Learning outcomes of Optometry (ECOO)

Part A: Optics and Optical Appliances

SUBJECTS:

Geometrical Optics
Physical Optics
Visual Optics
Visual Perception
Optical appliances
Occupational optics

Part B: Clinical Investigation and Management

SUBJECTS:

Vision and Aging Refraction
Low Vision
Ocular motility and Binocular Vision Contact Lenses
Investigative Techniques
Paediatric Optometry
Refractive surgery

Part C: Biological and Medical Sciences

Anatomy and Histology
Neuroscience
General Physiology and Biochemistry
General Microbiology and Immunology
General Pharmacology
Pathology and General Medical Disorders
Epidemiology and Biostatistics
Ocular anatomy and Physiology
Ocular Pharmacology
Abnormal Ocular Conditions

Subject 1: Geometrical Optics

Learning outcomes:

The candidates should demonstrate fundamental knowledge and insight into geometrical optics in order for the candidate to be able to understand and solve problems related to the eye and optical instruments/lenses, their function and correction. Knowledge and understanding should be demonstrated in the areas of:

(1) refraction at single spherical or plane surfaces, (2) thin lenses, (3) thick lenses, (4) aberrations,

(5) apertures, (6) spherocylindrical lenses, (7) thin prisms, (8) mirrors, and (ophthalmic and optical instruments.

The aim is to achieve knowledge of the fundamentals of geometrical optics and how they apply to the human eye.

Subject 2: Physical Optics Learning outcomes:

The candidates should demonstrate fundamental knowledge and insight into physical optics in order for the candidate to be able to understand and solve problems related to the eye and optical instruments/lenses, their function and correction. Knowledge and understanding should be demonstrated in the areas of:

(3) wave optics, (2) interaction of light on matter, (3) polarization, (4) transmission through successive (4) polarisers, and (5) image quality.

The aim is to achieve knowledge of the fundamentals of physical optics and how they apply to the human eye.

Subject 3: Visual Optics

Learning outcomes:

The candidates should demonstrate fundamental knowledge and insight into visual optics in order for the candidate to be able to understand and solve problems related to image formation, both qualitative and quantitative, for the candidate to investigate the optics of the human visual system and refractive correction. Knowledge and understanding should be demonstrated in the areas of: (1) schematic eye models,

(2) dioptrics of the eye, (3) entopic phenomena, (4) quality of retinal image, and (5) radiation and the eye.

Subject 4: Visual Perception (from summer 2010 this belongs to Part C and is examined in Part C, too!!)

Learning outcomes:

The candidates should demonstrate knowledge and understanding of the physical and physiological aspects of vision including the principals of psychophysical measurements, visual detection, visual discrimination, visual search and attention and binocular vision. Knowledge and understanding should be demonstrated in the areas of : (1) visual pathway, (2) colour vision, (3) space perception, (4) form perception,

(5) light perception, (6) motion perception, (7) temporal perception,

(8) basic psychophysical methods and theory, (9) psychophysical scaling methods and theory, and (10) signal detection methods and theory.

Subject 5: Optical appliances

Learning outcomes:

The candidates should demonstrate knowledge and skills of optical appliances and dispensing and how visual correction interact with the eye. Knowledge and skills should be demonstrated in the areas of: (1) physical characteristics of ophthalmic lenses, (2) optical characteristics of ophthalmic lenses,

(3) ophthalmic prisms and prismatic effect of lenses, (4) multifocal lenses,

(5) physical characteristics and biological compatibility of frame materials,

(6) specification and nomenclature of spectacle frame components,

(7) optical and spectacle frame considerations of high-powered lenses, (8) spectacle magnification, (9) absorptive lenses, (10) impact resistance, (11) optical tolerances and physical requirements of ophthalmic lenses and frame materials (EN), and (12) spectacle applications.

Clinical/practical competencis:

The ability to advise on and to dispense the most suitable form of optical correction taking into account durability, comfort, cosmetic appearance and lifestyle.

The ability to measure and verify optical appliances, taking into account relevant standards.

An understanding of prismatic effect, and the manipulation of lens form and setting to obtain the desired control of prismatic effect.

The ability to manage non-tolerance cases.

