Ask the Non-EEA Examiner - The 2008 Examination for Non-EEA/EU Qualified Optometrists

Are you preparing to sit the College of Optometrist’s Examination for Non EEA/EU Qualified Optometrists?

If you need a question answered on any aspect of the exam or understand anything specific about working as an optometrist in the UK, including employment options, then post your questions to us here.

Details on forthcoming Mock Exam Courses for Non EEA Qualified Optometrists by CLEARVIEW Training are available here.

More on standards and Markings:

You should be able to write an order for the frame, including things like angle of side, angle of splay, temporal width as well as eye size, DBL and side length.
You should know where to measure the length of side from and to
Have knowledge of some different frame materials, with the advantages and disadvantages of each. Note: cellulose nitrate is not legal in Britain.
You should be able to write an order for specs and lenses – this means knowing things like having to include heights of centres for high powers and for aspherics.
Also calculating blank size, and how to move optical centres to achieve required prisms without working the prism.
The presentation of spectacle prescription is where it specifies when BVD must be included – over + or – 5.00D.
For safety specs you need to know what all the markings are, both for oculars and frame/goggle. This is so that you can advise patients what to look for when they buy their safety appliance.

(Thank you Phyllis)

Joy Myint // Jan 18, 2008 at 10:05 am

An occluder? Hand held for covering the eye?

A hand held 6/60 letter downloadable from this site I believe…..

Lynne // Jan 19, 2008 at 11:49 pm

Thank you so much for the equipment and standards list.

Lynne // Jan 22, 2008 at 1:34 am

Hi
how in depth must low vision be known?
also do you have a formula to convert N notation to snellen, I have a formula to convert M notation to snellen but cannot find one for N notation.
thanks

Jane Macnaughton // Jan 24, 2008 at 1:34 am

Lynn,
Low Vision is not covered in any particular depth in the NonEEA exams - but there are two exams that the subject matter may be broached:
In the ODA oral exam: one of the criteria is that candidates should be able to ‘demonstrate an understanding of the causes of Partial Sight.’ This really refers to those disease conditions that are likely to cause a visual impairment, and the management of such.
Under the ‘UK Law & Practice exam one case record that you may have to read through and discuss could be one in which a Low Vision Aid has been dispensed. For this exam I would suggest that you stick to the basics,
•Be able to discuss simple adaptations to a routine eye examination that are necessary when you have a px with a visual impairment. Keep to the elderly rather than younger patients or children, as this age group is more likely to be discussed
•Be able to discuss the patient’s needs and perform a task analysis
•Discuss how you would determine the magnification required to meet those needs taking into consideration acuity and contrast reserves. There is no direct relationship between Snellen and N-point reading notation, only a rough estimate which few pratitioners actually use (6/60 divided by 3 = N20 point assuming a +4.00 add @25cms)
•Discuss the advantages of simple low vision aids such as hand and stand magnifiers. I doubt if there will be time to talk about telescopes.
•Be able to give appropriate advice and information on benefits and services taking into consideration local and national guidelines
•Be aware of the UK certification and registration documents which provide the legal framework of services for patients in the UK : Certification of Vision Impairment, the Referral of Vision Impairment and the Low Vision Leaflet – take a look at the Department of Health website.
That should give you more than enough to cover the subject in the detail that is required for this exam. The Eye Essentials Text, ‘Low Vision Assessment’ covers all in sufficient detail! (Am I allowed to say that?!)
There is also a blog post written on magnification last year. Click on Archives and then the category ‘Pre-Reg’ and you shall find it.

Lynne // Feb 4, 2008 at 4:40 am

Hi
for the dispensing exam which are the essential formula and calculations that must known: eg
Toric transposition
specticle mag
prism thinkness
effectivity and refractive index and surface power.

many thanks

Peter Chapman // Feb 6, 2008 at 2:27 am

Hi Lynne

Essential dispensing knowledge involving formula’s would include:

Prisms – be able to create prism by decentration using Prentice’s Law and also be aware on which lenses this can be achieved on. Be able to quickly calculate the amount of prism created should a lens be incorrectly centred in a frame. Be able to calculate differential prism. Also know the solutions for differential prism and understand and be able to apply formulas for this e.g. different size bifocal segments.

Also have knowledge of prism thinning in progressive powered lenses and be able to calculate how much prism thinning is needed

Sags- knowledge of how to apply the sag formula/ what sags alter would be much more applicable than being able to recite the formula. Be aware there are two sag formulas (approximate and accurate) and know the difference between these.

Effectivity and working distance – knowledge and understandings of the formulas relating to working distance should be known. For example you should be able to calculate the prescription required at 10mm from the original prescription tested at13mm.

Spectacle magnification - It is useful to be able to quickly approximate the amount of spectacle magnification created especially as this may lead on to further questioning regarding how spectacle magnification can be reduced.

Transposition should be easily done, with prescriptions being transposed from plus to minus cyl and vice versa. Also be familiar with a base, sphere and cross curve notation and be able to quickly convert this into a more familiar prescription form.

Aberrations - Have an idea of aberrations caused by spectacle lenses, especially transverse chromatic aberrations. Be able to calculate v values for lenses and know how these relate to TCA and what levels of TCA generally become symptomatic.

