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VTV CLINICAL TRAINING TEST 2025
What is Myopia? - ✔️ ✔️ nearsightedness, light focuses in front of retina making it difficult to see objects at a distance. light eyeball is too long and/or cornea is too steep
What is Hyperopia? - ✔️ ✔️ farsightedness, light focuses behind the retina making it difficult to see up close and far away
What is Presbyopia? - ✔️ ✔️ the inability to see up close (accommodate) as we age
What causes Presbyopia? - ✔️ ✔️ lack of flexibility in the lens
What is Monovision? - ✔️ ✔️ dominant eye corrected for distance and other eye is left slightly myopic (nearsighted) for reading vision. "blended monovision" at VTV, can be done w/ contacts, iols, lasik, etc.
Is everyone a LASIK candidate? - ✔️ ✔️ no. 10-20 % of peo9ple are not good candidates, usually due to mrx too high or corneas too thin
How do I know if I am a candidate for a refractive surgery? - ✔️ ✔️ series of testing/measurements evaluated by our doctors to determine which procedure you qualify for--if any
Does age make a difference for refractive surgery? - ✔️ ✔️ Yes--you must be 18 as vision can fluctuate when you are under 18
If I have cataracts, can I have refractive surgery? - ✔️ ✔️ Usually, it is better to have cataract surgery. We can do an advanced IOL to decrease/eliminate need for glasses
Is the effect of my refractive procedure permanent? - ✔️ ✔️ Generally, yes. However, presbyopia sets in around age 40, meaning readers will be needed again
Will having a refractive procedure interfere with having surgeries like cataract surgery later in life? - ✔️ ✔️ Generally no
Will I have 20/20 vision following refractive surgery? - ✔️ ✔️ The vast majority of patients will be 20/20 following surgery, however the main goal is to lessen dependency on glasses
Will I need glasses/contacts after refractive surgery? - ✔️ ✔️ Probably not. As patients near their mid 40s, however, most people need glasses for near vision regardless of having had refractive surgery before that point
Will having refractive surgery interfere with wearing contacts in the future? - ✔️ ✔️ No, if you wore them before fine, you should have no troubles following surgery
For LASIK--do you operate on both eyes at the same time? - ✔️ ✔️ Yes
Will I be awake during my LASIK procedure - ✔️ ✔️ Yes
Are my activities limited after having had an eye procedure? - ✔️ ✔️ You should stay away from pools for at least two weeks, avoid sports in which you can get hit in the eye/get sweat in the eye, and wear eye protection in dusty environments
Will someone be able to look at my eyes and know I have had a procedure? - ✔️ ✔️ No, only a doctor using a special microscope will be able to tell
Will my career choices be limited by having refractive surgery? - ✔️ ✔️ No, with rare exceptions like military fighter pilots may need PRK instead of LASIK
What is the success rate of refractive procedures? - ✔️ ✔️ LASIK has a greater than 98% success rate
Is there a charge for an enhancement after refractive surgery? - ✔️ ✔️ LASERS--within two years, n/c. after two years, there may be a charge based on how long ago your initial procedure was
RELACS--within two years, n/c. after two years, tiered pricing structure
What does LASIK stand for? - ✔️ ✔️ Laser Assisted in Situ Keratomileusis
How is LASIK performed? - ✔️ ✔️ surgeon creates a flap on the cornea that is gently lifted back, then the laser carefully sculpts the middle later of the cornea to reshape it so you can focus without glasses/contacts
How nearsighted to you have to be for LASIK? - ✔️ ✔️ LASIK: -0.25 to -9.00 range
EVO: -5.00 to -20.
Can LASIK correct farsightedness (hyperopia)? - ✔️ ✔️ yes
Can LASIK correct astigmatism? - ✔️ ✔️ yes
How long does a LASIK procedure take? - ✔️ ✔️ 5-7 minutes per eye
Will there be any pain during LASIK procedure? - ✔️ ✔️ No, only slight pressure for 30 seconds or so per eye
How long after LASIK will it take before I have good vision? - ✔️ ✔️ You will notice improvement the same day, with the following day vision being even better
When will I be able to return to work after LASIK procedure? - ✔️ ✔️ Most people go back to work the day after the procedure, some people do take a day off depending on their job
Are there any possible complications that may occur after LASIK? - ✔️ ✔️ common side effects include glare/halos. rare side effects include flap problems/infections/vision fluctuations/dryness
Will LASIK weaken my eye? - ✔️ ✔️ With proper screening/planning--no, it shouldn't
PRK/LASIK fees breakdown? - ✔️ ✔️ $3,150 per eye (after care included in this price, $450 per eye)
What is RK? - ✔️ ✔️ Radial Keratotomy.
