Healthcare Science Ophthalmic and Vision Science 2 and 3

Module details

Title

Healthcare Science Ophthalmic and Vision Science 2 and 3

Type

Specialist

Module code

SPS224

Credits

50

Requirement

Compulsory

Aim of this module

To provide the trainees with a fundamental theoretical background in Ophthalmic and Vision Science, assessment and rehabilitation that is essential for clinical practice and research in Ophthalmic and Vision Science.

To develop data analysis skills, the ability to synthesise information, their critical thinking and problem-solving skills for academic study as a healthcare scientist in Ophthalmic and Vision Science.

Patient Assessment

This module will provide the trainee with detailed knowledge and understanding of the impact of visual impairment and its clinical assessment, diagnosis and management. They will understand the aetiology and progression of a range of visual disorders AND gain experience of assisting in investigations and the interpretation of patient results.

Psychophysical Assessment of Vision

This module will provide the trainee with detailed knowledge and understanding of the measurement of visual performance. They will gain experience of assisting in performing and interpreting patient results using a range of ophthalmic equipment to assess, for example, visual acuity, colour vision and contrast sensitivity.

Ophthalmic Imaging with Light and Lasers

This module will provide the trainee with detailed knowledge and understanding of ophthalmic imaging techniques that utilise light and lasers, their clinical use and how they help in ophthalmic assessment, diagnosis and management. They will understand the aetiology, progression and management of ocular disorders using imaging techniques. They will gain experience in Ophthalmic Imaging by assisting in performing imaging studies and interpreting patient results in a range of ocular disorders.

Ultrasonography of Eye and Orbit

This module will provide the trainee with detailed knowledge and understanding of ultrasonography of the eye and orbit, and its clinical applications in ophthalmic assessment, diagnosis and management. The trainee will understand the aetiology, progression and management, gaining experience of assisting in performing and interpreting patient results using a range of ultrasound equipment.

Ocular Measurement, Refraction and Biometry

This module will provide the trainee with detailed knowledge and understanding of a range of methods for measuring ocular structures, and experience of performing, interpreting and applying results for a range of ocular disorders, including cataract, glaucoma and corneal pathologies. The trainee will also learn how to measure refractive error and optical aids.

Ocular Movement and Binocular Function

This module will provide the trainee with knowledge and understanding of ocular movement and binocular vision, methods of assessment and their clinical applications in ophthalmic assessment, diagnosis and management.

Visual Electrophysiology

This module will provide the trainee with detailed knowledge and understanding of electrophysiological testing of the eye and its clinical use in ophthalmic assessment, diagnosis and management. They will understand aetiology, progression and management, gaining experience of assisting in performing and interpreting patient visual electrophysiological recordings.

Submodules

Learning outcomes

1. Discuss different modalities of visual perception, including visual acuity and contrast sensitivity, visual field, colour vision, dark adaptation, and the anatomical and neurophysiological substrates of these modalities.

2. Discuss and critically appraise the application of the basic principles of psychophysics to methods of assessment of different modalities of visual perception.

3. Critically appraise the indications for and the interpretation of  assessments of visual perception in the diagnosis of ophthalmic diseases.

4. Describe and evaluate the different technologies and methods used to image and measure ocular structures, and the indications for and interpretation of results in the diagnosis of ophthalmic diseases.

5. Disuss ocular blood flow, the principles and methods of ocular angiography, and the indications for and interpretation of results in the diagnosis of ophthalmic diseases.

6. Explain and evaluate the physics underpinning a range of technology and scanning modes used for ultrasonography of eye and orbit.

7. Discuss the principles and methods of echographic examination of eye and orbit, to include screening, topographic examination, quantitative echography and kinetic echography, their clinical indications, and interpretation of findings.

8. Describe and evaluate a range of methods, including ultrasound, low coherence interferometry and corneal topography, used for measurement of ocular structures and refractive interfaces of the eye.

9. Discuss and justify the clinical indications for undertaking ocular measurements, and interpretation and calculations based on results of measurements.

10. Describe the neurological basis and mechanisms for binocular vision and control of eye movement, and clinical methods for assessment of eye movement.

11. Discuss different methods of tracking and analysing eye movement, including video- and electro-oculography.

12. Describe normal and abnormal visual development,  including suppression, amblyopia and developmental strabismus.

13. Explain the methods and different modalities used to assess the electrophysiology of vision and the anatomical and neurophysiological substrates of these modalities.

14. Discuss and justify the indications for and the interpretation of results in the diagnosis of ophthalmic disease.

15. Discuss national and international epidemiology of vision impairment and initiatives to reduce vision impairment, criteria for screening and national screening programmes for sight-threatening disease.

