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									                 2007 UBO/UBU
                 Conference
From Registration to Accounts Receivable – The Whole Can of Worms




   Briefing: Introduction to
             Anatomy of the Eye
   Date:          21 March 2007
   Time:          1010 – 1100




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2007 UBO/UBU Conference
From Registration to
Accounts Receivable
                                               Objectives

   By the end of this presentation you will be able to:
     – Recognize major components of the eye
     – Have a basic understanding of how the eye works
     – Understand how eye disease affects the
       components of the eye




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2007 UBO/UBU Conference
From Registration to
Accounts Receivable
                                  The Eye

   The eye allows us to see
    and interpret the shapes,
    colors and dimensions
    of objects in the world by
    processing the light they
    reflect or emit

   The eye is able to see in
    bright or dim light, but it
    cannot see objects when
    light is absent




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2007 UBO/UBU Conference
From Registration to
Accounts Receivable
                                                      The Eye



When you look at any object

   Light waves from that object enter the eye first through
    the cornea, which is the clear dome at the front of the
    eye
   Light waves progress through the pupil, the circular
    opening in the center of the colored iris
   Immediately behind the iris (and pupil) is the crystalline
    lens, and light passes through that also




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2007 UBO/UBU Conference
From Registration to
Accounts Receivable
                                                     The Eye



   Light waves are bent (converged) first by the cornea,
    then even more so by the crystalline lens, to a nodal
    point which is immediately behind the lens
   At the nodal point, the light waves (image) become
    reversed (turned backwards) and inverted (turned
    upside down)
   Light waves continue through the vitreous humor, the
    clear gel that makes up about 80% of the eye’s
    volume, and then back to a clear focus on the retina
    behind the vitreous
   The small, central area of the retina is the macula; it
    provides the best vision of any location in the retina

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2007 UBO/UBU Conference
From Registration to
Accounts Receivable
                          The Eye




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2007 UBO/UBU Conference
From Registration to
Accounts Receivable
                                                        The Eye

   The light impulses are changed into electrical
    signals, then sent through the optic nerve along the
    visual pathway to the occipital cortex, or posterior
    (back), of the brain
   This is where the electrical signals are seen by the
    brain as a visual image
   When light entering the eye is bright enough, the
    pupils will get smaller (constrict) due to pupillary light
    response




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2007 UBO/UBU Conference
From Registration to
Accounts Receivable
                          The Eye

Extraocular Muscles




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2007 UBO/UBU Conference
From Registration to
Accounts Receivable
                                                      The Eye

   All of the extraocular muscles, with the exception of
    the inferior oblique, form a “cone” within the bony orbit

   The apex of the cone is in the posterior aspect (back)
    of the orbit, while the base of the cone is the
    attachment of the muscles around the midline of the
    eye. This conic structure is referred to as the “annulus
    of Zinn,” and within this cone runs the Optic nerve
    (cranial nerve H)

    Within the optic nerve are the ophthalmic artery and
    the ophthalmic vein


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2007 UBO/UBU Conference
From Registration to
Accounts Receivable
                                                     The Eye



   The superior oblique muscle is different from the
    others, because before it attaches to the eye, it passes
    through a ring-like tendon, the trochlea, which acts
    like a pulley in the nasal portion of the orbit

   The inferior oblique muscle (not a member of the
    annulus of Zinn) arises from the lacrimal fossa in the
    nasal portion of the bony orbit and attaches to the
    inferior portion of the eye




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2007 UBO/UBU Conference
From Registration to
Accounts Receivable
                                                   The Eye



   The primary muscle that moves an eye in a given
    direction is known as the agonist

   A muscle in the same eye that moves the eye in the
    same direction as the agonist is known as a synergist

   A muscle in the same eye that moves the eye in the
    opposite direction of the agonist is the antagonist




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2007 UBO/UBU Conference
From Registration to
Accounts Receivable
                                                   The Eye

   Cardinal positions of gaze
     – Up/right
     – Up/left
     – Right
     – Left
     – Down/right
     – Down/left


   In each position of gaze, one muscle of each eye is the
    primary mover of that eye, and is “yoked” to the
    primary mover of the other eye


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2007 UBO/UBU Conference
From Registration to
Accounts Receivable
                                                The Eye



   A “vergence” or “disconjugate” movement involves
    simultaneous movement of both eyes in the opposite
    directions
   There are two principal vergence movements
     – Convergence – both eyes moving nasally or inward
     – Divergence – both eyes moving temporally or
       upward




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2007 UBO/UBU Conference
From Registration to
Accounts Receivable
                                                  The Eye

Strabismus
Usually when we see an object, the lines of sight are both
eyes intersecting at the object, or both eyes are pointing
at the object being viewed. An image of the object is
focused upon the macula of each eye and the brain
merges the two retinal images into one

When there is an extraocular muscle imbalance, one eye
is not aligned with the other eye, which results in a
strabismus




