final draft curriculum refractionist nurse 2012 seiha ... · global initiative for the elimination...

$: Final Draft Curriculum Refractionist Nurse 2012 Seiha ... · Global Initiative for the elimination of Blindness by the year 2020, VISION 2020 “the Right to Sight” in 1999. One$

ForewordForewordForewordForeword

Human Resource Development is the top priority of the Ministry of Health to

strengthen health care for Cambodian people. The Ministry of Health had supported the

Global Initiative for the elimination of Blindness by the year 2020, VISION 2020

“the Right to Sight” in 1999. One of the important components of VISION 2020 is refractive

Errors which is remain one of the main cause of blindness and visual impairment of people

at all ages.

The National Health Strategic Plan (2008-2015) of the Ministry of Health has given

high priority for upgrading skills and knowledge of health personnel in order to improve the

quality of work at hospital and health centers.

The National Program for Eye Health of the Ministry of Health has developed the

curriculum for the training of Refractionist Nurse to be able working in eye units of referral

Hospital throughout the country. After the course, the trainees will be able to provide basic

refraction service to meet the Global Initiatives and the Ministry of Health policy for

blindness prevention and eyes health. The curriculum for refractionist Nurse covers

appropriate competency for caring and improving the patients who have eye problem.

As there is a shortage of ophthalmic nurses generally, the training in refraction will

be extended to general nurses. It is therefore necessary to develop and expand the

curriculum for training of refractionist nurses to 6 months to accommodate general nurses.

Taking this opportunity the Ministry of Health expresses its sincere appreciation to

the working group for their hard working and contribution to the development of this

curriculum.

The ministry of Health believes that Curriculum for Refractionist Nurse Program will

bring along beneficiaries for people in the whole country who in need of refraction service

for their daily work and activities.

Phnom Penh,.................................

P a g e | iii

THIS CURRICULUM IS PREPARED BY THE FOLLOWING WORKING GROUP MEMBER

1- Prof. NGY MENG (NPEH)- Chairman

2- Asst.Prof. Do Seiha (NPEH) - Member

3- Asst.Prof. Sun Sarin (NPEH) -Member

4- Asst.Prof. Mar Amarin (NPEH) –Member

5- Dr. Sau Sokun Vary ( NPEH)- Member

6- Ms. Seng Sophal (NPEH) -Member

7- MA. Pheng Visoth (MoH) -Member

8- Mr. Prak Borei (Battambang)- Member

9- Mr. Nol Rothna (Takeo)- Member

10- Mr. Chea Seila ( ICEE )- Member

11- Mr. Horm Piseth ( FHF)- Member

12- Mr. Teakh Tath ( FHF )- Member

13- Mr. Sok Sen Alay ( FHF )- Member

14- Ms. Sokhom Vongsovannary Secretary

P a g e | iv

TABLE OF CONTENTS Page No

Introduction...................................................................................................................... 1

Objectives......................................................................................................................... 1

Job Description................................................................................................................. 1

Management Committee.................................................................................................. 2

Candidate Selection Criteria............................................................................................. 2

Trainers............................................................................................................................. 2

Course Duration............................................................................................................... 3

Course Venue.................................................................................................................... 3

Course Content................................................................................................................. 3

Evaluation Criteria............................................................................................................ 3

Education Standards......................................................................................................... 3

Standard Care …………….................................................................................................... 4

Modules........................................................................................................................... 12

Refractionist Nurse Training Curriculum Structure.......................................................... 25

Time Table........................................................................................................................ 29

Reference ........................................................................................................................ 32

National Refractionist Training Curriculum 2013-2017 P a g e | 1

I- Introduction

The blindness prevention programme in Cambodia has started since 1995 which aims to provide basic

eye care service in each region of Cambodia and to reduce blindness prevalence to less 0.5 % by the

year 2005 by the establishment of National Eye Care System Network development throughout the

country .This include Human Resource, Facility development, mobilization of national and

international resources as well as eye disease control 1.

After 12 years of implementation of National Action Plan for Blindness control, there were a lot of

achievement achieved in terms of the Overall Prevalence of Blindness has been declined. However,

the Cambodian Rapid assessment of Avoidable Blindness ( RAAB ) in 2007 revealed 2.8 % of blindness

of people age 50 and over and the prevalence of severe visual impairment is almost triple of

blindness rate , are caused by Cataract followed by Refractive Errors 2.

To tackle the above issue there is a need for medical personnel to train in Refraction and be able to

provide proper correction for patients at all ages. Persons are suitable for this important training are

those who had already trained as an ophthalmic nurse and currently employed at the eye unit/

hospital throughout the Country.

However as there is a shortage of ophthalmic nurses generally, the training in refraction will be

extended to general nurses. It is therefore necessary to develop and expand the curriculum for

training of refractionist nurses to 6 months to accommodate general nurses. It is proposed that the

new Nurse Refractionists Course be divided into 2 sections. Part 1 will encompass components of

ophthalmological nursing topics in preparation for Part 2, which will be an updated and expanded

version of the existing 3 month nurse refractionists curriculum. General nurses will be required to

complete Part 1 successfully before embarking on Part 2, and ophthalmic nurses will be eligible to

enrol directly into Part 2 of the new Nurse Refractionists Course.

II- Objective of training

To have knowledge of refractive error and perform appropriate refraction techniques to provide

suitable spectacle correction for patients.

III- Title : Refractionist Nurse

IV- Job description

1- To perform appropriate tests for assessment of eye coordination and binocular vision.

