COURSE CURRICULUM FOR
OCULAR SURGICAL ASSISTANT (OSA)
A. GENERAL INFORMATION
B. TRAINING MODALITY
C. BASIC SUBJECTS
D. EXAMINATION PATTERN
E. DETAIL SYLLABUS
A. GENERAL INFORMATION
(a) After the completion of the course, the trainees will be able to.
1. Read and understand ophthalmic medical records
2. History taking from all patients
3. Measure vision, IOP, lacrimal duct patency, Schirmer’s test and vital signs 4. Do preliminary examination of the eye, assess pupillary reflex and record the details 5. Assist the Ophthalmologist in the outpatient and ward sections
6. Identify ocular emergencies
7. in still eye drops
8. Irrigate the eye
9. Bandage tying and untying
10. Dressing preparation, bin packing
11. Tonometer cleaning and sterilization
12. Handle glucometer and test urine sugar
13. Assist in corneal scraping
14. Cleaning of OT
15. Prepare trolley for various procedures and surgeries
16. Assist the surgeon during different types of surgeries
17. Sterilization of instruments
19. Applying tropical anaesthesia
20. Handling instruments and equipment’s like cleaning and sterilization by autoclave, gas sterilisation
21. Draping and applications of Bridle suture
22. Cleaning the eye of post op patients
23. Counselling of post op medicines
25. Assist the ophthalmologists in the postoperative care
27. Provide counselling and support for the patients
29. Carry out the treatment instructions given by the ophthalmologists for in-patients and manage the wards.
(b) What knowledge / Theory they should have to perform the above activities.
| OPD & Ward | OT |
| • Anatomy and Physiology of the eye • Basic microbiology • Ocular Pharmacology • Ocular diseases • Instruments and equipment • Investigation procedures • Vital signs • Disinfection and Sterilization procedures • Systemic diseases • Maintenance of medical records | • Basic knowledge of suture, lenses and needles • Basic knowledge of different instruments used • Operation Theatre Management • Introduction to Ocular and general anaesthesia • Steps in minor surgeries • Steps in various types of surgeries • Different types of sterilization |
(c) What Practical / Skills they should be imparted?
• Eliciting history of the ocular complaints, usage of medications, operations and other medical complaints from the patients
• To do preliminary examination of the eye and recording the observations • Use Snellen’s chart to assess the visual acuity of the patient
• Use both contact & non-contact tonometer to measure intraocular pressure (IOP) • Check the lacrimal duct patency and record the results of the investigation • Measure the pulse and respiration rate of the patient
• Use a thermometer or a digital thermometer to measure temperature • Use a sphygmomanometer &stethoscope to measure blood pressure of the patient • Use a glucometer to measure blood sugar
• Use Schirmer’s strip to assess the severity of dry eye
• Prepare dressing materials (wiper, eye-pad and bandage)
• To tie a bandage for eye and untie it
• Bin packing of the dressing materials for sterilization
• Irrigate the eye to wash cornea and conjunctiva
• Dilate the pupil using dilating eye drops
• Clean the eye before and after surgery
• Handle sharps (blades, knives, needles) carefully and dispose them properly after use • Prepare the patient for surgery
• Take care of the patient after surgery
• Set up trolley forward rounds and for various surgeries in the OT
• Handle different instruments and equipment in OT during surgery • Prepare the correct eye for surgery
• Drape the patient for surgery
• Give topical anaesthesia before surgery
• Clean the instruments in the operation theatre by ultrasonic cleaning • Sterilize materials and instruments by using autoclave, Ethylene oxide and other means • Disinfect the OT by fumigation
• Do the packing for gas sterilization
(d) What communication skills they should have?
