indications for use
• Identification of structures
•use of a local anesthetic
• anterior chamber depth assessment with van Heric technique
Ophthalmoscopy - monocular and binocular indirect techniques
• monocular and indirect binocular head band ophthalmoscopy and microscopy of the fundus
• techniques and lens options and optical principle (field and magnification)
• procedure and technique
• image reversed and inverted
• use of mydriatics
• view of peripheral fundus
• normal and abnormal findings
•recording
Imaging
•various imaging techniques including OCT, SLO, FAF
Dry eye test
• observation, detecting, recognition and techniques
• examining the shape and location of unusual findings by microscope, including clusters, opacities, etc.
• lids and cornea microscopy findings in primary conjunctival disease
• signs and symptoms related to systemic diseases
• differential diagnosis of viral infection, bacterial infection and allergic conjunctivitis

Abnormal ocular conditions: Epidemiology, pathophysiology, diagnose, treatment options, prognosis and signs of associated general diseases

1 Orbit and ocular adnexa:
• Assessment of asymmetrical fissures
• Recognition of dysplasia craniofacial appearance
• General workup for periorbital ache/pain of unknown cause
• Exophthalmometry
• Palpation of orbital rim and anterior orbit
• Evaluation of episcleral venous dilation
• Assessment of periorbital oedema
• Testing for orbital bruits
• Valsalva maneuver in proptosis
• Workup for supected blow out fracture
• Tests for restrictive myopathy
• Special tests including tomograms, ultrasound, GT-scan, venograms
• 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
Examination:
• Palpation of relevant structures
• Lid eversion
• Diagnosis and management of marginal lid disease
• Tonus and strength testing of facial and lid muscles by the thrid and seventh cranial nerves
• Tests for integrity of the fifth cranial nerve
• Sinus evaluation (history, discharge, fever, etc.)
• Biomicroscopic appearance of relevant structures in health and disease
• External phtography and documentation

2 Lacrimal system and tears secretion:
Tears
• Sjögren syndrooma (primary/secundary)
• Dry eye disease (definition, etiology, classification, /assessment, tests, treatment according to DEWS II)
• Punctal plugs
• Palpation of sac, canaliculi, and lacrimal fossa; observation of lid dynamics, punctal position
• Saccharin taste test
• Signs and symptoms of related systemic diseases
• Punctal dilation; probing and lacrimal syringing
• Punctum/canalicular occlusion
Lacrimal system
• dacryoadenitis acute and chronic
• lacrimal gland tumors
• congenital dacryostenosis
• dacryocystitis acute and chronic
3 Conjunctiva
o Biomicroscopy to highlight and describe morpholog and location of ireegularities, deposits, opacities, etc.
o Evaluation of preauricular and submandibular lymph nodes
o History and evaluation of oropharynx for associated upper respiratory illness
o History related to associated urniary tract infection
o Biomicroscopic appreance of varied appearance of the lids and cornea in primay conjunctival disease
o Swabbing, scraping; smears, stains and cultures
o Signs and symptoms o related systemic diseases
• 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)
Differential diagnosis of viral, bacterial and allergic conjunctivitis
oTreatment of conjunctivits
Evaluation of regional lymph nodes

4 Cornea
o oBiomicroscopy to highlight and describe morpholog and location of ireegularities, deposits, opacities, etc.
oEvaluation of surface optical quality and abnormal curvature via reflections
oObtaining and interpreting smears and cultures
oSigns and symptoms of related systemic diseases
• 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

5 Sclera
oInvestigation of entities producing pain in or referred to eye and orbit
oBiomicroscopic techniques useful to detect episcleral and scleral inflammation deep to conjunctival injection/chemosis
oIndirect ophthalmoscopy to detect posterior scleritis
oSigns and symptoms of related systemic diseases
oUse of topical vasoconstrictor
• episcleritis
• scleritis (anterior)

6 Iris and ciliary body
oTransillumination in albinoids
oEvaluation of pupil
oBinocular indirect ophthalmoscopy, with scleral depression
oReferral critera for special tests
oSigns and symptoms of related systemic diseases

7 Pupillary, accommodative and refractive pathology
oEvaluation of the sympathetic pathway
oEvaluation of the parasympathetic pathway and surrounds in third nerve disease
oRelevant pharmacology: including diagnostic tests in Adie’s and Horner’s syndromes; testing for a pharmacologically blocked pupil as well as the effects of autonomically active drugs and toxicology o accommodative paresis, spasm and ciliary body oedema
oSwinging flashlight and pupil cycle tests
oEvaluation and recognition of signs of aberrant regeneration
oEvaluation of deep tendon reflexes in Adie’s syndrome
oEvaluation of suspicious refractive shifts

