The Ophthalmic Assistant

A Text for Allied and Associated Ophthalmic Personnel

11th Edition - March 28, 2022
Authors: Harold A. Stein, Raymond M. Stein, Melvin I. Freeman, Rebecca Stein
Language: English
Paperback ISBN:
9 7 8 - 0 - 3 2 3 - 7 5 7 5 4 - 6

Covering all the knowledge and skills needed for everyday duties as well as success on certification and recertification exams, The Ophthalmic Assistant, 11th Edition,… Read more

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Covering all the knowledge and skills needed for everyday duties as well as success on certification and recertification exams, The Ophthalmic Assistant, 11th Edition, is an essential resource for allied health personnel working in ophthalmology, optometry, opticianry, and other eye care settings. Drs. Harold A. Stein, Raymond M. Stein, and Melvin I. Freeman are joined by new editor Dr. Rebecca Stein and several new contributing authors who provide practical, up-to-date guidance on ocular diseases, surgical procedures, medications, and equipment, as well as paramedical procedures and office management for today’s practice. This outstanding reference and review tool provides essential knowledge and guidance for ophthalmic assistants, technicians, and technologists as critical members of the eye care team.

Cover image
Title page
Table of Contents
Any screen, Any time, Anywhere
Copyright
Preface
Acknowledgments
List of Contributors
List of Reviewers
Dedication
In memory of
In appreciation
Section 1: Basic Sciences
Chapter 1. Anatomy of the eye
Abstract
Chapter Contents
Surface anatomy
Tear film
Cornea
Sclera
Uvea
Angle structures
Lens
Vitreous
Retina
Optic nerve
Visual pathway
Ocular muscles
Summary
Questions for review and thought
Chapter 2. Physiology of the eye
Abstract
Chapter Contents
Alignment of the eyes
Looking straight ahead (fixation)
Locking images (fusion)
Eye movements
Looking toward a close object
Seeing in depth
Focusing at near (accommodation)
Transparent pathway for light
Retinal images
Intraocular pressure
Tears
Color vision
Questions for review and thought
Chapter 3. Optics
Abstract
Chapter Contents
Physical optics
Geometric optics
Spherical aberration
Chromatic aberration
Cylinders
Transposition
Practical aspects of optics
Optical illusions
Questions for review and thought
Chapter 4. Pharmacology
Abstract
Chapter Contents
General principles
Complications of locally administered drugs
Prescription writing
Autonomic drugs
Drugs that lower intraocular pressure
Anesthetics
Antiallergic and antiinflammatory agents
Contact lens solutions
Stains
Side effects of systemic medication
Questions for review and thought
Chapter 5. Microbiology
Abstract
Chapter Contents
Bacteria
Viruses
Fungi
Other microbes
Clinical indications for smears and cultures
Taking smears
Making a stain
Specimen collection for culture
Other aids to identify organisms
Summary
Questions for review and thought
Section 2: Clinical Practice
Chapter 6. Office efficiency and public relations
Abstract
Chapter Contents
How to make patients happy
Scheduling appointments
Booking the arriving patient
The reception room
Running late
Scribes
Making future appointments
Financing
Recall cards
Automated voice machines
Filing
Electronic medical and health records
Prescription pads
Office equipment
Personal qualities for improved office efficiency
Improving the patient experience through service recovery
Administrative assistant duties
Handling the ophthalmologist’s schedule
Handling sales representatives
Handling mail
Medical ethics
In the physician’s absence
Aids in public relations
Patient surveys
Publicity
Advertising
Summary
Questions for review and thought
Chapter 7. History taking
Abstract
Chapter Contents
Organization of a history
History procedure
General information
Chief complaint
History of present illness
Past health, medications, and allergies
Family history
Tips in history taking
Scribes
Acknowledgment
Summary
Questions for review and thought
Chapter 8. Preliminary examination
Abstract
Chapter Contents
Vision assessment
Measurement of glasses
Accommodation
Convergence
Color vision
Depth perception
External examination
Examination of the ocular muscles
Instillation of eyedrops and ointment
Ophthalmoscopy
Visual fields
Summary
