After completing this topic, students should understand:
Optometry’s role in Australia’s health system and team-based healthcare.
The scope of optometric practice.
Professional identity within optometry.
What it means to be a reflective practitioner.
Reflect on your beliefs about health and eye health.
Share influences shaping your beliefs about eye health.
Various definitions:
Oxford Dictionary: Free from illness or injury.
WHO: Complete physical, mental, and social well-being.
Australian Gov't: Highest attainable standard of health is a fundamental human right.
A range of factors including socioeconomic characteristics, culture, education, and individual behaviors.
Important determinants: tobacco use, diet, physical activity, access to services, etc.
Factors affecting eye health include:
Genetics
Age
Diet (e.g., omega-3 fatty acids, vitamins A, C, E)
Environmental factors
Trauma
Prevention and treatment of conditions that threaten eye integrity.
Primary eye care is essential in primary health care contexts.
Conducted to assess vision impairment and blindness prevalence.
Over 453,000 Australians impacted by vision impairment or blindness.
Main causes include uncorrected refractive error and cataracts.
Australia has comprehensive eye health services and highly qualified specialists.
Responsibility for eye health programs distributed across sectors.
Involves prescription of spectacles, contact lens fitting, and diagnosis of eye diseases.
Optometrists are primary health care specialists.
Optometrists work alongside dispensers, reception staff, and other health professionals.
Emphasis on inter-professional practice to improve patient outcomes.
Reflective practice involves:
Learning from experiences.
Thinking critically about professional practice.
Utilize the 4R model: Reporting, Relating, Reasoning, Reconstructing.
Skills necessary for professional effectiveness include:
Communication
Teamwork
Problem-solving
Initiative
Self-management
Technology adaptability.
Required activities include mental health awareness and teamwork skills development.
Focus on positive experiences in team assignments.
Critical tool for decision making in health.
In Optometry: Collecting patient information, making diagnoses, guiding treatment decisions.
Symptoms, diagnoses, treatments
Specialist reports, test results
Appointment and billing details
Prescriptions and pharmaceutical records
Genetic, dental records, other personal information (race, sexuality)
Drives healthcare delivery
Informs better health decisions
Facilitates effective treatment based on evidence.
Nationwide scheme in Australia, default enrollment unless opted out.
Secure online summary of key health information.
Accessible to healthcare providers, improving healthcare efficiency.
Allows tracking over time, especially during crises.
Patient Dimension: Information derived from patients.
Professional Dimension: Supports evidence-based clinical decisions.
Management Dimension: Administrative information for health service managers.
Integration of clinical expertise, patient values, and best available evidence from research.
Importance: Better patient outcomes through research-based treatments.
Ask: Formulate clinical questions.
Acquire: Search research literature for answers.
Appraise: Evaluate quality of evidence.
Apply: Implement findings in patient care.
Audit: Assess the use of evidence in practice.
Helps formulate clinical questions:
Patient/Problem
Intervention
Comparison/Control
Outcome
Ranges from opinion-based guidelines to systematic reviews.
Stronger evidence includes Randomised Controlled Trials (RCTs), systematic reviews.
Critical analysis of existing research on a topic.
Identifies gaps, strengths, and weaknesses within literature.
Addresses specific research questions using predefined criteria.
Involves summarising and critiquing research findings.
Be able to:
Critically appraise various types of studies.
Recognise limitations and biases in studies.
Engage in patient-centered care through shared decision-making.
Developed using high-quality research evidence to aid decision-making in clinical practice.
Important for standardized patient care across various conditions and procedures.
QUT acknowledges Turrbal and Yugara as First Nations owners of the lands.
Recognition of Elders, customs, and the role of Aboriginal and Torres Strait Islander peoples at QUT.
Mid-Semester Assessment: 30% of unit.
Divided into two parts (15% each):
Part 1: MCQs and short answer questions on Cultural Safety and Communication.
Part 2: Extended answer essay detailing culturally safe health care in a case scenario.
Assessment emphasizes effective communication and referencing course content.
