MAJLIS OPTIK MALAYSIA KEMENTERIAN KESIHATAN MALAYSIA

MODUL KURSUS KANTA LEKAP UNTUK JURUOPTIK BERDAFTAR

PEPERIKSAAN KANTA LEKAP DI BAWAH SEKSYEN 30(5) AKTA OPTIK 1991 (FORMAT PEPERIKSAAN TEORI DAN AMALI)

KANDUNGAN

1. Pengenalan (Introduction)

2. Objektif Kursus (Course objectives) & Hasil (Outcome)

3. Skop Kursus dan Penilaian (Scope Of The Course And Evaluation)

Lampiran 1

4. Borang Peperiksaan Preliminari (Preliminary Examination)

Lampiran 2

5. Borang Pemasangan Cubaan (Trial Fitting Form)

Lampiran 3

6. Borang Prosedur Pemeriksaan Pesakit Kanta Lekap (Examination Procedures For Contact Lens Patient)

Lampiran 4

MALAYSIAN OPTICAL COUNCIL MINISTRY OF HEALTH

CONTACT LENS COURSE FOR REGISTERED OPTICIANS

(KURSUS KANTA LEKAP BAGI JURUOPTIK BERDAFTAR)

1. INTRODUCTION

Registered Opticians have over the years been applying for permits to prescribe

contact lens as part of their practice. Their training and experience however

varies from practitioner to practitioner and it is difficult to monitor the quality of the

service provided. Hospital data shows that the incidence of contact lens related

ocular complications is significant and is a course for concern. Whilst the move is

to change the practice to allow only appropriately trained practitioner to prescribe

contact lens it is imperative upon the Malaysian Optical Council to ensure that

the remaining registered opticians who are eligible by law to prescribe contact

lens are properly trained.

It is recommended that prior to assessment the relevant professional bodies

conduct a course on contact lens that entails the prescribing, fitting, dispensing

and performing an aftercare examination of contact lens wearers for their

members.

Upon completion of the course the opticians will be invited to appear before the

Optic Council Evaluation Committee for an assessment of their competency in

contact lens practice.

2. COURSE OBJECTIVE

To prepare registered opticians eligible by law to prescribe, fit and dispense

contact lens safely

SPECIFIC OBJECTIVES:

2.1. To provide theoretical knowledge on the basic anatomy and physiology of

the eye with special reference to the eyelids, conjunctiva, cornea and the

tear film.

2.2. To provide basic knowledge on the disorders of the eyelids, conjunctiva,

cornea and the tear film and their recognition.

2.3. To provide basic knowledge on the optics of contact lens, types of

contact lens and indications for their use.

2.4. To provide the necessary knowledge on the proper prescribing, fitting,

dispensing and aftercare in contact lens practice.

2.5. To provide the necessary knowledge enabling contact lens practitioners

to detect common contact lens associated problems during an aftercare

examination and subsequent management (including early referral) of the

problem.

2.6. To provide knowledge on the setting up of a proper and safe contact lens

practice.

SPECIFIC OBJECTIVE 1

To provide theoretical knowledge on the basic anatomy and physiology of the

eye with special reference to the eyelids, conjunctiva, cornea and the tear

film.

Targets – Basic understanding of :

1. Anatomy of the eyelids, conjunctiva, cornea and the tear film.

2. Physiology of the eyelids, conjunctiva, cornea and the tear film.

SPECIFIC OBJECTIVE 2

To provide basic knowledge on the disorders of the eyelids, conjunctiva,

cornea and the tear film and their recognition.

Targets –

1. Basic understanding of common disorders affecting the eyelids,

conjunctiva, cornea and the tear film.

2. Demonstrate the ability to distinguish the difference between the

normal and abnormal structure of the eye.

3. Demonstrate the ability to recognise common disorders affecting the

eyelids, conjunctiva, cornea and the tear film.

