Clinical aspects of refraction measurement 1100-5BW13

LECTURES (The order of lectures is subject to change)

1. Corneal Topography
- Measurement techniques: Placido disc-based systems, Scheimpflug imaging, optical coherence tomography (OCT), and scanning-slit technology.
- Types of corneal maps: keratometric (sagittal and tangential), elevation, pachymetric, and epithelial thickness maps; commonly used color scales.
- Normal values and reference ranges for corneal maps, including keratometric map pattern classification, interocular differences in corneal curvature, normal elevation values relative to the best-fit sphere (BFS), and pachymetric progression.
- Characteristic changes in corneal maps at different stages of keratoconus.
- Characteristics of corneal maps following refractive surgery.
- Principles of accurate corneal measurements.
- Estimation of changes in selected corneal parameters (thickness and curvature) following refractive surgery.
- Preliminary assessment of the risk of post-refractive surgery corneal ectasia.

2. Dry Eye Disease
- Dry eye disease (DED): definition, classification, pathophysiology, and impact on quality of life.
- Current diagnostic and therapeutic guidelines and algorithms, including DEWS III.
- Types of dry eye disease: aqueous-deficient, evaporative, and mixed forms.
- Eyelid hygiene and tear film supplementation: principles of selecting appropriate treatments.
- Meibomian gland dysfunction (MGD): diagnosis and management.
- The use of intense pulsed light (IPL), meibomian gland expression (MGX), low-level light therapy (LLLT), and combination therapies in the management of MGD and DED.
- Individualized treatment strategies and discussion of current clinical research.
- Practical aspects of managing patients with dry eye disease.

3. Myopia from an Ophthalmological Perspective
- Myopia as a refractive error and a health concern affecting visual function development.
- The importance of full refractive correction for visual, cognitive, and educational development.
- Environmental factors associated with the onset and progression of myopia.
- Visual hygiene: near work, breaks, working distance, lighting, and workstation ergonomics.
- The importance of regular outdoor activities and exposure to daylight.
- Screen time and age-appropriate recommendations for limiting screen use.
- Myopia control methods: specialized spectacle lenses and contact lenses, orthokeratology, and low-dose atropine.
- The role of lifestyle modifications, sleep, physical activity, and diet.
- Principles of regular monitoring of patients with myopia.
- The influence of genetic and environmental factors on myopia development and progression.
- Current guidelines, treatment algorithms, and practical aspects of myopia management.

4. The Impact of Diabetes Mellitus and Arterial Hypertension on the Eye
- Diabetes mellitus and arterial hypertension as systemic diseases: basic pathophysiology, risk factors, and clinical significance.
- The effects of chronic hyperglycemia and vascular abnormalities on ocular structures.
- Ocular complications of diabetes: diabetic retinopathy and maculopathy, changes in the crystalline lens, cornea, and anterior segment, cranial nerve neuropathies, and neovascular glaucoma.
- The impact of arterial hypertension on retinal microcirculation and the optic nerve, including characteristic fundus findings.
- Factors influencing the development and progression of ocular complications, with particular emphasis on glycemic control, blood pressure regulation, and lipid abnormalities.
- The role of eye examinations in detecting and monitoring systemic complications of diabetes and hypertension.

5. Age-Related Macular Degeneration (AMD)
- Age-related macular degeneration (AMD): epidemiology, pathophysiology, and clinical significance.
- Physiological aging of the retina, retinal pigment epithelium (RPE), and Bruch's membrane and its relationship to AMD development.
- Drusen and other macular abnormalities: types and diagnostic significance.
- Forms of AMD: dry AMD, geographic atrophy, and neovascular AMD.
- Clinical manifestations, disease course, and risk factors for progression.
- AMD prevention and modifiable risk factors.
- Imaging techniques in AMD diagnosis: fundus photography, near-infrared reflectance imaging (NIR), fundus autofluorescence (FAF), and OCT.
- Current treatment options for AMD, including anti-VEGF therapy.
- Optometric examination of patients with AMD and low vision.
- Refraction, assessment of distance and near vision, and fundamentals of low vision rehabilitation.
- Selection of optical and non-optical low vision aids.

6. Glaucoma
- Glaucoma: epidemiology, classification, and fundamental mechanisms of glaucomatous optic neuropathy.
- Primary open-angle glaucoma (POAG): clinical characteristics, the role of intraocular pressure, and normal-tension glaucoma.
- Glaucoma risk factors: systemic, ocular, and vascular.
- Assessment of the optic disc and neuroretinal rim in glaucoma diagnosis.
- Functional assessment: standard automated perimetry and interpretation of results.
- Methods for early glaucoma detection and identification of pre-symptomatic changes, including selected psychophysical techniques.
- Secondary open-angle glaucoma, including glaucoma associated with pseudoexfoliation syndrome and pigment dispersion syndrome.
- Angle-closure glaucoma: mechanisms, risk factors, symptoms, and recognition of ophthalmic emergencies.
- Anterior chamber angle assessment: the van Herick technique, gonioscopy, anterior segment OCT (AS-OCT), and ultrasound biomicroscopy (UBM).
- Basic glaucoma treatment options: pharmacological therapy, laser procedures, and surgery.
- Optometric examination of patients with glaucoma and individuals at increased risk.