Developed by Māori nurse Irihapeti Ramsden in Aotearoa/New Zealand.
Focuses on the health provider's role and the impact of personal and organizational culture on patient care.
Governed by new codes of conduct from Ahpra and other organizations effective June 29, 2022.
Self-awareness: Understand personal culture and biases.
Power Relationships: Identify dynamics in health care settings.
Decolonization: Acknowledge history and effects of colonization.
Patient Experience: Culturally safe care is determined by the patient's experience, not the provider's definition.
Ahpra's Definition: Focus on culturally safe health care, free of racism, informed by Indigenous communities' perspectives.
Good Communication: Essential for effective patient education and care delivery.
Communication Models:
Simple model (Sender, Message, Receiver).
Expanded model includes context, channels, feedback, and noise.
Various barriers may hinder communication, including language, environmental factors, and biases.
Rapport: Establishing a good relationship with patients is critical for effective care.
Characteristics include respect, concern, understanding, trust, empathy, sensitivity, and sincerity.
Patients are more likely to change providers due to poor rapport than clinical incompetence.
Active Listening: Requires integration of verbal and nonverbal cues, demonstrating empathy.
Poor listening can stem from bias, concentration issues, or assumptions.
Involves cues such as body language, paralanguage, personal space, and professional appearance, all impacting patient perceptions and trust.
Definition of Academic Honesty:
Academic honesty is the commitment to producing original and authentic work.
It involves completing coursework with only the assistance allowed by the institution's guidelines.
QUT Policies on Academic Honesty:
The university has specific policies outlined in the Manual of Policies and Procedures (MOPP).
MOPP emphasizes the significance of academic integrity, ethical assessment, and maintaining high academic standards.
Benefits of Integrity:
Development of professional capabilities and reputation.
Encourages a culture of ethical practice in academic settings.
Types of Academic Misconduct:
Cheating: Seeking unfair advantages in exams.
Plagiarism: Copying someone else’s work or submitting your own work again as if it were new (self-plagiarism).
Contract Cheating: Outsourcing your work to others for completion.
Collusion: Collaborating with others on an assignment without permission.
Definition of Plagiarism:
Plagiarism is defined as representing another's ideas or expressions as your own. This includes:
Direct copying or summarizing without acknowledgment.
Using another's ideas or research results without proper credit.
Common Forms of Plagiarism:
Copied diagrams, plans, or any non-textual material without attribution.
Reusing elements of previous work without acknowledgment.
Case Study 1:
Jack and Jill create a rough draft together.
Jack, unable to complete his own work, slightly alters Jill's work and submits it.
Case Study 2:
Group lab work leads to individual reports.
Weng creates graphs but other group members submit them without acknowledgment.
Case Study 3:
Mary finds uncredited information online and assumes it's free to use without citation.
Planning and Note-taking:
Manage time effectively and familiarize yourself with the material.
Take concise notes instead of copying directly.
Citing and Referencing:
Keep a running bibliography.
Use quotation marks for exact phrases and reference non-common knowledge.
Understanding Ethics:
Ethics delineates the standards of right and wrong, emphasizing rights, obligations, and fairness.
Professional ethics is a code of conduct adopted by various professions.
Hippocratic Oath Principles:
Beneficence: Striving to do good for each patient.
Non-maleficence: Avoiding harm; weighing risks and benefits.
Respect for Autonomy: Honoring patients' choices about their health.
Justice: Fair treatment of all patients regarding resources and time.
Ahpra & National Boards Code of Conduct (June 2022):
Establishes ethical guidelines for Health Practitioners in various domains, including optometry.
Right to Respect and Care:
Patients should be treated respectfully and without exploitation in safe environments.
Informed Decisions:
Patients have the right to clear information on their condition and treatment options.
Confidentiality:
Assurance of privacy in all care-related matters.
Right to Complain:
Patients can voice grievances and seek resolution for any dissatisfaction.