16. Explain the causes and categories of low vision, social and psychosocial impact, and rehabilitation, including environmental design, daily living skills, and optical and electronic aids.

17. Explain abnormal structure and function of the visual system in adults and children.

18. Discuss the process of construction of a differential diagnosis, and how further investigations can assist the reaching of a diagnostic conclusion.

19. Critically evaluate how methods of assessment of the visual system can be used to monitor ophthalmic disease, and to assess and compare the effectiveness of new and current therapies for diseases of the visual system.

20. Explain the principles of pharmacology and modes of action, administration and adverse effects of commonly used drugs for the investigation and treatment of ophthalmic disease.

21. Identify and explain new and potential developments in assessment of diseases of the visual system, critically review the literature, present the material to peers and demonstrate independent, lifelong learning skills.

Indicative content

Anatomy, physiology, pathology of the visual system

• Comprehensive knowledge of the anatomy and function of the eye, visual pathway, primary visual cortex, visual association areas, including pathways for different modalities of visual perception, and brainstem centres and pathways for oculomotor reflexes
• Diseases and disorders of eye, ocular adnexae and visual pathway Relevant systemic diseases and their ocular manifestations

 Clinical assessment, diagnosis, disease management

• Patient/professional partnerships, effective communication, understanding of consequences of vision loss and other special needs to patients and families, confidentiality, documentation
• Interpretation of referral information, history taking, determination of appropriate investigations, comprehensive ophthalmic patient examination
• Construction of differential diagnosis, role of further investigations to narrow diagnostic possibilities, limitations of own role in diagnostic process
• Preparation of factual and diagnostic reports to address the identified clinical question

 Optical functions of the eye, ocular measurement and biometry

• Optical interfaces of the eye, physiological optics, errors of refraction, low and high order optical aberrations, causes and consequences
• Keratometry, measurement of axial length, anterior chamber depth with  low coherence interferometry and A-scan, the relationship of these measurements to refractive error and intraocular lens power, algorithms for calculating IOL power, sources of error, assessment of accuracy
• Biometry and calculation of IOL power in complex cases, including post- corneal refractive surgery, media opacities and high myopia
• Corneal topography: different methods, algorithms, appropriateness of methods to clinical context, effects of refractive surgery and corneal disease, interpretation of results
• Corneal pachymetry: different methods, algorithms, assessment of accuracy, clinical applications of results

Visual perception

• Visual acuity and contrast sensitivity: concepts of minimum resolvable, minimum angle of resolution, principles of logarithmic scales for measuring visual acuity; principles and measurement of contrast sensitivity; retinal and visual cortex pathways for visual acuity and contrast sensitivity
• Visual field: principles, methods of visual field assessment for screening and clinical management, including kinetic, standard automated, short wavelength, flicker/frequency doubling perimetry; measurement and analysis of light sensitivity, strategies and algorithms used, progression analysis, indications and interpretations in range of clinical contexts, sources of error, artefacts
• Colour vision: retinal receptors and neural processing, congenital and acquired defects, indications for and methods of testing, interpretation in clinical context
• Dark/light adaptation: physiological basis, methods of assessment, clinical indications and interpretation

 Imaging of eye with light and lasers

• Principles, methods and techniques for photography of anterior segment of eye and ocular fundus, differences in procedures and techniques for retinal disease imaging and screening for retinal disease
• Principles of contact lens imaging of the eye, including gonioscopy Principles, procedures and techniques for performing ocular angiography with fluorescein and indocyanine green, contraindications, the appropriateness of procedure for investigation of ocular condition, the quality of the results, and interpretation of the findings in clinical context
• Principles, methods and techniques for imaging the eye with different  forms of scanning laser, including optical coherence tomography, scanning laser ophthalmoscopy and scanning laser polarimetry; identification of normal and abnormal findings, quality of image and artefacts and the appropriateness of procedure for investigation of ocular condition and interpretation of the findings in clinical context

Ultrasonography of eye and orbit

• Principles, methods and techniques for examining and measuring anterior and posterior segment of eye and orbit eye with A- and B-scan ultrasound, including topographic examination of the globe, kinetic echography, quantitative echography of globe and orbit, principles of Doppler ultrasound
• Diagnostic interpretation of normal and abnormal findings and artefacts, in context with clinical presentation and findings

 Binocular vision and visuomotor system, vision development

• Binocular vision: definition, methods of depth perception, retinal correspondence, fusion, stereopsis, cortical topography, abnormalities of binocular vision, methods of assessment
• Visuomotor system: types of ocular movement, including vergence, versions, saccades, smooth pursuit, oculomotor reflexes and control systems, classification of abnormal ocular movements, clinical methods of assessment, gaze tracking