• Properly read the details in the medical record and check the identity of the patient, the investigations done and the results
• Communicate clearly to the patient for history taking and record the findings properly, the details given in the medical prescription
• Give adequate information about the various diseases
• Effectively counsel the importance of follow‐ up and review
• Explain the after effects of an eye drop/ointment before administering • Explain clearly the procedures or investigations to be done
B. TRAINING MODALITY
Theory, Practical and Log Book
C. BASIC SUBJECTS
• Ocular Anatomy, • Ocular Physiology,
• Ocular Pharmacology, • Ocular Microbiology & clinical pathology • Ocular Diseases • OPD procedures
• In-patient procedures • Basic nursing care
• Ophthalmic surgical procedures, • Ocular injuries and emergencies • Community ophthalmology and medical records
D. EXAMINATION PATTERN
Theory, Practical & Viva by External
F. SUGGESTED MODE OF TEACHING AND EXAMINATION FOR ALL COURSES
Theory, Practical & Viva by External
• Lectures
• Skill sessions
• Hands-on practice
• Power point presentations
• Assignments Suggested activities for Evaluation
• Written examinations
• Skill assessment
• Viva examinations
• Reading& understanding a medical record
• Assessment of blood glucose
• Temperature
• Pulse & Respiration
• Blood Pressure
• Trolley set up: (Cataract, Glaucoma & corneal ulcer)
• Bandage Tying & Untying
• Case presentation of post -operative patients
• Dressing preparation OP
• Tonometer: Cleaning and Sterilization
• Measurement of IOP using Schiotz tonometer
• Measurement of vital signs
• Testing Lacrimal Duct Patency
• Urine Test
• Handling the Glucometer & Strip position checking
• Bandage tying and untying
• Dressing preparation
• Field testing
• Aseptic techniques
• Trolley set up (Cataract & glaucoma)
• Draping the patient and application of speculum & Bridle sutures • Cleaning and Sterilization of instruments
• Utilization of sterile items (Medicine, IOL, suture)
• Assisting the doctors in various surgeries and OP procedures
Unit I: Ocular anatomy
Specific objectives
• To have a knowledge of ocular anatomy
• To understand the various structures in the eye
Common diseases affecting them Gross anatomy of the eyeball – the bony orbit- the conjunctiva, ––- the extra ocular muscles – the eyelids – the lacrimal apparatus –– blood supply of the eye – nerve supply of the eye. The sclera -the cornea- the limbus – chambers of the eye – angle of the anterior chamber – the iris and pupil- the crystalline lens – Ciliary body – the choroid -Vitreous – the retina – Optic Nerve – Visual pathway
Unit II: OCULAR PHYSIOLOGY
Specific objectives
• To know the basics of ocular physiology
• To understand the function of various structures in the eye.
Common tests to assess the ocular functions General Physiology of eye – visual perceptions -assessment of visual acuity. The cornea – the lens – tears –the Schirmer’s test- the aqueous humours – measurement of IOP ––colour vision – the visual pathway – pupillary pathways and reflexes -accommodation – ocular movements – binocular single vision
Unit III: Ocular pharmacology
Specific objectives
• To know about the ophthalmic medications
• To know the actions and adverse effects of drugs.
• To monitor the patients after the administration of drugs
Drug delivery system – astringents and decongestants – antibiotics – antivirals – antifungals – autonomic drugs – mydriatics and cycloplegics – local anaesthetics – ocular hypotensive – corticosteroids – non steroidal anti-inflammatory drugs – viscoelastic substances – ocular reactions to systemic medications –preservatives in eye drops – systemic drugs used in Ophthalmology.
Unit IV: Microbiology & Clinical pathology Specific objectives
• To discuss the characteristics of microorganisms including bacterial, viral and fungal infections.
• To discuss the measures to control the spread of micro-organisms • Introduction to various microorganisms – bacteria, Fungi, Virus, Parasites. Bacteria classification of bacteria- Gram positive and negative cocci- Gram positive and neg ative bacilli –fungi – viruses – parasites – smear preparation – gram- staining proce dure – sterilization, disinfection and antisepsis – dry heat – moist heat – autoclave – gas sterilization – chemical sterilization – important principles of asepsis. Blood and its components, Estimation of blood sugar/ Albumin, Examination of urine
Unit V: Ocular Diseases
Specific objectives
Diseases of the eyelid, conjunctiva and diseases of the lacrimal apparatus Specific objectives:
• To discuss the various diseases and disorders of the lid and conjunctiva, cornea, lens, lacrimal apparatus.