AProf Katrina Schmid
Email: k.schmid@qut.edu.au
Suggested Reference: Lee Ann Remington, Clinical Anatomy of the Visual System (2012) - ebook available.
Aim: To introduce foundational knowledge in ocular anatomy and physiology.
Learning Outcomes:
Understand basic ocular anatomy of the eye.
Identify key structures and comprehend main physiological processes.
Begin to understand how structural abnormalities precipitate eye disease.
Topics Covered:
Terminology and Definitions (Anatomy, Ocular Anatomy, Physiology, Ocular Physiology)
Gross Anatomy of the Eye (Visible structures)
Comparison to a Camera
Refractive Errors
External and Internal Ocular Structures
Anatomy: Identification and description of structures.
Ocular Anatomy: Identification and description of eye structures.
Physiology: Processes involved in how the body functions.
Ocular Physiology: Specific to the functioning of the eyes.
Inner vs Outer: Terms describing locations within the eye.
Acronyms play a critical role in optometry. Examples include:
AC: Anterior Chamber
ACD: Anterior Chamber Depth
BCVA: Best Corrected Visual Acuity
IOP: Intraocular Pressure
Numerous abbreviations exist beyond those listed here.
The eye is vital for vision and is a unique organ.
The retina develops from the brain and is specialized for vision.
Ocular components are critical for focusing light and forming images on the retina.
The eye functions analogously to a camera, utilizing components such as:
Diaphragm (Iris): Controls light entry.
Lens: Focuses light onto the retina.
Retina: Receives the image and transmits signals to the brain.
Shape & Size:
The adult eyeball is approximately 24mm in diameter.
Eye size influences refractive state (Emmetropia, Myopia, Hyperopia).
Myopia: Light focuses in front of the retina, affecting distant vision.
Hyperopia: Light focuses behind the retina, affecting near vision.
Astigmatism: Causes blurred vision due to uneven curvature of the cornea.
Key components include:
Zonular Fibres, Iris, Pupil, Lens, Cornea, Retina, Fovea, Optic Nerve, Sclera, Choroid, Ciliary Body, Vitreous Chamber, Anterior Chamber.
Outer Fibrous Layer: Cornea and Sclera.
Middle Vascular Layer: Uveal tract (Iris, Ciliary Body, Choroid).
Inner Neural Layer: Retina.
Protective components:
Eyebrows and Eyelids (superior and inferior).
Bony orbit and surrounding soft tissue.
Importance: Protection from environmental damage.
Eyebrow: Helps in dust protection.
Eyelids: Spread tears and provide protection.
Eyelashes: Trap debris.
Palpebral Fissure: Space between open eyelids.
Responsible for tear production and drainage:
Lacrimal Gland: Produces tears.
Drainage via nasolacrimal system into the nose.
Functions:
Lubricates the cornea.
Provides nutrients and antimicrobial factors.
Composed of lipid, aqueous, and mucin layers.
Cornea: Outer layer, transparent, provides optical power.
Sclera: Opaque, tough outer coat; protects eye contents.
Conjunctiva: Mucous membrane; aids lubrication and immunity.
Space between cornea and lens filled with aqueous humor.
Supplies nutrients and oxygen to cornea and lens.
Biconvex, transparent; aids in accommodation for focusing.
Space filled with vitreous humor, helps maintain eye shape.
Consists of the pigmented, vascular layers (Iris, Ciliary Body, Choroid).
Multi-layered, light-sensitive tissue responsible for phototransduction.
Contains photoreceptors (Cones and Rods) that send visual signals.
Process of converting light energy into electrical signals in the eye.
Carries visual signals from the retina to the brain; origin of the "blind spot" due to absence of photoreceptors.
Visual Pathway
Eye Movements
Ocular Transparency
Oxygen and Blood Supply
Intraocular Pressure
Effect of Aging
The visual pathway transmits visual sensations from the retina to the brain.
Light absorbed by photoreceptor cells.
Impulse travels through retinal layers.
Information is sent via optic nerve.