IP/RP ratios – have an understanding on the bearing of these ratios with regards to multifocal lenses, be able to calculate an IP/RP ratio, and know which IP/RP ratios are available in specific lens forms. (a lens catalogue is provided in the exam).

Peter

Lynne // Feb 14, 2008 at 3:01 am

hi
which method is correct or recommended when doing a trial frame refraction ( if needed to do a trial frame refraction) . once ret is completed and VA taken is it better to go straight to duochrome, leave on green best and then do jackson X-cyl and then add plus to relax acomodation and reduce plus to max plus. Or is it better to find sphere first then once max plus/ min minus achieved, then do duochrome and then jackson X-cyl.

Also duochrome doesn’t always work on older patients, is it acceptable to add -0.50 over ret, then carry on with jackson X-cyl?

Lynne

lilly // Feb 17, 2008 at 3:59 am

Hi,

I am starting to study for the registration examinations, and I was wondering if there were any past examination papers available to indicate the types of questions asked.

I don’t really know where to start! I graduated 7 years ago, and have done post-graduate therapeutics studies, but I am a bit rusty on the physics and optical theories.

Any help is much appreciated.

Thanks,

Lilly

Jane Macnaughton // Feb 19, 2008 at 3:25 am

Hi Lynn,
The same principles of refraction apply whether you are using a phoropter or a trial frame.
Think about the circle of least confusion (CLC): according to Andrew Franklin (Eye Essentials – the Routine Examination), we want to try to place the CLC on the retina before X-cyl technique. As the visual system has a degree of depth of focus, the only way to assure that the CLC is on the retina is to allow the patient to put it there with accommodation (assuming they have any). We aim therefore to allow the patient to accommodate minimally by slightly under-plussing them. Of course older patients have to accommodation so, modifying the BVS by -0.25 is not unreasonable.
Whether you use the duochrome or not to assist in this method is up to you – as long as you are aware of the limitation of the duochrome itself.
For these exams, the Eye Essentials Series is good – they were written with these exams in mind. (20% discount here)

In addition, if you want to practice the Routine Exam, have someone watch you and take notes using the following Routine Examiner Checklist

Jane Macnaughton // Feb 19, 2008 at 4:57 am

Hi Lilly
The first thing you need to do (unless you already have) is to contact Paul Mills at the College of Optometrists and register your interest in taking the NonEEA exams.
The syllabus may be downloaded from the College website here.
If you are studying for the NonEEA Qualified Optometrists Exams then there are no past examination papers as such with example questions as the NonEEA Exams are practical and oral based. However, contained within the syllabus is a copy if the mark sheets used by the examiners which will give you an idea of what they will be looking for.

didi odeh // Feb 22, 2008 at 3:20 am

hi
please can i have a list of drugs used by optometrists.
thanks

Jane Macnaughton // Feb 25, 2008 at 3:28 am

Hi Didi
I have added a link on our new resource page: the document you want is called the Optometrist’s Formulary.

Lynne // Mar 6, 2008 at 10:06 am

Is there a website that the standards can be downloaded from?

the lens catalogue which company is the one that we are possibly going to be examined on?

thanks

Jane Macnaughton // Mar 6, 2008 at 1:43 pm

Hi Lynne
The Lens catalogue that is referenced in the exams is the one from Norvilles. We have added links on the resources page from the other lens manufacturers so that you can download additional material for comparison.
I shall get back to you on the standards. I know that they cannot be downloaded, but what we really need is a definitive summary that we can reference.

Jane Macnaughton // Mar 6, 2008 at 1:56 pm

Hi Lynne
Standards: DOCET put together a (free) online Distance Learning Package on Occupational Optometry in 2004. It contains a wealth of information (including info on standards) that is just at the right level for the exams. I have also added a link on the resources page. Let me know it is useful.

didiodeh // Mar 7, 2008 at 4:13 am

hi
what other things would i need for the exams apart from my ophthalmoscope and retinoscope, and how can i source them…

Jane Macnaughton // Mar 8, 2008 at 2:26 am

I shall start compiling some equipment lists and post them on the resources page.

judesuyi // Mar 10, 2008 at 6:49 pm

Under what status can I come to London for the nom eu exam and what will become of my status after the exam.
Jude Obasuyi

judesuyi // Mar 10, 2008 at 6:57 pm

What book will you recommend for facial measurement and frame and lens measurement.
Jude Obasuyi

judesuyi // Mar 10, 2008 at 7:01 pm

Can you give me the list of the drugs that are important in terms of the non eea exam.

Lynne // Mar 11, 2008 at 9:09 am

Hi
the DOCET website is very good.
do we need to bring a frame rule and facial rule?

thanks Lynne

Jane Macnaughton // Mar 11, 2008 at 11:11 am

Drugs – thanks Judesuyi, I shall contact one of our Drugs examiners and see what we can do there for you.
DOCET - thanks Lynne, I have added links into the Resources pages. What, specifically did you find it useful for?
Re Frame Rules etc: In the Routine exam you will need something to take a PD with (a Frame rule is an obvious choice if you have one). Both Frame and Facial Rules are provided in the Dispensing station exam.

ndidi // Mar 15, 2008 at 11:53 am

hi jane,
pls where can i buy a trial frame?