1 National Strategic Plan for Blindness Prevention and Control 2008-2015

2 Do Seiha et al Rapid Assessment of Avoidable Blindness in Cambodia 2007


2- To perform appropriate to take child’s vision and vision screening for schools

3- To perform an advanced refraction techniques

4- To assess correctly the presence of low vision in patients and have knowledge of its

management

5- To understand and interpret a spectacle prescription and accurately measure the power of

a spectacle lens

6- To have knowledge of the difference ophthalmic lenses and frames

7- To fit lenses, frames and optical devices correctly for patients requiring optical correction

8- To manage a refraction clinic and spectacle supply effectively

9- To provide eye health care education for patient

10- To conduct Vision screening in rural communities

11- To Provide Basic Eye Management for common eye problem and refer

V- Management Committee

Management committee is a joint collaboration and made up by

• The Ministry of Health

• The National Program for Eye Health

• Ophthalmological Society of Cambodian

• The Cambodian Optometry Society

• The Cambodian Ophthalmic Nurse Association

• The Fred Hollows Foundation

• The International Centre for Eyecare Education

The management committee are composing of the following:

• Director of Training

• Training Coordinator

• Training Secretary

VI- Candidates Selection Criteria : Part I and Part II

Part I and Part II : Graduate General Nurse

Part II : Ophthalmic Nurse

VII- Trainers

- Local Trainer : An experience Refractionist Nurse Trainer, ophthalmic nurse trainer and

Ophthalmologist with proven skills and experience in the teaching subjects, recognized by

MoH, the Cambodian Ophthalmological Society ( COS ).


- Expatriate Lectures : An expatriate ophthalmologist/ Optometrist/ Ophthalmic Nurse with

an internationally recognized qualification, with a minimum of 5 years experience and

proven teaching skills.

VIII- Course Duration : 6 months

( Part I take 3 Months, Part II take 3 months )

IX- Course Venue : National Program for Eye Health/ Dept. Ophthalmology

X- Course Content

During the study the candidate will full time attend teaching sessions. The teaching methods will

follow a problem oriented approach, divided in modules. The teaching will be done in two parts

1- Basic Ophthalmology :

a. Anatomy, Physiology of the eye,

b. Common Eye Condition

c. Nursing Management of Eye Conditions

d. Community Ophthalmology

2- Refraction

a. Basic Optic, Ophthalmic Lenses ,

b. All types of Refractive Errors ,

c. refraction techniques ,

d. Prescribing spectacles ,

e. Frame and Lens selection & materials

f. Fitting and edging of spectacles

g. Outreach and Vision Screening in Provinces.

These will be supplemented by lectures, tutorials and practical in the Eye Hospital.

XI- Evaluation Criteria

Pre training evaluation test will be conducted; Mid-term evaluation and Final Assessment will be done

at the end of the Training. Theoretical and Practical assessment will be conducted for trainees.

Trainees are required to clinically manage a minimum of 40 patients independently. A logbook of

patients seen should be kept and presented for examination at the end of the course.

XII- Education Standards 1- ATTITUDE AND RESPONSIBILITY

Passing Rate :

Theorical : 40%

Practice : 60%

Passing : 65 %


STANDARD CARE

ATTITUDE AND RESPOSIBILITY

STANDARD OF CARE COMPETENCY

Any form of visual assessment should be

carried out in a manner of competency

and thoroughness in accordance with the

Standards of Care for eye care personnel

� Exhibit awareness and understanding of Standards of Care

� Perform all specific duties in accordance with Standards of

Care

All persons are equally entitled to

comprehensive visual assessment and the

provision of appropriate eye care where

indicated

� Treat all persons equally

� Provide services only where necessary for the eye care of the

person or when initiated by the person

� Hold interests and well-being of those requiring eye care

ahead of self-interest

� Advise of the service of affordable or subsidised eye care

schemes where available

� Provide appropriate community eye care services

Individual eye care personnel are

expected to perform their duties without

the need for supervision, but in

cooperation with other eye care providers

and health workers in order to provide

the best care possible

� Perform duties independently and conscientiously

� Consider consequences of actions and advice and accept

responsibility for own actions

� Seek advice from other health care personnel and refer where

necessary

� Work as part of a team

� Demonstrate awareness of the roles of other healthcare staff

Eyecare personnel should satisfactorily

maintain the workspace and equipment

required to perform their duties and

ensure the availability of sufficient

resources for the provision of necessary

eye care

� Ensure safety, cleanliness and general order of workspace

environment

� Maintain equipment in a safe, accurate, working state

� Maintain an inventory (perform regular stocktaking and

ordering) to ensure availability of adequate resources

� Perform monitoring and administrative duties as required for

reporting of eye unit activities


CASE HISTORY


All persons are entitled to a comprehensive

case history in order to provide care

appropriate for the visual and general

health status of the individual, as well as

assessing specific visual requirements

� Exhibit appropriate attitude for creation of comfortable and

effective interaction with person.

� Communicate effectively whilst providing a comfortable

environment with consideration of the cultural, physical,

intellectual, and emotional background of the person

� Apply suitable questioning techniques for obtaining required

information in the most effective manner

• Demonstrate a structured approach for acquiring the relevant

information

� Obtain general personal details as well as specifics relating to

reason for vision examination and visual demands

� Obtain relevant detail relating to previous visual history and

general health information

� Maintain organised, clear and understandable written

summary of gathered case history data


MEASURING VISION


Visual acuity measurement should be carried out on all persons as the initial testing procedure in the assessment process

� Implement required conditions for the accurate measurement

of both distance and near visual acuity

� Consider chart type according to individual ability and

understanding

� Provide clear and concise testing instructions for optimal

understanding as well as efficiency of acuity assessment

� Apply good observational skills to ensure accuracy of

measurement

� Demonstrate correct procedural process, with consideration

of current spectacle correction if applicable

� Perform overall procedure in the most efficient and thorough

manner possible

� Record clear and accurate visual acuity measurement,

indicating presence of optical correction where valid

All persons with presenting distance visual acuity of 6/9 or worse in either eye shall be provided with subsequent pinhole visual acuity assessment

� Consider requirement for further visual acuity measurement

with pinhole based on initial assessment

� Demonstrate correct testing technique, including clear and

concise instructions, and record results appropriately

� Understand and interpret significance of information

obtained, and implement appropriate management

A recordable gross measure of vision should be elicited in the situation where poor vision prevents a chart visual acuity measurement