Questions for review and thought
Chapter 9. Visual function and impairment
Abstract
Chapter Contents
Introduction
Vision loss
Types of vision
Luminance versus illumination
Measurement and assessment of visual loss
Aspects of visual impairment
Visual functions
Why perform visual screening
Testing
Everyday visual experience
Interventions for rehabilitation
Chapter 10. Understanding ophthalmic equipment
Abstract
Chapter Contents
Equipment used for refraction
Equipment used to detect muscle imbalance
Instruments used to determine power of lenses
Instruments used to examine the interior of the eye
Instruments used to study the anterior segment of the eye
Instruments used to examine the angle structures of the eye
Instruments used to assess the cornea
Instruments used to determine tear flow
Instruments used to measure intraocular pressure (tonometer)
Special instruments
Computerized corneal topography
Diagnostic ultrasound: A-scan and B-scan
Radioactive phosphorus
Electroretinography and electrooculography
Lasers
Summary
Questions for review and thought
Chapter 11. Maintenance of ophthalmic equipment and instruments
Abstract
Chapter Contents
Applanation tonometer
Noncontact tonometer
Lensmeter
Keratometer
Slit-lamp biomicroscope
Phoropter (Fig. 11.4)
Projector
Chapter 12. Refractive errors and how to correct them
Abstract
Chapter Contents
Emmetropia
Ametropia
Refractometry and refraction
Retinoscopy
Autorefractors
Subjective refining of refraction
Anisometropia
Aniseikonia
Aphakia
When to refract after cataract surgery
Presbyopia
Complaints: how to anticipate them
Glasses checks and how to handle them: 12 key points
Summary
Acknowledgment
Questions for review and thought
Chapter 13. Facts about glasses
Abstract
Chapter Contents
History
Frames
Dispensing spectacle frames
Lenses
Role of protective lenses in sports
Production of prescription lenses
Care of glasses
Acknowledgment
Questions for review and thought
Chapter 14. Rigid contact lenses: basics
Abstract
Chapter Contents
Development
Optics
How the corneal contact lens works
Terminology
Designs
Patient examination
Fitting corneal contact lenses
Evaluating contact lenses
Insertion and removal techniques
Care
Evaluating the fit
Adjustments
Problems associated with overwearing contact lenses
Uses
Summary
Questions for review and thought
Chapter 15. Soft contact lenses
Abstract
Chapter Contents
History of hydrophilic lenses
Advantages
Disadvantages
Patient evaluation
Manufacture
Inventory versus diagnostic lenses
Lens inspection
Disinfection
Cleaning
Insertion and removal techniques
Taco test
Precautions for wear
Wearing schedules
Thin and ultrathin lenses
Correction of astigmatism
Medical uses
Extended-wear lenses
Disposable lenses
Innovations in design
Contact lenses in industry
Special occupations
Common questions and answers
Role of the ophthalmic assistant
Questions for review and thought
Chapter 16. Advanced techniques in soft and rigid contact lens fitting
Abstract
Chapter Contents
Abnormal symptoms and signs
Follow-up keratometry
Special lenses
Contact lenses for keratoconus
Role of corneal topography
Manufacturing and modification
Gas-permeable lenses
Hydrogel tinted contact lenses
Recommendations for selection of rigid or soft contact lenses
Questions for review and thought
Chapter 17. Managing a contact lens practice
Abstract
Chapter Contents
Patient management
Planning
Understanding your organization
Finances
Marketing
Advertising
Staff development
The contact lens practice staff
Office equipment and space
Ongoing care
Chapter 18. Visual fields
Abstract
Chapter Contents
Preliminary procedures
Facilities for field testing
Confrontation test
Perimeters
Measuring a field on the perimeter
Charts
Special perimetric techniques
Normal visual field
Pathologic defects in the visual field
Contraction of the visual field
Hysterical visual field
Summary
Questions for review and thought
Chapter 19. Automated visual field testing
Abstract
Chapter Contents
Understanding the principles of perimetry
Test stimulus
Understanding threshold
Test patterns
Testing strategies
Automated perimetry: basic rules of testing
Analysis software and printouts
Summary
Chapter 20. Computers in ophthalmic practice
Abstract
Chapter Contents
Computer basics
Computer components
Computer tasks