Pathway sequence:
Retina
Optic nerve
Optic chiasma
Optic tracts
Lateral geniculate nucleus
Optic radiations
Primary visual cortex
At Lateral Geniculate Body (LGB) and visual cortex, information is modified before reaching perception.
Central Scotoma: Damage in the retina affecting central vision.
Monocular Vision Loss: Loss in one eye due to optic nerve damage.
Bitemporal Hemianopia: Loss of lateral vision due to optic chiasma involvement.
Contralateral Homonymous Hemianopia: Loss of the same side visual field in both eyes due to optic tract damage.
Screening Tests: Includes Amsler grid and confrontation tests.
Threshold Testing: Automated perimetry.
Extraocular Muscles: Six muscles provide control over eye movements.
Ductions: Monocular eye movements.
Abduction(lateral) and Adduction(medial).
Supraduction (upward) and Infraduction (downward).
Rotation: Incycloduction (intorsion) and Excycloduction (extorsion).
Dextroversion: Both eyes turn right
Laevoversion: Both eyes turn left
Supraversion: Eyes look up
Infraversion: Eyes look down
Convergence: Both eyes move inward
Divergence: Both eyes move outward
Types:
Cornea
Aqueous humour
Lens
Vitreous humour
Inner retina
Achieved by lack of blood vessels, nerve fibers, and structured arrangement of components.
Cornea: Collagen fibrils arrangement.
Aqueous: Blood-aqueous barrier prevents large molecular entry.
Lens: Lack of blood vessels and regulated fiber arrangement.
Vitreous: Collagen matrix helps in maintaining transparency.
Decreased blood flow and tear quality.
Lens becomes larger and clarity reduces leading to presbyopia.
Vitreous liquefaction affecting vision.
Increased prevalence of refractive errors, cataracts, age-related maculopathy, glaucoma, diabetic retinopathy, and dry eye.
Blind Spot Demonstration: Observe the blind spot of the eye.
Blood Vessel Patterns: Light test to see retinal blood vessels.
Eye Movement Simulation: Use simulators to see impacts of muscle palsy.
Create EOM Model: Hands-on activity to understand extraocular muscle functions.
Utilize Anatomy TV Database: Explore 3D eye anatomy for interactive learning.
Instructor: Professor David AtchisonEmail: d.atchison@qut.edu.au
Reference Books:
Jalie M (2021). Principles of ophthalmic lenses, 6th ed., Association of Dispensing Opticians.
Atchison DA, Smith G (2000). Optics of the human eye, Butterworth-Heinemann.
Module Overview:
Focus on foundation knowledge in ophthalmic optics and visual optics: lenses, prisms, and image formation in the eye.
Learning Outcomes:
Understand lenses and prisms, ocular components, and image formation in the eye.
Application of optics to the field of vision,
Includes the eye's optics and corrective devices.
Focus on the corrective devices aspect.
Relation to refractive anomalies and correcting lenses in visual optics section.
Sign Conventions:
Light travels from left to right.
Object/image distances, focal lengths, and radii of curvature are measured from optical surfaces.
Distances in the direction of light are positive.
Units:
Basic metric unit is metre (m).
Derived units include lens power in dioptres (D) and prism power in prism dioptres.
Equations for Lenses:
Surface Power:
F = (n' – n)/r
Refraction Equations:
L = n/l
L' = n'/l'
n'/l' – n/l = F
L' – L = F
Example Problems:
Applications of the above equations demonstrated through examples with calculated surface powers and distances.
Types of Lenses:
Spherical (spherical and astigmatic lenses).
Positive (thickest in the middle) vs Negative (thinnest in the middle).
Introduction to Prisms:
Solid pieces of glass or plastic with two plane surfaces inclined at an angle.
Prism Characteristics:
Prism angle, deviation, and power defined with equations.
Use in correcting ocular muscle defects.
Examines how the optics of the eye interact with physiological processes and affect visual performance.
Overlap with ophthalmic optics, including the positioning of the eye's optical components.
Components:
Tear film, cornea, anterior chamber, iris, lens, vitreous chamber, optic nerve.