� Perform correct additional visual acuity testing technique with

consideration of the vision level of the individual

� Apply standard recording procedure


ASSESSMENT OF REFRACTIVE ERROR AND PRESBYOPIA


Prior to assessment of refractive error and

presbyopia, it should be ensured that all

persons have undergone preceding ocular

health assessment by appropriately

trained personnel, and all inflammatory

anterior eye health problems treated and

inactive

� Ensure eye health examinations undertaken previously

through relevant questioning in original case history

� Consider appropriateness of provision of refraction based on

presence or absence of prior eye health examination, and

general anterior eye observation

Those with presenting distance visual

acuity of worse than 6/6 in either eye and

a subsequent pinhole visual acuity of 6/12

or better should undergo refraction

� Consider requirement for refractive error assessment based

on case history and visual acuity information

� Perform both objective and subjective refraction techniques

in the correct manner in order to elicit an accurate

measurement of refractive error

� Apply logical progression of refraction methods

� Provide clear and concise explanation and testing instructions

for understanding and efficiency

� Apply good observational skills to ensure accuracy of

measurement

� Record final measurement of refractive error clearly with

indication of best corrected distance visual acuity

All children under 15 years of age should

be provided with a cycloplegic refraction

(where refraction is indicated by

presenting and pinhole visual acuity) in

the presence of:

- Suspected hyperopia

- Fluctuating accommodation

- Unreliable verbal feedback

- Convergent strabismus

� Consider requirement for cycloplegia based on age, case

history information, initial refraction results (objective and

subjective), and binocular vision status

� Perform required preliminary testing to ensure suitability of

use of cycloplegic agent

� Provide clear and understandable explanation of the

requirement for, actions of, and expected effects of

cyclopegia

� Perform both objective and subjective cycloplegic refraction

techniques in the correct manner in order to elicit an accurate

measurement of refractive error

� Record measurement of refractive error with indication of

presence of cycloplegia

� Demonstrate knowledge of adverse side-effects of cycloplegic

agents, and implement appropriate management if required

� Arrange follow-up non-cycloplegic refraction if required


All persons over 40 years of age

(presbyopes) should be assessed for the

requirement of near vision optical

correction

� Consider requirement for presbyopic near vision spectacles

based on age of person and individual visual demands

� Determine presbyopic reading addition with consideration of

age-related guides, distance and near visual acuities, and

required working distance

� Record final reading addition or full near vision correction and

best corrected near visual acuity

� Understand significance of best corrected near visual acuity

and implement appropriate management where required

PRESCRIBING SPECTACLES


When finalising a distance spectacle

prescription, individual requirements,

previous spectacle prescription,

improvement in visual acuity, type and

magnitude of refractive error, and

conditions of testing should all be

considered.

� Ensure need and willingness for distance spectacle

correction according to the individual

� Consider necessity for correction of small amounts of

hyperopia, myopia or astigmatism

� Explain clearly if spectacles NOT required

� Consider difference in refractive error between eyes

� Ensure adequate improvement in vision with new spectacles

where presence of existing optical correction

� Adjust measurement of refractive error appropriately in the

case of cycloplegic assessment, including consideration of

binocular vision status

When finalising a presbyopic near addition,

or near vision lens, general consideration

of individual near vision demands, previous

near vision spectacle lens power, and

improvement in visual acuity should be

made.

� Ensure need and willingness for near vision correction

according to the individual

� Explain clearly if spectacles NOT required

� Regard required working distance of the individual

� Provide demonstration of affect of the near vision lens

� Explain advantages and disadvantages of bifocal and

multifocal lens types

� Allow comparison and choice between current and new near

vision lens powers where required


Where spectacles are prescribed, all

information required for the accurate

dispensing of optical correction best suited

to the individual should be clearly provided

• Record date of examination and personal identification

details correctly

• Record prescription accurately, with clear indication of lens

type and mode of wear

• Obtain and accurately record individual measurements

necessary for spectacle dispensing

• Signs prescription with legible personal identification and

qualification

Provision of readymade spectacles should

be considered as a viable, affordable form

of vision correction for persons with

suitable refractive error and made

available where indicated

• Considers provision of readymade spectacles as option of

optical correction

• Ensures suitability of readymade spectacles for individual

based on refractive error status, frame size, and

interpupillary distance

• Provides choice between made-to-order and readymade

spectacle correction

• Maintains an affordable supply of readymade spectacles

based on population needs

A person for which spectacle correction is

prescribed must be well informed about

their requirement for spectacles, and their

visual state monitored appropriately

• Provide clear and understandable explanation to the

individual as to their refractive state, and when spectacles

should be worn

• Ensure awareness of benefits of optical correction

• Explain requirement for monitoring and re-examination, and

implement as stated

ESTABLISHING REFRACTION CLINIC


To make sure that the refraction clinic is

function well and provides a good service

to patient who have eye problems.

• The operating and closing times of the clinic must be

displayed on a sign on the front door of the clinic.

• The eye care practitioner must be at the clinic 15 minutes

before the opening times to make sure that they are ready to

see patients as soon as the clinic opens.

• Te clinic must close and open at the stated time

• The clinic must be clear and tidy in all areas includes: Waiting

room, examination room, dispensing room, in toilet area

must have soap for washing hand, cleaning activities must be

done daily.

• All equipment must be return to its correct place at the end

of each day.

• All equipment must turn off, wipe down and covered with

dust-protectors at the end of the day.

• All patient records cards must be filed in alphabetically in a


storage cupboard at the end of each day.

• All stationery must be stored in a storage cupboard at the

end of each day.

• At the end of each week, all clinic room must have their stock

checked and re-ordered when necessary.

• When you sell spectacle, you must give a receipt to the

patient, and you must keep a copy of the receipt in the

receipt book.

• A set amount of the money must be kept in a safety box;

when selling spectacle the money must be kept in a safety

box immediately.

• All the time and all the money must be locked in the safe box

and storage in the cupboard.

Good hygiene must be maintained

throughout the clinic to have a safe

working environment. Refraction clinic is a

health clinic so it is important to prevent

the spread of disease to people who are

having their eyes examined and staff who

work in the clinic.

• All eye care practitioners must wear neatly in clean clothes

and must be well groomed. Finger nails must be kept short,

hair must be clean and tied up if it is too long and shoes must

be worn at all times.

• Eye care practitioners must be wash their hands with

antiseptic soap before and after examining every patient’s

eyes.

• Equipment must be wiped down with alcohol swabs between

each eye examination.

• All waste from the clinic must be put into the allocated

rubbish bins-all internal rubbish must be lined with plastic

rubbish bags.