Jane Macnaughton // Mar 17, 2008 at 3:56 am

Jude

Regarding Registration: You need to contact Paul Mills at the College of Optometrists. Paul overseas the applications for overseas practitioners seeking UK registration. You can also find out some initial detail here.
Your application for the NonEEA exam or other agreed route to UK qualification will depend upon your original optometry qualification and the experience you have gained since qualification. After completing the exam successfully, you may then register with the General Optical Council as a UK practitioner.

Jane Macnaughton // Mar 17, 2008 at 4:10 am

Ndidi
Trial Frames:
Optical Marketplace (old and new)
Birmingham Optical: Oculus Universal Trial Frame (a favourite amongst students - and me)
Keeler: Oculus Universal Trial Frame

Peter Chapman // Mar 18, 2008 at 12:19 pm

Regarding a book for facial and frame measurements, both the frame and facial rules come with good manuals, but should you not have access to these, Practical Dispensing by Antony Griffiths has sections on both frame and facial measurements as well as other areas of dispensing.

Lynne // Apr 7, 2008 at 5:11 am

When using the frame rule is it best to mark the box centers first so that can measure things like bridge height etc accurately?
also when reading off the rule for eg the angle of crescent do you take it as 80 where the frame point on the rule or is it 10 ( from the center line out?)

thanks

Lynne // Apr 7, 2008 at 6:01 am

do we need to do gonio, 90D/70D and goldman tonometry in the exam?

do you have any examples of the type of case history we could expect in the law part of the exams.

thanks

Jane Macnaughton // Apr 10, 2008 at 3:16 am

Hi Lynne
No Gonio, and no Volk in the ODA. The NonEEA ODA station exam is still under the old system - Volk lenses were only introduced into the exams for UK trainees over the past two years and currently wll not afftect you. Gonio has become more of a specialised technique here adopted by quaifed pracitioners who have devleoped a specilaist interest ibn Glaucoma.

Regarding the case rescrd - we will be giving you a selection of case scenarios for discussion on the course in May.

Peter Chapman // Apr 14, 2008 at 3:31 am

Lynne,

In answer to the dispensing questions…
1. There is no specific need to mark the datum centres. For the measurements, the frame can be moved across the rule so it is symmetrical across the relevent reference point.

2. With regard to the angle of crest measurement, the reading is taken from the scale opposite the segment diameters. Align the load bearing surfeace of the bridge along the flat edgeand the reading is taken along the plane of the rim.

Hope this helps

Sheila // Apr 15, 2008 at 8:43 am

Hello, I have moved here from Australia and will be sitting the June non-EEA exams. All my notes and textbooks are back in Australia. Will the Clearview course in MAry provide sufficient study notes for the examinations ?

Jane Macnaughton // Apr 15, 2008 at 9:14 am

Hi Sheila
The notes provided on the May course will provide the basis of your studies. The objectives of this course is to assist your exam preparation, put your through mock exams, give you an indication what to study and a guide to likely questions and pass-fail criteria. However, what the course is not there for, is to teach optometry (4 days clearly not being enough!). Most candidates would use the notes as their base and read around each subject again to refresh the detail. Many of the presentations will give additonal detail, especially where the information is non generic and more specific to UK practice.

Sheila // Apr 16, 2008 at 11:46 am

Thank you Jane. I have been able to source some notes from a colleague at work, who is a pre-reg student. Hopefully those plus the Course notes will be Ok ?

Dave E // Apr 23, 2008 at 6:44 pm

Hi there, I am a NZ qualified and practicing optometrist with 8 years experience. I had 3 questions I wanted to ask regarding your course and the examinations to register as an optometrist in the UK.
1) what are the dates for the examinations this year (you’ve given the dates for the course but I wasn’t sure how soon afterwards the actual exams are and how many days they are spread over)
2) what happens if I fail an aspect of the exams? Say I have a bad ret day (it happens sometimes!), or a blank out? Do I get the chance to repeat the exam again immediately or do I have to wait until the cycle of exams are held again whenever that would be (6-12mths)?
3)finally, like most optoms I know here I have developed my own method of subjective refraction. It works very well for me and for my patients. However for the British examinations will I be expected to do subjective refraction in a prescribed manner, or will I be questioned if I perform it in my own way, or (hopefully) will I be judged solely on the outcome - how correct my prescription is for the patient?

sorry to ask a flood of questions all at once, I really appreciate your help

cheers - Dave
New Zealand

Jane Macnaughton // Apr 25, 2008 at 8:29 am

Hi Dave
Thank you for the questions.
The exam dates for 2008:
Week commencing 16th June held at the Fight for Sight Clinic, City University. Closing date for application – May 9th 2008.
The next set of exams will be in early January of 2009 with a closing date set towards the end of November. For full detail you need to contact Paul Mills at the College of Optometrists. I am not sure if the dates have been made public as yet. However, as soon as they are, I shall post them on the resources page.

If you fail an exam, sadly there is no option to resit at the time. The re-sit would be taken at the next scheduled exam dates. You will have a limited number of re-sits before you would have to take them all again (if at all). Refer to the Exam Guidelines on the Resources page).

Everyone has his or her own way of doing a subjective. Our suggestion is to do what you normally do – don’t change things just for the sake of the exam – that is when things usually do go wrong. We are all different. If you do ret whilst standing on your head, you will raise a few eyebrows – but as long as you can justify the result then you should be fine. (However, I should imagine that one might take some doing!).

