Study Guide

Objective

After work placement (9 op) students are able to perform independently standard eye examination and contact lens fitting also to children and elderly people and describe vision correction if needed. She/he is able to use diagnostic drugs safely manner and is able to perform cyclorefraction. She/he is able to exam eyes to detect possible eye diseases, injuries and disorders and refer for further investigations and care if needed. She/he is able to communicate with clients and is able to understand client´s needs and expectations but is able to handle also situations where expectations are not filled.
Clinical exam:
The ability to manage a patient presenting with an incomitant deviation (i.e., an anomaly of the extra-ocular muscles).
The ability to manage an adult patient with heterotropia.
The ability to manage children at risk of developing an anomaly of binocular vision.

The ability to properly advise on refractive surgery options and possible outcomes.
The ability to identify corneal ectasia and dystrophies and other contraindications to refractive surgery.
The ability to perform the techniques used in the pre-operative assessments.
The ability to manage the aftercare of patients having undergone refractive surgery.
The ability to identify post-operative complications.
The ability to manage refractive surgery patients in a safe, ethical, and confidential fashion.
The ability to create and keep clear, accurate, and contemporaneous patient records.
The ability to interpret and respond appropriately to existing records.
The ability to make a judgement regarding referral and an understanding of referral pathways.
The ability to demonstrate an understanding of the legal, professional, and ethical obligations of an optician / optometrist.
The ability to identify external pathology and offer appropriate information and advice to patients not needing referral.
The ability to manage a patient presenting with a red eye.
The ability to evaluate glaucoma risk factors, to detect glaucoma and refer accordingly.
The ability to manage a patient presenting with macular degeneration or other macular disease.
The ability to recognise, evaluate and manage diabetic eye disease and refer accordingly.
The ability to evaluate and manage a patient presenting with symptoms suggestive of retinal detachment.
The ability to recognise manifestations of systemic disease.
The ability to assess symptoms and signs of neurological significance.
The ability to manage patients presenting with sight-threatening eye disease.
An ability to recognise adverse ocular reactions to medication.
The ability to recognise, evaluate and manage optic nerve and optic nerve head disease and refer accordingly.

Portfolio:
The ability to manage non-tolerance cases (i.e., the ability to handle cases when the optical appliance due to lens design, lens fitting or frame fitting cannot be tolerated by the patient).
The ability to advise, prescribe and dispense spectacles, or fit contact lenses, for VDU users and other vocational purposes.
The ability to advise, prescribe and dispense spectacles for eye protective use.
The ability to use appropriate ocular diagnostic drugs to aid refraction if and when needed.
The ability to manage patients presenting with an anomaly of binocular vision.
The ability to fit soft contact lenses.
The ability to manage the aftercare of patients wearing soft contact lenses.
The ability to advise on contact lens materials and care regimes.
The ability to fit rigid gas permeable contact lenses.
The ability to fit contact lenses to patients with astigmatism.
The ability to fit contact lenses to patients with presbyopia.
The ability to use diagnostic drugs to aid ocular examination.
The ability to obtain and interpret information on patient’s general health, medication, school work, sports, hobbies, lifestyle, and special needs pertinent to children and infants.
The ability to assess children’s (not infants) visual function using appropriate techniques.
The ability to interpret and investigate the presenting symptoms and concerns of the patient.
The ability to develop a management plan for the investigation of the patient.
The ability to recognise common ocular abnormalities and to refer when appropriate.
The ability to manage a patient presenting with reduced vision.
The ability to manage a patient presenting with cataract.
Low vision:
The ability to take an accurate history from patients with a range of low vision conditions.
The ability to obtain and interpret information on significant symptoms pertinent to low vision conditions and patient’s concerns.
The ability to obtain and interpret information on relevant family history pertinent to low vision conditions.
The ability to assess patients with impaired visual function.
The ability to advise visually impaired patients about their impairment, disability or handicap.
The ability to advise on the use of, and to dispense simple low vision aids including: hand and stand magnifiers, typoscopes and hand held telescopes.
The ability to advise on the use of and to dispense complex spectacle lens forms, including: multifocals, high corrections, and their applications to specific patient needs.
The ability to advise on the use of optical and non-optical aids to achieve object enlargement types of magnification (e.g., CCTV or digital tablets).
The ability to manage non-tolerance cases (i.e., the ability to handle cases when the optical appliance due to lens design, lens fitting or frame fitting cannot be tolerated by the patient).
The ability to advise, prescribe and dispense spectacles, or fit contact lenses, for VDU users and other vocational purposes.
The ability to advise, prescribe and dispense spectacles for eye protective use.