OPHTHALMIC NURSE COMPETENCY


Attend to ophthalmic patients in Out

Patient Department (OPD)

• Registration of patients

• Patients history taking

• Visual Acuity taking

The Ophthalmic Nurse must be able

to: Perform Eye examinations

• External eye examination (Eyebrow, Eye lid, Eye lashes,

Conjunctiva, Sclera and cornea)

• Internal examination (anterior chamber, iris, pupil, lens)

• Fundus examination (check the red reflex by direct

ophthalmoscope)

• Take Intra ocular pressure

• Color vision test


Perform Nursing procedures

• Epilation of eye lashes

• Remove skin suture

• Remove superficial foreign bodies from conjunctiva

(bulbar, fornix) cornea.

• Inserting and removing prostheses (artificial eye)

• Removal of concretion

• Applying eye bandage

• Eye swabbing and padding

• Application of eye ointment.

• Instill eye drops.

• Irrigating of the eye (chemical burn)

Performed coordinated function:

Community Ophthalmology. Together

with an Ophthalmologist in the Eye

Unit or Eye hospital plan and organize

outreach program by conducting: Eye

screening in the health center and

school children.

• Increase awareness of eye care through advertisement

an promotion.

• Decide on when to refer patients with ophthalmic

problem.

• Networking and linkage with other health care centers

for safe and continuous delivery of eye care.

• General concept of vision 2020

• Plan health education / Healthy eye promotion


PART I

Module 1 : General professional nursing knowledge (35 hours , 1 Week )

Learning Objective Time Learning contents Teaching and Learning

Methods

Teaching Aids and

Materials

Assessment

At the end of this module the

trainee will be able to:

� Discuss nurse’s attitude to

work and role

� Describe the code of

conduct in Ethics of

nursing practice

� Discuss the historical

perspective in leadership

and management and its

influence on nursing

management

� Demonstrate awareness of

communication skill,

motivation, conflict

management, and

management of group or

the team as they relate to

nursing leadership and

management

35 hours

1 week

� Nursing Ethics

� Leadership

management

� Roles and functions of

planning

� Roles and functions in

organizing


staffing


directing


controlling

� Lectures/Discussion

� Workshop/(Role

playing)

� Group discussion

and reporting

� Handouts

� Papers/pen

� Visual aids

� Projector/power

point/laptop

computer

� Oral and

written

examination

� Observation

on attitudes

and

behaviour


Module 2 : Basic Science (General Ophthalmology) (70 hours, 2 Weeks)

Learning Objective Time Learning contents Teaching and

Learning Methods

Teaching Aids and

Materials

Assessment

At the end of this module

the trainee will be able

to:

� Describe the Anatomy

and Physiology of the

normal eye

� Demonstrate and

understand eye

structure and function

70 hours � Embryology of the eye

� Anatomy of the normal eye

� Anatomy and Physiology of

the orbit and globe


lids, Conjunctiva and

Lacrimal system


the cornea, Sclera and Lens


the Uveal tract


of the Vitreous, retina and

optic nerve


Extraocular Muscles

� Optic and Refraction

� Active

lecture/tutorial

� Discussion/Demon

stration

� Self study and

reporting

� Eye model

� Posters

� Slides

� Diagram

� Handouts

� Reference books

(Ophthalmology)

� Projector/Laptop

(Power points)

� Practical and

written

examination

� Oral

questions and

answers

Module 3 : Clinical ophthalmic condition (Pathology and Physiology) (280 hours , 8 Weeks)


Learning Methods

Teaching Aids and

Materials

Assessment



� Distinguish the condition

and appearance of a

healthy eye

105

hours

� Common eye problems

and management

� Common eye problems

and management

� Common lid

� Lectures/Tutorial

� Discussion

� Clinical setting:

- Identify with

patient’s eye

� Patients

� Torch/Penlight

� Slides/Posters

� Handouts

� Ophthalmology

� Practical and

written

examination

� Clinical

performance


� Discuss the cause and risk

factors of eye disease

� Describe the signs and

symptoms of each

condition

� Describe the necessary

investigation, requires in

each case

� Recognise the

complications and

prognosis of each

condition

� Recognise and manage of

common disorders and

ocular emergencies.

abnormalities: Stye,

chalazion, ptosis,

blepharitis, ectropion,

trichiasis

� Conjunctiva:

conjunctivitis, red eye,

pterygium,pinguela,

foreign body.

� Cornea: foreign body,

epithelial defects, ulcer,

scars.

� Lens: cataract

� Glaucoma

� Uveitis

� Vitamin A deficiency

� Diseases of the orbit,

globe and

� cornea, sclera lens and

� Uveal tract and

management.

� vitreous, retina, Diabetic

� optic nerve and

management.

� Common Medical and

Ophthalmic emergencies :

Hypoglycemia

� Foreign body

� Trachoma

condition

- Participate in

eye

examination of

the patient’s

eyes

- Make a

diagnosis and

state the

management

� Clinical

demonstration

and observation

� Clinical teaching or

couching

book

� Schiotz

tonometer

� Snellen Chart

� Case

management

presentation

� Clinical

assessment

record book


Module 4 : Community ophthalmology (35 hours, 1 week)


Learning Methods

Teaching Aids

and Materials

Assessment



� Define blindness

� Prevention of blindness

� Describe the importance of

early intervention on each

eye diseases

� Identify and provide

counselling for blind

patients

� Organize eye screening

� Train health workers and

village health volunteer on

Primary Eye Care

� Describe the social

economic factors and their

impacts on health

� Advise blind patients and

their families on

community rehabilitation

� Vision 2020 (20/20)

� Low vision

� Childhood blindness

35

hours

� Definition of blindness

according to WHO

� Exposure to the eye unit

� Community exposure

� How to conduct eye

screening

� Conduct health

education program

� Conduct a survey on

identifying eye problem,

economic status of the

local communities

� Principle of

rehabilitation

� Basic principle of

teaching

� Vision 2020

� Low vision


� School Health Program

� Lectures

� Demonstrations/di

scussion

� Field work

� Exposure to the

communities

� Plan community

activities

- LCD Projector

set

- Clipboard

- Pen/Pencil

- Whiteboard

- Penlight/Laser

projector

- Video/Slides

Hand out

� Practical and

written

examination

� Case report

� Project


PART II

Module 5: REFRACTION (350 hours, 10 weeks)

Objective Time Contents

(Knowledge, Skill, Attitude)

Learning

Experience

Teaching Methods

Training

Materials

Student

Assessment

I. BASIC OPTICS, EYE OPTICS AND ACCOMMODATION (2days)

To have a knowledge of

light travel through a

substance or medium and

how it work, the speed of

light and index.