Refractive surgery used to correct myopia in the late 80s, early 90s pre LASIK/PRK. radial incisions are used to relax the cornea (incisions made from pupil toward periphery of cornea)
What is astigmatism? - ✔️ ✔️ Cornea is asymmetric--think football shaped instead of basketball shaped. light focuses on different spots in the retina due to this football shape
How much astigmatism is worthwhile correcting at the time of cataract surgery? - ✔️ ✔️ Most IOLs treat around 1 diopter or greater of astigmatism. correcting all refractive error is important
What is AK? - ✔️ ✔️ Astigmatic Keratotomy
one or two incisions are made at the steepest part of the cornea to relax the cornea to a more round shape
What are AKs used for? - ✔️ ✔️ to decrease the amount of astigmatism a patient has
What does PRK stand for? - ✔️ ✔️ Photo Refractive Keratectomy
How is PRK different from LASIK? - ✔️ ✔️ PRK--no flap
what does epi mapping show? - ✔️ ✔️ epithelial thickness of cornea--can be used to detect keratoconus, post operative monitoring for early signs of corneal ectasia, detects surface irregularities that may not be seen on slit lamp/pentacam
What is the Visian EVO lens? - ✔️ ✔️ implantable contact lens measured specifically for your eye that is placed BEHIND the iris and IN FRONT of the natural lens. (also called phakic IOL/ICL/implantable collamer lens)
EVO ICL recovery process? - ✔️ ✔️ these are some of our happiest patients on day one, recovery is quick. avoid heavy lifting for a few days, no submerging head under water for 1-2 weeks, no eye rubbing
Can both eyes receive EVO ICL treatment at the same time? - ✔️ ✔️ yes
Name the path of light through the eye? - ✔️ ✔️ tear film
cornea
aqueous humor
pupil
lens
vitreous
retina
optic nerve
brain
How many layers of the cornea are there? - ✔️ ✔️ Five
Name the layers of the cornea - ✔️ ✔️ Epithelium (top layer)
Bowman
Stroma
Descemets
Endothelium (bottom layer)
What is the function of endothelial cells - ✔️ ✔️ to pump fluid out of the cornea, back into the eye (sump pump of cornea)
What is the surgery that is used to replace endothelial cells? - ✔️ ✔️ DSEK or DMEK
What does DSEK stand for? - ✔️ ✔️ Descemet Stripping Endothelial Keratoplasty
What two layers are replaced with a DSEK? - ✔️ ✔️ Descemets and Endothelium (+ stroma cells!!)
What two layers are replaced with a DMEK - ✔️ ✔️ Descemets and Endothelium (no stroma cells!! much thinner transplant compared to DSEK)
What is the difference between a DSEK and DMEK? - ✔️ ✔️ both remove descemets and endothelium (two inner most layers of cornea) but DMEK grafts DO NOT include stroma cells while DSEK grafts DO include stroma cells.
requirements for a patient after DMEK/DSEK? - ✔️ ✔️ lay on their back with eye to the sky for 45 minutes out of every hour for 2-3 days following surgery\
How long until air bubble goes away following DMEK? - ✔️ ✔️ usually 4-6 days, some patients come to one week post op with air bubble still there
What is Fuchs dystrophy? - ✔️ ✔️ disease where endothelial cells of the cornea (the pumper cells) stop working, fixed w/ DMEK/DSEK
Carbonic anhydrase inhibitors
Beta blockers
Alpha-agonists
Rhokinase inhibitors
What is typically the first medication prescribed for glaucoma? - ✔️ ✔️ prostaglandins
What are three prostaglandins? - ✔️ ✔️ latanoprost
vyzulta
travaprost
bimatoprost
name some rho kinase inhibitors - ✔️ ✔️ rocklatan
rhopressa
name the carbonic anhydrase inhibitors - ✔️ ✔️ dorzolamide, brinzolamide
Name an alpha agonist - ✔️ ✔️ brimonidine
name a beta blocker - ✔️ ✔️ timolol
what is the fysx opap? - ✔️ ✔️ a pair of goggles you sleep in at night to lower iop. first way invented to lower iop in glaucoma patients without surgery/drugs. invented at VTV