Again, there are tolerances within which you must stay (written in the Guidelines) but it’s the whole package that the examiner is looking for, not your ability to do individual tests.

Hope that helps - Jane

Sheila // May 6, 2008 at 12:49 pm

Hello,

For the mock exams next week, would you like us to dress professionally, or keep it casual ? Thanks YOu

Jane Macnaughton // May 6, 2008 at 10:21 pm

Hi Shelia
Monday and Thursday lectures - Casual.
Tuesday & Wednesday - smart business dress if you can - some of you are comng from a long way so Smart Casual will suffice if there is not enough room in the suitcase for another outfit.

Sheila // May 7, 2008 at 12:03 pm

Thanks Jane. I am coming to London for the week, so I will see what I can fit in my bag :) Thanks again.

Jane Macnaughton // May 8, 2008 at 3:37 am

We have recently uploaded a useful handout from Catherine Viner on the National Health Service which was requested at the recent NonEEA course in South Africa. Please refer to the Resources page.

Lynne Holmes // May 9, 2008 at 5:46 am

in the contact lens fitting assesment is the refractive error given, I know K’s are given.
thanks

Jane Macnaughton // May 10, 2008 at 8:26 am

Yes, Rx is given so that you calculate the lenticular or corneal astigmatism when discussing lens choice

NAVIN // May 16, 2008 at 2:08 am

Iam an Indian Optometrist,preparing for registration exam;can I brought a slitlamp for ocular examination

Jane Macnaughton // May 17, 2008 at 2:12 am

Slit lamps are provided in all exam cubicles for these exams. Slit lamp skills are examined during the contact lens exam (aftercare section). One or two practitioners may decide to examine the fundus using a Volk and Slit Lamp during the Routine exam although most opt to us a direct as the patient is not dilated. I must say that it does appear to be a rather drastic move to use your own slit lamp however you would not be the first to request this. However my argument against this would be that when qualified you would need to use the equipment of the practice in which you are working, so getting used to more than one piece of equipment is in your favour in the long term.
If you are intending to use your own equipment, may I suggest that you first ask the examinations coordinator at the College?

Dave E // May 17, 2008 at 2:19 am

Hi there, I am a NZ qualified and practicing optometrist with 8 years experience. I had 3 questions I wanted to ask regarding your course and the examinations to register as an optometrist in the UK.
1) what are the dates for the examinatins this year (you’ve given the dates for the course but I wasn’t sure how soon afterwardst the actual exams are and how many days they are spread over)
2) what happens if I fail an aspect of the exams? Say I have a bad ret day (it happens sometimes!), or a blank out? Do I get the chance to repeat the exam again immediately or do I have to wait until the cycle of exams are held again whenever that would be (6-12mths)?
3)finally, like most optoms I know here I have developed my own method of subjective refraction. It works very well for me and for my patients. However for the British examinations will I be expected to do subjective refraction in a prescribed manner, or will I be questioned if I perform it in my own way, or (hopefully) will I be judged solely on the outcome - how correct my prescription is for the patient?
sorry to ask a flood of questions all at once, I really appreciate your help
cheers - Dave
New Zealand

Jane Macnaughton // May 17, 2008 at 2:30 am

The exams are held over four days, week commencing June 16th 2008. For full details visit the College website, where you can download the Regulations and Guidelines. The next sets of exams are held in January 2009, which is provisionally set to be the week commencing the 5th January 2009. What you would first do is to contact Paul Mills at the College of Optometrists who will give you full details on the application process.

Bad ret days do occur. However re-sits don’t happen there and then, you would need to wait for the next set of exams to re-sit (currently twice a year).

You are judged not only on the outcome but also how you get there. However, we all have our own ways of doing things including our subjective. We acknowledge that. We would expect that you do what you would normally do – try not to pull out something for the sake of the exam. You may do retinoscopy standing on your head –as long as you can justify why (that could be tricky in this case!) and of course get the correct answer to within a stated tolerance (in the guidelines). What we are looking for is whether or not you are Safe to Practice.

Aadil // May 17, 2008 at 2:45 am

HI
Im really concerned about the binocular vision and dispensing exams in jan 2009. can u recommend any text or information to help me? perticularly the dispensing exam because I have no idea of how to do the different measurement like refractive index for eg.and also to get info on lense materials, advantage and disadvantages.

with regards to binocular vision, what wud be the best text to use for the exam?

please help
many thanks

with regards to dispensing is there a text take covers all there is to know about dispensing esp. for the exam?

thank you
aadil

Jane Macnaughton // May 17, 2008 at 2:52 am

Any good BV text should cover the syllabus.
One recently used by the NonEEA Optometrists preparing for the June exams is Fiona Rowe’s Clinical Orthoptics (Blackwell).
The Eye Essentials Series (Elsevier) also have a BV text by Bruce Evans which is set at the right ‘pitch’ but may not be detailed enough if you haven’t done BV for a while. Bruce Evans has also added to Pickwell’s Binocular Vision Assessment which is in more detail.
There is no single Dispensing text that I am aware of – I shall pass you over to Peter to answer that!