14 Hrs 1. OPTICS

� Light and Seeing

� Behaviour of Light

� Optical Medium

� Refractive Index

� Reflection & refraction

� Prism

� Lenses

� Optical Centre

� Plano Lenses

2. EYE OPTICS AND

ACCOMMODATION

� How normal eye work

� The eye with refractive

errors

� Accommodation

- Lecture

- Demonstration

- Drawing

- Light projection

- Discussion

- LCD Projector set

- Diagram/Picture

- Clipboard

- Pen/Pencil

- Whiteboard

- Penlight/Laser

projector

- Lenses

- Prism Lens

- Video/Slides

- Hand out

- QCMs

- Oral Question

- Name of light in

diagram.

- Calculation Amp.

of accommodation

II. REFRACTIVE ERRORS


refractive error of the

eyes, the cause of

refractive errors and how

to correct it,

21 Hrs � Hyperopia

� Myopia

� Astigmatism

� Presbyopia

- Lecture

- Diagram

- Name on diagram

- Video/Slides show

- LCD Projector set

- Diagram/Picture

- Clipboard

- Pen/Pencil

- Video/Slides

- Whiteboard

- Lenses

- QCMs

- Oral Question


To know about how lens

made and focus lights

when passing through it.

To know a specific lens to

correct refractive errors of

eyes.

To know how to interpret

the prescription in plus or

minus cylinder form and

its axis.

1. SPHERICAL LENSES

� Spherical Lens and

refractive errors

� Spherical Lens and shape

� Spherical lens and power

2. ASTIGMATIC LENSES

� Astigmatic Lens and eyes

� Cylindrical Lenses

� Sphero-Cylindrical Lenses

� Standards axis notation

� Power of astigmatic lenses

� Astigmatic lens shape

3. OPTICAL CROSS AND

TRANSPOSITION

� Optical cross

- Sphero-cylindrical Lenses

- Optical Cross

- Drawing Optical Cross

- Minus and Plus cylinder

notation.

� Transposition

- Method of transposition

- Lecture

- Demonstration

- Drawing

- Light projection

- Discussion

- Practice

- LCD Projector set

- Diagram/Picture

- Clipboard

- Pen/Pencil

- Whiteboard

- Penlight/Laser

projector

- Spherical lens &

Astigmatic lenses

- Video/Slides

- Hand out

- QCMs

- Oral Question

- Identify lenses

- Practice


III. TRIAL LENS SETS AND TRIAL FRAMES

To know the feature of

trial set and trial frame,

location of plus lenses,

minus lenses cylinder

lenses, prism and

accessory. How to

adjustment trial frame

7 Hrs TRIAL SET AND TRIAL

FRAME

� Trial sets

� Spherical Lenses

� Cylindrical trial Lens

� Prism trial Lens

� Accessory trial Lens

� Trail Frames

- Lecture

- Picture show

- Demonstration

- Role play

- LCD Projector set

- Diagram/Pictures

- Trial lens set

- Trial frames

- QCMs

- Oral Question

- Practice

IV. INTRODUCTION TO REFRACTION

To know the keys methods

of refraction or different

way to measuring

refractive error of the eyes

and the goals of refraction

examination.

14 Hrs � Clinical Refraction

� Measuring refractive error

� Objective Refraction

methods

� Subjective refraction

methods

� Goal of refraction

� Estimation refractive error

� The art of refraction

- Lecture

- Demonstration

- Drawing

- Practical in

pair/group

- Practical with

model eye

- Practical with

patient

- LCD Projector set

- Diagram/Picture

- Retinoscope

- Autorefractor

- Trial lens set

- Trial frames

- Model eye

- Pen/Pencil

- Whiteboard

- Penlight/Laser

projector

- Video/Slides

- Hand out

- QCMs

- Oral Question

- Practice

- Case study

- Practical exam

V. REFRACTION MODULE

To know about the

communication skill with

patient, collecting

information related to

patient vision problems

and other general health

condition which related to

the eye.

175 Hrs

1. CASE HISTORY

� Understanding the problems

� Case History

� How to taking case history

� Thinking about case history

- Lecture

- Demonstration

- Role play

- LCD Projector

- Recording form

- Clipboard

- Handout

- Pens

- QCMs

- Oral Question

- Role Play

- Case study

To have knowledge of how

to measure visual acuity at

distance and near and

2. VISUAL ACUITY & PINHOLE

� Visual acuity

� Testing Distance VA

- Lecture

- Demonstration

- Drawing

- LCD Projector

- Clipchart

- Handout

- QCMs

- Oral Question

- Practice in pair


prediction how much

refractive error patient

has.

� Type of VA measurement

� Recording Distance VA

� Distance VA Chart

� Measuring Near VA

� Pinhole Test

� Pinhole Result mean

� What to do if pinhole

improve

- Discussion

- Practice in pairs

- Distance VA

charts

- Near VA chart

- Penlight

- Meter

- Pinhole

- Occluder

- Case study

To know the objective

refraction methods by

using retinoscope to

define refractive error of

eyes

3. RETINOSCOPY

� Retinoscopy

� Movement of the

retinoscopic reflex

� Looking at retinoscopic

reflex movement

� Alignment of streak and red

reflex

� Streak retinoscopy method

� Frequent retinoscopy

problems

- Lecture

- Demonstration

- Video/Slides show

- Practice with

model eye

- Practice in pair

- LCD Projector

- Retinoscopes

- Trial Lens sets

- Model eyes

- Clipchart

- Handout

- Visual aid

- QCMs

- Oral Question

- Practice

- Case study

- Practical exam

To know the way to

measure papillary distance

for distance prescription

and near prescription,

mono and binocular PD.

4. INTERPUPILLARY DISTANCE

� Definition of PD

� Measuring Distance PD

with PD ruler

� Finding Near PD with a PD

Ruler

� Measuring PD using

pupillometer.