Computer-controlled ophthalmic equipment
Special ophthalmic applications
Summary
Section 3: Common Clinical Eye Problems or Common Clinical Conditions
Chapter 21. Ocular injuries
Abstract
Chapter Contents
Diagnosis of ocular injury
Conjunctival and corneal foreign bodies
Intraocular foreign bodies
Contusion of the eyelids: black eye
Contusions of the globe
Penetrating eye injuries
Lacerations of the lids
Fractures of the orbit
Chemical injuries
Injuries caused by sports
Injuries caused by radiant energy
Prevention of traumatic injuries to the eye
First-aid care by the ophthalmic assistant
Computed tomography scans (also see Ch. 41)
Magnetic resonance imaging
Questions for review and thought
Chapter 22. The urgent case
Abstract
Chapter Contents
Ocular emergencies
Urgent case: to be seen within the hour
Urgent case: to be seen the same day
Temporal arteritis
Priority case: to be seen within days
Summary
Questions for review and thought
Chapter 23. Common eye disorders
Abstract
Chapter Contents
Conjunctiva
Cornea
Eyelids
Lacrimal apparatus
Questions for review and thought
Chapter 24. Common retinal disorders
Chapter Contents
Retinal artery occlusion
Retinal vein occlusion
Diabetic retinopathy
Retinitis pigmentosa
Retinopathy of prematurity
Retinoschisis
Retinal breaks
Retinal detachment
Central serous chorioretinopathy
Changes in the retina from concussion
Foreign body in the eye
Solar retinopathy
Age-related macular degeneration
Ocular manifestations of common systemic diseases
Infectious diseases of the retina and choroid
Malignant melanoma
Retinal imaging modalities: fluorescein angiography
Questions for review and thought
References
Chapter 25. Glaucoma
Abstract
Chapter Contents
Introduction
Classification
Primary open-angle or chronic glaucoma
Secondary glaucoma
Primary angle-closure glaucoma
Congenital glaucoma
Diagnosis
Pathophysiology and the longitudinal treatment plan for progressive primary-angle glaucoma
Treatment
Management of the patient by the ophthalmic assistant
Disinfection and sanitization of glaucoma instruments
COVID-19 impact on glaucoma care
Summary
Questions for review and thought
References
Chapter 26. Uveitis
Abstract
Chapter Contents
Introduction
Classification of uveitis
Approach to the patient with uveitis
Treatment of uveitis
Questions for review and thought
References
Chapter 27. Dry eye disease
Abstract
Chapter Contents
Introduction
Classification
Subjective evaluation
Objective evaluation
Systemic
External
Lids and lashes
Meibomian gland dysfunction
Tear film
Ocular surface staining
Cornea, conjunctiva, and sclera
Management
Summary
References
Chapter 28. Examination of the newborn, infant, and small child
Abstract
Chapter Contents
Approach to parent and child
Vision assessment
External examination
Instillation of eyedrops
Refraction
Retina and optic nerve examination
Common pediatric disorders
Questions for review and thought
Chapter 29. Ocular motility, binocular vision, and strabismus
Abstract
Chapter Contents
Evaluation of strabismus
Sensory testing
Sensory adaptation to strabismus
Amblyopia
Eccentric fixation
Treatment of strabismus
Summary
Questions for review and thought
References
Section 4: Surgical Technique
Chapter 30. Aseptic technique and minor office surgery
Abstract
Chapter Contents
Aseptic technique
Minor office surgery
Complications during and after office surgery
Summary
Questions for review and thought
Chapter 31. The operative patient
Abstract
Chapter Contents
Arrangements for the operation
Preparing the child and parent for surgery
Preparing the adult for major ocular surgery
Eye surgery
Types of anesthesia
Questions for review and thought
Chapter 32. Highlights of ocular surgery
Abstract
Chapter Contents
Strabismus surgery
Cataract surgery
Glaucoma surgery
Retinal detachment surgery
Vitreous surgery
Laser surgery
Corneal transplantation
Eyelid surgery
Pterygium removal
Dacryocystorhinostomy
Enucleation and evisceration
Eye dressings
Summary
Questions for review and thought
Chapter 33. Assisting the surgeon
Abstract
Chapter Contents
Bedside ophthalmic assistant
Operating room assistant
Amoric environment
Care and handling of surgical instruments
Operating room microscope
Ethical behavior of the ophthalmic assistant
Medicolegal tips