Peter Chapman // May 17, 2008 at 12:09 pm

I believe there are two books that will give a general overview of lenses and materials. These are: Ophthalmic Lenses & Dispensing by Mo Jalie and
Practical Dispensing by Anthony Griffiths. Both will cover lens materials, design and safety lenses.
Frame and facial measurements and adjustments are also covered in the book by Anthony Griffiths as well as a section on paedriatric dispensing, so this may give a broader coverage of topics needed for the final exams.

Lynne Holmes // May 19, 2008 at 2:51 am

I does anyone know were I can get a wratten filter to use with a slit lamp ( for those that don’t have one built in). I tried keeler, they don’t do them.

thanks
Lynne

Jane Macnaughton // May 19, 2008 at 3:18 am

Hi Lynne
Ciba Vision are kindly sending some to me for you.

NAVIN JOSE // May 19, 2008 at 3:24 am

Iam an Indian optometrist.Can I get 3-4 months clinical training in U.K hospitals before exam

Aadil // May 19, 2008 at 10:07 am

HI Peter and Jane

thanks very much on the book recommendations. it should put me in the right direction now

Aadil

Jide // May 23, 2008 at 12:37 am

Please may I know the order for which binocular vision examination is carried?
Thanks

Jude // May 23, 2008 at 12:46 am

I don’t really know if you are in a position to answer this, but I wish to know if I can come over to the Uk say seven months before my exams and also if it is possible for me to take up some non professional jobs in the UK before my exams? Thank you very much.
Jude

Jane Macnaughton // May 24, 2008 at 8:46 am

Hi Navin and Jude

UK Expereince.
The first thing that you need to do is to discuss your position with Paul Mills at the College of Optometrists. The College will let you know whether or not you can apply for the exams, or complete a period of study first at one of the UK Optometry institutions.
If you wish to gain some experience in practicing in the UK then that is more tricky. You need to be registered wit the GOC to become a student practitioner to gain experience, whether this is within the Hospital Eye Service or within General Optometric practice. And I am not sure whether that option is available for you
However, some overseas practitioners make arrangements to gain experience of the UK Optometry profession by taking a non-clinical roles within a practice. You will not be able to examine patients though.
My suggestion is that you discuss your position first with the College and go from there.

Jane Macnaughton // May 24, 2008 at 8:57 am

Jude,
The examination record sheet for the BV exam is outlined on the College’s NonEEA Examination guidelines (p25 click here). The outline of the exam is on page 11. The main elements of the exam are history taking, checking VA, cover tests, motility and using any additional tests to decide up the mature of the anomaly that is presented. You will be given the patients spectacle Rx where relevant. You would typically choose those tests that you would need in order to come to a conclusion on both the motor and the sensory status of the condition presented. For example, the use of a prism bar, stereotests, or Bagolini lenses.

Dave // May 27, 2008 at 1:18 pm

Hi Jane
I was reading the above q’s and a’s and noted that you mentioned there had been a non-EEA course held in South Africa (your comment May 8th) - are non-EEA courses held elsewhere, like Australia? and if so where could I find out details like dates, course content etc…

cheers
Dave
New Zealand

Camy // May 28, 2008 at 12:00 am

Hi,

Please either direct me to a website or provide me with detailed instructions on how to take the Angle of Crest and Angle of Splay measurements. (I have read the explanation earlier in this thread but still have difficulty with this - Apical Radius??)

Thanks,
Camy

Jane Macnaughton // May 28, 2008 at 1:31 am

Dave
Yes, we were invited out to SA earlier this year to talk to 40 SA optometrists who were considering both OCANZ and UK registration. This had been arranged by a local firm in Johannesburg - Bev Meekel Consulting. We have no immediate plans for Aus/NZ however if there is enough interest then yes we would consider it.

Jude // May 28, 2008 at 5:42 am

Hi
Please, in the course of
binocular vision examination, I wish to know which tests comes under the motor investigation and which comes under the sensory investigation and also,the additional test that may be added and when is it necessary to add these extra tests.
Thank you.
Jude

Jude // May 28, 2008 at 5:52 am

Hi,
Please may I know the areas I need to concentrate on in the pharmacology and pathology aspect of the non EEA exam.
Thank you
Jude

Jane Macnaughton // May 28, 2008 at 9:43 am

Jude
BV:Not quite sure what you mean about extra tests- unless you are referring to the exam sheet? In order to come to a conclusion regarding diagnosis you should have knowledge of which tests are appropriate to the condition that you are investigating. You should always have a routine for investigation but one that is adaptable under the circumstances.

Motor Investigation: for example motility and cover test
Sensory test: stereotests, Bagolini lenses.

Pharmacology: you will need knowledge of general principles of pharmacology, mechanisms of pharmacology and the eye. You should know what is available for use in the UK (refer to the Optometrists Formulary on the Resources Page) and how each works: including indications and contraindications. Also side effects.

Ocular Pathology – the station and viva exam will focuses around Investigation (how to look for it), Interpretation (looking at the results you have found) and Management (now you have found it – what are you going to do about it). Your pass/fail criteria will certainly be around referral criteria.

General areas to consider: Glaucomas, Diabetes, Cataract, Sudden loss of vision, deferential diagnosis of the red eye, hypertension. But basically, anything goes. (Sorry!)