� Why PD is importance

- Lecture

- Demonstration

- Drawing

- Discussion

- Practice in pairs

- LCD Projector set

- Diagram/Picture

- Clipboard

- Pen/Pencil

- Whiteboard

- Penlight/Laser

projector

- Video/Slides

- Hand out

- PD Rulers

- Pupilometre

- Pinhole

- Trial Frames

- QCMs

- Oral Question

- Practice in pair

- Case study

- Clinical practical

examination

To know the technique to

fine the best vision sphere

power and comfortable

prescription after

5. BEST VISION SHPERE

REFRACTION

� Correcting refractive error

� Subjective refraction

- Lecture

- Demonstration

- Video/Slides show

- Practice in pair

- LCD projector

- Trial frame

- Trial Lens set

- Distance Chart

- QCMs

- Oral Question

- Practice in pair

- Clinical practical


retinoscopy result.

� Best Vision Sphere(BVS)

� Astigmatism and BVS

- Discussion

- Hand out

- Clip chart

examination

To know the steps to

determine cylinder power,

approximately axis, and

exact axis methods.

6. SPHERO-CYLINDRICAL

REFRACTION

� Astigmatism search

� Finding the cylinder axis

� Finding the cylinder power

- Lecture

- Demonstration

- Drawing

- Discussion

- Trial sets

- Trial Frames

- PD ruler

- Cross cylinder

- QCMs

- Oral Question

- Practice in pair

- Clinical Practical

examination

To know the concepts of

how to control amplitude

of accommodation while

performing refraction, in

order to fine a comfortable

prescription, avoid of over

minus or not enough plus

correction.

7. CONTROLLING

ACCOMMODATION

� Controlling accommodation

� How to avoid over minus or

not enough plus.

- Lecture

- Demonstration

- Drawing

- Discussion

- Video/Slides

- LCD Projector

- Vide/slides

- Trial sets

- Trial Frames

- PD ruler

- Cross cylinder

- Cycloplegic drug

- Penlights

- Handout

- QCMs

- Oral Question

- Practice in pair


examination

To know the techniques of

controlling

accommodation and

balancing between both

eye’s power.

8. +1.00D TEST &BINOCULAR

BALANCING

� After the distance

prescription

� +1 Test method

� Binocular Balancing Method

- Lecture

- Demonstration

- Drawing

- Discussion

- Video/Slides

- LCD Projector

- Vide/slides

- Trial sets

- Trial Frames

- Occluder

- Penlights

- Handout

- QCMs

- Oral Question

- Practice in pair


examination

To know how to do a near

refraction for a person

with presbyopia so that

can give the correct

reading addition.

9. NEAR REFRACTION FOR

PRESBYOPIA

� Correcting Presbyopia

� Preparation and estimation

of Add

� Adjust Add power

� Check the range of clear

vision

- Lecture

- Demonstration

- Drawing

- Discussion

- Video/Slides

- LCD Projector

- Vide/slides

- Trial sets

- Trial Frames

- Metres

- Reading testing

chart

- Occluder

- Penlights

- Handout

- QCMs

- Oral Question

- Practice in pair


examination

To understand the method

in relevant tests to define

10. RELEVANT TEST IN

REFRACTION

- Lecture

- Demonstration

- LCD Projector

- Vide/slides

- QCMs

- Oral Question


abnormality of the eyes

cause visually discomfort.

� Covered/Uncovered test

� Near Point of convergent

� Stereopsis test

� Motility test

� Color vision test

- Drawing

- Discussion

- Video/Slides

- Trial sets

- Trial Frames

- Metres

- Reading testing

chart

- Ishihara

- Occluder

- Penlights

- Handout

- Practice in pair


examination

VI. DECISSION AND PRESCRIBING SPECTACLES : 1 week

To know a basic guide on

how to when and how to

prescribes spectacle for

patient.

35 Hrs 1. PRESCRIBING SPECTACLE

• Refraction Check

• Before Prescribing

• Prescribing spectacle

• Explanation of the

examination

• Writing a prescription

spectacle

- Lecture

- Demonstration

- Discussion

- Practice in pair

- LCD Projector

- Vide/slides

- Trial sets

- Trial Frames

- Metres

- Reading testing

chart

- Occluder

- Penlights

- Handout

- QCMs

- Oral Question

- Practice in pair


examination


making decision on a near

lens addition for patient

with presbyopia so that

they can have a clear and

comfortable near vision.

2. PRESCRIBING SPECTACLE

FOR PRESBYOPIA

• Prescribing spectacle for

near

• Near ADD and working

distance

• Choice of lenses for near

spectacles

• Telling patient about their

new near spectacles

- Lecture

- Demonstration

- Discussion

- Practice in pair

- LCD Projector

- Vide/slides

- Trial sets

- Trial Frames

- Metres

- Reading testing

chart

- Occluder

- Penlights

- Handout

- QCMs

- Oral Question

- Practice in pair


examination


how to prescribes

astigmatism lenses with

patient astigmatism so

3. PRESCRIBING SPECTACLES

FOR ASTIGMATISM

• Cylinder Power

• Cylinder Axis

- Lecture

- Demonstration

- Discussion

- LCD Projector

- Vide/slides

- Trial sets

- Trial Frames

- QCMs

- Oral Question

- Practice in pair



that they can have a clear

and comfortable vision

- Metres

- Spectacle

examination

- Case study

To know the guideline and

recommendation for

prescribing readymade

spectacles for patient.

4. PRESCRIBING READY

MADE SPECTACLES

• Readymade

spectacle(RMS)

• Prescribing RMS

• PD of RMS and frame

selection

- Lecture

- Demonstration

- Discussion

- LCD Projector

- Vide/slides

- Spectacle

- Frames

- QCMs

- Oral Question

- Practice in pair


examination

- Case study

VII. ESTABLISHING A REFRACTION CLINIC


how well to set up

refraction clinic in order to

deliver efficient refraction

service to ensure that

patient can receives the

best refraction service.