8 Anterior chamber, angle structures and abnormal IOP
oTensions
oBiomicroscopic appearance of associated anterior segment signs of glaucomas
oAssessment of post surgical eyes

9 Lens, aphakia and pseudophakia
• lens metabolism and toxicology
• cataract types: congenital, juvenile, senile
• nuclear, cortical and subcapsular cataract
• trauma, infection and inflammation, metabolism disorders, genetic disorders
• surgery treatment
• complications after surgery

10 Vitreous and vitreo-retinal disorders
• Vitreous and age
• Posterior vitreous detachment
• Asteroid hyalosis
• Vitreous hemorrhage
• Vitreus and retina anatomy
• Retinal detachment: regmatogenic, traktioablation- ja eksudative ablation
• Retinal detachment: differential diagnosis
• Retinoschisis
• Macula hole
• Macula pucker, epiretinal membrane

11 Choroid, uvea
• Choroid coloboma
• Uveitis types
• Choroidal nevus
• Choroidal melanoma

12 Retina
• Retinal blood circulation
• Signs of retinal diseases
• Changes in retinal pigment epithelium
• Retinal dystrophies
• Retinopatia centralis serosa
• Macula degenerations
• Seniili macula degeneraation
• Myopic macula degeneraation
• Vascular diseases: retinal artery and retinal vein occlusions, retinal infections, non-typical retinal vein

13 Optic nerve head and papilla
o nerve toxicology
o colour vision testing in optic nerve disorders
o visual field testing
o testing for objective and subjective afferent papillary defects
o pupil cycle ties
o Pulfrich phenomenon
o use of neutral density filters
o interpretation o electrodiagnostic tests, coontrast sensitivity, etc.
o observation of nerve head and peripapillary retina with opthalmoscope, fundus lenses and stereophotography
o carotid assessment
o plain x-rays, tomograms, CT-scans ultrasound and intravenous fluorescein
• blood circulation in optic nerve head
• signs of optic nerve head diseases
• congenital abnormalities and pseudopapilloedema
• myopic optic nerve head
• pathological edema of the optic nerve head
• papillitis
• iscemic papillopathy
• glaucoma signs
• papilla and tumors

14 Senosoorinen neurovisuaalinen patologia:
oTransient neuro-visual episodes
oDetailed visal fields
oDetailed headache workup
oIndications, limitations, risks and costs of intravenous angiography, direct puncture angiography, plain x-rays, tomograms, CT-scan, air studies EEG, radio-nucleotide scanning, nuclear magnetic resonance scand
oSigns and symptoms of related systemic diseases

15 Okulomoorinen neuropatologia
oObjective and subjective testing for incomitancy
oStrength and fatigue testing in myopathies
oRecognition and examinatnion for orbital signs
oUnderstanding indications for intravenous tension
oSigns and symptoms of related systemic diseases and observation, inspection, recognition of signs, and techniques and skills appropriate to supranuclear oculomotor neuropathology including:
•Observation, inspection and testing stability or eyes infixation
•Testing for adequacy of pursuits
•Testing fro adequacy of saccades
•Testing for extraocular muscle reflexes
•Assessment of ”dizzy” patient

16 General diseases and eye
• Ocular findings of systemic diseases
• Hypertension and hypertensive retinopathy

17 Ocular emergency and urgent situations
Ocular injury/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

Refractive surgery:
Biology and biomechanics of corneal refractive surgery
o Corneal wound healing
o Munnerlyn’s formula
Referrals
o Absolute and relative general health contraindications
o Absolute and relative ocular health contraindications
Pre-operative assessment
o History and symptoms
o Vision assessment (high and low contrast)
o Ocular examinatinon
o Pachymetry
o Keratometry
o Topography
o Tomography
o Pupillometry
o Wavefront abberometry
Patient counselling
o Patient expectations: dispelling the myths
o Vision after treatment
o Risk and complications
o Informed consent
Precautions
o Ectasia
o Corneal dystrophies
o Keratitis
Treatment options
o Incisional keratotomy (RK, AK)
o Surface ablation: Photorefractive Keratectomy (PRK) and Laser epithelial kertomileusis (LASEK)
o Laser in-situ kertomileusis (LASIK)
o Clear lens extraction and intraoculr lens (IOL) implant
o Phacic intraocular lens implant
o Implantable contact lens (ICL)
o Intrastromal corneal implants
Postoperative assessment
o Follow-up schedule
o Typical symptoms
o Vision assessement
o Ocular examination
o Typical early postoperative signs
Postoperative complications
o Keratitis
o Diffuse lamellar keratitis
o Steroid response and elevated IOP
o Haze and regression
o Microkeratome-related and other flap related complications
o Dry eye and neurotrophic epitheliopathy
o Epithelial ingrowth
o Visual complications
o Ectasia
o Endophthalmitis
Postoperative care
o Discharge criteria
o Considerations for re-treatment