Content

Professional development and quality
Career planning
The importance and obligation of continuing education
- Various options for maintaining knowledge
Professional and interest associations that run and represent the professional interests of an optometrist at national and international level
- Developing quality standards.
- Membership of trade unions and clubs
Authorities that supervise and regulate optometrist profession
Intolerance cases
Work placement in hospital - surgery, eye examinations

Location and time

Autumn Semester 2022 Department of Optometry

Materials

Hietanen, Jaana 2001. Punainen silmä. Duodecim 2001;117(6):583-589.
Färkkilä, Markus 2019. Päänsärky. Duodecim 2019.
Kirsi Setälä, Mikko Kallela, Leena Valanne, Juha Hernesniemi, Reza Dashti, Jose Pelaez ja Markus Färkkilä 2007: Idiopaattinen intrakraniaalinen hypertensio, »pseudotumor cerebri». Duodecim 2007;123(1):55-63.
Seppänen, Matti 2021: Ohimovaltimotulehdus (temporaaliarteriitti). 28.12.2021 Duodecim. https://www.terveyskirjasto.fi/dlk00932.
Brendan T. Barret 2014. Clinical Procedures in Primary Eye Care. Chapter 6.14 Motility test and other tests for diagnosing/measuring incomitancy.
Yue M. Liu: The Safety of Orthokeratology—A Systematic Review 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4697954/pdf/ecl-42-35.pdf

Lecture notes and materials:
Aberrations and spectacle correction. Ville Varmavuo.
Non-tolerance of the spectacles. Terhi Peltola.
Topography/tomography. Jukka Häkämies.
IOL lenses - how to choose the lens? Jukka Häkämies.
Refractive surgery - cases. Terhi Jurvanen.
Orthokeratology: Satu Autio
Optometric practice (legal obligations for optometric practice, continuing education, professional organisations, ethical and cultural standard, disease specific referral guidelines) : Satu Autio

Teaching methods

Work placement
Learning diary of work placement in hospital
Patient eye examination in Optometry clinic of the HyMy-village
Practical/clinical examinations
Lectures
Written Assignments
Peer tutoring younger students
Portfolio

Employer connections

work placement 9 ECTS including:
- 5 weeks in Optometric practice
- 1 week in hospital Department of Ophthalmology
- eye examinations in patient clinic

Exam schedules

Clinical exam and two retakes in week 39.
For Portfolio cases deadlines are: 5 cases 7.9, 10 cases 3.11.2022, 15 cases 10.11.2022 and 20 cases 17.11.2022.