7 Hrs � Refraction Clinic

� Set up a refraction clinic

- Room

- Lighting

- Vision Chart posting

- Computer

- Dispensing stock

- Clinic Lay-out

� Standard operation

procedure

- Lecture

- Demonstration

- Discussion

- LCD Projector

- Vide/slides

- Hand out

- Clipboard

- QCMs

- Oral Question &

examination

VIII. MANAGE A CLINIC FOR REFRACTION SERVICES


how to manage clinic and

control the stock and

supplies in a refraction

clinic

14 Hrs � Stock and Inventory

� Initial stock and common

stock

� Ordering stock

� Record Keeping

� Banking

� Bill and Accounts

� Filing

- Lecture

- Demonstration

- Discussion

- LCD Projector

- Vide/slides

- Hand out

- Clipboard

- Forms

- QCMs

- Oral Question

Examination


Module 6 : SPECTACLE DISPENSING

Objective Time Topics

(Knowledge, Skill, Attitude)

Teaching Methods

Learning

Experiences

Training

Material

Student

Assessment

To refresh knowledge of basic

optic and how the lights are

travel when across a prism or

lens and its direction.

7 Hrs � Optic and Ophthalmic Lenses

� Light Rays & behaviour of light.

� Reflection & Refraction

� Prism

� Lens ( Spherical & Astigmatism

� Introduction to progressive

lenses and bifocal

- Lecture

- Discussion

- Drawing

diagram

- Demonstration

- Practice

- LCD Projector

- Computer

- Lenses (+ & -)

- Progressive lens

- Bifocal lens

- Whiteboard

- Markers

- Practical

assessment

- QCMs & Answer

To have knowledge of how to

use lensmeters, measuring

lens power, determine axis

and dotting lenses.

7 Hrs

� Focimetry/Lensmetry & Hand

Neutralisation

� Focusing lensmeter

� Measuring lens power

� Dotting lenses

� Measuring sphero-cylinder

� Measuring progressive lenses

� Measuring bifocal lens

� Special notes

- Lecture

- Discussion

- Drawing

diagram

- Demonstration

- Practice

- LCD Projector

- Lenses Sphere + -

- Astigmatic lenses

- Progressive

lenses

- Trial sets

- Whiteboard

- Lensmeter

- Markers

- Diagram

- Handout

- Practical

assessment

- QCMs & Answer

- 25 completed

spectacles

To have the knowledge the

type and material of

spectacle frames,

To know on how to measure

the different type of frame

and fitting a lens in reference

points.

7 Hrs

� Spectacle Frames

� Type of spectacle frames

� Frame material plastics

� Frame material metal

� Manipulation of frames

� Frame Measurement

� The Boxing system

� The Datum line System

� Comparing the system

� Lens reference points

- Lecture

- Discussion

- Drawing

diagram

- Demonstration

- Practice

- Optical

workshop

activities

- Video show

- LCD Projector

- Computer

- Whiteboard

- Markers

- Diagram/Picture

- Frames

- Fame ruler

- Frame lay-out

chart

- Frame heater

- Practical

assessment

- QCMs & Answer

- Label name on

diagram

To have knowledge of how to 7 Hrs � Measuring Pupillary Distance - Lecture - LCD Projector - Practical


measure between the centre

of pupils in mono and

binocular method.

� Monocular PD

� Binocular PD

� Corneal Reflex Pupillometer

� Measuring bifocal and

progressive heights

- Demonstration

- Practice in pair

- Drawing

- Video show

- Computer

- PD rulers

- Whiteboard

- Markers

- Diagram/Picture

assessment

- QCMs &

Answer

- Label name on

diagram

Understanding on how to fit

spectacle on patient’s face in

accurate techniques and

satisfaction with prescription

14 Hrs

� Fitting Spectacle

� The Triangle Fitting

� The Bridge Fitting

� Pantoscopic Tilt

� Frame Adjustment- the steps

� Spectacle delivery verification

- Lecture

- Demonstration

- Practice in pair

- Case study

- Optical

workshop

Activities

- LCD Projector

- Frames

- Pliers

- rulers

- Marker

- Progressive lay-

out chart

- Frame heater

- Practical

assessment

- QCMs &

Answer

- Label name on

diagram

- Quality control

To know how to operate auto

lens- edger and fitting in

accurate prescription for

patient

14 Hrs

� Cutting the Lenses

� Checking the lenses

� Decentration

� Cut a former

� Block or Mark-up a lens

� Edging lens with auto edger

� Hand edging

� Fit the lens into a frame

� Verify that the final spectacle

� Single vision lens

� Progressive lenses

� Bifocal lensess

- Lecture

- Demonstration

- Practice in pair

- Group

discussion

- Optical

workshop

activities

- LCD Projector

- Auto-Lens edger

- Hand edger

- Lensmeter

- Frames

- frame heater

- lens blocker

- Lenses (all type)

- Markers

- Screw drivers &

Adjustment Tools

- Practical

Assessment

- QMCs & Answer

- Quality control

To have knowledge on how to

adjust a spectacle frame so

that they can fit a patient

comfortably and what to tell

patient to take care it.

14 Hrs

� Adjustment and care of

spectacle

� Optical spectacle

� Spectacle frame parts

� Choosing a spectacle frame

� Tools uses to adjust spectacle

� Adjust spectacle

� Methods

� Problem solving guide

� Adjust old spectacle frame

� Caring for spectacle

- Lecture

- Demonstration

- Practice in pair

- Group

discussion

- Optical

workshop

activities

- LCD Projector

- Frame adjusting

pliers

- Frame heater

- Screw drivers

- Frames

- Spectacle

- Practical

Assessment

- QMCs & Answer

- Quality control


REFRACTIONIST NURSE TRAINING CURRICULUM STRUCTURE

TOPIC LESSION TITLLES THEORY HS PRATICAL HS CREDIT

Module I

General professional

nursing knowledge

� Leadership management

� Roles and functions of planning,

organizing, staffing, directing

and controlling

35 2

Module II

Basic Science

(General

Ophthalmology)

� Embryology of the eye

� Anatomy of the normal eye

� orbit and globe

� lids, Conjunctiva and Lacrimal

system

� cornea, Sclera and Lens

� Uveal tract

� Vitreous, retina and optic nerve

� Extraocular Muscles

70 5

Module III

Clinical ophthalmic

condition (Pathology

and Physiology)

� Common eye problems and

management

� Common lid abnormalities: Stye,

chalazion, ptosis, blepharitis,

ectropion, trichiasis

� Conjunctiva: conjunctivitis, red

eye, pterygium,pinguela, foreign

body.