4. Demonstrate the ability to perform specific techniques to assess tear

film function and corneal integrity. .e.g.: use of flourescein in the

assessment of tear film stability, Schirmer test, and diagnosis of

corneal abrasion.

SPECIFIC OBJECTIVE 3

To provide basic knowledge on the optics of contact lens, types of contact

lens and indications for their use and contact lens solutions.

Targets :

1. Basic understanding of contact lens optics

2. Acquired knowledge of the types of lens available in the market and

their indication for use.

3. Acquired knowledge on contact lens solutions and the proper care of

contact lenses

SPECIFIC OBJECTIVE 4

To provide the necessary knowledge on the proper prescribing, fitting,

dispensing and aftercare in contact lens practice.

Target: Competence in the performance/testing of :

1. Use the ophthalmic appliances associated with contact lens practice

e.g. keratometry and slit lamp biomicroscopy

2. Preparation/placement/removal of diagnostic contact lenses from the

eyes (include RGP, soft lenses and special design lenses like toric

lenses)

3. Assessment of optimal fit of contact lenses on the eyes and their

optical correction

4. Identifying normal physiological responses and abnormal corneal and

lid responses to contact lens wear

5. Identifying abnormal tear stability changes as results of lens wear

6. Use of different solutions for contact lens maintenance

7. Differential diagnosis for contact lens related eye problems

SPECIFIC OBJECTIVE 5

To provide knowledge on the setting up of proper and safe contact lens

practice.

Targets :

1. Demonstrate understanding of a proper contact lens practice that is

safe to practitioner and patients by having appropriate appliances such

as keratometer, slit lamp biomicroscope and diagnostic lenses for trial.

2. Demonstrate understanding on the level of hygiene required for proper

maintenance of contact lenses for office and patients use.

3. Acquired knowledge on a proper recording/recalling system for contact

lens patient.

3. OUTCOME

At the end of the course, participants would have:

3.1. Acquired knowledge basic anatomy and physiology of the eye in

particular the corneas and tears.

3.2. Acquire the necessary knowledge and skills to diagnose common

disorder affecting the anterior segment of the eye.

3.3. Acquired skills in the proper prescribing and fitting of contact lenses.

3.4. Acquired skills in the detection and management of contact lens

associated problem.

3.5. Be able to set up a proper contact lens practice and carry out contact

lenses examination and dispensing in a professional manner.

MALAYSIAN OPTICAL COUNCIL MINISTRY OF HEALTH MALAYSIA

LAMPIRAN 1

SCOPE OF CONTACT LENS COURSE AND EVALUATION 1.1 Background

A. Basic Anatomy & Physiology of the eye.

i) Cornea ii) Conjunctiva iii) Eyelids iv) Tear film

B. Physical properties of Contact lens Material

i) Lens type (Hard, RGP, Soft, and Silicone) ii) Lens design iii) Oxygen permeability iv) Water content v) Oxygen transmissibility vi) Durability vii) Deposits & scratch resistance viii)Rigidity & flexibility

1.2. Instrumentation

Type of instrument required in Contact Lens Fitting

i) Slit Lamp ii) Keratometer iii) Radiuscope

1.3. Consulting room procedures and equipment

i) Hygienic procedures to avoid cross-infection. ii) Decontamination and disinfecting of trial lenses.

1.4. Preliminary considerations and examination.

i) Discussion with patient ii) Indications and contraindications iii) Advantages and disadvantages of Contact Lens compared with

spectacles

iv) External eye examination v) Assessment of tears & lids characteristics vi) Patient Suitability for lens types (base on diagnosis) vii) Advantages and disadvantages of lens type.

