Typical Eye Exam

Preparation:

 Patient Intake: Greet the patient, confirm their date of birth, and collect a brief
medical history, including any current medications and past eye conditions.
 Pre-testing: This might involve measuring visual acuity using a Snellen chart at
various distances (far and near vision).
 Pupillary Distance (PD) Measurement: The ophthalmic medical assistant may
measure the distance between the centers of the patient's pupils using a
pupillometer. This is important for accurate eyeglasses fitting.

External Eye Exam:

 The ophthalmic medical assistant may assist the ophthalmologist by observing the
patient's eyelids, lashes, conjunctiva (white part of the eye), iris (colored part of the
eye), and cornea (clear dome-shaped surface at the front of the eye) using a bright
light and a magnifying lens.

Tonometry:

 This test measures intraocular pressure (IOP), which is the fluid pressure inside the
eye. The ophthalmic medical assistant may help prepare the tonometer and position
the patient for the test. Different types of tonometers may be used, and some
require topical anesthetic eye drops before measurement.

Vision Testing:

 Refraction: This test determines the patient's refractive error

(nearsightedness, farsightedness, or astigmatism) and helps determine the correct
eyeglass prescription. The ophthalmic medical assistant may present various lenses
to the patient using a phoropter while the ophthalmologist asks the patient to
identify which lens provides the clearest vision.
 Keratometry: This test measures the curvature of the cornea, which is important
for accurate contact lens fitting. The ophthalmic medical assistant may operate the
keratometer and record the measurements.

Dilation:

 The ophthalmic medical assistant may instill dilating eye drops into the patient's
eyes to widen the pupils for a better view of the inner structures of the eye.

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Funduscopic Examination:

 After the pupils are dilated, the ophthalmologist will use an ophthalmoscope to
examine the retina (light-sensitive tissue at the back of the eye), optic nerve, macula
(central area of the retina responsible for sharp central vision),and blood
vessels. The ophthalmic medical assistant may dim the room lights and help position
the patient for this examination.

Additional Tests (if needed):

 Depending on the patient's medical history or presenting complaints, additional

tests like visual field testing (assessing peripheral vision) or optical coherence
tomography (OCT) (providing a detailed cross-sectional image of the retina) might
be performed. The ophthalmic medical assistant may assist with these tests or
prepare the equipment.

Wrap-up:

 After the examination, the ophthalmologist will discuss the findings with the patient
and recommend a treatment plan if needed. The ophthalmic medical assistant may
help explain the doctor's recommendations and schedule any follow-up
appointments.
 The ophthalmic medical assistant may also update the patient's medical records and
file any test results.

Additional Tasks:

 Throughout the exam, the ophthalmic medical assistant may perform other tasks
such as:
o Maintaining a sterile environment
o Assisting the patient with putting on and removing examination gowns
o Answering patient questions about the exam or procedures
o Providing general patient education on eye care

Visual acuity refers to the sharpness or clarity of your vision, specifically how well you can
distinguish details at a given distance. It's essentially a measure of how well your eye
focuses light onto the retina, which translates into the level of fine detail you can perceive.

 Measurement: Visual acuity is typically measured using a Snellen chart, which

displays rows of letters or symbols that progressively decrease in size. The distance
at which you can correctly identify the smallest letters or symbols determines your
visual acuity score.
 Notation: Visual acuity is expressed as a fraction. For example, 20/20 vision is
considered normal visual acuity. This means you can see clearly from 20 feet away
what a person with normal vision can see from the same distance (20 feet).
 Variations: Deviations from 20/20 indicate some level of vision impairment.
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 o Fractions with a higher number in the denominator (bottom number) signify
nearsightedness (difficulty seeing distant objects clearly). For
example, 20/40 vision means you need to be 20 feet away to see what
someone with normal vision can see from 40 feet.
o Fractions with a higher number in the numerator (top number) signify
farsightedness (difficulty seeing near objects clearly). For instance, 20/100
vision indicates you need to be 20 feet away to see what someone with
normal vision can see from 100 feet.

Focusing for Distance and Near Vision: The Role of the

Lens
The part of the eye primarily responsible for focusing light for distance and near vision is
the lens. The lens is a transparent, flexible structure located behind the iris (colored part of
the eye). It works similarly to a camera lens, adjusting its shape to focus light rays onto the
retina at the back of the eye.

 Distance Vision: When you look at distant objects, the ciliary muscles surrounding
the lens relax, causing the lens to flatten. This flattened shape allows light rays
coming from far away to converge precisely on the retina, resulting in clear distant
vision.
 Near Vision: When you focus on near objects, the ciliary muscles contract, causing
the lens to bulge. This increased curvature allows the lens to focus light rays
converging from close distances onto the retina, enabling clear near vision.

Understanding Peripheral Vision vs. Central Vision

 Central Vision: This refers to the sharpest part of your vision, concentrated directly
in front of your gaze. The macula, a small central region of the retina, is responsible
for central vision. It contains a high concentration of light-sensitive cone
cells, enabling us to perceive fine details, color, and good visual acuity.
 Peripheral Vision: This refers to the vision encompassing the outer areas of your
visual field, extending outwards from your central vision. The peripheral
retina, containing more rod cells than cones, is less sensitive to detail and color but
plays a crucial role in:
o Depth perception: By perceiving objects in our periphery, we can judge
their distance and our spatial relationship to them.
o Movement detection: Our peripheral vision is highly sensitive to
movement, alerting us to potential dangers or objects entering our field of
view.
o Maintaining situational awareness: Peripheral vision allows us to be
aware of our broader surroundings without constantly having to move our
eyes.

