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96031 Clinical Management of Refractive Error

Warning: The information on this page is indicative. The subject outline for a particular session, location and mode of offering is the authoritative source of all information about the subject for that offering. Required texts, recommended texts and references in particular are likely to change. Students will be provided with a subject outline once they enrol in the subject.

Subject handbook information prior to 2020 is available in the Archives.

UTS: Health (GEM)
Credit points: 6 cp
Result type: Grade and marks

There are course requisites for this subject. See access conditions.

Description

Foundation knowledge of optics and refractive errors acquired in 96027 Eye and Visual Systems is expanded in this subject to include detailed learning of the aetiology of refractive errors and the scientific and clinical aspects of their management. Students are encouraged to critically evaluate different methods of ascertaining refractive error and the underpinning ocular biometry based on the current research evidence available. Through a problem-based inquiry approach to learning, students develop an understanding of the advantages and limitations of different methods of correcting ametropia, including optical and surgical methods and how these influence management plans, with particular regard to the life stage, ocular health including strabismus, lifestyle and occupation of the individual. Areas of controversy and complex practice are studied, such as latent and manifest hyperopia, development of astigmatism, the aetiology of myopia, progressive myopia and keratoconus. On completion of this subject students have the orthoptic clinical skills required to objectively and subjectively assess refractive status and be proficient in the prescription of spectacle lenses.

Subject learning objectives (SLOs)

31.1. Apply basic understanding of the different types of refractive errors and the underlying anatomical and optical properties of the eye (ocular biometrics) that cause ametropia to determine the impact of refractive errors on visual performance, patient comfort and functionality.
31.2. Utilise knowledge of refraction over the life course as well as ocular conditions and disorders that impact and change refractive status and interpret signs and symptoms and plan appropriate methods of investigation and management including optical and surgical therapeutic techniques.
31.3. Utilise sound clinical reasoning and evidence based practice to effectively manage complex orthoptic and ophthalmic conditions using optical corrections.
31.4. Use novice practitioner skills for refractive errors investigation such as retinoscopy and subjective refraction and interpret observations and test results to correctly prescribe glasses.
31.5. Apply advance clinical communication skills to effectively explain test procedures, clinical conditions, therapeutic and surgical management techniques for the correction of refractive errors in terms that can be readily understood by a diverse range of patients, while demonstrating a respectful and compassionate approach to patient care.

Course intended learning outcomes (CILOs)

The learning outcomes for this subject are as follows:

  • Demonstrate professional behaviour and expertise in the delivery of safe, competent and responsible practice for the benefit and care of patients and the wider community. (.01)
  • Reflect on knowledge, attitudes and skills acquired for the evaluation and integration of emerging evidence into practice, promoting the growth of personal and professional learning and the education of others. (.02)
  • Analyse and synthesise knowledge of health sciences concepts and theory, and apply skills of scientific research and clinical reasoning to support decision-making in orthoptic practice. (.03)
  • Be an advocate for their patient, demonstrating sound, ethical, compassionate and respectful patient-focused care while acknowledging responsibility for personal health and wellbeing. (.05)
  • Effectively and accurately communicate to patients, their families, carers and members of the healthcare team and contributing to the wider role of health education and its promotion, acknowledging and adapting communication to address cultural and linguistic diversity. (.06)
  • Demonstrate knowledge of health systems and concerns in national and global communities, with awareness of the social and cultural context of their practice reflected in a consultative approach to the formulation and implementation of management plans that meet the diverse needs of individuals and communities. (.07)
  • Demonstrate respect and value for diverse ways of knowing, being and doing, in particular recognising the diversity of Indigenous Australians while critically reflecting upon the impact of ongoing colonisation and its pervasive discourse on their health and wellbeing, and integrating this knowledge into practice. (.08)
  • Represent the role of the orthoptist in multidisciplinary environments and through self-awareness and acknowledgement of the contribution of other health practitioners, support an interdisciplinary approach to attain the best outcomes for patients. (.09)

Contribution to the development of graduate attributes

This subject contributes to the development of the following graduate attributes:

• Lifelong Learning

• Professional Capacity

• Global Citizenship

Teaching and learning strategies

Preparation for Learning: Students will be provided with the details of preparation activities each week through the subject’s UTSOnline site. Activities are designed to help students prepare for their learning in lectures and workshops by engaging them with textbook, journal and other readings, videos, online resources, quizzes and short answer questions and group discussion. In addition, clinical practical classes have pre-practical reading and questions attached, which are expected to be completed prior to attending these classes to ensure maximal time can be spent on hands-on practice.