Location and time

Autumn Semester 2021 Department of Optometry

Materials

The tasks and materials prepared by the teacher are covered by copyright law (Tekijänoikeuslaki 404/61), which guarantees the ownership of these materials to the teacher. Tasks and MATERIALS are not permitted to be used for purposes other than for individual studying. Dissemination of these materials is only allowed with the permission given by the teacher.
Lecture notes, articles
Books
- Kanski´s Clinical Ophthalmology, A Systematic Approach, 8th Edition by Brad Bowling FRCSEd(Ophth), FRCOphth, FRANZCO (Author), Elsevier, 2016, ISBN: 978-0-7020-5572-0 ; 978-0-7020-5573-7
- The Eye Basic Sciences in Practice, 4th Edition by John V. Forrester (Author), Andrew D. Dick (Author), Paul G. McMenamin (Author), Fiona Roberts (Author), Eric Pearlman (Author), Elsevier, ISBN: 978-0-7020-5554-6
- 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.
- Ocular Pathology, 8th Edition by Myron Yanoff, Joseph W. Sassani. Elsevier, 2020, ISBN:978-0-323-54755-0
- 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.
Current Care Guidelines: Glaucoma, Wet AMD, diabetic retinopathy and cataract.
Studies: ETDRS, AREDS

Teaching methods

Interactive lectures
Guided practicals
Laboratory instructions /Workshops
Guided assignments
Practicals done and assessed (verbal feedback is given during the practicals)
Practical competency assessment

Exam schedules

Written examination: Posterior segment 25.10.2021 Retake 1 22.11.2021 Retake 2 16.12.2021
Written examination: Anterior segment 14.12.2021 Retake 1 24.01.2022 Retake 2 16.02.2022 Moodle multiple choice examination (online): Neuro-optometry 17.12.2021 Retake 1 17.01.2022 Retake 2 xx.xx.2022

Student workload

Theory 8 ETCS with 82h lectures followed by two 2-hour exams: Abnormal Ocular Conditions (anterior and posterior segment; neuro-optometry)
Refractive surgery 2 ETCS with 4h lectures and one written assignment
Clinical assessment techniques, including practical competency assessments 5 ECTS with 14h lectures and 21 practicals 3h each

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.

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:
- 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 methods and criteria

Written examination 80%, practical competency assessments 20%

Written examinations
- anterior segment exam
- posterior segment exam
- neuro-optometry exam, Moodle (multidisciplinary questions)

Practicals returned and approved.
To pass the course, the students are expected to attend the lectures and practicals.
Practical assessment sheets returned.
OCT task returned.
Refractive surgery task returned.
Learning assignments approved
Practical competency assessment: represent 20% of the final course mark. In the practical assessments the students demonstrate their ability to perform direct ophthalmoscopy (fundus drawing is assessed), to use Goldmann applanation tonometry in measuring IOP, to measure corneal thickness with pachymetry and evaluate anterior and posterior segments with slit lamp including indirect ophthalmoscopy (re safety and hygiene).
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Assessment criteria

Written examinations anterior and posterior segments: 60% is required to pass.
Neuro-optometry multidisciplinary exam Moodle: 70% is required to pass (time limited)
Practical competency assessment: 60% is required to pass.
Three practical competency assessments: 1 direct ophthalmoscopy 2 GAT+CCT, 3 anterior and posterior segment microscopy, individually assessed. Grade 0-5.

Absences must be covered by attendance during another session. All practical work sheets must be returned at the end of the course and approved by the lecturers Pass / Redo
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Permitted aids at the examination
Standard: Pen, pencil, eraser, ruler, calculator.

Qualifications

Pathology and Pharmacology