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Tests for Assessing Focusing Ability and Visual Field
 Visual Acuity Testing (Snellen Chart): As mentioned earlier, this test measures
visual acuity at various distances, indicating the clarity of both distance and near
vision.
 Refraction Testing (Phoropter): This test helps determine the specific lens power
needed to correct focusing problems. The ophthalmic assistant may present various
lenses through a phoropter while the patient identifies which lens provides the
clearest vision at both far and near distances.
 Keratometry: This test measures the curvature of the cornea, which plays a role in
focusing light. The ophthalmic assistant may operate the keratometer to obtain
these measurements.
 Pupillary Distance (PD) Measurement: The PD is the distance between the
centers of the pupils. This measurement is crucial for accurate eyeglasses
fitting, especially for near vision correction.
 Visual Field Testing: This test assesses a patient's peripheral vision. The
ophthalmic assistant may prepare the equipment and guide the patient through the
test, which might involve looking straight ahead while responding to light stimuli
appearing in different areas of the peripheral vision field.

An occluder is a simple tool used in eye examinations to temporarily block the vision in one
eye.

Visual Acuity Testing: This is the familiar Snellen chart test where the patient reads
letters or symbols at various distances. An occluder is used to cover one eye at a time while
the other eye is tested. This allows the doctor to assess the visual acuity of each eye
individually and identify any potential differences.

 Cover Test: This quick test evaluates how well your eyes work together and
identifies any potential strabismus (misalignment of the eyes). The ophthalmologist
will have the patient focus on a target while alternately covering each eye with the
occluder. Any movement of the uncovered eye to maintain focus on the target
indicates a potential misalignment.
 Heterophoria Assessment: Similar to the cover test, this test helps detect latent
misalignment of the eyes. The patient focuses on a target while the occluder briefly
covers one eye. If the uncovered eye drifts slightly upon uncovering, it suggests
heterophoria, where the eyes maintain alignment with effort.
 Fixation and Saccades: This test may be used to assess eye movement control. The
patient focuses on a target while the ophthalmologist covers one eye with the
occluder. The occluder is then quickly removed, and the doctor observes how
quickly the uncovered eye fixates back on the target.
 Pupillary Light Reflex (PLR) Testing: This test assesses the response of the pupils
to light. The ophthalmologist shines a light into one eye while the other eye is
covered with the occluder. Both pupils should constrict (get smaller) in response to

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 the light, even in the covered eye (indirect reflex). This test helps evaluate nerve
function and potential neurological issues.
 Ocular Motility Testing: In some cases, the occluder might be used to assess eye
movement range. The patient may be asked to follow the occluder as it is moved in
different directions to evaluate the range of motion of each eye.

By strategically occluding one eye at a time, these tests allow the ophthalmologist to gain
valuable insights into individual eye function, binocular vision (how well both eyes work
together), and potential eye movement abnormalities.

One day after glaucoma surgery (pseudophakic, meaning an artificial lens has been
implanted), a typical eye exam will focus on monitoring the healing process and checking
for any potential complications. Here's what an ophthalmic medical assistant might
perform during this post-operative visit:

Visual Acuity Testing:

 The assistant will likely repeat a visual acuity test using a Snellen chart to assess the
patient's vision in both eyes. While vision may be blurry initially due to post-
surgical inflammation, a noticeable improvement from baseline vision is a positive
sign.

Intraocular Pressure (IOP) Measurement:

 This is a crucial test to monitor the effectiveness of the glaucoma surgery. The
assistant may help prepare the tonometer and take IOP measurements in both
eyes. A significant reduction in IOP compared to pre-surgical readings indicates
successful pressure control.

Slit-Lamp Examination:

The doctor will be looking for:

o Corneal clarity: Checking for any signs of infection or inflammation in the

cornea.
o Anterior chamber: Assessing the fluid-filled chamber at the front of the eye
for any abnormalities like bleeding or inflammation.
o Iris: Examining the colored part of the eye for proper positioning and signs
of inflammation.
o Pupillary response: Observing the pupil's reaction to light.
o Pseudophakic lens: Evaluating the position and clarity of the artificial lens
implant.

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Funduscopic Examination:

 While less common on the first day post-op, the ophthalmologist might perform a
dilated funduscopic exam to examine the retina and optic nerve at the back of the
eye. The assistant may help with pupil dilation and room lighting adjustments for
this examination.

Reviewing Medications:

 The assistant may go over the patient's post-operative medication

regimen, ensuring they understand how to use the prescribed eye drops and any
oral medications.

Additional Tests (if needed):

 Depending on the specific surgery performed and the patient's condition, additional
tests like ultrasound imaging or visual field testing might be conducted on
subsequent visits, but not typically on the first day post-op.