� Cornea: foreign body, epithelial

defects, ulcer, scars.

� Lens: cataract

� Glaucoma

� Uveitis

� Vitamin A deficiency

� Diseases of the orbit, globe and

� cornea, sclera lens and

� Uveal tract and management.

� vitreous, retina, optic nerve and

management.

� Common Medical and

Ophthalmic emergencies :

Hypoglycemia

� Foreign body

� Chemical injury, Ocular trauma

� Acute visual loss

210 70 16


Module IV

Community

ophthalmology

� Community exposure

� How to conduct eye screening

� Conduct health education

program

� Conduct a survey on identifying

eye problem, economic status

of the local communities

� Principle of rehabilitation

� Basic principle of teaching

� Vision 2020

� Low vision


35 1

Module V

REFRACTION

� Basic Optics, Eye Optics And

Accommodation

� Refractive Errors

� Trial Lens Sets And Trial Frames

� Introduction To Refraction

� Refraction Module

� Decission And Prescribing

Spectacles

� Establishing A Refraction Clinic

� Manage A Clinic For Refraction

Services

105

245

13

Module VI

SPECTACLE

DISPENSING

� Optic and Ophthalmic lenses

� Focimetry/Lensmetry & Hand

Neutralisation

� Spectacle Frames

� Frame Measurement

� Measuring Pupillary Distance

� Fitting Spectacle

� Cutting the Lenses

� Adjustment and care of

spectacle

35

35 3

Total 455 385 39


SCHEDULE

For General Ophthalmic Nursing Part (Part I):

Week 1:

Module I: General professional nursing knowledge

Time Mon Tue Wed Thu Fri

08:00 - 12:00 Classroom Classroom Classroom Classroom Classroom

12:00 - 14:00 Lunch break


Week 2:

Module II: Basic Science (General Ophthalmology)





Week 3:

Module II: Basic Science (General Ophthalmology)





Week 4:

Module III: Clinical Ophthalmic Condition (Pathology and Physiology)





Week 5:






Week 6:







Week 7:



08:00 - 12:00 Clinical

Practice in

OPD

Clinical

Practice in

OPD

Clinical

Practice in

OPD

Clinical

Practice in

OPD

Clinical

Practice in

OPD



Week 8:



08:00 - 12:00 Clinical

Practice in

OPD

Clinical

Practice in

OPD

Clinical

Practice in

OPD

Clinical

Practice in

OPD

Clinical

Practice in

OPD



Week 9:





14:00 - 17:00 Clinical

Practice in OT

Clinical

Practice in OT

Clinical

Practice in OT

Clinical

Practice in OT

Clinical

Practice in OT

Week 10:





14:00 - 17:00 Clinical

Practice in OT

Clinical

Practice in OT

Clinical

Practice in OT

Clinical

Practice in OT

Clinical

Practice in OT

Week 11:

Module IV: Community Ophthalmology


08:00 - 12:00 Practice in

Community

Practice in

Community

Practice in

Community

Practice in

Community

Practice in

Community


14:00 - 17:00 Practice in

Community

Practice in

Community

Practice in

Community

Practice in

Community

Practice in

Community


Week 12:

Self Study and Final Exam for General Ophthalmic Nursing Care (Part I)


08:00 - 12:00 Self study Self study Self study Examination Examination


14:00 - 17:00 Self study Self study Self study Examination Examination

Note: for Refraction Part (Part II)

Week 13:

Module V: Refraction


08:00 - 12:00 Classroom:

Pre-course

assessment

Classroom Classroom Classroom Classroom



Week 14:

Module V: Refraction




14:00 - 17:00 Practice Practice Practice Practice Practice

Week 15:

Module V : Refraction





Week 16:







Week 17:






Week 18:






Week 19:



08:00 - 12:00 Outreach

Field practice

Outreach

Field practice

Outreach

Field practice

Outreach

Field practice

Outreach

Field practice


14:00 - 17:00 Outreach

Field practice

Outreach

Field practice

Outreach

Field practice

Outreach

Field practice

Outreach

Field practice

Week 20:





14:00 - 17:00 Classroom Classroom Practice Practice Practice

Week 21:



08:00 - 12:00 Outreach

Field practice

Outreach

Field practice

Outreach

Field practice

Outreach

Field practice

Outreach

Field practice


14:00 - 17:00 Outreach

Field practice

Outreach

Field practice

Outreach

Field practice

Outreach

Field practice

Outreach

Field practice


Week 22:

Module VI: Spectacle dispensing module





Week 23:

Module VI: Spectacle dispensing module





Week 24:

Module VI: Self Study and Final Examination


08:00 - 12:00 Self Study Self Study Final Exam Final Exam Final Exam


14:00 - 17:00 Self Study Self Study Final Exam Final Exam Post-Course

assessment


REFERENCES

ICEE Refraction Manual Copyright @ 2005

ICEE Refraction Manual Copyright @ 2008

Jack Kansky – Clinical Ophthalmology

Clinical Science – American Ophthalmology

National for Eye Health – RABB 2007

Refractive Error in School Children Survey in Cambodia

National Strategy Plan for Blindness Control

Rapid Assessment of Avoidable Blindness in Cambodia 2007

Adler F.H 1987 Physiology of the Eye C V Mosby, St Louis

Greer C.H 1979 Ocular pathology Blackwell, Oxford

Wolff E. 1976 Anatomy of the Eye and orbit H.K. Lewis, London

Snell. Lump Clinical anatomy of the eye Blackwell Scientific

Kanski JJ Clinical Ophthalmology, Butterworths, London

Kanski Jack, 1985 The Eye in Systemic disease , Butterworths, London

WHO Publications

Low cost spectacle productions

Conjunctivitis of the newborn

Guidelines for programmes for the prevention of blindness

Guide to trachoma control

Management of cataract in primary health care

Methods of assessment of avoidable blindness

final draft curriculum refractionist nurse 2012 seiha ... · global initiative for the elimination...

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