Subject 6: Occupational optics Learning outcomes:

The candidates should demonstrate knowledge and understanding and be able to discuss and test visual function in relation occupational optics. Knowledge, understanding and testing skills should be demonstrated in the areas of : (1) visual performance, (2) ocular injuries, (3) eye protection and its regulations, (4) lamps and lighting and regulations regarding lighting, (5) visual display units, and

(6) regulations related to vision and driving.

Clinical/practical competencis:

An understanding of eye protection regulations, and relevant standards, and the ability to advise on occupational visual requirements.

The ability to prescribe and dispense spectacles for vocational use.

Subject 7: Vision and Aging

Learning outcomes:

The candidates should demonstrate knowledge and understanding and be able to discuss, test and explain the human development of the visual system and its response to aging.

Knowledge, understanding and testing skills should be demonstrated in the areas of :

(1) normal vision development in the infant and child, (2) normal motor development in the infant and child, (3) Normal cognitive and social development in the infant and child,

(4) effects of early environmental restrictions, (5) normal changes in vision with ageing,

(6) Anomalies of Child Development, (7) clinical techniques and tests to assess the development

of children at various ages, (8) clinical characteristics of children who deviate from normal

patterns of development, and epidemiology of developmental disorders

(9) tests that diagnose vision problems which may be associated with deviations from normal

patterns of development, (10) tests used by optometrists to determine a child's level of visual-perceptual development, (11) role of the optometrist and other disciplines in screening, evaluating,

managing and referring children who deviate from normal patterns of development,

(12) anomalies of the Ageing Adult, (13) clinical characteristics of changes in perceptual function (non-visual) associated with ageing, (14) symptom profiles, clinical procedures, and tests identifying changes in vision,

(15) clinical management of ageing patients with multisensory loss,

(16) assessment of the need for referral and consultation with other disciplines,

17) colour vision anomalies by type and prevalence,

(18) colour vision tests used for both screening and diagnosis of congenital colour vision anomalies,

(19) conditions for colour vision testing, (20) societal implications of colour vision anomalies, and (21) assessment of the need for referral and consultation with other disciplines.

Subject 8: Refraction

Learning outcomes:

The candidates should demonstrate knowledge, understanding and skills, and be able to discuss and refract patients in the most suitable way. Knowledge, understanding and testing skills should be demonstrated in the areas of : (1) different refractive states of the eye, (2) mechanisms of presbyopia,

(3)anamnesis, (4) preliminary testing, (5) Objective static and dynamic refractive status, including automatic refractive devices, (6) standard subjective refraction procedures, including astigmatic diais, crossed cylinders, stenopaic slit, fogging methods and equalisation (duo chrome) techniques, (7) binocular subjective refraction procedures, including accommodation binocular balancing methods, (8) binocular subjective refraction procedures, including accommodation binocular balancing methods, (9) cycloplegic subjective and objective techniques, (10) automatic computer assisted subjective procedures, laser refraction and variations in procedures for the various ametropias, (11) identification, treatment and management using spectacle and contact lenses and prognosis,

and (12) observation and recognition of clinical signs, and techniques and skills for determining the near add.

Clinical/practical competencis:

The ability to take an accurate history from patients with a range of optometric conditions.

The ability to elicit significant symptoms.

The ability to elicit relevant family history.

The ability to elicit issues pertaining to the patient’s general health, medication, work, sports, lifestyle and special needs.

The ability to impart to patients and explanation of their physiological or pathological eye condition. An ability to understand a patient’s fears, anxieties and concerns about their visual welfare, the eye examination and the possible ocular side effects of medication.

An ability to understand the patient’s expectations and aspirations and manage empathetically situations here these cannot be met.

The ability to communicate with patients who have poor, or non-verbal, communication skills, or those who are confused, reticent or who might mislead.

The ability to communicate bad news to patients in an empathetic and understandable way.

The ability to manage patients in a safe, ethical and confidential fashion.

The ability to create and to keep clear, accurate and contemporaneous patient records.

The ability to interpret and respond appropriately to existing records.

The ability to make a judgement regarding referral and an understanding of referral pathways.

The ability to demonstrate an understanding of the legal, professional and ethical obligations of a registered optometrist.

The ability to refract a range of patients with common optometric problems by appropriate objective and subjective means.

The ability to make appropriate prescribing and management decisions based on the refractive and oculomotor status.

The ability to use appropriate ocular diagnostic drugs to aid refraction.