• To know about the signs and symptoms of various diseases and disorders of the lid and conjunctiva
• To know the various treatment modalities
Lids : Entropion– ectropion – trichiasis – ptosis – blepharitis
–hordeolum – chalazion – important tumours
Lacrimal apparatus: Diseases of the lacrimal gland – the dry eye
syndrome – watering from the eye –dacryocystitis
Conjunctiva: Different types of conjunctivitis – trachoma – Pterygium – Pinguecula – Bitot’s spots
Cornea : Inflammation of the cornea – bacterial keratitis – mycotic keratitis – fungal keratitis – viral keratitis – peripheral keratitis – inter stitial keratitis – corneal dystrophies- scleritis–Episcleritis
Lens: Cataract – subluxation of the lens – dislocation of the lens –
Management of cataract – Intraocular lenses – Posterior capsular opacification
Diseases of the uvea and various glaucoma’s
• To know the signs and symptoms of different types of glaucoma
• To know the various treatment modalities
Uvea: Anterior uveitis – parsplanitis – posterior uveitis – AIDS – endophthalmitispan ophthalmitis Glaucoma: Intraocular pressure – congenital glaucoma – primary angle closure glaucoma – primary open-angle glaucoma – lens induced glaucoma’s – secondary glaucoma’s, Diseases of retina & vitreous
Retina: Vascular disorders – age-related macular degeneration – retinitis pigmentosa – retinal detachment – hypertensive retinopathy – diabetic retinopathy – treatment Vitreous: vitreous opacities – vitreous haemorrhage – vitrectomy,: Neuro ophthalmolo gy, Intraocular tumours, diseases of the orbit , Tumours: Leukocoria in children – retino blastoma- melanoma of the choroid Orbit: Proptosis – orbital inflammation – thyroid ophthalmopathy – optic nerve tumours – Injuries Neuro ophthalmology: optic neuritis – Papilledema – optic atrophy – common diseases affecting chiasma – visual path way – Occipital cortex – common diseases affecting oculomotor nerve, Trochlear nerve, Trigeminal nerve, Abducent nerve and facial nerve.
Unit VI : OUT-PATIENT PROCEDURES
Specific objectives
• To know the basic functions of outpatient department to understand the preliminary examinations done in OPD Orientation to out-patient services:
patient reception – instrument, equipment and supplies – communication with patients – departmental structure and function Fundamentals of outpatient services: History taking – external examination of the eye –visual acuity– measuring intraocular pressure – evaluation of the patency of lacrimal drainage apparatus Management strategies in out-patient services: public relationsPatient care and patient satisfaction – patient.
• To know how to assist surgeons in various investigations and procedures Out-patient services Laser in ophthalmology – fundus fluorescein angiography – ultrasonography in ophthalmology – ultrasound bio microscopy – corneal topography – optical coherence tomography Assisting in special procedures: corneal scraping – fundus fluorescein angiography – ultrasonography –corneal topography – assisting in incision and drain age of abscesses – assisting in fitting a prosthetic eye – laser capsulotomy – Nd Yag peripheral iridotomy
Unit VII : IN-PATIENT PROCEDURES
Specific objectives
• To know about the ward practices
• To discuss pre and post operative care given to the respective patients • To manage various kind of situations in the health care In patient services: Differences between eye-ward and general ward – location and working environment in ward – instruments and equipment’s in ward 8 Admission and Discharge of Patients: Admission procedure- arrangement of patient’s room, bed making, housekeeping- discharge proce dure Preoperative Ophthalmic Care: Preoperative evaluation – preoperative preparation and instructions – day care surgery procedure- biometryPostoperative ophthalmic care: Preparation of dressing – assisting doctors in ward rounds –identification and manage ment of post operative complications – night dutypost operative patient counselling
Unit VIII : COMMUNITY OPHTHALMOLOGY AND MEDICAL RECORDS
COMMUNITY OPHTHALMOLOGY:
Specific objectives
• To understand the different categories of visual impairment
• To understand the different methods of intervention
• To appreciate the need for eye donation
• To know the basics of organizing eye camps Blindness – categories of visual impair ment –Magnitude – Various diseases causing blindness – methods of intervention –nutritional blindness – National program for control of blindness – vision 2020 – the right to sight initiative – human resource development – role of camps in blindness prevention- role of eye banks in blindness prevention. Planning and organisation of School sight programme and community eye care programmes
MEDICAL RECORDS:
Specific objectives
• To know the use and importance of medical records
• To be familiar with different types of medical records
• To understand the filing methods and preservation of medical records Introduction to Medical Records; – use and value of for medical record – content of medical records-out patient record, inpatient admission record filing methods– preservation of medical records- medical record retention policy
Unit IX : BASIC NURSING CARE
Specific objectives
• To know about the ward practices
. • To discuss pre and postoperative care given to the respective patients . • To manage various kind of situations in the health care in patient services Differences between eye-ward and general ward – location and working environ ment in ward – instruments and equipment’s in ward. Needs of patients and princi ples of nursing care: Basic nursing principles- safe and healthy environment – care of equipment –– personal care of the patient – nutrition needs of the patient – assess ment of general condition – recording of pulse – Blood pressure – Respiration rate – ECG – height – weight etc.