can glaucomatous damage be reversed? - ✔️ ✔️ no, glaucoma is all about prevention
what is a cataract? - ✔️ ✔️ the natural clouding and hardening of your lens
what can be done for cataracts? - ✔️ ✔️ the only thing that can be done is cataract surgery
what are the five types of lenses that can be used for cataract surgery? - ✔️ ✔️ Basic (Standard) monofocal lenses
Multifocal lenses
Extended Depth of Focus lenses
Toric lens
Light Adjustable Lens
Basic (Standard) Monofocal - ✔️ ✔️ fixed focus at one distance, after surgery most patients require a thin pair of glasses for clear distance vision and cheaters/bifocal/trifocal for reading
Multifocal - ✔️ ✔️ has a series of concentric circles that focus at distance, intermediate, and near. may induce some night time glare and halo but gives most visual freedom (panoptix) 99.2% satisfaction rate
EDOF - ✔️ ✔️ a central bump in the lens stretches light out to focus light at distance and intermediate (no near) less glare and halos
How much do premium lenses cost - ✔️ ✔️ Toric--$3,750 per eye
Distance and Near--$4,750 per eye (panoptix)
LAL--$4,750 per eye
Does my insurance pay for premium lenses? - ✔️ ✔️ insurance only pays for the cataract portion of the procedure, they do not pay the extra cost of a premium iol (or extra testing/treatments that come w/ premium lenses)
what does an optometrist do? - ✔️ ✔️ primary eye doctors who examine/diagnose/treat/manage diseases and disorders of the visual system. ophthalmologist and optometrists work together hand in hand at vtv
what does an optician do? - ✔️ ✔️ an optician dispenses glasses and contacts to patients
what are VTV shared values? - ✔️ ✔️ Caring
Fun
Committed
Egalitarian
Excellence
What is co-management? - ✔️ ✔️ co-management is the sharing of patients care between VTV doctors and the patient's own optometrist. we are (co)managing your care together
Why does VTV promote co-management? - ✔️ ✔️ co-management creates strong relationships between our office and doctors in the community. if the patient selects their own doctor for follow up care we encourage it. we are always here if needed if something isn't right.
How does co-management benefit the patient? - ✔️ ✔️ the patient is able to maintain care with someone they trust and have seen for years. also it is an added benefit to patients who do not live close to our office to see someone near their home.
True or False: co-managing is more expensive? - ✔️ ✔️ FALSE
True or False: if a patient has a primary od who regularly works with VTV, the patient must co-manage with that doctor - ✔️ ✔️ FALSE--it is up to the patient to decide
True or False: if a patient wants to co-manage with a new doctor we have never worked with, they cannot - ✔️ ✔️ FALSE
True or False: patients can only comanage if they are having LASIK - ✔️ ✔️ FALSE
what is ptosis? - ✔️ ✔️ droopy eyelid
what is dermatochalasis? - ✔️ ✔️ excessive skin above the eyelids
what is entropion? - ✔️ ✔️ a turning in of the eyelids
what is ectropion? - ✔️ ✔️ a turning out of the eyelids
what are puncta? - ✔️ ✔️ the drainage pathways of tears into the nose
how many puncta are there? - ✔️ ✔️ there are two in each eye, upper and lower
what do neuromodulators (botox/dysport/xeomin) do? - ✔️ ✔️ injectable muscle relaxants that cause muscles to relax, thereby decreasing wrinkles
what is a blephoroplasty - ✔️ ✔️ removing the excess skin from your eyelids to help improve your vision/your appearance or both
is a blepharoplasty covered by insurance? - ✔️ ✔️ it can be cosmetic (not covered by insurance) or medical (covered by insurance), depending on the severity of your droopy eyelids.