1.5. Contact Lens Fitting Protocol

i) Refraction ii) Measurement of ocular dimensions (keratometer, corneal & pupil

size) iii) Trial fitting; Lens Selection

a. Base Curve b. Lens Diameter (HVID +2mm SCL, HVID-2mm RGP) c. (iii)Centre thickness d. (iv)Water content e. (v) Lens type (spherical/toric) f. Back Vertex Power (BVP)

iv) Fitting Assessment for soft lenses & rigid gas permeable lenses. Able to identify loose, tight, flat or steep fitting using:

a. Slit lamp b. Fluorescein dye pattern for RGP

v) Documentation & specification of contact lens after fitting of contact lens

1.6. Contact lens dispensing/delivery to patient

i) Information of the lens care regimen ii) Type of solutions & disinfecting regimen for different types of contact

lenses & components of solutions e.g. preservatives iii) Insertion & removal technique iv) Information on adaptation v) Information on suggested wearing schedule vi) Information on signs of complication vii) Advice on contact lens wear: Do’s & Don’ts viii) After care visit schedule

1.7. Aftercare

i) Initial discussion/investigate problems & complaints ii) Visual acuity and over-refraction iii) Slit lamp examination iv) Assessment of contact lens fitting v) Assess contact lens condition vi) Review method of insertion & removal vii) Review lens care regimen

1.8 Contact lens wear problems & solutions:

i) Skill to differentiate between contact lens and non contact lens emergencies

ii) Management of non contact lens emergencies e.g. deposits on contact lenses, discomfort

iii) Identify cases that need referral to ophthalmologists iv) Common contact lenses associated problem

II. PRACTICAL

1. Scope

i) Assessment of Rigid Gas Permeable Contact Lens ii) Assessment of Soft Contact Lens iii) Soft Contact Lens Aftercare examination iv) Rigid Gas Permeable Lens Aftercare examination v) Skills in anterior segment examination - Keratometry and Slit-Lamp

biomicroscopy.

III. EVALUATION FORMAT

Enclose is a copy of Evaluation Format which has been endorsed by the Council.

LAMPIRAN 2

PEPERIKSAAN KANTA LEKAP

MAJLIS OPTIK MALAYSIA

SEKSYEN 30

PEPERIKSAAN PRELIMINARI (PRELIMINARY EXAMINATION)

Nama pesakit____________________________________ Tarikh ____________

Tarikh lahir ______________ No rekod ____________

SIMPTOM UTAMA : (CHIEF SYMPTOM)

RIWAYAT OKULAR: (OCULAR HISTORY)

KESIHATAN UMUM/PENGUBATAN: (GENERAL HEALTH/MEDICATION)

UJIAN ENTRANS (ENTRANCE TEST)

Ujian

penglihatan (Vision test)

MATA KANAN (RIGHT EYE)

Lubang pin: (pinhole)

MATA KIRI (LEFT EYE)

Lubang pin:

(pinhole)

Tanpa bantu (unaided)

Dibantu (aided)

Tanpa bantu (unaided)

Dibantu (aided)

Jauh (distance)

Dekat (near)

Jauh (distance)

Dekat (near)

Jauh (distance)

Dekat (near)

Jauh (distance)

Dekat (near)

Ujian

Hirschberg (Hirschberg

test)

Ujian

katup (cover test)

Reaksi

pupil (pupil

reaction)

Rx cermin

mata (spectacles Rx)

PEMERHATIAN UMUM (GENERAL OBSERVATION)

PEMERIKSAAN LUAR MATA (EXTERNAL EYES EXAMINATION)

PEMERIKSAAN BIOMIKROSKOP (BIOMICROSCOPY EXAMINATION)

KELOPAK MATA &

KONJUNKTIVA (EYELIDS & CONJUNCTIVA)

AIR MATA PRA KORNEA (PRECORNEAL TEAR)

KORNEA (CORNEA)

KANTA KRISTALIN (CRYSTALLINE LENS)

CAMBER ANTERIOR (ANTERIOR CHAMBER)

IRIS (IRIS)

UJIAN VAN HERICK (VAN HERRICK TEST )

PEMERIKSAAN REFRAKSI (REFRACTION EXAMINATION)

KERATOMETRI (KERATOMETRY)

K1:

K2:

K1:

K2:

RETINOSKOPI (RETINOSCOPY)