An understanding of the special examination needs of patients with learning and other disabilities. An understanding of the special examination needs of patients with severe visual field defects.

The ability to manage non-tolerance cases.

Subject 9: Low Vision

Learning outcomes:

The candidates should demonstrate knowledge, understanding and skills, and be able to discuss and manage patients whose vision cannot be improved significantly using conventional spectacles or contact lenses, in order to make the most of their residual vision using magnifying systems and

imaging technology. Knowledge, understanding and testing skills should be demonstrated in

the areas of : (1) definitions and regulations of low vision, (2) incidence and causes,

(3) measurement of visual performance, (4) magnification, non-optical aids, (6) illumination and lighting, (7) aids for peripheral field, (8) eccentric viewing and steady eye strategy,

(9) environmental modification, and (10) clinical procedures.

Clinical/practical competencis:

The ability to take an accurate history from patients with a range of optometric conditions.

The ability to elicit significant symptoms. The ability to elicit relevant family history

The ability to elicit issues pertaining to the patient’s general health, medication, work, sports, lifestyle and special needs.

The ability to impart to patients and explanation of their physiological or pathological eye condition.

An ability to understand a patient’s fears, anxieties and concerns about their visual welfare, the eye examination and the possible ocular side effects of medication.

An ability to understand the patient’s expectations and aspirations and manage empathetically situations where these cannot be met.

The ability to communicate with patients who have poor, or non-verbal, communication skills, or those who are confused, reticent or who might mislead.

The ability to communicate bad news to patients in an empathetic and understandable way.

The ability to manage patients in a safe, ethical and confidential fashion.

The ability to create and to keep clear, accurate and contemporaneous patient records.

The ability to interpret and respond appropriately to existing records.

The ability to make a judgement regarding referral and an understanding of referral pathways.

The ability to demonstrate an understanding of the legal, professional and ethical obligations of a registered optometrist.

The ability to assess patients with impaired visual function

The ability to advise visually impaired patients about their impairment, disability or handicap.

The ability to advise on the use of, and to dispense simple low vision aids including: hand and stand magnifiers, typoscope and hand held telescopes.

The ability to advise on the use of and to dispense complex spectacle lens forms, including: multifocals,

high corrections, and their applications to specific patient needs.

An understanding of the application of complex low vision aids, e.g., spectacle-mounted telescopes, CCTV.

Subject 10: Ocular Motility and Binocular Vision

Learning outcomes:

The candidates should demonstrate knowledge, understanding and skills, and be able to discuss and manage patients who suffer from binocular vision problems and who are at risk of developing binocular vision problems. Knowledge, understanding and testing skills should be demonstrated

in the areas of :

(1) nature of binocular vision anomalies, (2) binocular vision routine examination, (3) examination of young children, (4) evaluation and management of heterophoria, (5) evaluation and management of heterotropia (strabismus), and

(6) examination and management of incomitant deviations and nystagmus.

Clinical/practical competencis:

The ability to assess binocular status using objective and subjective tests.

An understanding of the management of patients with an anomaly of binocular vision. The ability to investigate and manage adult patients presenting with heterophoria.

The ability to manage an adult patient with heterotropia.

The ability to manage children at risk of developing an anomaly of binocular vision. The ability to manage children presenting with an anomaly of binocular vision.

The ability to manage a patient presenting with an incomitant deviation.

Subject 11: Contact Lenses

Learning outcomes:

The candidates should demonstrate knowledge, understanding and skills, and be able to discuss and undertake examinations and management of patients wanting to wear or who are already wearing contact lenses. Knowledge, understanding and testing skills should be demonstrated in

the areas of : (1) treatment and management of refractive/oculomotor/sensory integrative conditions using contact lenses, (2) lens types and materials: hard lenses; haptics; lathecut, moulded, and spincast soft lenses, (3) optics of contact lenses: curves, zones, widths and tear lens effects, sagittal depth; centre and edge thickness; flex, asphericity and toric designs and quadrantic specific designs, and oblong geometries with reverse curves, (4) theories and methods of fitting: lens design, specifications of orders, lens verification and evaluation, insertion and removal techniques, design of wearing schedules, fluorescein evaluation and fitting criteria, (5) patient selection based upon history,

analysis of primary care data, correlations of data, facial physiognomy, and contraindications;

and management based upon education and patient handling and control, (6) the examination of a new prospective contact lens patient, the anterior segment examination and measurement, (7) contact lens selection from presently available types and forms of lenses, (8) care of lenses; handling; cleaning; preservatives available; disinfection methods and solutions, (9) follow-up care; adaptation, physiologic and post-fitting complications, allergic responses, lens changes and mechanical problems,