Communication and Education:

o Answering patient questions about their recovery and expectations.

o Providing post-operative care instructions, including proper eye drop
application and activity restrictions.
o Scheduling follow-up appointments.

In the initial data entry part of an eye exam for a glaucoma patient who is one day post-
operative (pseudophakic):

Patient Demographics:

 Full name and date of birth

 Address and phone number
 Insurance information

Medical History:

 Briefly confirm any relevant medical history, such as diabetes, high blood
pressure, or any other conditions that could affect eye health.
 Ask about any allergies, especially to medications.

Surgical History:

 Specifically inquire about the recent glaucoma surgery, including the date of surgery
and the type of procedure performed (e.g., trabeculectomy, implant placement).

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Current Medications:

 Make a detailed list of all current medications, including prescription and over-the-
counter drugs, as well as any herbal supplements. This is crucial to identify potential
interactions with post-operative medications.

Symptoms:

 Ask about any post-operative symptoms the patient might be experiencing, such as:
o Pain or discomfort in the eye
o Redness or irritation
o Blurred vision (considering post-surgical healing can cause blurry vision, this
might be expected but any significant worsening should be noted)
o Sensitivity to light
o Discharge from the eye

Vision Changes:

 Briefly inquire if the patient has noticed any changes in their vision since the
surgery, focusing on any significant improvements or worsening compared to their
baseline vision.

Compliance:

 Ask about the patient's understanding and adherence to post-operative

instructions, including medication usage and activity restrictions.

Additional Information:

 The assistant might also inquire about the patient's use of eyeglasses or contact
lenses.
 Depending on the practice's protocol, they might ask for the patient to confirm they
have a ride home after the appointment, considering some glaucoma medications
can cause temporary blurred vision.

By collecting this initial data, the ophthalmic medical assistant creates a clear picture of the
patient's post-operative status, allowing the ophthalmologist to conduct a focused
examination and address any potential concerns.

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The eye can be broken down into three main layers, with various components within each
layer. Here's the order of eye parts from outermost to innermost:

Outer Layer (Fibrous Tunic):

1. Sclera (the white part): This tough, white outer layer protects the inner eyeball
and provides attachment points for the extraocular muscles that control eye
movement.
2. Cornea: The clear, dome-shaped structure at the front of the eye. It allows light to
enter the eye and plays a crucial role in focusing light.

Middle Layer (Vascular Tunic):

3. Choroid: A dark, pigmented layer containing blood vessels that nourish the outer
layers of the eye.
4. Ciliary Body: A muscular ring that controls the shape of the lens, allowing the eye to
focus on near and far objects.
5. Iris: The colored part of the eye that controls the amount of light entering the eye by
adjusting the size of the pupil (the dark opening in the center).

Inner Layer (Nervous Tunic):

6. Retina: This light-sensitive layer at the back of the eye contains photoreceptor cells
(rods and cones) that convert light into electrical signals. These signals are then
transmitted to the brain via the optic nerve.
7. Optic Nerve: A bundle of nerve fibers that carries the electrical signals from the
retina to the brain, where they are interpreted as vision.

Additional Internal Structures:

 Lens: A transparent, crystalline structure located behind the iris that helps focus
light onto the retina.
 Aqueous Humor: A clear fluid filling the space between the cornea and the lens.
 Vitreous Humor: A clear gel-like substance that fills the space between the lens and
the retina.

The eye relies on a delicate interplay between several structures to function

properly. Here's a breakdown of the specific roles played by aqueous humor, vitreous
humor, and the optic nerve:

Aqueous Humor:

 Function: This clear, watery fluid fills the anterior chamber (front cavity) of the
eye, located between the cornea and the lens. It plays several crucial roles:
o Nourishes the cornea and lens: Since these structures lack blood
vessels, the aqueous humor provides essential nutrients and oxygen.
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 o Helps maintain eye shape: The aqueous humor contributes to maintaining
the intraocular pressure (IOP),which helps the eyeball keep its round shape.
o Light refraction: The aqueous humor plays a minor role in bending
(refracting) light rays as they enter the eye.
o Removes waste products: The aqueous humor continuously
circulates, carrying away waste products from the eye through drainage
channels.

Vitreous Humor:

 Function: This clear, jelly-like substance fills the vitreous cavity, the large space
behind the lens and in front of the retina. The vitreous humor has several important
functions:
o Maintains eye shape: The vitreous humor plays a significant role in
maintaining the eye's overall shape and provides a cushion for the delicate
retina.
o Supports the lens: The vitreous humor helps hold the lens in place.
o Light transmission: The vitreous humor is transparent, allowing light to
pass through unimpeded on its way to the retina.

Optic Nerve:

 Function: The optic nerve is a bundle of nerve fibers that carries electrical signals
from the retina to the brain. Here’s how it functions:
o Photoreceptor conversion: The light-sensitive cells (rods and cones) in the
retina convert light energy into electrical signals.
o Signal transmission: These electrical signals travel through the optic nerve
fibers.
o Brain interpretation: The optic nerve transmits the signals to the
brain, where they are interpreted as vision.

In summary:

 Aqueous humor nourishes and helps maintain the shape of the front part of the
eye, while also removing waste.
 Vitreous humor acts like a gel cushion, supporting the lens and maintaining the
overall shape of the eye.
 The optic nerve acts as a critical information highway, carrying visual signals from
the light-sensitive retina to the brain for processing into vision.