Jude // May 29, 2008 at 9:09 am

Hi Jane,
Please may I know the percentage of people who pass the non eea exam at first sitting and also, if only one aspect of the exam is failed say dispensing, do you repeat all or just the one failed. Thank you

Jude

Peter Chapman // May 29, 2008 at 1:08 pm

Camy,

Watch this space, i will try a produce a photo of angle of splay and apical radius being taken and speak to Jane if there’s any way of posting them. Angle of crest is a frame measurement, is this what you are after, or are you after crest height which is a facial measurement?

Camy // May 30, 2008 at 1:18 am

Hi Peter,
Thanks for the update and for the effort being put into answering the Q. To be quite honest, I am quite puzzled about both measurements - the angle and height - any assistance with both will be much appreciated.

Thanks,
Camy

Nikky // May 31, 2008 at 11:52 am

Hi there

Have managed to get myself all into a muddle and have a BV question : )

To check the sensory status during the exam, should I use the Mallett Mod. OXO to check for suppression, or does this only check global suppression? Furthermore, is this only for near - was not sure about the instructions in the Eye Essentials book - 1.5m for distance? Or do I have to change and use the normal OXO chart for distance?

An example of flow for the exam for the sensory status would then be:
check stereopsis (Randot), if present, continue to Mod. Oxo to check for HARC/ gobal suppression. If no/ltd stereopsis, then check suppression (peripheral)?
Continue analysis from these results?
Is this about right?
Looking forward to your reply.
Thank you - drivig myself nuts at the moment!
Kind regards
Nikky

Normally I would use the Worth 4 Dot to check suppression

Lynne // May 31, 2008 at 1:07 pm

if in an exam you don’t know an answer what is the best way to answer?

If you are ill on the day if the exam, who do you contact?

I am sure as the exam get closer there be a few more questions, thanks for answering so many already- life saver!
Lynne

Jenny // Jun 2, 2008 at 7:43 am

Hi Jane,
Just a question about the Friday after the exams. Our timetables say we see the assessment board at 10am. Generally how long does this take? What would be the lastest we should expect to be finish for that day.
Hope you can help. Just trying to organise train times.
Thanks Jenny

Jane Macnaughton // Jun 3, 2008 at 12:52 am

Hi Jude (May 29)
The statistics are not available I am afraid. In the past the UK graduates had around 35% pass rate first time round. Most passing after the re-sit attempt. I should imagine this % would be higher for NonEEA as they are already experienced practitioners in their own right.
You repeat the one/s that you fail, but at the next sitting. There is a limit on how many times you can re-sit however, this information is available in the College Guidelines.

Jane Macnaughton // Jun 3, 2008 at 1:01 am

Lynne (May 31)
Just say you don’t know – there is nothing worse than digging yourself into a hole. Often the examiner will re-phrase the question or back track a little and come at the question a different way. You probably do know the answer – examiners will extract the info out of you if they are convinced it is in there somewhere!

If you are ill (don’t be – I shall give you a hard time if you are!) then you need to contact Paul Mills directly. If he is at the exam centre he will have a mobile – you should contact the College who will then give him a message.

Jane Macnaughton // Jun 3, 2008 at 1:22 am

Jenny (June 2)
You will all have been given the 10am Assessment Board start time. You will then filter in one by one - each lasting only a few minutes - should all be done and dusted by 1pm. However, I should make sure that you have enough time to see everyone and say your goodbyes!

Nick // Jun 3, 2008 at 2:20 am

Hi Jane, I had a couple of questions I was hoping you or your team could answer:
1. Is Lissamine green available or being used in the UK? If so, is it also a P medicine like NaF?

2. Is chloramphenicol 1% also a P (Pharmacy) medicine in the UK like 0.5% drops are?

3. If you are a level two additional supply optometrist, does that mean you can just write an order to the pharmacist for the level 2 drugs or can you also supply them directly to the patient?

4. For a Level 1 Optom, have I read it correctly that a signed order to the pharmacist for a particular patient can only be for Cyclopentalate, Tropicamide, Chloramphenicol, Fusidic acid? Nothing else, even in an ‘emergency’?

5. What concentration of Phenylephrine is a P (Pharmacy) medicine? is it just 0.12% or is 2.5% also a P med?

Thanks for your help,
Nick M

Jane Macnaughton // Jun 3, 2008 at 4:51 am

Camy (May 28)
Peter has been busy with his camera. Let us know if this helps: Peter’s Guide to Facial Measurements

Camy // Jun 3, 2008 at 10:44 pm

Peter/Jane,
This information is exceptionally helpful and more than I expected. I am grateful for the effort made in answering the question.
THANKS!!!
Camy

Simon Frackiewicz // Jun 4, 2008 at 4:34 am

Hi Nikky

The Maddox Rod is used to measure the size of a deviation, thus, whist I suppose it technically would confirm the sensory status (seeing the spot and line at the sime time must mean that simultaneous perception exists), it would be preferable to use either Worths lights or Bagolini’s striated lenses.

The OXO test would confirm the presence of gross suppression, but again is more useful for measuring an associated deviation. The presence of suppression could be confirmed with the above tests of sensory fusion, and may be measured using the polarised letters on the near Mallett Unit.

