Introduction to COE Exam Crash Course.

The COE examination process assesses, for registration purposes, the medical knowledge and clinical skills of international optometrists whose basic medical qualifications are not recognised by the Medical Board of Australia. The COE examination focuses on basic and applied medical knowledge across a wide range of topics and disciplines, involving understanding of disease process, clinical examination, diagnosis, investigation, therapy and management, as well as on the candidate’s ability to exercise discrimination, judgment and reasoning in distinguishing between the correct answer and plausible alternatives.

OCANZ EXAMINATION PAPER 1: CLINICAL SCIENCE EXAMINATION

OCANZ exam Module 1: Professional Responsibilities

Maintains knowledge, expertise and skills: Maintenance and development of optometric knowledge, equipment and clinical skills (approximately 1 question).

Integration: Integration of clinical expertise with the best available evidence, the patient’s perspective and the practice context when making clinical decisions (approximately 2 questions).

Information: Provides advice and information to patients and others (approximately 3.5 questions).

Legal obligations involved in optometric practice: safe practice environment, negligence, understanding of statutory and common law obligations, insurance, employment agreements, relevant Acts including Health Insurance Act, Registration Acts, Poisons Acts, informed consent, patient referral, issuing of sick leave certificates (approximately 1.5 questions).

Factors affecting the community's need for optometric services: Epidemiology of ocular disorders, provision of health and other services, demographics of the patient population (approximately 2 questions).

OCANZ exam Module 2: Communication and Patient History

Interpretation: Interpretation of patient information, for example, from other professionals and from previous histories (approximately 3.5 questions).

OCANZ exam Module 3: Patient Examination

Formulates and Implements examination plan:The examination plan is based on patient history and is progressively modified (including the use of alternative and/or extra test procedures to maximise confidence in findings) to provide the information required for diagnosis (approximately 7 questions).

Assessment of the ocular adnexa and the eye:Anatomy of the ocular adnexa, the eye, the visual and pupillary pathways; anatomy and actions of the extraocular and intraocular muscles; equipment and pharmaceuticals used in the examination of the eye: macro-observation, lid-eversion, slit-lamp biomicroscopy, direct and indirect ophthalmoscopy, use of diagnostic pharmaceuticals including for pupil dilation, retinoscopy, keratometry, gonioscopy, tonometry, tear dynamics, pupil reactions, nystagmus, eye movements, amblyopia; ocular pathology, pharmacology and microbiology; effects of pathological and physiological changes on visual function (visual acuity, fields, colour vision etc.); interpretation of information from optical coherence tomography etc. (approximately 18 questions).

Assessment of visual processing:

Normal developmental milestones, consideration of brain injury or neurological disease, recognition of when it is necessary to assess visual information processing skills (approximately 2 questions).

Assessment of the significance of signs and symptoms found during ocular examination: ocular, visual and non-ocular signs and symptoms: social, emotional, neurological factors etc. (approximately 4 questions).

Assessment of visual processing: normal developmental milestones, consideration of brain injury or neurological disease, recognition of when it is necessary to assess visual information processing skills (approximately 2 questions).

Assessment of the significance of signs and symptoms found during ocular examination: ocular, visual and non-ocular signs and symptoms: social, emotional, neurological factors etc. (approximately 4 questions).

OCANZ exam Module 4: Diagnosis and Management

Prognosis: Evaluate the expected prognosis of the condition (approximately 2 questions).

Spectacles: Determination of the patient's prescription based on: case history, refraction findings, magnification requirements, dispensing requirements and limitations, vertex distances, aniseikonia, vergence status, accommodation status; sports, vocational and occupational visual and safety requirements; lens design and materials (prism, tints, base curves, thickness, special lenses and treatments, interpupillary distance, coatings, near additions); care regime, standards, the written prescription (approximately 13 questions).