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The different parts of the eye can be susceptible to various issues and diseases. Here's a
breakdown of some common eye problems and the parts of the eye they affect:

Outer Layer (Fibrous Tunic):

 Sclera: While uncommon, the sclera can be affected by conditions like episcleritis
(inflammation of the tissue between the sclera and conjunctiva) or scleral thinning
(a weakening of the scleral tissue).
 Cornea: Scratches, infections (keratitis), corneal ulcers, and conditions like
keratoconus (thinning and bulging of the cornea) can affect the cornea.

Middle Layer (Vascular Tunic):

 Choroid: Inflammation of the choroid (choroiditis) can occur, though less frequent
than other eye problems.
 Ciliary Body: Iritis (inflammation of the iris) and uveitis (inflammation of the entire
uveal tract, including the iris, ciliary body, and choroid) can affect the ciliary body's
function. Glaucoma, a group of conditions causing optic nerve damage due to high
intraocular pressure, can be linked to malfunction of the ciliary body's fluid
drainage mechanisms.
 Iris: Iritis, as mentioned earlier, can cause redness, pain, and light sensitivity.

Inner Layer (Nervous Tunic):

 Retina: Age-related macular degeneration (AMD), diabetic retinopathy (damage to

retinal blood vessels caused by diabetes), retinal detachment (separation of the
retina from the underlying layer), and macular holes are some of the conditions
affecting the retina and potentially leading to vision loss.

Other Internal Structures:

 Lens: Cataracts (clouding of the lens) and presbyopia (age-related decline in near
focusing ability) are common lens-related issues.
 Aqueous Humor: Imbalances in aqueous humor production or drainage can
contribute to glaucoma.
 Vitreous Humor: Floaters (debris seen within the vitreous) and retinal detachment
can be associated with changes in the vitreous humor.
 Optic Nerve: Glaucoma, optic neuritis (inflammation of the optic nerve), and
ischemic optic neuropathy (damage to the optic nerve due to lack of blood flow) can
affect the optic nerve, leading to vision loss.

Additional Considerations:

 Some eye diseases can affect multiple parts of the eye. For instance, diabetic
retinopathy can damage both the blood vessels in the retina and the vitreous humor.

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  External factors like trauma or infections can also cause eye problems, affecting any
part of the eye depending on the location and severity of the injury/infection.

DISTANCE VISION TESTS

1. Snellen Chart Test:

 This is the classic eye chart most people associate with vision testing. It displays
rows of letters or symbols that progressively decrease in size the further down the
chart you go. The patient sits or stands at a standardized distance (typically 20 feet
or 6 meters) from the chart and covers one eye at a time while reading aloud the
smallest line of letters they can see clearly.
 The doctor compares the patient's results to a standard (20/20 vision), indicating
how well the patient sees compared to someone with normal vision at that distance.

2. LogMAR Chart:

 Similar to the Snellen chart, the LogMAR chart displays letters or symbols of
decreasing size. However, the size differences between lines are more precise on a
logarithmic scale, allowing for more accurate measurement of visual
acuity, especially for patients with near-normal vision or significant vision
impairment.

3. Early Treatment Diabetic Retinopathy Study (ETDRS) Chart:

 This variation of the Snellen chart uses standardized letters specifically designed for
early detection of vision changes associated with diabetic retinopathy. It may be
used alongside a regular Snellen chart, particularly for patients with diabetes.

4. Retinoscopy:

 This objective test doesn't require the patient to actively read anything. The doctor
shines a light into the patient's eye and observes the reflection from the retina using
a retinoscope. By analyzing the light reflex, the doctor can assess the refractive error
(nearsightedness, farsightedness, or astigmatism) and determine the appropriate
lens power for corrective eyewear.

5. Automated Refraction:

 This technology utilizes an autorefractor, a machine that projects light into the eye
and measures the way the light reflects off the retina. It provides a starting point for
determining the refractive error, which can then be further refined by the doctor
during the retinoscopy exam.

Additional Considerations:

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  Pinhole Test: While not strictly a distance vision test, a pinhole test can be used to
differentiate between refractive errors and other potential causes of blurry
vision. By looking through a card with tiny holes, the pinhole can temporarily
improve focus if the blurry vision is due to refractive error.

Choosing the Right Test:

The type of test used for distance vision assessment might vary depending on factors like
the patient's age, ability to cooperate with reading charts, and the doctor's preferred
method. In most cases, a combination of tests might be used to get a comprehensive
evaluation of the patient's distance vision.

NEAR VISION TESTS

1. Near Point Reading Test:

 This simple test uses a Jaeger chart or Rosenbaum pocket vision screener held at a
comfortable reading distance (typically 16-18 inches) from the patient's face. The
chart contains paragraphs of progressively smaller text sizes. The patient reads
aloud the smallest paragraph they can see clearly. Similar to the Snellen chart for
distance vision, this helps assess near visual acuity.

2. Near Vision Card:

 This handheld card might contain letters, numbers, or symbols of varying

sizes, similar to a near point reading test chart. The patient holds the card at a
comfortable reading distance and reads aloud the smallest line they can see clearly.