Student workload

5 weeks, 25 days of work placement 9 ECTS = 187 h
Peer tutoring 27h = 1 ECTS
Portfolio 2 ECTS including 3 workshops, 9 hours
Clinical /practical examinations 1 ECTS,10 contact hours
Lectures and written assignments 1 ECTS, 13 contact hours
Eye examinations in University Clinic 1 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.
Detailed description of the course:
Eye examinations and contact lens fittings at the University patient clinic: The student conducts a minimum of 5 examinations and acts as the clinic manager once.
Portfolio: Students will write a Portfolio of 20 cases (comprehensive optometric examinations including assessment of ocular health) according to ECOO requirements. Clear, accurate and consistent patient record information must be able to be displayed for each (20) case.
The cases analysed are as follows (20):
Systematically analyzed cases, of which 5 cases include the dispensing, selection and delivery of spectacles.
5 contact lens fittings including eye examination and assessment of ocular health. These must be:
• 1 RGP fitting (for another student if needed)
• 2 includes follow-ups
5 comprehensive optometric eye examinations:
• 1 optional case
• 2 cases of binocular vision disorders (prisms, orthoptic exercises, vision rehabilitation, Fresnel, accommodation disorders)
• 1 child 12 years of age or younger
• 1 low vision assessment and optical device fitting, counseling and guidance
5 comprehensive optometric eye examinations:
• contains clinically significant findings (abnormal eye finding) where 3 have been referred to an ophthalmologist. All eye examinations have been done with dilated pupils, if possible. Detailed description: red eye, glaucoma, diabetic retinopathy, cataract and age-related macular degeneration.
• A referral to an ophthalmologist must be attached to the case analysis.
5 comprehensive optometric eye examinations:
• The spectacle prescription and lens and frame selection, measurements, etc., may include special skills such as occupational or safety spectacles, spectacles for a child, high ametropia, spectacles for a hobby, or other cases that require special skills.
The portfolio also includes a list of 50 comprehensive eye examinations and 20 contact lens fits. Students record their examinations for the last two years.

HYMY-village final year clinic: Students have to participate at five clinics at University and do full eye examinations. The students will practice patient communication, perform optometric procedures and use necessary instrumentation, write and keep patient records and refer patients. Students attend supervised patient clinics, where each student will perform and observe full eye examinations of external patients. Students will also perform and observe follow-up appointments.
Student requirements for clinic eye examinations:
• The ability to obtain and interpret information on relevant family history.
• The ability to obtain and interpret information on issues pertaining to the patient’s general health, medication, work, sports, hobbies, lifestyle and special needs.
• The ability to explore the patient’s understanding of their visual problems and give patients an explanation of their physiological or pathological eye condition.
• An ability to understand and recognise a patient’s fears, anxieties and concerns about their visual welfare, the eye examination and the possible ocular side effects of medication.
• An ability to understand and recognise the patient’s expectations and aspirations and manage with empathy situations where these cannot be met.
• The ability to communicate with patients who have poor, or non-verbal, communication skills, or those who are confused, reticent or misleading.
• The ability to communicate bad news to patients in an empathetic and understandable way.
• The ability to manage patients in a safe, ethical and confidential fashion.
• The ability to create and to keep clear, accurate and contemporaneous patient records.
• The ability to make a judgement regarding referral having an understanding of referral pathways.
• The ability to demonstrate an understanding of the legal, professional and ethical obligations of a registered optometrist.
• The ability to use appropriate ocular diagnostic drugs to aid refraction if and when needed.
• The ability to investigate and manage an adult patient presenting with heterophoria.
• The ability to use instruments in ocular examination and to understand the implications of the findings in terms of subsequent examination techniques.
• The ability to take an accurate history from patients with a range of low vision conditions.
• The ability to obtain and interpret information on significant symptoms pertinent to low vision conditions and patient’s concerns.
• The ability to obtain and interpret information on relevant family history pertinent to low vision conditions.
• The ability to assess patients with impaired visual function.
• The ability to advise visually impaired patients about their impairment, disability or handicap.
• The ability to advise on the use of, and to dispense simple low vision aids including: hand and stand magnifiers, typoscopes and hand held telescopes.
• The ability to advise on the use of and to dispense complex spectacle lens forms, including: multifocals, high corrections, and their applications to specific patient needs.
• The ability to advise on the use of optical and non-optical aids to achieve object enlargement types of magnification (e.g., CCTV or digital tablets).
• The ability to take an accurate history from patients with a range of optometric conditions specific to children.
• The ability to obtain and interpret information on significant symptoms pertinent to paediatric conditions and patient’s or parent’s concerns.
• The ability to obtain and interpret information on relevant family history pertinent to paediatric conditions.
• The ability to obtain and interpret information on patient’s general health, medication, school work, sports, hobbies, lifestyle, and special needs pertinent to children.
• The ability to advise, prescribe and measure spectacles for VDU users and other vocational purposes.
• The ability to advise, prescribe and dispense spectacles for eye protective use.
• The ability to interpret and respond appropriately to existing records concerning eye examination and contact lens fitting.
Tutoring: Students tutor younger students in University in those laboratory or practicals they have done themselves during all semesters.