 Electrophysiological assessment of visual function

• Principles of electrophysiology, VEP, ERG, EOG instrumentation, techniques, difficulties and troubleshooting, normal findings, artefact reduction
• Patient preparation: electrode selection, correct positioning and application, removal and sterilisation.
• Test selection and protocols in context of clinical question, patient age, co- operation and ability
• Annotation of recordings with relevant settings, clinical status, etc. Assessment and interpretation of the results

Epidemiology, screening and vision impairment

• National and international prevalence of vision loss, definitions and criteria for registration with vision impairment, initiatives for prevention of blindness
• Causes and forms of vision impairment and strategies and methods for vision rehabilitation
• Principles, criteria and quality measures for screening programmes, current and potential screening programmes for ocular diseases in UK

Ophthalmic pharmacology

• Cholinergic and adrenergic receptors and neurotransmission in the eye Categories of drugs used in ophthalmic practice
• Drug preparations, administration, absorption and penetration into the eye, systemic and topical drug adverse effects: side effects, toxicity and allergy
• Regulations for prescription, supply and administration and storage of ophthalmic drugs
• Patient concordance and compliance

Activities

Patient Assessment 

• Identify a patient referred for investigations of vision impairment and, with permission, follow the progress of the patient from the initial consultation through investigations, follow-up appointment and/or surgery, and reflect on your learning from this process.
• Observe history taking, with permission, with at least two patients, to include a new referral and a follow-up appointment. Develop and practise the skill of history taking and present your history findings for a range of patients, and suggest appropriate investigations based on this information.
• Support the management of the patient appointment system from initial appointment through follow-up and discharge processes to understand the patient pathway and the significance of the appointment system. Discuss the options for patient pathways and support with your supervisor, including patient treatment for at least two types of vision impairment and to include two patients of different age ranges.
• Attend and support at ophthalmic/vision clinics. To include observation and support for triage, eye casualty, medical imaging, routine consultant-based clinic, orthoptics, low vision clinic, surgery (theatre or day case) and, for example, refractive surgery such as LASIK. Relate clinic experience to individual patient pathways and treatment plans, and further follow-up activities and intervention options.
• Under supervision, maintain electronic patient records. Discuss the importance of these records and the associated statutory and patient rights associated with patient data. Evaluate the effectiveness of electronic data systems and their use within the ophthalmic and vision patient services.
• Eye-drop administration training and certification to local protocol. Under supervision, observe and assist with administration of eye drops for at least two patients, to include patients of different age range and vision impairment. Discuss the risks, benefits and  requirements  for prescription/administration.
• Observe the role of social work, including child/vulnerable adult protection policy, in relation to vision impairment. Report on the potential range of services and support available and how this interacts with services provided in the ophthalmic/vision primary and secondary care services.
• Take part in a multidisciplinary team meeting and reflect on the way the multidisciplinary team contributes to the care of patients with vision impairment.
• Attend a range of outpatient clinics for patients with vision impairment and discuss the role of the multiprofessional team in patient care. This may include community units, medical outpatients, primary and secondary care contexts, and specialist units.

Psychophysical Assessment of Vision

• Attend and, where possible, participate in screening programmes for glaucoma and/or diabetes, and evaluate and discuss the role of screening programmes and their contribution to patient care.
• Identify at least one patient attending for subjective tests and, with permission, follow the progress of the patient from the initial consultation, through investigations, follow-up appointment and/or surgery and discharge, and reflect on your learning from this process.
• Attend a range of outpatient clinics for assessment of visual acuity in children and adults, including adults who are illiterate, have learning difficulties, or who are non-English speaking, with Snellen/logMAR and contrast sensitivity and discuss the role of the multiprofessional team in the care of patients.
• Assess the visual field with standard automated perimetry (or equivalent where not possible) and observe other methods that may include kinetic perimetry, microperimetry, automated Amsler grid testing and frequency doubling perimetry. Reflect on the selection and use of each type of equipment in relation to patient referral and needs.
• Observe dark adaptometry being performed on a patient/volunteer and experience the test being performed on oneself. (Not all vision centres have such equipment.)

Ophthalmic Imaging with Light and Lasers

• Observe a range of investigations by specialists to include photography/angiography/OCT and, if possible, gonioscopy sessions, and discuss the indications for and contraindications to each investigation with your training supervisor.
• Identify a patient referred for ophthalmic imaging and, with permission, follow the progress of the patient from the initial consultation, through investigations, follow-up appointment and/or surgery and discharge, and reflect on your learning from this process.
• Under supervision, perform a range of investigations using photography and OCT, leading eventually to hands-on experience of angiography, not necessarily including critical-phase images. Reflect on and discuss your experiences in terms of the appropriateness of method, effectiveness and patient experience.
• Observe and participate in post-acquisition image assessment and possible image processing, and discuss results in terms of differential diagnosis and treatment plans for patients with a range of vision disorders/disease.
• Attend reporting sessions and discuss a series of reports and the impact on clinical care with your training officer.