3. Holdsworth Two-Dot Test:

 This test helps assess accommodation, the eye's ability to focus on near objects. The
doctor holds a small card with two dots side-by-side at a comfortable reading
distance for the patient. The patient focuses on one dot while the doctor slowly
brings the card closer to the patient's nose. Normally, the patient's eyes will
converge (turn inward) to maintain focus on the near dot as it gets closer. This test
can indicate potential focusing issues that might contribute to difficulty seeing near
objects clearly.

4. Retinoscopy (at Near Distance):

 As mentioned for distance vision testing, retinoscopy can also be used to assess near
vision. The doctor shines a light into the patient's eye while the patient focuses on a
near target held at a reading distance. By analyzing the light reflex at near focus, the
doctor can further refine the lens power needed for near vision correction.

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5. Automated Refraction (at Near Distance):

 Similar to distance testing, some autorefractors can also measure refractive error at
a simulated near reading distance. This provides additional data for the doctor to
determine the most appropriate near vision lens correction.

Additional Considerations:

 Pinhole Test: As with distance vision testing, the pinhole test can be used to
differentiate between refractive errors and other causes of blurry near vision.

TERMINOLOGY
Normal Eye (Emmetropia):

 Terminology: Emmetropic simply means normal vision. A person with an

emmetropic eye can focus clearly on distant objects without needing corrective
lenses.
 Cause: The cornea and lens effectively focus light rays precisely onto the
retina, allowing for clear vision at distance and the ability to accommodate (adjust
focus) for near vision.
 Prescription: No corrective lenses are needed (written as Plano or Pl).

Farsightedness (Hyperopia):

 Terminology: Hyperopia refers to difficulty focusing on near objects. People with

hyperopia may see distant objects clearly but struggle to see objects up
close, especially with increased age when the ability to accommodate weakens.
 Cause: In hyperopia, the eyeball is either shorter than normal, or the cornea is too
flat. This shape prevents light rays from focusing precisely on the retina, causing
near objects to appear blurry.
 Prescription: A positive (+) lens prescription is used to converge (bend) light rays
more effectively, allowing them to focus on the retina for clear near vision.
 Example Prescription: For mild hyperopia, the prescription might look like "+1.00
Sphere (OD and OS)". This signifies a +1.00 diopter (unit of lens power) correction
in both the right eye (OD) and left eye (OS).

Nearsightedness (Myopia):

 Terminology: Myopia refers to difficulty focusing on distant objects. People with

myopia can see near objects clearly but distant objects appear blurry.
 Cause: In myopia, the eyeball is either too long, or the cornea is too curved. This
shape causes light rays to focus in front of the retina, resulting in blurry distant
vision.

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  Prescription: A negative (-) lens prescription is used to diverge (spread) light rays
slightly before they enter the eye, allowing them to focus precisely on the retina for
clear distant vision.
 Example Prescription: For mild myopia, the prescription might look like "-1.50
Sphere (OD and OS)". This signifies a -1.50 diopter correction in both eyes.

Additional Notes:

 Astigmatism is another refractive error that can cause blurry vision at all
distances. It's caused by an irregular curvature of the cornea or lens, and the
prescription will include additional terms like "cylinder" and "axis" to correct for
this irregularity.
 Presbyopia is an age-related condition where the ability to focus on near objects
diminishes. People with normal vision or pre-existing farsightedness may
experience presbyopia and require reading glasses for near tasks.

An eyeglass prescription for someone with astigmatism will include additional information
compared to a prescription for nearsightedness or farsightedness. Here's a breakdown of
what the prescription might look like:

Sphere (Sph): This indicates the overall corrective power for nearsightedness (negative
value) or farsightedness (positive value), similar to prescriptions for regular
nearsightedness or farsightedness.

Cylinder (Cyl): This value represents the additional lens power needed to correct the
astigmatism. For astigmatism correction, the Cyl value will always be accompanied by an
Axis value (see below). The Cyl value can be positive or negative depending on the type of
astigmatism.

Axis: This value indicates the direction of the astigmatism in degrees (ranging from 0 to
180). The axis essentially specifies the orientation of the cylindrical lens needed to
compensate for the irregular corneal curvature.

Here's an example of a prescription for someone with astigmatism:

 OD: -1.00 Sph -0.50 Cyl @ 90° (Right Eye)

 OS: -1.25 Sph -0.75 Cyl @ 180° (Left Eye)

Decoding the Example:

 This person is slightly nearsighted in both eyes because both Sphere (Sph) values
are negative (OD: -1.00, OS:-1.25).
 They also have astigmatism in both eyes, indicated by the Cyl value (OD: -0.50, OS: -
0.75). The negative Cyl values suggest they might have a with-the-rule astigmatism
(common type).

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  The Axis values (OD: 90°, OS: 180°) specify the orientation of the corrective lens
needed for each eye.

Additional Notes:

 The exact format of a prescription might vary slightly depending on the doctor or
clinic.
 Astigmatism prescriptions can also be written in a simplified format if there's
minimal spherical correction (nearsightedness or farsightedness). For example, a
simplified version of the above prescription might look like:
o OD: -0.50 Cyl @ 90°
o OS: -0.75 Cyl @ 180°
 It's important to note that only a qualified eye doctor can assess your
eyes, determine the specific prescription for your astigmatism, and provide you with
corrective lenses.

