IV Disorders of refraction, the crystalline lens and zonules
Essential topics/experience:
To have become familiar with the following:

i. Ametropia: including hypermetropia, myopia, astigmatism and their complications.

ii. Accommodation problems: including spasm and presbyopia.

iii. Lens opacification: including types of cataract, relationship of opacity to symptoms, contribution to visual loss in co-morbidities; systemic associations; cataract surgery and its complications.

iv. Pseudoexfoliation of the lens capsule: including its recognition and significance.

v. Calculation of intraocular lens power: according to the patientís needs.

vi. Liaison: with contact lens service.

Practical skills:
To have undertaken (under supervision until proficient) the following:

i. Retinoscopy with trial lenses and subjective refraction.

ii. Correction of refractive error by spherical, cylindrical and multi-focal lenses.

iii. Lens neutralisation and use of focimeter.

iv. Biometry and keratometry for intraocular lens calculation

v. Surgery for routine cataract, including extracapsular extraction and phacoemulsification with intraocular lens insertion; management of intra-operative complications [50 cataract or other intraocular procedures].

vi. Yag laser posterior capsulotomy [20].

Background theory/principles:
To have gained an awareness of the following:

i. Basis of spectacle intolerance from poor dispensing or defective prescription.

ii. Use of logMAR charts in assessment of acuity.

iii. Alternatives to capsular IOL fixation.

iv. Combined cataract and glaucoma/corneal transplantation surgery.

v. Ectopia lentis and Marfan syndrome.

vi. Contact lenses and refractive surgery.

vii. Therapeutic contact lenses.

viii. Fluidics and ultrasonics.

ix. Intraocular lens design and biomaterials.

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