Healthcare Science Ophthalmic and Vision Science 2 and 3 (SPS224)

50 credits

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.

Important information

The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.

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