Detailed characteristics of each component:
Cornea: Mean power ~ +43 D, anterior and posterior radii of curvature, aspheric nature.
Lens: Maintains power through shape and gradient index; power changes with accommodation.
Refraction in Eyes: Types of ametropia explained:
Myopia (shortsightedness), hyperopia (farsightedness), and astigmatism.
Myopic and hyperopic corrections through appropriate lenses.
Addressing presbyopia with positive lenses.
Explanation of astigmatic corrections using different powers for principal meridians.
Surface Power: F = (n' – n)/r
Refraction: L = n/l , L' = n'/l', n'/l' – n/l = F
Prism Power: P = 100 tan(d)
Deviation Relation: d = (n – 1)a
Effectivity/Transfer: L+ = L/(1 – (d/n)L]
Assignments:
Students are tasked with solving complex optics problems to reinforce understanding.
Example problems offer scenarios such as lens measurements, refractive index calculations, and neutralization techniques.
Instructor: Professor Joanne Wood
Dept: Optometry & Vision Science, Centre for Vision and Eye Research
Contact: j.wood@qut.edu.au; Ph: 3138 5701
Module covers the fundamental principles of vision:
Visible light
Duplex retina characteristics (rods vs. cones)
Eye's response to light and visual stimulation
Dark and light adaptation
Spatial vision (visual acuity & contrast sensitivity)
Motion sensitivity
Perceptual constancies
Binocular and colour vision
Definition: Light as electromagnetic radiation (wave/photons)
Wavelength Range: Human visible light: 400-700 nm
Colour Spectrum: violet (400 nm) to red (700 nm)
Nature of Light: Light waves are not coloured; perception arises from visual system interpretation.
White Light: Mixture of visible wavelengths
Light Interaction:
Absorption: E.g., absorbing dust and water vapor
Reflection: Light-coloured surfaces reflect, dark-coloured absorb
Transmission: Light passing through surfaces
Refraction: Light bending when passing through materials (e.g., glass)
Key Structures: Cornea, pupil, retina, lens, photoreceptors (rods & cones), optic nerve, macula.
Light Interaction in the Eye: Reflection, absorption, scattering, transmission, refraction.
Aging Effects:
Lens yellows with age, reducing transmission of shorter wavelengths
Macular pigment and blood vessels absorb shorter wavelengths.
Pathway from retina to:
Optic nerve → Optic chiasm → Optic tracts → LGN → Visual cortex
Projection: Visual information is upside down and laterally reversed on the retina.
Photoreceptors: Two types, rods (for low light) and cones (for bright light).
Operational Range: ~10 log units of light levels
Retinal Types:
Photopic: Cones (daylight vision)
Mesopic: Combination of both
Scotopic: Rods (night vision)
Visual Systems:
Scotopic (rods): High sensitivity, poor resolution
Photopic (cones): Poor sensitivity, excellent resolution
Key Characteristics Table:
Receptor Types: Rods vs. Cones
Morphology: Free-floating vs. discs attached to membranes
Sensitivity & resolution metrics (Weber’s fraction).
Distribution: ~120 million, absent at fovea.
Function: Scotopic vision, high sensitivity, colorblind.
Response Rate: Slower, detects dim lights through linking across retina.
Distribution: ~6 million, packed at fovea
Function: Photopic vision, quicker response, ability for color perception.
Types of Cones: Three (differing peak sensitivities).
Composition: Rods contain rhodopsin; cones have three pigments with distinct spectral sensitivity.
Chromophore: Retinal derived from Vitamin A, essential for color vision.
Concept: Slow recovery of sensitivity in reduced light, divided into two phases:
First Phase: 5-10 mins, rapid cone adaptation.
Second Phase: 10-45 mins, rod adaptation.
Effects of Aging: DA reduces with age and certain diseases.
Visual Acuity: Ability to resolve fine details; measured using standard charts (Snellen & logMAR).
