Principles and Practice of Primary Care Optometry – Clinical Procedures, Interpretation & Diagnosis
Milan-Bicocca 2011
Abstract: This lecture and hands-on laboratory course presents a comprehensive overview of eye care clinical techniques and procedures and presents an a
clinical scheme for important diagnostic considerations for the primary care optometrist. The program builds upon basic principles of slit lamp biomicroscopy
as an extension of more advanced techniques including applanation tonometry, gonioscopic evaluation of the anterior chamber angle structures, pupillary
dilation and contact and noncontact fundus examination. The laboratory also includes a demonstration laboratory applying direct and indirect stereoscopic
binocular ophthalmoscopy. Emphasis is placed on the application of primary care techniques for detection of findings and the diagnosis of anterior and poster
segment disorders.. Each student will have the opportunity, under supervision, for hands-on practice to develop entry level experience with all techniques. Case
studies are used to illustrate the clinical utility and importance of an expanded scope of practice in disease detection, differential diagnosis and patient
management.
Training Course Title
Module I
Anterior segment
disorders
Module II
Posterior segment
disorders
Description
This module presents an overview of important external
diseases typically encountered in primary eye care
settings and presents an overview of important
diagnostic features of various conditions. Basic
principles of diagnosis of infectious and inflammatory
conditions are reviewed and the application of clinical
decision making skills is discussed in light of the
diagnosis and management of anterior segment eye
disease, including the most common conditions that are
recognized by comprehensive slit lamp biomicroscopic
examination. Case studies illustrate the clinical utility
of the clinical techniques presented in the
workshop/laboratory module.
The second module addresses important findings in
posterior segment disorders. It focuses on presenting a
comprehensive methodology for fundus examination
and for understanding the important diagnostic
considerations in posterior segment disease. The course
considers the important findings in retinal and choroidal
disease, differential diagnosis, natural history. Emphasis
is placed on clinical application of techniques presented
in the laboratory module. Case studies are used to
illustrate clinical findings and diagnosis.
1
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Lesson Elements
Background/patient symptoms
Classification of external disease
Detection
Differential diagnosis
Disorders of the lids and adnexa
Disorders of the conjunctiva/sclera
Contact lens related complications
Corneal inflammation/infection
Iris/Anterior chamber/crystalline lens
Anterior segment trauma
Overview/epidemiology/risk factors
Review of retinal and choroidal anatomy and physiology
Classification of posterior segment disorders
Clinical features and findings
Differential diagnosis
Macular disorders
Retinal vascular disease, including manifestations of
systemic disease
o Hypertension
o Diabetes
Module III
Clinical workshop
and laboratory
This third module focuses on a variety of clinical
techniques with an emphasis on developing entry
level competency for the student. The workshop
allows for hands-on experience with the
instrumentation and time is allotted for each
students practice the techniques and procedures.
Additional consideration is given to related topics
specific to clinical application of instrumentation
and techniques covered in the laboratory. Emphasis
is placed on clinical techniques and in recognizing
important clinical findings, differential diagnosis
and in applying appropriate diagnostic testing
strategies, especially for those conditions
represented in Modules 1 and 2.
2
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Slit lamp Biomicroscopy
o Anterior chamber evaluation
o Angle estimation
Direct ophthalmoscopy
Guidelines for pupil dilation
Ocular Fundus examination
o Fundus Biomicroscopy
 Hand-held fundus lenses
 Fundus contact lenses
o Binocular indirect ophthalmoscopy
Nonmydriatic fundus photography
Guidelines for safe pupillary dilation