Questions for review and thought
Chapter 34. Ambulatory surgery
Abstract
Chapter Contents
Ambulatory surgery centers
Tips on medical/legal protection
Preparation for admission
Admission for surgery
Postoperative recovery
Summary
Questions for review and thought
Chapter 35. Lasers in ophthalmology
Abstract
Chapter Contents
Laser theory
Pumping and spontaneous emission
Stimulated emission
Types of lasers and their clinical use
Safety in the laser clinic
Future applications of laser technology
Questions for review and thought
Chapter 36. Refractive surgery: today and the future
Abstract
Chapter Contents
Laser vision correction
Corneal inlays
Corneal laser for macular degeneration
Summary
Bibliography
Chapter 37. Corneal collagen crosslinking in the management of ectatic diseases
Abstract
Chapter Contents
Keratoconus
Pellucid marginal degeneration
Corneal ectasia following laser-assisted in situ keratomileusis or small incision lenticule extraction
Development of corneal crosslinking
Basic research on safety of corneal crosslinking
Technique of corneal crosslinking
Contraindication to corneal crosslinking
Clinical outcomes of corneal crosslinking
Topographically linked ablation
Intrastromal corneal rings
Potential future advances in corneal crosslinking
Summary
Further reading
Chapter 38. Wavefront aberrations and custom ablation
Abstract
Section 5: Ocular Imaging
Chapter 39. Ophthalmic photography
Abstract
Chapter Contents
Photographic terms
Digital imaging
External photography
Photo slit-lamp biomicrography
Goniography
Endothelial specular photomicrography
Fundus photography
Fluorescein angiography
Video recording
Image presentation
Summary
Questions for review and thought
Chapter 40. Optical coherence tomography
Abstract
Chapter Contents
The technician’s role
Normative databases
Progression analysis
Nonexudative age-related macular degeneration
Exudative age-related macular degeneration
Other macular abnormalities
Vitreomacular traction
Glaucoma
Keratoconus screening
Refractive surgery
Corneal pathologies
Summary
Chapter 41. Computerized corneal topography
Abstract
Chapter Contents
Introduction and basics
Clinical uses
Corneal topography analysis in refractive surgery
Corneal topography and cataract surgery
Corneal topography and contact lens fitting
Keratoconus
Summary
Chapter 42. Specular microscopy
Abstract
Chapter Contents
Specular microscope
Endothelial specular photomicrography
Chapter 43. Diagnostic ultrasound
Abstract
Chapter Contents
General considerations and conventional ultrasound diagnoses
Ultrasound biomicroscopy
Conjunctival and adnexal disease
Summary
Suggested readings
Section 6: Special Procedures
Chapter 44. Blind persons in the modern world
Abstract
Chapter Contents
Blindness defined
Partial sight and blindness
Recent vision loss
Total blindness
The blind child
Rehabilitation
Available aids
Questions for review and thought
Chapter 45. Cardiopulmonary resuscitation
Abstract
Chapter Contents
Cardiopulmonary resuscitation
Special situations
Final thoughts
Questions for review and thought
Section 7: Ocular Vignettes
Chapter 46. History of spectacles
Abstract
Chapter Contents
Antiquity
The beginning
Early eyeglasses
Rivet spectacles
Manufacture
The frame
Scissor spectacles and fork glasses
Single lenses and monocles
Spring spectacle frames
Temple pieces and curved earpieces
Lorgnettes
Goggles and sunglasses
Glasses in the Far East
Summary
Further reading
Chapter 47. Art and the eye
Abstract
Chapter Contents
El Greco (1541–1614)
The eyes of the Impressionists
Claude Monet (1840–1926)
Vincent van Gogh (1853–1890)
Edgar Degas (1834–1917)
Camille Pissarro (1830–1903)
Mary Cassatt (1844–1926)
Summary
Dedication
Further reading
Section 8: Role of Assistants in Eye Care
Chapter 48. Allied health personnel in ophthalmology
Abstract
Chapter Contents
Evolution of training and service requirements of allied health personnel
Divisions of ophthalmic medical personnel developing under the International Joint Commission of Allied Health Personnel in Ophthalmology
Education of ophthalmic medical personnel
Certification and training levels for ophthalmic medical personnel
Subspecialty certification fields for ophthalmic medical personnel in the International Joint Commission of Allied Health Personnel in Ophthalmology