VA

VA

REFRAKSI SUBJEKTIF (SUBJECTIVE REFRACTION)

VA

VA

AMPLITUD AKOMODASI (ACCOMMODATIVE AMPLITUDE)

TAMBAHAN DEKAT (NEAR ADDITION)

____________________

SASARAN(TARGET):

____________ @________ cm

______________________

SASARAN(TARGET):

____________ @________ cm

PENILAIAN BINOKULAR (BINOCULAR ASSESSMENT)

UJIAN KATUP (COVER TEST)

JAUH: (DISTANCE) DEKAT: (NEAR)

FORIA JAUH (DISTANCE

PHORIA)

HORIZONTAL:

VERTIKAL:

RADAS(APPARATUS):

FORIA

DEKAT (NEAR PHORIA)

HORIZONTAL:

VERTIKAL:

RADAS(APPARATUS):

NISBAH

AC/A (AC/A RATIO)

RX AKHIR (FINAL RX)

MATA KANAN (RIGHT EYE)

VA MATA KIRI

(LEFT EYE)

VA

CALON(CANDIDATE)

NAMA :____________________________

T/TANGAN:____________________________

TARIKH :____________________________

PEMERIKSA(EXAMINER)

NAMA :___________________________

T/TANGAN:___________________________

TARIKH :___________________________

BORANG PEMASANGAN CUBAAN (TRIAL FITTING FORM)

NAMA:_____________________TARIKH:_________PEMERIKSA:_______________ (NAME) (DATE) (EXAMINER)

PEMBOLEHUBAH

PENILAIAN

(ASSESSMENT VARIABLES)

BOZR

ALIGNMENT ALIGNMENT

Mata (Eye) Kanan (Right) Kiri (Left)

Bacaan Keratometri (Keratometry reading)

_____D@____ _____D@____

Low K radius________mm

_____D@____ _____D@____

Low K radius___ _____mm

Rx cermin mata (Spectacles Rx)

_____DS______DC x______

______DS_____DC x______

HVID

_________mm

________mm

Pemeriksaan mata

asas (Baseline Eye Check)

Konjunktiva (Conjunctiva)

Slightly red staining

Kornea (Cornea)

(clear) (staining)

Konjunktiva (Conjunctiva)

(clear) (staining)

Kornea (Cornea)

(clear) (staining)

Kanta cubaan

(Trial Lens):

__________________

Bahan(Material):

__________________

BOZR __________mm

Kuasa(Power) __________mm

Diameter kanta __________mm (Lens diameter)

BOZR __________mm

Kuasa(Power) __________mm

Diameter kanta __________mm (Lens diameter)

Penilaian Pemasangan Kanta (Lens Fit Assessment)

Sentrasi (Centration)

Horizontal __________mm

(nasal/temporal)

Vertikal __________mm

(superior/inferior)

Horizontal __________mm

(nasal/temporal)

Vertikal __________mm

(superior/inferior)

Pergerakan dengan

kelip mata (Movement with Blink)

mm

mm

Pergerakan Movement

lancar tersekat-sekat

(smooth) (jerky)

putaran apeks(apical rotation)

lancar tersekat-sekat

(smooth) (jerky)

putaran apeks(apical rotation)

Laju pergerakan (Speed of Movement)

cepat(fast) sederhana(average)

perlahan(slow)

cepat(fast) sederhana(average)

perlahan(slow)

Kestabilan (Stability)

Jika tidak, sila terangkan

(If no, please explain)

ya (yes) tidak(no) Jika tidak, sila terangkan

(If no, please explain)

ya(yes) tidak(no)

LAMPIRAN 3

Corak floresin pusat

(Central Fluorescein

Pattern)

takung(pooling) optimum

(optimum)

sentuh(touch)

takung(pooling) optimum

(optimum)

sentuh(touch)