When checking a patient’s sensory status, it pays to remember that if stereopsis is present, then sensory fusion MUST exist, and there is then no need to check it with any other test. If stereopsis is absent, then one should use an alternative test, whilst at the same time considering the motor status. For example, if the patient has a 35 dioptre esotropia from childhood, then there is no possibility of any measurable stereopsis, and in this case, all sensory tests will confirm either suppression or, less likely, diplopia. If, however, their deviation is only 10 dioptres, they may have no measurable stereopsis, but could feasibly have ARC. In this case, Worth’s lights or Bagolini’s lenses will give a BSV response, but one would expect an area of suppression detectable using the Mallett Unit or foveal Worth’s lights. If there is no deviation on cover test, and stereopsis is either reduced or absent, investigate for microtropia with identity (monofixation syndrome) and bear in mind the influence of amblyopia on the results.

I hope this is of some use.

Simon

Jude // Jun 4, 2008 at 5:48 am

Hi Jane
I am quite impressed on the released guide to facial measurement. Can you please do the same for lens and frame measurement or at least anything that can aid its understanding. Thank you.
Jude

Jane Macnaughton // Jun 4, 2008 at 6:10 am

Jude - thank you. You will find that Peter mentioned a selection of texts which would be hepful in this instance (see May 17 above) Hope these help.

Nick M // Jun 4, 2008 at 9:10 am

Hi Jane,

I have another question on the legal use of Chloramphenicol that I’m having trouble with:

Lets say we have a patient whom we’d like to have topical Chloramphenicol as prophylaxis after trivial eye trauma, (say, epithelial and expected to resolve with no consequence, like after a minor foreign body removal) - but enough trauma that it should be reviewed in 24hrs and have prophylaxis.

Am I correct that I cannot supply them chloramphenicol as a P medicine directly, because it is only a P medicine if we are treating bacterial conjunctivitis?

Therefore if I wish to give them Chloramphenicol for any other indication, then I have to request it as a POM from the pharmacist, in which case I can only do that if they cannot see their GP?
I know I can supply Chloramphenicol for other indications as a POM ‘in and emergency’ but would the above situation be ‘an emergency’?

I think this part of the Formulary confuses the situation a bit -
“1.7. An order made under the Opticians Act 1989 provides that where it appears to a
registered optometrist that a person consulting him/her is suffering from an injury or
disease of the eye, the optometrist shall refer that person to a registered medical
practitioner, except in specified circumstances where otherwise it is impractical or
inexpedient to do so or there is no justification for such a referral. ”

Because the minor trauma is ‘inconsequential’ and it is inexpedient to send a person along to the GP for the prophylactic anti-biotic, would an optometrist be justified in giving the patient a signed order to take to the pharmacist? By the time the patient saw the GP it might have resolved, but it might have worsened without the antibiotic and by then it’s too late.

I know this is a very hypothetical situation but it seems like just the sort of questions that might be asked in an exam.
What is the recommended course of action in this situation?
Thanks for your help,

Nick M

Nikky // Jun 5, 2008 at 1:40 pm

Hi there Simon

Thanks so much for the detailed feedback.

Just to confirm something from our BV session with you during the prep week: Mod Mallett Unit tests a higher level of BV (stereopsis) than the Bagolini lenses => better to use?

Kind regards
Nikky

Lynne // Jun 6, 2008 at 9:35 am

Hi Jane

I have a few dispensing questions.
1. if working out the prism on a oblique cyl how would you do it? I have a formula 2/3 X F if the axis is 135, is there an easier wy withour needing a calcualator.
2. how do you workout the inset of a bifocal?
3. were are the optical centre in a bifocal- is distance the pd but were is near?
4. what formula do you recommend to use to work out the sag- eg in the oral if they ask what centre thckness is needed?
5. do we need to know the tolerances of lenses, for checking off.

the photos Peter posted are great.
thank you so much
Lynne

Jude // Jun 6, 2008 at 3:54 pm

Hi Jane,
Please I want to know if there is any job like optometrist assistant in UK, and if yes is registration with GOC required? Thank you
Jude

David // Jun 8, 2008 at 2:22 am

Hi Jude, There are positions within the Optometry sector in the UK called Optical/dispensing Assistants. This role is wide and varied and includes certain elements of dispensing with some elements of retail, it does not require registration with the GOC and there are a wide variety of practices recruiting across the UK. If you require and more information, please feel free to email me on david@ukoptometry.co.uk.

David.

Lynne // Jun 8, 2008 at 11:11 am

Hi Jane

with regard to optometry what local legislation do optometrist need to follow, which is more important local or GOC?

thanks
Lynne

ndidi // Jun 8, 2008 at 11:33 am

hi jane
just wondering if i could stain the soft lens during fitting or aftercare. or i don’t need to?
also do we really need to memorize the optical tolerances and standards, they are quite a lot?
Now this is a BV question… when performing an ocular motility test and your px reports a diplopia at a particular position why do we then go ahead to perform a cover test at that position,what are we trying to assess or check?
i would also like to see the answers to nick’s last 2 questions. thanks
didi

Lynne // Jun 10, 2008 at 7:56 am

when doing the BV testing is it best to do cover test then motilities, then if a deviation is find do cover test or krimsky in 9 position of gaze, or should we do cover test in 9 position from the start?
Is it a good idea to do a red lens test if suspect a incomitantcy, or to make it easier to see diplopia?
thanks
Lynne

Peter Chapman // Jun 11, 2008 at 12:08 am

Hello Lynne,

1. To work out either prismatic effect at a decentred point on a lens or to find the decentration required to produce prism on a lens with oblique cylinders cannot be done quickly. Two methods are possible; one involves calculations using sin and cos rules whilst the other uses a graphical construction. I feel you would be very unlucky to get asked anything other than axis 90 and 180 in an exam.