                                                             14
 2007 UBO/UBU Conference
 From Registration to
 Accounts Receivable
                                                     The Eye

Strabismus, (cont’d)
With strabismus, while one eye is fixating on a particular
object, the other eye is turned in another direction, either
inward (cross-eyed), outward (wall-eyed), upward, or
downward

As a result, the person either experiences “diplopia”
(double vision) or the brain learns to turn off (suppress)
the image of the strabismic eye to maintain single vision

The angle of deviation of the strabismus is measured in
prism diopters


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 2007 UBO/UBU Conference
 From Registration to
 Accounts Receivable
                                       Diseases of the Eye


Diabetic Retinopathy
This is a complication of diabetes mellitus in which long-
term exposure to high glucose levels in the blood has
damaged retinal blood vessels. This results in new
growth of abnormal blood vessels, fluid buildup in the
macula (macular edema), inadequate blood supply to the
retina and possibly blood and fluid leakage into the retina
and the vitreous body




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2007 UBO/UBU Conference
From Registration to
Accounts Receivable
                                        Diseases of the Eye

   A cataract is a clouding of the eye's natural lens,
    which lies behind the iris and the pupil
   The lens is mostly made of water and protein. The
    protein is arranged in a precise way that keeps the
    lens clear and lets light pass through it. But as we
    age, some of the protein may clump together and
    start to cloud a small area of the lens. This is a
    cataract, and over time, it may grow larger and
    cloud more of the lens, making it harder to see




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2007 UBO/UBU Conference
From Registration to
Accounts Receivable
                                        Diseases of the Eye

   Researchers are identifying factors that may cause
    cataracts such as:
     – People with diabetes
     – Users of steroids, diuretics, and major tranquilizers
     – Users of a lot of salt
     – Cigarette smoke
     – Air pollution
     – Heavy alcohol consumption




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2007 UBO/UBU Conference
From Registration to
Accounts Receivable
                                     Diseases of the Eye

Glaucoma
 Glaucoma represents injury to the optic nerve
  secondary to elevated pressure inside the eye.
  However, there are exceptions to this definition
 Some patients with sustained high intra-ocular
  pressure never develop any of the signs of optic nerve
  damage and therefore, do not truly have glaucoma.
  These patients are said to have ocular hypertension
 Other patients may progressively lose vision and
  become blind, even though they never exhibit "high"
  eye pressures. These patients have low tension
  glaucoma (also called normal tension glaucoma)


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2007 UBO/UBU Conference
From Registration to
Accounts Receivable
                                       Diseases of the Eye

Glaucoma (cont’d)

   Most patients with glaucoma do have elevated
    intraocular pressure. Along with the eye pressure,
    other parameters are evaluated in the search for
    glaucoma, such as peripheral vision, visual contrast
    sensitivity, optic nerve cupping (a hollowing out of the
    center of the optic nerve head in the back of the eye),
    and gonioscopy (visualizing the anatomy of the filtering
    angle of the eye, where the cornea and the iris join)




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2007 UBO/UBU Conference
From Registration to
Accounts Receivable
                                                   The Eye

Miscellaneous tidbits about the eyes
 Anterior chamber – refers to the fluid filled (aqueous
  humor) space between the cornea and the iris/pupil
 Posterior chamber – refers to the fluid filled (aqueous
  humor) ring-shaped space between the iris/pupil and
  the lens and ciliary body
 Anterior segment – refers to the intraocular portion of
  the eyeball and holds the anterior and posterior
  chambers of the eye
 Posterior segment – refers to the large vitreous-filled
  space between the retina and the lens and where the
  optic nerve comes into the eye


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2007 UBO/UBU Conference
From Registration to
Accounts Receivable
                                                  The Eye

Miscellaneous tidbits about the eyes (cont’d)
 A newborn’s eyeball is about 18 millimeters in
  diameter, from front to back. It grows gradually to a
  length of approximately 24-25 millimeters (about 1”), or
  just smaller than a 1 1/2” ping pong ball!

   CPT codes in the 60,000 series are divided by the
    anatomical location of either
              Anterior segment
              Posterior segment
              Ocular adenexa




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2007 UBO/UBU Conference
From Registration to
Accounts Receivable
                          The Eye




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2007 UBO/UBU Conference
From Registration to
Accounts Receivable
                                                                          The Eye

Resources:
           http://www.cms.hhs.gov/MLNProducts/65_ophthalmology.asp

http://www.cms.hhs.gov/MLNProducts/Downloads/internet_only_manuals.pdf
                     Internet only manuals, coding

                      http://www.visionchannel.net/diabeticretinopathy/
                               Great website for information

       http://www.bertscope.com/Literature/Lit_Requests/info_poster.html
                       Free eye posters and online stuff

                     http://www.optima-hyper.com/eyetests/fitness.htm
                                Optima’s Eye Fitness Tests




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