Corak floresin

tengah-periferi Mid-peripheral Fluorescein

Pattern)

takung(pooling) optimum

(optimum)

sentuhan tipis(narrow touch)

takung(pooling) optimum

(optimum)

sentuhan tipis(narrow touch)

Kelegaan pinggir

kanta (Edge Clearance)

rendah(low) sederhana(average)

tinggi (high)

rendah(low) sederhana(average)

tinggi(high)

Kelas pemasangan (Fit Classification)

longgar(flat) ketat(steep)

optimum(optimum)

terima(accept) tolak(reject)

longgar(flat) ketat(steep)

optimum(optimum)

terima(accept) tolak(reject)

Refraksi dengan kanta

lekap(Over refraction)

________DS VA________

________DS VA________

Rx kanta lekap akhir (Final Rx)

________DS_______DCx_______

VA_______

________DS_______DCx_______

VA_______

Jika ditolak, apakah

tindakan seterusnya

untuk mendapatkan

pemasangan yang

optimum? (If rejected, what can be

improved?)

Tahap keselesaan

pesakit selepas 15

minit (Patient Comfort Rating after

15 minutes)

Selesa (Comfortable)

Tidak selesa (uncomfortable)

Tidak diterima (unacceptable)

Selesa (Comfortable)

Tidak selesa (uncomfortable)

Tidak diterima (unacceptable)

Soalan. Adakah terdapat perbezaan diantara pemasangan kanta mata kanan dan mata kiri?

Nyatakan sebab-sebab bagi jawapan anda. (Question. Is there any difference in lens fit between the right and left eyes? State the reasons for your answer.

Prosedur Pemeriksaan Pesakit Kanta Lekap

(Examination Procedures for Contact lens Patients)

Pesakit (Patient) ______________________________________________________________

Tarikh (Date) _______________________

Sejarah WT hari ini Jam (History WT today) _________________________ (hours)

WT biasa Jam (usual WT) ___________________________ (hours)

Nama kanta (Lens Name)

RE_____________________________

LE__________________________________

Sistem Jagaan (Care System)

_______________________________________________

Pematuhan (compliance) _____________________________________

Enzim (Enzyme)

_______________________________

Kekerapan (how often) _______________________________

Kali terakhir guna (Last used)?

__________________________

Penglihatan

(Vision) Keselesaan

(Comfort)

Masuk / Keluar (Insertion/Removal)

Lain-lain (others)

Usia kanta RE_______bln/th

(Lens age) LE_______bln/th

Aduan utama: (Chief complaint)

Perubahan kesihatan?/ubatan?/alahan? (Change in health?/medication?/allergies) ___________________________________________________________________

Pakai kanta (with lenses on)

RE

LE

Akuiti Visual (Visual acuity)

6/

Near:

6/

Near:

Retinoskopi (retinoscopy)

_________________________

6/

__________________________

6/

Refraksi dengan kanta lekap(Over-Rx)

_________________________

6/

__________________________

6/

Muka depan keratometri (Front Surface keratometry)

K1:____________D @_______

K2:____________D @_______

K1:________________D @ ________

K2:________________D @ ________

Penampilan mire [Mire appearance (SCL)]

Sebelum kelip (Before Blink) ___________________________

Selepas Kelip (After blink) ___________________________

Sebelum kelip (Before blink)____________________________

Selepas Kelip (After blink) ___________________________

Lag

RGP Posisi

Kornea (Cornea)

Posisi

Kornea (Cornea)

SCL

Gaze Tegak Ke depan (Straight Ahead Gaze)

________________________mm

____________________________mm

Gaze Atas (Up Gaze)

________________________mm

____________________________mm

WT=Masa Pakai (Wearing Time); bln = bulan; th = tahun

LAMPIRAN 4

Biomikroskopi (biomicroscopy) Tandakan: takik,koyak,calar,deposit (Indicate: nicks, tears,scratches,deposits)

Kanta (Lens) Kanta (Lens)

Corak Floresin (RGP) [Fluorescein Pattern (RGP)] Tengah (centre) Spara-periferi (mid-periphery)