Active Lectures: Lectures provide an introduction to topic content each week and guest lecturers are invited to share their professional expertise on particular topic areas at relevant times throughout the session. Lectures are active and require students to engage and participate in the analysis of case presentations, quizzes and trivia, class discussion and debate and other active and collaborative learning methods.

Case-based Learning: Case-based learning is a form of problem-based learning (PBL) and a key learning strategy used in workshops. Authentic patient clinical cases are analysed individually and in small (POD) groups. Through this students develop skill in clinical reasoning and practice the application of theoretical knowledge gained in lectures and practical classes to differentially diagnose and develop appropriate plans for the investigation and management of patients with a variety of ocular conditions.

Research-integrated Learning: Taking an evidence-based approach to the investigation and management of patient cases is essential for effective patient care and an important skill for Orthoptic students to develop. Current research is integrated into content provided in lectures and pre-work and students are provided opportunities in workshop classes and through assessment to read, discuss and utilise current research in ophthalmology and orthoptics in the context of evidence-based patient care.

Collaborative Learning: As health professionals, teamwork is an essential skill to ensure patients are managed appropriately within interdisciplinary teams of health professionals. Teamwork skills are developed through collaboration with peers in active lectures and workshops, conducted in collaborative POD classrooms, as well as, when performing clinical skills in practical classes and through group assessment.

Reflective Learning: Students are encouraged to critically reflect on their learning throughout the subject to identify areas where they may improve their performance and to assist in the development of lifelong learning skills. Specific activities where reflective learning is encouraged are; self-evaluation of clinical skill performance in practical classes against OSCE marking criteria and skill achievement checklists and through post lecture/workshop review of learning questions on UTSOnline.

Practice-based Learning: Clinical practical classes are conducted in small groups (max. 12 students) each week for this subject. These provide students with an opportunity to learn and develop competency in clinical skills relevant to orthoptic practice. These sessions are entirely practice-based and following a short demonstration of the skill, students are closely supervised and provided instruction and feedback, as they participate in hands-on practice of skills, including the use of specialised orthoptic and ophthalmic equipment and technology.

Authentic and Simulated Clinical Experiences: Clinical practical classes are conducted in our dedicated teaching clinic rooms and provide students with access to a simulated clinical environment including, key technology used in professional orthoptic practice. Students participate in role play and simulation of various refractive conditions using lenses.

Self-directed Practice: Clinical practical classes provide students with supervised practice of clinical skills, however, to attain a sufficient level of competency in clinical skills, self-directed practice outside of class time is required. As a general guide, students are expected to spend approximately 1 hour of self-directed practice in the orthoptic dedicated teaching clinics per subject. This is important preparation for clinical placement and your OSCE exams.

Ongoing Feedback: In-class verbal feedback is an important teaching and learning strategy employed throughout the subject. Students are provided with immediate feedback relating to the performance of clinical skills in clinical practical classes and relating to clinical reasoning and understanding of key concepts by staff facilitating workshops. There are opportunities for verbal formative feedback on assignments before submission and detailed written formative and summative feedback following submission. In week 14, Mock OSCE exams are held to provide students with formative feedback on clinical skills prior to the OSCE exams.

Content (topics)

The subject lays out the principles and practice of refractive error management. The aim of the subject is for students to acquire fundamental clinical skills in evaluating refractive status and its management. The subject covers a comprehensive spectrum of aetiology, assessment and treatment of refractive error which prepares students for the Orthoptic workforce. It is expected that by the end of semester, student will be able to competently diagnose and manage refractive error eye conditions using optical techniques while developing an understanding of surgical methods of correction.

Topics covered in this subject include; Anatomical and optical components of refraction; epidemiology of biometry & refractive errors and changes with age; hyperopia and presbyopia; myopia; principles and methods of refraction including objective and subjective methods; high myopia; astigmatism; anisometropia; prescription of glasses and contact lenses; dispensing glasses; contact lens fitting; corneal topography, aberrations and laser refractive surgery; premium IOLs and Intacts.