Contrast Sensitivity: Alternative approach assessing spatial vision using sine wave gratings, sensitive to spatial frequency changes.
Visual Acuity Factors: Optical blur, luminance, retinal eccentricity, age.
Contrast Sensitivity Factors: Age, luminance, and retinal eccentricity.
Visual Acuity Measurement: Snellen and logMAR charts
Contrast Sensitivity Functions: Generated via sine wave gratings for varying spatial frequencies.
Definition: Ability to detect moving targets.
Importance:
Navigation and survival.
Provides basic contextual information:
Attracting attention.
Understanding 3D form.
Figure and ground perception (camouflage effects).
Interaction with environment during activities such as walking and driving.
Real Motion: Physical movement of an object.
Apparent Motion: Perceived when objects are presented sequentially and separated in space.
Induced Motion: Perceived motion of a stationary object due to surrounding movements.
Autokinetic Effects: Illusions of motion in stationary objects in a dark environment.
Movement After-effects: Illusory motion after adaptation to actual motion.
Definition: The ability of the visual system to recognize motion of living creatures from minimal input.
Patterns of motion for living creatures differ from inanimate objects.
Related concepts:
Shapes or types of biological motion can reflect gender and emotions (e.g., heavy/light, nervous/relaxed).
Definition: Perception that object properties (e.g., color, size, shape) remain stable despite changes in visual conditions.
Types:
Lightness Constancy: Perceived reflectance remains constant regardless of illumination.
Shape Constancy: Shape perception is stable despite varying viewpoints, dependent on depth information.
Size Constancy: Physical size appears consistent despite changes in distance.
Definition: Instances where perception diverges from actual stimuli.
Often arise from breakdowns of size and shape constancies.
Common Examples:
Moon Illusion: Moon appears larger on the horizon than at zenith but is actually the same size.
Ames Room: People of equal height appear different due to distorted room geometry.
Müller-Lyer Illusion: Lines of the same angle appear different in length.
Definition: Utilization of both eyes to create a cohesive image of the visual world.
Advantages:
Enhanced depth perception and larger visual fields.
Redundant visual input in cases of injury or disease.
Stereopsis: Depth perception arising from the slight differences in images received by each eye due to eye separation.
Requirements for Effective Binocular Vision:
Two eyes with separation and overlapping fields.
Ability to merge images from both eyes into one percept.
Motor Alignment Capacity: Refers to accurate eye movements in response to retinal disparities.
Corresponding Points: Points in each eye that correspond visually, leading to image fusion.
Retinal Disparity: Small differences between eye images contribute to depth perception,
Types:
Crossed disparity: Sensation of nearness.
Uncrossed disparity: Sensation of farness.
Too much disparity can lead to double vision.
Occurs when objects fall on non-corresponding retinal points, causing a double vision effect, typically felt in peripheral vision.
Example demonstration of crossed vs. uncrossed diplopia by focusing on distant vs. near objects.
Various assessments for binocular vision:
TNO random dot stereograms using colored glasses.
Randot stereo tests utilizing polarized light.
Definition: Related to light properties and the interaction with observer perception.
Light Sources:
Natural sources emit a broad range of wavelengths, while artificial sources may have narrow spectrums.
Surface Reflectance: The perceived color is dependent on both light wavelengths that reach and reflect off of surfaces.
Additive Colour Mixing: Combining different lights (RGB) creates new colors.
Subtractive Colour Mixing: Mixing pigments (CMY) results in colors based on absorption properties of pigments.
Example: Mixing red and green may result in varying hues based on absorption.
Human colour vision operates as a trichromatic system (three cone types - S,M,L).
Colour perception is influenced by the integration of cone types into color-opponent pathways within the visual system.
Congenital defects often involve missing or altered cone pigments, affecting color perception.
Types:
Dichromats: Absence of one cone type.
Protanopia, Deuteranopia, Tritanopia: Specific cone deficiencies leading to impaired color resolution.
Tests:
Pseudoisochromatic plates (Ishihara).
Hue discrimination tests (D-15).