2. When ordering bifocals, most practitioners will use a “geometric inset” for the near segment. This is simply calculated as:
Geometric inset = 0.5(PD-NCD) where PD = pupil distance
And NCD = near centration distance

This is fine for most lenses, however, becomes slightly inaccurate at very high powers. If high powers are dispensed, then the inset needed for coincident fields of view can be calculated by the formula:

Inset = p(L/L+F-S) where p= mono pd
L= object vergence
F= distance correction
S= dioptric power of the vertex distance

This answer needs to be multiplied by -1 to create a positive integer.

For the purpose of the exam, the geometric inset should suffice, however knowledge of the other measurement may be useful for the viva.

3. The optical centre of a bifocal is the pd for the distance portion. For the near segment, the optical centre is the geometric centre of the segment, however this is often different due to the near visual point.

4. To calculate the sag, use the approximate sag formula.

5. I have checked with Jane, knowledge of the tolerances will be needed for the viva but you will not be able to have a copy to hand.

Hope this answers everything!

Catherine V // Jun 12, 2008 at 12:40 pm

Nick

In this situation, I would think that most practitioners, if they thought the patient didn’t need referral on to HES that day, would instill chloramphenicol in practice and send the patient home with a few minims of chloramphenicol with instructions to instill 4 hourly and review again the next day. It would also be prudent if the patient patient were given advice to return or take themselves to casualty immediately should VA drop, or pain, redness, photophobia, lacrimation increase.

All this should, of course, be noted on the patient’s record card.

Catherine

Nick - more to follow.

Jane Macnaughton // Jun 12, 2008 at 12:55 pm

Lynne June 8

GOC national protocols are a must. Local differences are not expected from you in this exam as for all intents and purposes, you are working yes).
Stick to GOC guidelines. Everything is based on those anyway.

Didi June 8

CL Staining: You should avoid staining the soft lens and e aware of the potential hazards if stain enters the lens.
So, in the aftercare section, make sure you have finished all of your checks of the soft lens, remove it from the eye and then continue with your examination, without and then with Fluorescein. You do not need to put the soft lens back in again, and you would typically inform the patient that they must not re-insert his or her CL again until the Fluorescein has completely gone. If you have accidentally dribbled copious amounts of Fluorescein into the patient’s eye (nervous hands!) then it would seem sensible to offer to irrigate the eye before the patient leaves the room. The examiner will probably tell you not to bother however as there will not be enough time.

Optical tolerances: no need to memorize them. (there are too many to memorize) You should have a rough idea of what they are and be able to discuss the consequences if a lens is found to be outside of tolerance.

British Standards: you should know that they exist, what they are there for and have a basic outline of what they are. Eye protection / Safety eyewear is the most important which includes the markings etc and why they are there. However, getting hold of copies of the standards is one of the most difficult tasks known to man. For you and the examiners! I have placed one or two links on the resources page which may assist.

Ocular motility: if your patient reports diplopia at a specific point in the motor field this must be fully investigated to be able to determine which eye and muscle/s are affected. Conducting a CT in any position of gaze is done for the same reason it is done in the primary position.
Take a look at Simon’s ‘What’s on BV’ series which looks into the CTest in more detail.

Lynne June 10
BV: The first option. Only if a deviation is found then you would go on to conduct a CT in the other positions of gaze. Having said that, given the exam, it is likely you will need to do this with most pxs anyway.
Red lens test: put it in if you feel this would be of benefit to you. But be wary of the limitations.

Nick (June 3)

1. Lissamine green is not very widely used in the UK although is becoming more popular. I cannot find a classification (P,POM etc) on my box in practice so presume its on the GSL list. (Peter Chapman)

2. Phenylephrine is a P medicine at 2.5% concentration. There is also a 10% concentration (also a P medicine) although this strength is not widely used in optometric practice. (Peter Chapman)

Nikky (June5)
The Mallett Unit is not a test of stereopsis, rather somewhere between sensory fusion and simultaneous perception, in the same way as Bagolini glasses. My point was simply that if you have managed to elicit a positive response with the Mallett Unit, i.e. both Nonius markers are visible simultaneously, and aligned, then there can be no suppression, thus you have effectively proved the presence of simultaneous perception/sensory fusion and to do Bagolini would be a waste of time. If they fail to see both markers simultaneously, i.e. suppression is present, they may still have the potential for gross binocularity and doing Bagolini glasses is then a valuable test as the stimulus presented to the patient is larger, and may well exceed the suppression scotoma.

If you prove the presence of stereopsis with an actual stereo test, then sensory fusion MUST exist, i.e. using Bagolini glasses will tell you nothing new. Mallett Unit would still be indicated for its proper function of assessing associated phoria. (Simon)

This thread is now closed. Good Luck to one and all!
Jane

Ask the Non-EEA Examiner - The 2008 Examination for Non-EEA/EU Qualified Optometrists

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