Dispensing of optical prescriptions: Interpretation of prescription, Australian and New Zealand standards, resolution of ambiguity in specification and usage; frame selection, parameters of the prescription to be measured; processes and limitations involved in the dispensing of optical appliances are understood; patient instructions, fitting of spectacles to patient, inspection of lenses and spectacles (approximately 6 questions).

Contact lenses: Suitability of lenses for the patient's needs, lifestyle, vocation, risk factors, vision, comfort and duration of wear, contra-indications, ocular integrity, physiology and environment, slit-lamp biomicroscopy, topography/keratometry observations, vital dye staining, working distances, anisometropia, aniseikonia, vergence accommodation status, special lenses and treatments, sports requirements, incidental optical effects, lens design, materials, tints, trial lens fitting techniques, care and maintenance regimen, determination of the prescription, performance of the contact lens, monitoring of contact lens wear, recognition and management of contact-lens related conditions, frequency and content of after-care visits, monitoring of patient adherence to the wearing and maintenance regimen, the written prescription (approximately 16 questions).

Low vision devices: Types of low vision devices available, prescription, evaluation, monitoring, working distances, magnification requirements, incidental optical effects, low vision device design, special materials, tints, selection and prescription of the most appropriate device, clear instructions, description of the use of the device (approximately 6 questions).

Precautionary procedures, non-pharmacological and palliative management, avoidance of cross-infection, non-pharmacological treatment or intervention procedures, therapeutic device fitting and emergency ocular first aid to manage eye conditions and injuries: Patient counselling on sunglasses, lid hygiene, artificial tears, use of eye patches and analgesia; method to avoid contamination of medicines and cross infection; epilation, lid scrubs, lacrimal system dilation and irrigation, foreign bodies, emergency management of trauma, management of commonly presenting eye conditions including the use of bandage contact lenses (approximately 12 questions).

Visual therapy program: Diagnoses and treats or refers patients diagnosed with accommodative vergence, strabismus and amblyopic conditions (approximately 3 questions).

Referral and receipt of referrals: Need for referral recognised, urgency, documentation, scope and limitations of services provided by optometrists and other health and allied health professionals; choice of practitioner for referral; recognition of the need for co-management with another optometrist or a member of another profession, post-operative referral (approximately 4 questions).

Provision of pre-and post-operative co-management with Ophthalmologists: Pre-operative assessment and advice, post-operative assessment and monitoring, treatment/referral alternatives, provision of emergency care (approximately 8 questions).

Advice on vision in the workplace: Safety lenses, radiation protection, eye protection, visual standards, sunglasses, tints, industrial and environmental analysis, Australian and New Zealand standards, lighting, ergonomic design, industry and other occupational requirements for colour vision, visual acuity, spectacle powers, certification of fitness for designated occupations or tasks, counselling on occupational needs and suitability; implications for family members (approximately 3 questions).

OCANZ exam Module 5: Health Information Management

Record keeping: Storage and security of patient records (approximately 1 question).

Legislative requirement regarding record retention/destruction: records for children versus adults, methods of destruction (approximately 1.5 questions).

OCANZ EXAMINATION PAPER 2: DIAGNOSIS AND MANAGEMENT EXAMINATION

The Diagnosis and Management paper is a 3-hour paper (no additional reading time) comprising 18 short answer questions (SAQs). Most questions have multiple parts that address case histories and cases. These may be accompanied by photographs of clinical conditions. Candidates will observe and identify in the photographs pathological and other conditions (including normal variations) of the eye and adnexa, binocular vision anomalies, vergence accommodation disorders, visual perceptual findings, refraction findings, contact lens fittings, colour vision assessment results, visual field results, etc.

• Candidates can be required to do tasks such as:
• describe abnormal or normal features
• discuss observations in anatomical, biochemical, microbiological and/or pathological terms
• offer a diagnosis or diagnoses to account for observations and provide justifications for the diagnoses
• suggest appropriate treatment or management including criteria for referral or monitoring
• list systemic, ocular and visual signs and symptoms associated with the condition
• list extra tests needed for a differential diagnosis
• discuss the likely prognosis of the condition.