The diagram is labeled with the following parts of the eye and their functions:

 Sclera (white): The tough, white outer layer of the eye that protects the inner
eyeball.

pen_spark

 Cornea: The clear, dome-shaped structure at the front of the eye that covers the iris
and pupil and helps to focus light.

15
  Conjunctiva: The thin, transparent membrane that covers the white part of the eye
(sclera) and the inner surface of the eyelids.

 Iris: The colored part of the eye that controls the amount of light entering the eye by
adjusting the size of the pupil.

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  Pupil: The black opening in the center of the iris that light passes through to reach
the retina.

 Lens: A clear, flexible structure behind the iris that helps to focus light onto the
retina.

17
  Retina: The light-sensitive layer of tissue at the back of the eye that converts light
into electrical signals that are sent to the brain.

 Macula: The part of the retina that is responsible for central vision.

18
  Optic nerve: The bundle of nerve fibers that carries electrical signals from the
retina to the brain.

 Vitreous body: The clear, jelly-like substance that fills the inside of the eyeball.

19
  Aqueous humor: The clear, watery fluid that fills the front chamber of the eye,
between the cornea and the lens.

Some of the diseases that can affect these parts of the eye include:

 Sclera: Episcleritis (inflammation of the tissue between the sclera and conjunctiva),
scleral thinning
 Cornea: Scratches, infections (keratitis), corneal ulcers, keratoconus (thinning and
bulging of the cornea)
 Conjunctiva: Conjunctivitis (pink eye)
 Iris: Iritis (inflammation of the iris)
 Lens: Cataracts (clouding of the lens), presbyopia (age-related decline in near
focusing ability)

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  Retina: Age-related macular degeneration (AMD), diabetic retinopathy (damage to
retinal blood vessels caused by diabetes), retinal detachment (separation of the
retina from the underlying layer), macular holes
 Optic nerve: Glaucoma (a group of conditions causing optic nerve damage due to
high intraocular pressure), optic neuritis (inflammation of the optic nerve), ischemic
optic neuropathy (damage to the optic nerve due to lack of blood flow)
 Vitreous body: Floaters (debris seen within the vitreous), retinal detachment

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Floaters and flashes of light are common eye phenomena, and while they can be
bothersome, they aren't always a cause for concern. Here's a breakdown of the causes
behind these occurrences:

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Floaters:

 Posterior Vitreous Detachment (PVD): This is the most frequent cause of

floaters. The vitreous humor is a gel-like substance that fills the center of your
eye. As we age, the vitreous humor naturally starts to liquefy and pull away from the
retina. These detachments can cast tiny shadows on the retina, which we perceive as
floaters. PVD is usually harmless and painless.
 Vitreous Opacities: Degenerative changes within the vitreous itself can sometimes
cause the formation of clumps or strands that appear as floaters. These opacities are
usually unrelated to PVD and may not cause any symptoms.
 Eye Injuries: Trauma to the eye can cause bleeding or other debris to enter the
vitreous, leading to the perception of floaters.

Flashes of Light:

 Posterior Vitreous Detachment (PVD): As mentioned earlier, PVD can also cause
flashes of light. When the vitreous humor pulls away from the retina, it can tug on
the retina, stimulating the light-sensitive cells and causing flashes in your
vision. These flashes are usually temporary and painless.
 Retinal Tears: In some cases, sudden flashes of light, especially with a shower of
floaters, can indicate a retinal tear. A retinal tear is a serious condition where a rip
occurs in the retina. If left untreated, a retinal tear can lead to retinal detachment, a
more significant issue that can cause permanent vision loss.

Other Less Common Causes:

 Migraines: Flashes of light, sometimes accompanied by wavy lines or other visual

disturbances, can be an aura symptom associated with migraines.
 Inflammation: Internal eye inflammation (uveitis) can sometimes cause floaters
and flashes.
 Retinal detachment: As mentioned previously, retinal detachment itself can cause
both floaters and flashes.

When to Seek Medical Attention:

 Sudden onset of numerous floaters

 A significant increase in the number and intensity of existing floaters
 Flashes of light, especially if they appear suddenly and in large numbers
 Any accompanying symptoms like blurry vision, distorted vision, or a curtain
coming down over your field of vision

Early detection and treatment of retinal tears can significantly improve the chances of
successful repair and prevent vision loss. If you experience any sudden changes in your
vision or any of the concerning symptoms mentioned above, it’s crucial to seek immediate
medical attention from an ophthalmologist (eye doctor).

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Both dry AMD and wet AMD affect the macula, a small central region of the retina
responsible for sharp, central vision. The macula allows us to see fine details, colors, and
helps with activities like reading, driving, and recognizing faces.

Dry AMD (Non-Neovascular Age-Related Macular Degeneration):

 Terminology: Dry AMD is also referred to as non-neovascular AMD because it

doesn't involve abnormal blood vessel growth.
 Cause: In dry AMD, deposits called drusen accumulate under the macula. The exact
cause of drusen formation is unknown, but aging and genetics likely play a
role. Over time, light-sensitive cells in the macula deteriorate, leading to vision loss.
 Progression: Dry AMD progresses slowly. Early stages may cause mild blurring or
distortion in central vision. As the condition worsens, central vision can become
significantly impaired, but peripheral vision (side vision) is usually
unaffected. There is currently no cure for dry AMD, but lifestyle modifications and
nutritional supplements might help slow its progression.