Pinggir (Edge)

Kanta(lens) Kanta(Lens)

Tanpa Kanta( With Lenses Off)

Kekunci gred(Grade keys): ): 0-tiada (nil) 1-sedikit kesan (trace) 2-sedikit (mild) 3-sederhana (moderate) 4-parah (severe)

PEMERIKSAAN LAMPU CELAH (SLIT LAMP EXAMINATION)

RE LE

Tiada(Absent)

Ada(Present)

Tiada(Absent)

Ada(Present)

Gred(Grade)

0

1

2

3

4 Striae Kornea

(Corneal striae)

Gred(Grade)

0

1

2

3

4

Gred(Grade)

0

1

2

3

4 Edema kornea

(Corneal Oedema)

Gred(Grade)

0

1

2

3

4

Gred(Grade)

0

1

2

3

4 Neovaskularisasi kornea

(Corneal Neovascularization)

Gred(Grade)

0

1

2

3

4

Gred(Grade)

0

1

2

3

4 Staining pukul 3 dan 9

(3 and/or 9 O’clock Staining)

Gred(Grade)

0

1

2

3

4

Gred(Grade)

0

1

2

3

4 Staining Kornea lain

(Other Corneal Staining)

Gred(Grade)

0

1

2

3

4

Gred(Grade)

0

1

2

3

4 Mikrosis epitelia

(Epithelial Microcyst)

Gred(Grade)

0

1

2

3

4

Gred(Grade)

0

1

2

3

4 Kemerahan Limbal (Limbal Injection)

Gred(Grade)

0

1

2

3

4

Gred(Grade)

0

1

2

3

4 Kemerahan Bulbar

(Bulbar Injection)

Gred(Grade)

0

1

2

3

4

Gred(Grade)

0

1

2

3

4 Kemosis

(Chemosis)

Gred(Grade)

0

1

2

3

4

Gred(Grade)

0

1

2

3

4 Keabnormal Konjunctiva Tarsal

(Tarsal Conjunctival Abnormalities)

Gred(Grade)

0

1

2

3

4

Arahan: Jika keabnormalan hadir, tunjukkan sebab dengan tandakan (X) pada kotak yang berkenaan dan catat kedudukannya pada rajah berikut Instruction : If Abnormalities are present, indicate cause (s) by ticking (X)at the appropriate box (es) and note location in diagram below

Ada (present)

Tiada (Absent)

Komen jika ada (Comment if any)

Ada (present)

Tiada (Absent)

Komen jika ada (Comment if any)

1.Blefaritis

(Blepharitis)

2.Infiltrat Kornea

(Corneal Infiltrates)

3.Bebola Musin

(Mucin Ball)

4.Iritis

(Iritis)

5.Ulser Kornea

(Corneal Ulcer)

6.Lain-lain, jelaskan

(GPC, mata kering etc.)

Others, explained

(GPC, dry eye, etc.)

Komen dan Ujian Tambahan (eg Ujian untuk mata kering: BUT, Schirmer)

Comments and Additional Tests (eg. Test for Dry Eye : BUT, Shirmer)

Keratometri (Keratometry)

K1_______________D @_______________

K2_______________D @_______________

K1___________________D @___________

K2___________________D @___________

Retinoskopi (Retinoscopy)

6/

6/

Subjektif (Subjective)

6/

6/

Verifikasi kanta guna radiuskop(pilihan) [Verification of Lenses using radiuscope (Optional)]

Pemeriksaan teliti kanta (Inspection of Lenses)

Ringkasan Penilaian Lawatan [Summary of Visit Assessment (problem)]

Rangka tindakan (Plan)

Panggil semula 3 bulan / 6 bulan / setahun (Recall 3 months/6 months/yearly)

Modifikasi (Modification)

Nama

BOZR

Diameter total

BVP

Lain-lain

Calon: (Candidate)

Pemeriksa: (Examiner)