Assessment

Assessment task 1: Written Assignment

Intent:

Refractive errors are a common clinical condition. Understanding of the different types of refractive errors and their implications for the patient in regards to both prognosis and therapeutic management are important. This assignment asks you to consider some of the more common questions that are raised by patients in regards to the management of their or their child’s refractive error. You must be able to give an evidence-based response to these questions, some of which are highly controversial.

Objective(s):

This task is aligned with the following subject learning objectives:

31.1, 31.2 and 31.3

This task is aligned with the following course learning outcomes:

.01, .02, .03 and .06

Type: Literature review
Groupwork: Individual
Weight: 30%
Length:

2000 Words

Criteria:

Detailed assessment criteria provided in class and on UTSOnline.

Assessment task 2: OSCE (must-pass component)

Intent:

This exam is an authentic form of assessment, conducted in a simulated clinical environment to most appropriately assess a student’s clinical competency for participation in a future clinical working environment, including clinical placement. An objective structured clinical exam (OSCE) enables students to demonstrate components of understanding, clinical and equipment skill, clinical reasoning and communication that are not readily assessed in a written format. These exams will allow the student to demonstrate knowledge they have gained across the subject through lectures, clinical practicals and through self-directed practice.

Objective(s):

This task is aligned with the following subject learning objectives:

31.4 and 31.5

This task is aligned with the following course learning outcomes:

.01, .05, .06, .07, .08 and .09

Type: Examination
Groupwork: Individual
Weight: 30%
Length:

30 minutes approximately

Criteria:

You will be assessed on:

  • Your competency in performing clinical procedures safely and ensuring patient comfort throughout the examination.

  • Your ability to demonstrate a clear understanding of the task and competently perform the skill, to obtain accurate results and document these as would be appropriate in a medical record.

  • Your ability to complete set tasks in a given timeframe and demonstration that you would be able to perform efficiently in a clinical setting.

  • Your ability to communicate appropriately with a patient including, correct targeting of instruction and ability to adapt instruction to ensure patient understanding.

  • Demonstrated clinical reasoning skill in the context of a specific patient scenario, through the selection of appropriate test procedures, correct interpretation of results, understanding of the case and ability to verbally justify reasoning to the examiner.

  • Demonstrated professionalism in a clinical environment.

Prior to the exam students will be given the criteria for individual examinable skills and formative feedback on performance during Mock OSCEs.

Assessment task 3: Written Examination

Intent:

The written exam will aid determination of whether you have met the learning objectives of this subject and will give a summative assessment of your level of knowledge and understanding of the content. This also provides you an opportunity to demonstrate your understanding and ability to clinically reason through patient cases.

Objective(s):

This task is aligned with the following subject learning objectives:

31.1, 31.2, 31.3 and 31.4

This task is aligned with the following course learning outcomes:

.01, .02 and .03

Type: Examination
Groupwork: Individual
Weight: 40%
Length:

2 hours and 10 minutes reading time

Criteria:

You will be assessed on your level of content-based knowledge, as well as, problem-solving and clinical reasoning ability within the context of clinical management of refractive error, demonstrated through accurately expressed ideas and conclusions. Marks awarded for individual questions will be stated in the exam.

Minimum requirements

Students are required to attend 90% of scheduled lectures. Clinical practicals will be scheduled on weeks 1-14. It is expected that students attend 100% of scheduled clinical practicals.

Note: there is a must-pass assessment in this Subject. Please check assessment descriptions for details.

Required texts

Coursework Assessments Policy

Coursework Assessments Procedures

Graduate School of Health Policy, Guidelines and Procedures (login required)

Additional required readings will be provided via UTSOnline

Recommended texts

Students will be required to access journals through the UTS library and reference appropriate journal articles. Specific references may be indicated, if required via UTSOnline throughout semester by the coordinator or lecturers. In addition, the following texts may be of use:

Ansons, AM & Davis H, (2014) Diagnosis and Management of Ocular Motility Disorders 4th ed. Wiley-Blackwell

Rowe, FJ (2012) Clinical Orthoptics. John Wiley & Sons, Hoboken

Hoyt CS & Taylor D (2013) Pediatric Ophthalmology and Strabismus 4th ed. Saunders Ltd.