Work placement: Students have 4 weeks of work placement in an optometric practice and 1 week in a hospital eye department. They do comprehensive eye examinations and contact lens fittings. All eye examinations include eye health assessment. Supervisor has to have rights to prescribe diagnostic drugs and they must have proper equipments in optometric practice including biomicroscope and a lens for the fundus examination. Hospital training can be done in public or private hospitals. The aim is to get acquainted with the work of an ophthalmologist and optician at the hospital and see patients with various eye diseases. Student write a learning diary about their days in hospital.

Evaluation scale

0-5

Assessment criteria, satisfactory (1)

The student is able to:

- apply professional knowledge in the field appropriately
- use concepts and information in his field systematically
- argue a course of action on the basis of research information and findings
- find information and argue the use of his sources
- work in various duties depending on the assignment
- define the principles of and requirements for his actions
- show that he has achieved the targets for core competence
- find out the safety instructions concerning a word assignments and to act accordingly
- act according to the relevant professional ethical principles
- plan and guide the operation of multidisciplinary groups
- communicate about professional issues

Assessment criteria, good (3)

The student is able to:

- use concepts and knowledge in his field fluently and comprehensively
- assess and use information sources and research information with a critical eye
- apply research information to professional assignments
- operate in a range of work situations, also in international contexts
- act in a client- and customer-oriented way and as an entrepreneur
- act responsibly in work duties, taking safety issues into consideration
- evaluate actions from the viewpoint of professional ethics
- represent his professional field in multidisciplinary and international groups and projects

Assessment criteria, excellent (5)

The student is able to:

- display a good understanding of professional information
- use theoretical and professional concepts and knowledge like an expert and combine them into larger entities
- create and communicate new information
- develop innovative and alternative solutions to professional assignments and problems
- apply professional expertise in new situations - take responsibility for a professional process in its entirety
- develop the community's safety and responsibility
- apply professional ethics in various situations
- manage the professional development of individuals/groups
- act purposefully and to develop himself and working life

Assessment criteria, approved/failed

The student is able to:

- apply professional knowledge in the field appropriately
- use concepts and information in his field systematically
- argue a course of action on the basis of research information and findings
- find information and argue the use of his sources
- work in various duties depending on the assignment
- define the principles of and requirements for his actions
- show that he has achieved the targets for core competence
- find out the safety instructions concerning a word assignments and to act accordingly
- act according to the relevant professional ethical principles
- plan and guide the operation of multidisciplinary groups
- communicate about professional issues

Assessment methods and criteria

- Workplace period completed and written tasks done. At the end of the course, the student must have 50 comprehensive examinations approved, 20 contact lens-related examinations approved and additional examinations completed according to the given list. Work placement: supervisor optometrist assess and approve the whole period (grade 0-5). All work sheets from work placement must be returned at the end of the period and approved by the lecturers Pass / redo.
- Learning assignments Pass / redo.
- The content of the Portfolio is evaluated according to the ECOO guidelines: https://ecoo.info/wp-content/uploads/2022/03/Part-III-ECOO-Portfolio-Guidance-Feb-2021.pdf. Pass/redo.
- Practical competency assessment: represent 100% of the final course mark. Grade 0-5. In the practical assessments the students demonstrate their ability to perform:
The ability to manage an adult patient with heterotropia.
The ability to manage children at risk of developing an anomaly of binocular vision.
The ability to properly advise on refractive surgery options and possible outcomes.
The ability to identify corneal ectasia and dystrophies and other contraindications to refractive surgery.
The ability to identify external pathology and offer appropriate information and advice to patients not needing referral.
The ability to evaluate and manage a patient presenting with symptoms suggestive of retinal detachment.
The ability to manage patients presenting with sight-threatening eye disease.
The ability to recognise, evaluate and manage optic nerve and optic nerve head disease and refer accordingly.

Prerequisites

Work Placement in Optometric Practice, Pediatric Eye Diseases and Vision and Low Vision Patient and Elderly People