what are guttata? - ✔️ ✔️ it is a drop out of endothelial cells of the cornea most frequently seen in Fuchs' dystrophy
what is considered low myopia? - ✔️ ✔️ between 0 and -3.00 diopters
what is considered moderate myopia? - ✔️ ✔️ between -3.00 and -6.00 diopters
what is considered high myopia? - ✔️ ✔️ higher than -6.00 diopters
what is considered a thin cornea? - ✔️ ✔️ less than 500 microns (average thickness 550)
what is the purpose of a gas-permeable (RGP) over refraction? - ✔️ ✔️ RGP gives a new spherical surface to the cornea which allows light to better focus at the back of the eye (the contact "smooths" over the cornea by sitting on top of it, letting us know if the problem is with the cornea or if it is elsewhere in the eye)
what are the three types of OCTS (optical coherence tomography) that we perform? - ✔️ ✔️ Retina OCT, Glaucoma OCT (RNFL), Anterior Segment OCT
how quickly should patient calls be returned by our medical staff? - ✔️ ✔️ the same day
how quickly should doctor calls be returned by our doctor team? - ✔️ ✔️ the same day
what happens during corneal collagen cross-linking? - ✔️ ✔️ the collagen fibers in the cornea are strengthened as a result of the interaction between the vitamin b2 solution and the light treatment
how does a stent lower IOP? - ✔️ ✔️ it provides better outflow of aqueous humor through the drainage system
what is the money per eye that goes to the co-managing doctor when patients go with an upgraded lens, and who decides how much it is? - ✔️ ✔️ your local eye doctor decides how much to charge for aftercare--the money is for extended aftercare that takes place AFTER the first three months of standard cataract follow up (global period after surgery is 90 days). during this time, their physicians will monitor your progress and determine if additional treatment like YAG or LASIK fine tune is needed
what is CoFi? - ✔️ ✔️ CoFi is a platform we use to collect payment for both ourselves and comanaging doctors at the same time. VTV not legally allowed to collect money for other doctor offices, so CoFi allows us to avoid people paying us for surgery then getting upset that they are paying their primary od for aftercare (one payment instead of two). some OD offices to not utilize CoFi
What is meant by deductible, co-insurance, out of pocket? - ✔️ ✔️ you pay the amount of your deductible first. once your deductible is met, your insurance will start to pay a percentage and you will be responsible for the percent of your co-insurance. if your plan has a total out of pocket amount, once you have reached this, your insurance will cover at 100%
what is the best way to explain to patients that the charge should be covered by their insurance? - ✔️ ✔️ we will submit the charges to your insurance. once your insurance has processed your claim, it will apply to your deductible/co-insurance
when is a copay due? - ✔️ ✔️ copay is due at the time the patient presents for their appointment, not required if a patient is here for a post-op visit
what is a medicare replacement plan? - ✔️ ✔️ this is a plan that a patient opted to have to replace their medicare part b. it is not used along with their medicare care. we want our patients to avoid these, especially if they have chronic diseases like glaucoma, because they can limit the scope of our care
what procedures do you need to be off blood thinners? - ✔️ ✔️ lid cases. complex cases that require a retrobulbar block (yamane, xens, pkp, tubes, RBBs + GLP1 patients)
what are the NPO guidelines for all procedures EXCEPT cataract/migs/combination migs/cataract procedures? - ✔️ ✔️ no food 6 hours prior, then clear liquids (water/black coffee) up to 2 hours prior. nothing after that
cataract/migs/combo cat migs--do not have to follow these guidelines
what type of sedative will patients receive for cataract surgery? - ✔️ ✔️ MKO melt (doesn't require an IV, invented at VTV, no opiod)
how long is the average length of stay for cataract surgery? - ✔️ ✔️ 2-3 hours from check in to check out
which patient populations will need to be hospitalized for surgery? - ✔️ ✔️ general anesthesia, patients over 450 pounds, people under the age of 14
how long will dilation last after cataract surgery? - ✔️ ✔️ 24-72 hours
what must every sedated patient have after an ASC surgery? - ✔️ ✔️ a driver and access to a responsible party who can watch them overnight. without these, surgery may be cancelled
what is the name of the software we use to inquire about a patients insurance benefits? - ✔️ ✔ ️ pverify
What does FORD stand for? - ✔️ ✔️ Family
Occupation
Recreation
Dreams
this information should be added in each patients chart for future reference to make the patient experience world class
what do we mean by the "three legged stool" at VTV? - ✔️ ✔️ 1. do the right thing
- invest in the worlds best technology
- make the patient experience second to none
VTV allows me how much $ with no questions asked to delight a patient? - ✔️ ✔️ $
best description for the "see&do" programs we offer for cataracts/refractive surgery? - ✔️ ✔️ patient comes to VTV to be seen in clinic in the morning, have surgery early afternoon, and be back to us or their co-managing doctor for their one day/follow up appointments
what does 20/20 vision mean? - ✔️ ✔️ 20/20 means you can see at 20 feet away what an average person can see at 20 feet away
what does 20/40 vision mean? - ✔️ ✔️ you need to be 20 feet away to see what an average person can see at 40 feet away (worse than 20/20)
what does 20/15 vision mean? - ✔️ ✔️ you can see at 20 feet away what an average person needs to be at 15 feet away to see (better than 20/20)
what is the same day/next day (back to back) after cataract surgery? - ✔️ ✔️ patients can have their second eye done the day after their first eye
why can't they do both cataract surgeries on the same day? - ✔️ ✔️ we like to make sure the first eye heals properly before we do the second eye. most eye surgeons still perform cataract surgery 1 week to 1 month apart, but we believe with our advanced technology it is safe to perform these surgeries back