(10) bifocal and astigmatic contact lenses; types, basis of selection and adaptation, techniques of fitting, and care for each, (11) specially designed lenses and fitting procedures for keratoconus and irregular corneas, for keratoplastic and after refractive surgeries, sports vision, diseased and traumatic corneas, cosmetic (prosthetic) use, iris colour changes and colour vision deficiencies, (12) Specially designed

lenses and fitting procedures for Orthokeratologie, and (13) Parameter modification in theory and practice.

Clinical/practical competencis:

The ability to insert and remove contact lenses and instruct patients in these procedures. The ability to fit soft contact lenses.

The ability to manage the aftercare of patients wearing soft contact lenses.

The ability to advise on contact lens materials and care regimes.

The ability to manage the aftercare of patients wearing rigid gas permeable contact lenses.

The ability to fit rigid gas permeable contact lenses.

An understanding of, and the ability to fit contact lenses to patients with astigmatism.

An understanding of the techniques used in fitting contact lenses to advise patients requiring complex visual correction.

The ability to manage patients in a safe, ethical and confidential fashion.

The ability to create and to keep clear, accurate and contemporaneous patient records.

The ability to interpret and respond appropriately to existing records.

The ability to make a judgement regarding referral and an understanding of referral pathways. The ability to demonstrate an understanding of the legal, professional and ethical obligations of a registered optometrist.

Subject 12: Investigative techniques

Learning outcomes:

The candidates should demonstrate knowledge, understanding and skills, and be able to discuss and undertake examinations of patients using investigative techniques. Knowledge, understanding and

testing skills should be demonstrated in the areas of : (1) colour vision investigation, (2) keratometry,

(3) retinoscopy, (4) automatic objective refraction, (5) slit lamp examination of the external and internal eye, (6) tonometry (contact and non-contact), (7) direct ophthalmoscopy,

(8) monocular indirect ophthalmoscopy, (9) binocular indirect ophthalmoscopy, (10) gonioscopy,

(11) lacrimal system evaluation, (12) fundus biomicroscopy, and (13) quantitative perimetry.

Clinical/practical competencis:

The ability to assess a patient’s colour vision and to determine whether it achieves the standards required by various vocational groups.

The ability to use instruments in ocular examination and to understand the implications of the findings in terms of subsequent examination techniques.

The ability to assess the external eye and adenexa. The ability to assess the tear film.

The ability to assess pupil reactions.

The ability to use a slit lamp.

The ability to use diagnostic drugs to aid ocular examination.

The ability to examine fundi using direct and indirect techniques.

The ability to use instruments to measure corneal curvature.

The ability to investigate visual fields and to analyse and interpret the results.

The ability to use a contact tonometer to measure intraocular pressure and analyse and interpret the results. The ability to make an assessment of the fundus in the presence of media opacities.

The ability to use a slit lamp to detect anterior chamber signs of ocular inflammation.

The ability to assess visual fields of patients with reduced visual acuity.

Demonstrate an understanding of techniques for assessment of vision in infants.

An understanding of the assessment of visual function, including the use of specialist charts for distance and near vision, and the effects of lighting, contrast and glear.

Subject 13: Paediatric Optometry

Learning outcomes:

The candidates should demonstrate knowledge, understanding and skills, and be able to discuss and manage children in an optometric setting. Knowledge, understanding and testing skills should be demonstrated in the areas of : (1) Paediatric communication skills, (2) Assessment of visual acuity, (3) Refractive examination, (4) Myopia, (5) Binocular vision disorders, (6) Paediatric eye disorders, (7) spectacle dispensing, (8) contact lenses, and (9) low vision assessment and management.

Clinical/practical competencis:

The ability to take an accurate history from patients with a range of optometric conditions.

The ability to elicit significant symptoms.

The ability to elicit relevant family history.

The ability to elicit issues pertaining to the patient’s general health, medication, work, sports, lifestyle and special needs.

An ability to understand the patient’s expectations and aspirations and manage empathetically situations where these cannot be met.