Ophthalmic sub specialty nursing care – glaucoma – retina, cornea- orbit – paediat ric cases Managing systemic conditions: asthma- diabetes mellitus – hypertension
Unit X : OPHTHALMIC SURGICAL PROCEDURES Specific objectives
• To know about do’s and don’ts in the OT including aseptic techniques • To know sterilization, disinfection and microbiological surveillance of OT. • To understand the various steps of surgical procedures and assisting for various surgical procedure
Orientation to Operation Theatre: To understand – orientation to septic operation theatre location– dress code – operation theatre discipline- aseptic theatre Disinfec tion and sterilization procedures : instrument cleaning and packing for sterilization– methods of sterilization – sterilization of phaco emulsification instruments – mainte nance of sterility – control of air-borne infection – decontamination process –scrub bing, gowning and gloving methods – operation theatre cleaning
infection control: sources of infection- infection – control programme–segrega tion and methods of waste disposal– bio-waste management
Instrument and equipment maintenance: Electrical connections – microscopes – phaco machine surgical instruments
Role of Scrub Nurse: Setting up of trolley for various surgeries,-Identification of the Instruments and its use -draping the patient -handling of instruments, manage ment of 12 intra operative complication, Anterior vitrectomy, management of infected cases, Instruments for different surgeries
Ocular anaesthesia – drugs, purpose, procedure, contra indications-complica tions of retro bulbar anaesthesia –facial nerve block – topical anaesthesia,-general emergency in operation theatre General anaesthesia -Introduction about general anaesthesia -purpose of general anaesthesia, indication of general anaesthesia pre-operative preparation- history ,investigation- equipment used for general anaesthesia-patient counselling, pre operative case sheet checking -assisting doctors
Basic knowledge of sutures,
needles and lenses
sutures and needles
intraocular lenses
Surgical procedures & Role of ophthalmic assistant in cataract surgery: Cataract – pre-operative evaluation – types of surgery – steps of surgery – assist ing – instrument s required – cataract surgery complications Role of ophthalmic assistant in assisting specialty surgeries: Lacrimal sac surgeries – (DCR, DCT) – Glaucoma surgeries, Trabeculectomy, Trabeculectomy with ECCE), Keratoplasty, Orbital surgeries – assisting
Other Procedure: fundus fluorescein angiography – ultrasonography in ophthal mology – ultrasound bio microscopy – corneal topography – optical coherence tomography Assisting in special procedures: corneal scraping – fundus fluorescein angiography – ultrasonography –corneal topography – assisting in incision and drainage of abscesses
Unit XI : OCULAR INJURIES AND OCULAR EMER GENCIES SPECIFIC OBJECTIVES
Specific objectives
• To know about the emergency care
• To identify the ophthalmic emergencies
• To identify different types of injuries
• To give timely intervention and care 13 Ocular injuries: Chemical injuries (Acid, Alkali) -Penetrating injury / perforating injury,- foreign body – blunt injuriesOcular emergen cies: Corneal emergencies – postoperative emergencies – Endophthalmitisretinal emergencies – traumatic optic neuropathy-acute congestive glaucoma – immediate treatment measures
G. REFERENCE BOOKS
• Samar K. Basak, Essentials of ophthalmology, Current Books International,5th edition
• A. Samuel Gnanadoss, Ophthalmic Nursing, JAYPEE,
• Handbook for clinical ophthalmic assistants, Aravind eye care system • Hand book for surgical ophthalmic assistant, Aravind eye care system • Introduction to basics in ophthalmic assisting, Aravind eye care system • Ophthalmic Nursing Manual, Aravind eye care system