Orthoptics and Work Placement (10 ECTS)

Learning outcomes

Knowledge base
Students are able to
• describe the characteristics of binocular vision disorders in cases of abnormal retinal correspondence or suppression
• evaluate if orthoptic treatment is suitable for the patient
• evaluate the meaning of AC/A-ratio in corrections as prism and spherical power control the accommodative vergence
• describe the features of anisometropia and justify the treatment options

Clinical/practical base
Students are able to
• make binocular vision examination with various methods
• plan and implement an orthoptic treatment

After work placement (5 ECTS) students are able to the student is able to plan and make objective and subjective refraction and asses near addition. They are able to evaluate binocular vision. They are able to properly record patient data. They are able to justify and recommend different vision solutions for the needs of the customer. They are able to communicate with the client about vision, vision problems and vision corrections.

Clinical exam:
Students are able to
• make retinoscopy exam, interpret and explain the results
• measure IOP (non- contact), interpret and explain the results
• to take an accurate history from patients with a range of optometric conditions
• obtain and interpret information on significant symptoms and patient’s concerns
• obtain and interpret information on relevant family history
• to refract patients by appropriate objective and subjective means
• to make appropriate prescribing and management decisions based on the refractive and oculomotor status
• assess pupil reactions
• communicate in a respectful tone and manner and respecting the relevant ethical and cultural rules
• listen actively and to communicate effectively
• listen and ask questions to understand the patient’s concerns and viewpoints
• communicate in a timely manner
• be aware of and responsive to verbal and non-verbal communication
• recognise and adjust to cultural differences
• use effective cross-cultural communication skills if appropriate

Content

Vision therapy/Orthoptic treatment:
definition, target group, routine orthoptic eye examination including appropriate anamnesis
Abnormal retinal correspondence (ARC) - definition, theory, examination, epidemiology, classification, treatment
Suppression – definition, examination, depth, extent and treatment
Prisma adaptation
Examination techniques: Bagolin lens, jump vergence, vergence facility, binocular refraction method with fogging, H-test and light pen: assess binocular vision field extent
Grafical analysis: Donders
Anisometropia and aniseikonia
o epidemiology, classification, symptoms, etiology, treatment, problems with correction
Orthoptic training
- theory, sensory and motor activation
- physiological diplopia; meaning as a part of binocular vision and suppressio control
-spasm control
-training for accommodation: far-near jump, Brock string, push-up, flipper
-training for insufficient convergence and divergence; anti suppression treatment, Brock string, stereogram cards, two pencil
Vision Therapy: plan and management process: theory, model/stucture of the treatment process, symptoms and identification, management plan, exercises (independent and office), patient advising, control visits including control visit and further management plan.

Prerequisites

Binocular Vision

Teaching methods

Lectures, online lectures, group working, independent working, written assignments, work placement, practical examinations

Location and time

On the later period during the semester (autum: period 2. / spring: period 4.)
Lectures are held at Metropolia Myllypuro Campus and online. Students choose their work placement location.

Learning materials and recommended literature

Lecture notes, articles, suggested online material as sites and videos
Literature including:
Primary Care Optometry: The patient history p 99-111, The binocular vision examination p 224-248, Management of anomalies of refraction and binocular vision p 251-273
Borish´s Clinical Refraction: Fusion and Binocularity, p 121-156.

Alternative completion methods of implementation

No

Internship and working life connections

Workplace training 3 weeks: Autumn semester 2020 weeks 45, 46 and 47

Exam dates and retake possibilities

Portfolio /Learning diary return date in the end of December 2020 > evaluation with written feedback in January 2021

A practical demonstration test/examination on the following eye examination techniques: NPC, H-test, Accommodation amplitude with Duane, MEM, Cover test (near), Phorias (distance) with von Graeffe and fusional reserves

International connections

No

Student workload

If the student has a decision of special educational need, shall this student contact the teacher of the course immediately after the end of the registration period (or latest before the start of the course.)

2 ECTS theory, lectures and workshops 31h
written examination
self-directed written assignment: binocular vision and accommodation disorders
3 ECTS practicals 45h
Individually assessed practical examination (NPC, H -mobility test, accommodation amplitude Duane, cover test, Graeffe-method, fusional reserves, MEM) 3h
5 ECTS Work placement, 3 week
- 15 x refractions, min. 8 including MEM, NRA/PRA, acc. facility test
- 1 dispensing case

Content scheduling

Lectures and practicals will be in 2. period.
Practical examination for investigative techniques will be at the end of the period.

Further information for students

Previously required courses in eye examination SX00DS01, SX00DS02, SX00DS03 ja SX00DS04 shall be passed before participating in this course.

Work placement: 3 weeks. Students have to do:
• 15 eye examinations that consist of preliminary tests (H-test, cover test, accommodation amplitude, NPC, pupil reactions), retinoscopy and refraction, near vision assessment and binocular vision assessment and prescribing for spectacles.
• Moodle online assignment
• Moodle online exam on one of dispensing case; spectacle lenses for a presbyopic (lens type, depth of vision in various areas of lenses)
• Observe two eye examinations (optometrist/ophthalmologist) and reflect that to the Gold Standard and ECOO recommendation.

Detailed content
*Duane classification on the heterophoria and AC/A: Divergence excess, Basic exodeviation, Convergence insufficiency, Divergence weakness, Basic esodeviation, Convergence excess.
*Anisometropia and aniseikonia: influence to the binocularity, static and dynamic aniseikonia, test and measurement of aniseikonia, treatment and management with spectacle.
*ARC and NRC: theoretical background, examination of the retinal correspondence: Bagolin and cover test
*Concomitant and comitant deviations: specific symptoms and double vision, intermittent and constant deviation
*Suppression: evaluation
*Binocular refraction with fogging method.
*H-test with pen light: evaluation of the binocular vision field.
*Typical asthenopic symptoms in deviations and accommodation problems: anamnesis
*Cases: treatment and management of the binocular vision problem patient including the classification, analysis of the AC/A, Sheard and Percival criterions, horizontal and vertical prism, Fresnell, spherical power lenses and vision therapy, problem oriented response (management/ spectacles) to anamnesis, descriptive and ICD 10 patient recording.
*Vision therapy: theoretical background, motor and sensory activation, plan and management to alleviate the symptoms, physiological diplopia as a suppression control
*Vision therapy in the accommodation problems: exercises (Near-far jump, Brock-string, push-up, flipper)
*Orthoptic exercises for the convergence insufficiency and divergence weakness (anti-suppression, Brock-string, stereograms cards, two pencil)
Vision Therapy: plan and management process: Symptoms and identification, management plan, exercises (independent and office), patient advising, control visits including control of spasm and final evaluation, further management plan. Vision therapy process with (fellow student) patient including examination, choosing the exercises and control visit.
*Graphical analysis

Assessment methods and criteria

Attendance at the lectures and practicals
-Individual Binocular vision portfolio 100% of the grade 0-5, case assignments, reflection,
- Workplace: assignments included to portfolio
- Assignments: 15 eye examinations at the practicals and 15 eye examinations at the work placement period

Case learning TASKS:
1. Orthoptics: report/portfolio is evaluated on a scale of 0-5
2. Tasks completed during the work placement: vision examinations, Lens task (online exam), and vision examination reflection task

Screening test: eye examination methods NPC, cover test, H-test, Graeffe, reserves, A-amplitude, MEM

Participation in teaching: continuous assessment + all oral and written assignments

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