Ultrasonography of Eye and Orbit

• Identify two patients with disorders of vision requiring ultrasonography and critically reflect on the effect on the lifestyle of the patient and the role of the healthcare scientist in the diagnosis and treatment of the patients.
• Observe a series of patients reviewed as new and follow-up patients in an outpatient clinic and critically appraise the process of referral, diagnosis and treatment, including the range of healthcare professionals who contribute to the care of each patient and how the inter-professional team work together.
• Observe, with permission, patient investigations at clinics that use ultrasonography extensively, e.g. adnexal clinic, oncology clinic, vitreo-retinal clinic. Reflect on and discuss the patient experience.
• Observe other structural ionising and non-ionising imaging departments, e.g. computed tomography (CT) imaging, magnetic resonance imaging (MRI) and X-ray, and evaluate/discuss how other imaging modalities complement one another. 

It is also recommended that trainees get the opportunity to: 

• Perform A- and B-scan ocular ultrasound imaging on healthy and abnormal eyes.

Ocular Measurement, Refraction and Biometry

• Attend low visual aid clinic, orthoptics clinic, adnexal clinic and contact lens clinic to observe the assessment of refraction in patients of different ages with a range of visual disorders of varying severity. Reflect on and discuss your experiences and the effect/benefits for patient care and pathways.
• Hands-on experience of performing refraction measurements on colleagues/volunteers and appropriate patients. Reflect and discuss the experiences from your own/volunteers’ perspectives in relation to the patient needs. Consider the application of these investigations for a range of patients with differing needs, including a range of visual impairments, language, speech or physical disability.
• Observe how the full range of equipment is calibrated to ensure correct, repeatable and reliable measurement, and to better understand the techniques underlying ocular measurement, refraction and biometry. Discuss the implications of incorrect calibration for patient investigation and care. 

It is also recommended that the trainee: 

• Under supervision, perform/check calibration of a limited range of equipment.

Ocular Movement and Binocular Function

• Identify at least two patients of varying ages and varying degrees of severity who require orthoptic assessments and, with permission, follow the progress of the patient from the initial consultation, through investigations, follow-up appointment and/or surgery, and reflect on your learning from this process.
• Assess a patient with suspected stereopsis with one commonly used method and explain the underlying principles of the method used.
• Observe strabismus surgery of both adults and children and discuss the impact of this treatment on patient recovery and vision improvement.
• Attend strabismus clinics and reflect on the way the multidisciplinary team contributes to the care of patients.
• Attend a range of outpatient clinics that patients with orthoptic disorders may attend, and discuss the role of the multiprofessional team in the care of patients.
• Attend a meeting at which the outcome of a clinical audit, research, innovation or service development is presented and discuss with your training supervisor how evidence-based practice is implemented with respect to strabismus investigation.

Visual Electrophysiology

• Observe adult and paediatric electrophysiology clinics and discuss the indications, contraindications and adaptations that need to be made. Reflect on how this will inform your future practice.
• Observing tests being performed in theatre and/or the intensive care unit (ICU) and discuss the impact of this treatment on patient prognosis and future care.
• Experience of the tests being performed on oneself (not necessarily with pupillary dilation and topical anaesthesia) and reflect on the experience in terms of the patient needs for support, information and care.
• Experience of using the equipment to perform standard tests and analyse results. Reflect and discuss the use, benefits, differentiation and application of different equipment and range of tests. Discuss and agree the analysis of results to inform your future practice.
• Experience of experimentation on colleagues/volunteers to observe the effects of varying stimulus and recording parameters. Discuss and review with colleagues/volunteers to reflect on the patient needs for support and information, including patients with varying levels of visual disability/disorder, language/speech difficulties and patients of different age ranges.
• Attendance at reporting sessions. Discuss with your training supervisor how evidence-based practice is implemented with respect to patients receiving ophthalmic/vision care and treatment.
• Perform routine calibration of stimulator and recording equipment and discuss the implications of incorrect calibration for patient care and investigation results. 

It is also recommended that the trainee: 

• Experiences extended test protocols that go beyond International Society for Clinical Electrophysiology of Vision (ISCEV) standards and discussion of their application, use and impact on patient care, experience and investigations.
• Observes normal data collection to contrast with patient data collection. Consider the differentiation between the two and the implications for evidence-based practice, patient care, patient engagement and patient treatment.