The ability to communicate with patients who have poor, or non-verbal, communication skills, or those who are confused, reticent or who might mislead.

The ability to communicate bad news to patients in an empathetic and understandable way. The ability to manage patients in a safe, ethical and confidential fashion.

The ability to create and to keep clear, accurate and contemporaneous patient records.

The ability to interpret and respond appropriately to existing records.

The ability to assess children’s visual function using appropriate techniques.

Subject 14: Refractive Surgery

Learning outcomes:

The candidates should demonstrate knowledge, understanding and skills, and be able to discuss and undertake examinations and management of patients wanting to undergo or who have undergone refractive surgery.

Knowledge, understanding and testing skills should be demonstrated in the areas

of patient counselling and pre- and post operative assessments. Knowledge and understanding should be demonstrated in the different treatment options and postoperative complications.

Clinical/practical competencis:

The ability to properly advise on refractive surgery options and possible outcomes.

The ability to identify corneal ectasia and dystrophies and other contraindications to refractive surgery. An understanding of which techniques that is necessary in the pre-operative assessments.

The ability to perform the techniques used in the pre-operative assessments.

The ability to manage the aftercare of patients having undergone refractive surgery.

The ability to identify post-operative complications.

The ability to manage patients in a safe, ethical and confidential fashion.

The ability to create and to keep clear, accurate and contemporaneous patient records.

The ability to interpret and respond appropriately to existing records.

The ability to make a judgement regarding referral and an understanding of referral pathways The ability to demonstrate an understanding of the legal, professional and ethical obligations of a registered optometrist.

Subject 15: Anatomy and Histology

Learning outcomes:

The candidates should demonstrate fundamental knowledge and insight into general anatomy and histology. Knowledge and understanding should be demonstrated in the areas of:

(1) head and skull (muscles, arteries, veins, lymphs, cranial nerves, sinuses, vestibular system, (2) cells (membranes, compartments, organelles, stem cells, cell differentiation), and

(3) tissues (epithelium, glands, connective tissue, muscle, blood, nerves).

Subject 16: Neuroscience

Learning outcomes:

The candidates should demonstrate fundamental knowledge and insight into the area of neuroscience. Knowledge and understanding should be demonstrated in the areas of:

(1) electrophysiology of the nerve cells (resting and action potential, synapses, receptors),

(2) neuroanatomy (brain, cranial nerves, spinal cord, autonomic nervous system), and

(3) neurophysiology (reflexes, pain and sensation, vestibular system, propioceptive sensation, autonomic nervous system).

Subject 17: General Physiology and Biochemistry

Learning outcomes:

The candidates should demonstrate fundamental knowledge and insight into physiology and biochemistry. Knowledge and understanding should be demonstrated in the areas of:

(1) respiration, (2) gastrointestinal activity, (3) muscles, (4) body fluids, (5) renal system, (6) circulatory system, (7) endocrine system, (8) proteins, (9) carbohydrates,

(10) lipids, (11) molecular biology, and

(12) bioenergetics.

Subject 18: General Microbiology and Immunology

Learning outcomes:

The candidates should demonstrate fundamental knowledge and insight into general microbiology and immunology.

Knowledge and understanding should be demonstrated in the areas of:

(1) virology, (2) bacteriology, (3) mycology, (4) parasitology, (5) antigens and antibodies, (6) complement system, (7) non-specific immunity, (8) specific immunity,

(9) hypersensitivity response, and (10) autoimmunity.

Subject 19: General Pharmacology

Learning outcomes:

The candidates should demonstrate fundamental knowledge and insight into general pharmacology. Knowledge and understanding should be demonstrated in the areas of:

(1) pharmacokinetics, (2) pharmacodynamics, (3) drugs acting on the autonomic nervous system, (4) analgetics and local anaesthetics, (5) antipyretics and anti-inflammatory drugs, (6) antibiotics,

(7) antiviral drugs, (8) antiallergic drugs, (9) drugs affecting respiratory and cardiovascular system, (10) antiseptics, disinfectants, preservatives, (11) common systemic side effects of medications, and (12) general health.