Wet AMD (Neovascular Age-Related Macular Degeneration):

 Terminology: Wet AMD is also called neovascular AMD because it involves the
growth of abnormal new blood vessels beneath the macula.
 Cause: In wet AMD, abnormal blood vessels leak fluid and blood into the
macula, damaging the light-sensitive cells and causing rapid vision loss. The exact
cause of this abnormal blood vessel growth is not fully understood, but it's thought
to involve a combination of genetic and environmental factors.
 Progression: Wet AMD is a more aggressive form of AMD and can progress
quickly. Symptoms like sudden blurry vision, distorted vision, or a dark spot in the
central vision can develop rapidly. Early diagnosis and treatment with anti-VEGF
injections are crucial to prevent severe vision loss.

In Summary:

 Both dry AMD and wet AMD affect the macula.

 Dry AMD is a slow-progressing form with drusen formation and gradual vision
loss.
 Wet AMD involves abnormal blood vessel growth under the macula, causing
rapid vision loss.
 Early detection and treatment are essential for preserving vision in both
cases.

Diabetes can cause several eye conditions, some more serious than others. Here's a
breakdown of the main ones:

Diabetic Retinopathy:

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  This is the most common eye complication caused by diabetes. It occurs when high
blood sugar levels damage the blood vessels in the retina, leading to:
o Leakage: Damaged blood vessels can leak fluid and blood into the
retina, causing blurry vision and even blindness if left untreated.
o Abnormal blood vessel growth: In some cases, new, abnormal blood
vessels can grow on the surface of the retina. These fragile vessels can bleed
into the vitreous humor (the gel-like substance in the eye) and further impair
vision.

Diabetic Macular Edema (DME):

 This is a complication of diabetic retinopathy where fluid leaks from damaged blood
vessels and accumulates in the macula (the central part of the retina responsible for
sharp, central vision). DME can cause blurred vision, distorted vision, and difficulty
seeing colors.

Glaucoma:

 People with diabetes are at an increased risk of developing glaucoma, a group of

conditions that damage the optic nerve due to high pressure inside the eye. While
not directly caused by diabetes, diabetes can contribute to factors that increase the
risk of glaucoma.

Cataracts:

 Diabetics may develop cataracts (clouding of the lens) at a younger age and at a
faster rate than people without diabetes.

Importance of Eye Exams for Diabetics:

 Regular eye exams are crucial for diabetics because many diabetic eye problems can
progress without noticeable symptoms in the early stages. Early detection and
treatment can significantly improve the chances of preserving vision.

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Plaquenil (Hydroxychloroquine):

 Plaquenil is a medication used to treat certain autoimmune diseases like

lupus, rheumatoid arthritis, and Sjö gren's syndrome. These conditions cause
inflammation in various parts of the body, and Plaquenil helps suppress the immune
system's overactive response.

Special Eye Exams for People on Plaquenil:

 Plaquenil can, in rare cases, cause damage to the retina, potentially leading to vision
loss. This risk increases with factors like:
o Duration of use (longer use increases risk)
o Higher dosages
o Pre-existing retinal problems
o Kidney or liver disease
o Age (over 60)

Why People Take Plaquenil:

 Plaquenil can be very effective in managing the symptoms of autoimmune diseases

by reducing inflammation, pain, and swelling. It can significantly improve a person's
quality of life.

Early Detection of Plaquenil-Induced Retinal Toxicity:

 Regular eye exams with a specific focus on the retina are recommended for people
taking Plaquenil. These exams may include:
o Dilated pupil exam to get a better view of the retina
o Optical coherence tomography (OCT) to create detailed cross-sectional
images of the retina
o Visual field testing to assess peripheral vision

Early detection of Plaquenil-induced retinal damage allows doctors to:

 Reduce the dosage or discontinue the medication if necessary.

 Monitor the retina more closely.
 Consider alternative treatment options for the underlying autoimmune disease.

In Summary:

 Diabetes can cause various eye problems, with diabetic retinopathy being the most
common.
 Regular eye exams are crucial for diabetics to detect and manage these conditions
early.

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  Plaquenil is a medication used for autoimmune diseases, but it can rarely cause
retinal damage.
 People taking Plaquenil require special eye exams to monitor for potential retinal
problems.