Ophthalmic medical personnel allied with the International Joint Commission of Allied Health Personnel in Ophthalmology
Independent allied health personnel in visual science
The International Joint Commission of Allied Health Personnel in Ophthalmology certification process
The educational and certification history of the International Joint Commission of Allied Health Personnel in Ophthalmology
National organization of ophthalmic training and certification programs
National and international ophthalmologic societies
The future of allied health personnel in ophthalmology
References
Chapter 49. Ophthalmology ethics
Abstract
Chapter Contents
Introduction
Informed consent
Confidentiality
Truth telling
Boundary issues
Multiculturalism
Vulnerable populations
Pediatric ethics
Futility
Medical error
Impaired physicians and ophthalmic professionals
Resource allocation
Research ethics
Surgical innovation
Genetics ethics
Conflicts of interest
Advertising
Fee splitting
Medical industry
Cosmetic surgery
Refractive surgery
Trainees in patient care
Resolution of ethical dilemmas
Chapter 50. Allied ophthalmic health personnel: scope of practice
Abstract
Chapter Contents
Introduction
Defining scope of practice
Determining the scope of practice
Insurance risk and malpractice
Ethics and scope of practice
Summary
Further reading
References
Chapter 51. Testing and certification of ophthalmic skills
Abstract
Chapter Contents
Introduction
Knowledge-based examinations
Examination format and administration
Skill-based examinations
Value of certified allied ophthalmic personnel
Career advancement
Summary
References
Chapter 52. The development of allied ophthalmic personnel in North America and worldwide
Abstract
Chapter Contents
Introduction and history
Nature of the work
Future of ophthalmic assisting
Conclusion
References
Chapter 53. Ophthalmic assisting in the international community and in the prevention of blindness
Abstract
Chapter Contents
Introduction
VISION 2020: The Right to Sight
Latin America and the Caribbean
Sub-Saharan Africa
North Africa and the Middle East
South-East Asia
Western Pacific
Summary
In Remembrance
Acknowledgments
References
Chapter 54. Eye banking
Abstract
Chapter Contents
Introduction
The eye bank
Eye bank associations and medical standards
Ethics and guiding principles
References
Websites
Section 9: Atlas of Clinical Ophthalmic Disorders
Chapter 55. Atlas of common eye diseases and disorders
Abstract
References to Figures
Glossary
Appendices
Appendix 1. Ocular emergencies
Appendix 2. Following universal precautions
References
Appendix 3. Principles of informed consent
Contents of an informed consent document
Duty of disclosure
Material risks
Special and unusual risks
Consent
Exceptions
Failure to disclose
Appendix 4. Abbreviations and symbols in clinical use
Appendix 5. Optical constants of the eye
Appendix 6. Metric conversion (United States)
Appendix 7. Skill checklists
Skill checklists
Appendix 8. Translations of commonly asked questions and commands
Appendix 9. Office supplies in common use
Appendix 10. Estimating visual loss
Estimating loss of visual field
Estimating loss of muscle function
Appendix 11. Vision and driving
Visual acuity
Visual fields
Ocular muscle imbalance
Color blindness
Dark adaptation
Depth perception
Appendix 12. Diopters to millimeters of radius conversion tables
Appendix 13. Vertex conversion table
Appendix 14. Diopters of corneal refracting power to millimeters of radius of curvature,
Appendix 15. Compensation for effect of vertex distances when plus lens is moved away from the eye
Appendix 16. Compensation for effect of vertex distances when plus lens is moved toward the eye
Appendix 17. Dioptric curves for extended range of keratometer
Supplementary resources
Useful websites: Organizations
Useful websites: Health information
Ophthalmic allied health personnel accredited programs
Supplementary resources
Books, eBooks, downloadable PDFs, DVDs, CD-ROMs
Index

Life Sciences

Physical Sciences & Engineering

Social Sciences & Humanities

Health

The Ophthalmic Assistant

A Text for Allied and Associated Ophthalmic Personnel

Purchase options

Institutional subscription on ScienceDirect

Harold A. Stein

Raymond M. Stein

Melvin I. Freeman

Rebecca Stein