7. High Myopia
- Classification of myopia according to degree, etiology, anatomical characteristics, and age of onset.
- Epidemiology of myopia and high myopia as a growing public health concern.
- Genetic and environmental factors influencing myopia onset and progression.
- Mechanisms of emmetropization, axial elongation, and the role of peripheral defocus.
- Complications associated with high and pathological myopia, including increased risks of retinal abnormalities, myopic maculopathy, retinal detachment, glaucoma, and cataract.
- Methods for slowing myopia progression: environmental modifications, specialized spectacle lenses (DIMS, HAL), contact lenses, orthokeratology, atropine treatment, and repeated low-level red-light therapy (RLRL).
- Myopia correction options: spectacles, contact lenses, laser refractive surgery, and intraocular lens implantation.

8. Cataract
- Definition, classification, and types of cataract, including age-related, secondary, traumatic, and cataracts associated with systemic diseases.
- Characteristics of the most common types of lens opacities: nuclear, cortical, and posterior subcapsular cataracts, and their impact on visual quality.
- Risk factors and mechanisms of cataract development, including aging, diabetes, high myopia, inflammatory diseases, steroid use, trauma, and radiation exposure.
- Clinical manifestations and diagnosis of cataract using visual acuity assessment, slit-lamp examination, and preoperative investigations.
- Principles of patient selection for cataract surgery and basic surgical techniques, with particular emphasis on phacoemulsification.
- Types of intraocular lenses (IOLs): monofocal, multifocal, and extended depth-of-focus (EDOF) lenses, and principles of selecting the postoperative refractive target.
- Common postoperative complications and problems associated with intraocular lens positioning or selection.

9. Pediatric Eye Examination
- Visual development and emmetropization in children.
- Premyopia and risk factors for myopia development.
- Specific considerations in pediatric optometric examinations.
- Assessment of refractive error, binocular vision, and accommodation.
- Methods of refractive error correction in children.
- Myopia management and progression control.
- Clinical case analysis and selection of appropriate optometric management strategies.

10. Static and Mohindra Retinoscopy
- Fundamentals and applications of retinoscopy in objective refractive assessment.
- Types of retinoscopy: static retinoscopy, dynamic retinoscopy, and the Mohindra technique.
- Interpretation of the retinoscopic reflex: with-motion, against-motion, and neutralization.
- Retinoscopy techniques and principles of retinoscope operation.
- Working distance and appropriate working distance compensation.
- Detection and measurement of spherical refractive errors and astigmatism.
- Static retinoscopy procedures, including retinoscopy through a phoropter.
- Mohindra retinoscopy in pediatric patients.
- Practical exercises in refractive measurements and calculations.

11. Clinical Case Analysis – Workshops
The final three classes will be conducted as interactive workshops. Students will present selected clinical cases examined during the semester. The findings will then be analyzed collectively, with discussions focusing on possible diagnoses, interpretation of examination results, and appropriate optometric management strategies.

PRACTICAL CLASSES

1. Introductory practical session: operation of ocular diagnostic imaging devices.
2. Corneal topography and ocular surface assessment: non-invasive tear break-up time (NIBUT), tear film dynamics, tear film lipid layer assessment, conjunctival and limbal hyperemia grading, and meibography using a Placido disc-based corneal topographer.
3. Ocular surface assessment and corneal topography: practical examinations with patients.
4. Preoperative assessment for laser refractive surgery: corneal topography and tomography using anterior segment OCT for preliminary evaluation of patient suitability for laser refractive surgery.
5. Preoperative assessment for laser refractive surgery: practical examinations with patients.
6. Fundus examination: methods of fundus assessment, practical training with Volk lenses, direct ophthalmoscopy, and slit-lamp simulator exercises.
7. Glaucoma screening: anterior chamber angle assessment using slit-lamp biomicroscopy and AS-OCT, non-contact tonometry (air-puff tonometry), rebound tonometry (iCare), pachymetry, and visual field assessment.
8. Fundus examination: methods of fundus assessment, practical training with Volk lenses, direct ophthalmoscopy, and slit-lamp simulator exercises.
9. Ocular biometry: axial length measurement and monitoring of axial elongation in patients with progressive myopia.
10. Pediatric eye examination.
11. Static and Mohindra retinoscopy.
12. Optometric examination of patients with high refractive errors.
13. Optometric examination of patients with ocular diseases, systemic diseases, and patients who have undergone ophthalmic surgery.
14. Optometric examination of patients aged 60 years and older.

Practical sessions involving patients will require students to perform comprehensive optometric examinations, including screening procedures for various ocular diseases.