General Eye Exam:

 OU - Both Eyes (Oculus Dexter - Right Eye, Oculus Sinister - Left Eye can also be
used)
 OD - Right Eye (Oculus Dexter)
 OS - Left Eye (Oculus Sinister)
 IOD - Intraocular Pressure of the Right Eye
 IOS - Intraocular Pressure of the Left Eye
 BCVA - Best Corrected Visual Acuity
 CC - With Correction (wearing corrective lenses)
 UC - Uncorrected (without corrective lenses)
 IOP - Intraocular Pressure
 RE - Refraction (test to determine the corrective lens power needed)
 MR - Muscle Balance (assessment of how well the eyes work together)
 EOM - Extraocular Movements (evaluation of eye movement range)
 VF - Visual Field (assessment of peripheral vision)
 PEX - Pupils Equal and Reactive (normal pupil response to light)
 PEA - Pupils Equal and Active (brisk reaction to light)
 SLE - Slit Lamp Examination (detailed examination of the eye structures)
 OCT - Optical Coherence Tomography (imaging test of the retina)

Eye Conditions and Treatments:

 AMD - Age-Related Macular Degeneration

 DME - Diabetic Macular Edema
 PDR - Proliferative Diabetic Retinopathy
 NLP - No Light Perception (complete vision loss)
 NVD - Near Vision Deficit
 CL - Contact Lens
 IOL - Intraocular Lens (artificial lens implanted during cataract surgery)
 YAG - Yttrium-Aluminum-Garnet Laser (used for some glaucoma procedures)
 PRP - Panretinal Photocoagulation (laser treatment for diabetic retinopathy)
 PT - Physical Therapy (for eye muscle weakness)

Medications:

 GLA - Glaucoma Medication

 Miotic - Medication that constricts the pupil (often used in glaucoma treatment)
 Mydriatic - Medication that dilates the pupil (used for eye exams)
 NSAID - Nonsteroidal Anti-Inflammatory Drug

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Other:

 O.S. - Ocular Surface (referring to the outer structures of the eye)

 PCD - Preoperative Corneal Topography (mapping of the corneal surface before
surgery)
 UVS - Ultraviolet Shielding (sunglasses that block UV rays)

This is not an exhaustive list, but it covers many of the common acronyms you might
encounter during an eye exam or in ophthalmic discussions. If you come across an
unfamiliar term, don't hesitate to ask your ophthalmologist or ophthalmic technician for
clarification.

Ophthalmic medications come in various forms, including eye drops, ointments, and
inserts, and are categorized based on their intended purpose. Here's a breakdown of some
common types of ophthalmic medications and their associated cap colors:

Antibiotics: (Tan or Beige Cap)

 Treat eye infections caused by bacteria. Examples: Ciprofloxacin, Tobramycin,

Ofloxacin

Steroids: (Pink or White Cap)

 Reduce inflammation and swelling on the eye's surface or inside the eye. Examples:
Prednisolone acetate, Fluorometholone, Loteprednol

Anti-Glaucoma Medications: (Yellow or Dark Blue Cap)

 Lower intraocular pressure (fluid pressure inside the eye) to prevent glaucoma
progression. Examples: Timolol, Travoprost, Brinzolamide

Antihistamines/Mast Cell Stabilizers: (Pink or White Cap)

 Relieve symptoms of allergic conjunctivitis (itching, redness, watering). Examples:

Ketotifen, olopatadine

Mydriatics (Dilating Drops): (Red Cap)

 Widen the pupil for eye examinations or certain procedures. Examples:

Phenylephrine, Tropicamide

Miotics (Constricting Drops): (Green or Teal Cap)

 Narrow the pupil, sometimes used in glaucoma treatment. Examples: Pilocarpine

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Nonsteroidal Anti-inflammatory Drugs (NSAIDs): (Yellow or Orange Cap)

 Reduce pain and inflammation on the eye's surface. Examples: Ketorolac, Diclofenac

Artificial Tears: (White or Clear Cap)

 Lubricate and moisten the eyes for dry eye syndrome or irritation.

NexTech Data Entry

Entering information into the EMR (Electronic Medical Record)

Patient Demographics:

 Patient name
 Date of birth
 Gender
 Address
 Phone number
 Insurance information

Medical History:

 Ocular history (previous eye conditions, surgeries, medications)

 Systemic health history (general medical conditions, medications)
 Allergies (medication allergies, other allergies)

Chief Complaint (Reason for Visit):

 A brief description of the patient's symptoms or reason for the visit

Ocular History:

 Current eye problems

 Past eye surgeries or procedures
 Contact lens use (if applicable)
 Family history of eye diseases

Systemic History:

 Any general medical conditions that could affect the eyes

(diabetes, hypertension, autoimmune diseases)
 Current medications (prescription and over-the-counter)

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Social History:

 Smoking history
 Driving
 Occupation

Family History:

 Any eye diseases in the family (glaucoma, macular degeneration, diabetes, heart disease)

Visual Acuity:

 Measured with Snellen chart or other vision tests, recorded for distance and near vision
(with corrective lenses)

Intraocular Pressure (IOP):

 Measured with a tonometer, important for glaucoma assessment

Pupillary Light Reflexes:

 How the pupils respond to light stimulation (normal, sluggish, fixed)

External Eye Examination:

 Observations of the eyelids, eyelashes, and conjunctiva

Slit Lamp Examination:

 Detailed examination of the cornea, iris, lens, and anterior chamber using a bright light
and magnification

Ophthalmoscopy:

 Examination of the retina, optic nerve, and blood vessels using an ophthalmoscope

Diagnosis:

 The doctor's diagnosis based on the examination findings

Plan:

 Treatment plan, including medications, procedures, or follow-up appointments

Education:

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  Doctor's instructions for the patient, such as how to use medications or care for their eyes

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