Subject 20: Pathology and General Medical Disorders

Learning outcomes:

The candidates should demonstrate fundamental knowledge and insight into general pathology and general medical disorder and how they can affect the eye. Knowledge and understanding should be demonstrated in the areas of:

(1) inflammation and repair, (2) cardiovascular diseases and the eye,

(3) blood diseases and the eye, (4) endocrine diseases and the eye, (5) neurological diseases and the eye, (6) nutritional disorders, (7) rheumatoid disorders, Vasculitis and Collagenosis, (8) infectious diseases, (9) tumours, and (10) congenital and hereditary conditions.

Subject 21: Epidemiology and Biostatistics

Learning outcomes:

The candidates should demonstrate fundamental knowledge and insight into epidemiology and biostatistics, not only for application in laboratory experiments and research, but also for understanding how to interpret clinical evidence in optometric practice. Knowledge and understanding should be demonstrated in the areas of:

(1) epidemiological data (incidence and prevalence, odds, relative risk,

central tendency and variability), (2) screening concepts (sensitivity and specificity, predictive value, yield), (3) research design, and (4) morbidity and mortality.

Subject 22: Ocular anatomy and Physiology

Learning outcomes:

The candidates should demonstrate knowledge, understanding and skills, and be able to discuss and explain n detail the anatomy and physiology of the eye.

Knowledge and understanding regarding structure and function, and development and aging, should be demonstrated in the areas of:

(1) orbita, (2) extraocular muscles, (3) ocular blood supply, (4) ocular and orbital nerves, (5) eyelid, (6) eyebrow, (7) conjunctiva, (8) lacrimal system, (9) cornea, (10) sclera,

(11) anterior chamber and angle, (12) iris,(13) pupil and posterior chamber,

(14) ciliary body, (15) lens and zonule, (16) choroids, (17) vitreous,

(18) retina, (19) optic nerve, and (20) visual pathway.

Subject 23: Ocular Pharmacology

Learning outcomes:

The candidates should demonstrate knowledge, understanding and skills, and be able to discuss and manage patients when diagnostic drugs are indicated. Knowledge, understanding and testing skills should be demonstrated in the areas of :

(1) factors affecting drug absorption, (2) cycloplegics,

(3) mydriatics, (4) miotics, (5) local anaesthetics, (6) staining agents, (7) antimicrobial agents,

(8) solutions used in contact lens work, (9) decongestants, antihistamines and anti-inflammatory components, (10) ocular effects of drugs used systemically, (11) first-aid and emergency measures

used by the optometrists, and (12) formulation of eye preparations.

Subject 24: Abnormal Ocular Conditions

Learning outcomes:

The candidates should demonstrate knowledge, understanding and skills, and be able to detect and manage patients presenting with abnormal ocular conditions. Knowledge, understanding and detection skills should be demonstrated of ocular pathology affecting: (1) ocular adnexa, (2) lachrymal system,

(3) conjunctiva, (4) cornea, (5) sclera and episclera, (6) anterior uvea (iris and ciliary body),

(7) papillary, accommodative and refractive pathology, (8) orbit, (9) anterior chamber, angle structure

and IOP, (10) lens, (11) peripheral fundus and vitreous, (12) optic nerve and the optic nerve head, (13) fovea, (14) sensory neuro-visual pathology, and (15) oculomotor neuropathology.

Clinical/practical competencis:

The ability to interpret and investigate the presenting symptoms of the patient.

The ability to develop a management plan for the investigation of the patient.

The ability to identify external pathology and offer appropriate advice to patients not needing referral. An understanding of risk factors for common ocular conditions.

The ability to recognise common ocular abnormalities and to refer when appropriate.

The ability to manage a patient presenting with a red eye.

The ability to manage a patient presenting with reduced vision.

The ability to identify abnormal colour vision and to appreciate its significance.

The ability to manage a patient presenting with cataract.

The ability to evaluate glaucoma risk factors, to detect glaucoma and refer accordingly.

The ability to manage a patient presenting with macular degeneration.

The ability to recognise, evaluate and manage diabetic eye disease and refer accordingly.

The ability to evaluate and manage a patient presenting with symptoms suggestive of retinal detachment. An understanding of the treatment of a range of common ocular diseases.

The ability to recognise manifestations of systemic disease.

An understanding of the role of the optometrist in shared care schemes.

The ability to assess symptoms and signs of neurological significance.

The ability to manage patients presenting with sight-threatening eye disease.

An ability to recognise adverse ocular reactions to medication.