The Optical Vision Site

Optical Lenses and Coating Glossary

Written by Cathy on April 8, 2009 – 6:34 am -

Optical Lenses and Coating Glossary

Anti-Reflective Coating: This is a coating which can be applied to the outside or inside surface of any lens (clear or sun lens) to minimize the amount of light reflected by your lenses. It reduces reflections and glare. Reflections and glare may cause headaches or interfere with vision clarity. Regular lenses reflect a very small amount of light back into your eye, possibly skewing vision; anti-reflective coating helps to prevent this. It is best used on the back surface of a sun lens to minimize back glare.

Anti-Scratch Coating: A Coating  applied to the outside of the lens to minimize scratching. Does not make the lens scratch proof, but helps in reducing fine hair line scratches. All polycarbonate lenses come with an anti-scratch coating.

ANSI Standard Z87.1: The new standard is now called the ANSI Z87.1-2003 standard, and is performance driven with two levels of performance for non-plano (prescription) lenses.- Basic Impact- High Impact

• The new standard requires that prescription safety frames must meet the lens retention (High Velocity and High Mass) test requirement with 2.0mm lenses.
Please be aware that an employee subjected to High Impact may not be adequately protected if wearing lenses tested only for Basic Impact. Description of the new ANSI testing requirements:
High Impact Level Prescription Lenses
• Must not be less than 2.0mm thick.
• The lenses shall be capable of resisting impact from a 6.35mm (1/4 in.) steel ball traveling at 45.7 m/s (150 ft/s).
• Marking by manufacturer with “W” as a trademark would look
like this: W+ Basic Impact Level Prescription Lenses.
• Basic Impact lenses shall be a minimum 3.0mm thick except those lenses having a plus power of 3.00D or greater shall have a minimum thickness of 2.5mm (no change from the 1989 standard).
• Basic Impact lenses are not tested to stringent High Impact requirements.
• They will NOT be marked with a “+”
• Protectors with Basic Impact lenses will be delivered to the wearer bearing a Warning Label indicating that the protector only meets the Basic Impact Standard

Backside anti-reflective (AR) coating: light that comes from behind can cause you additional glare. Sunlight will hit the back of the lenses and bounces into the eyes. The purpose of a backside (AR) coating is to reduce the reflection off the lenses.

Ballistic Ballistic is any projectile in a high velocity.

Bifocal Lenses- Provides 2 types of Vision correction- One for distance and for near.

Blue Blocker Is a type of lens that will block the visible blue light without darkening the overall light. These lenses are usually brown, orange or red.

Color-Coated Lenses: Coloring on the outside of the lens. Lens mirror coating is a process that usually involves a metallic oxide coating being applied to a lens in a vacuum deposition to get the coatings evenly deposited across the surface. There is only a hand full of these machines in the United Stated that are used in these processes because of their expense. Every time a color is applied to a batch of lenses, the vacuum chamber must be meticulously cleaned to keep the next batch of a different color from being affected by the previous operation. Most coating labs run certain colors just once a week to keep the labor and materials expense down. Adversely mass produced lenses that you would get in a stock pair of sunglasses is done in a assembly line fashion, running a huge batch of lense all the same color until the run is complete. Custom prescription lenses are not cycled this quickly and usually takes a week for the turnaround time.

CR-39 (plastic) The advantages of plastic is that it is lightweight and easily tinted to just about any color. One of the disadvantages is that those lenses scratch easily.

Custom Lenses- Custom lenses are cataract lenses that allow patients with very bad vision get most of their sight back along with slab off lenses that help patients with vertical imbalance see much clearer without double vision effect. This type of correction is called a slab-off or bicentric grind.

DriveWear transitional lenses are the first and only photochromic lenses to darken behind the windshield of a vehicle, with the ability to react to visible light as well as UV light. By combining polarization with new photochromic technology, DriveWear lenses are capable of sensing and reacting to varying light conditions both outside and behind the windshield of the car. From bright sunlight accompanied by intense, blinding glare, to overcast inclement conditions,

G-15: Green-Gray lenses are the most popular general purpose lenses. Uniform absorption of colors throughout the spectrum allows colors to be seen exactly as they are with approximately 85% light absorption.Glass lenses: One major advantage is that it is very scratch resistant. However it is double the weight of conventional plastic. Also it is not as shatter resistant or safe as plastic. Can easily be tinted.

Glass lenses are the most scratch-resistant and distortion-free, but they are also heavier, more expensive and more likely to shatter.

High index 1.56: Thinner and lighter than regular plastic good for higher prescriptions. Can easily tinted into sunglasses.

High index 1.60: Thinner and lighter than 1.56 high index. These lenses already come with a scratch coat. Great choice for higher prescriptions.

High index 1.67: Thinner and lighter than 1.60. These lenses already come with scratch coating. Also a great choice for high prescriptions.

Impact Resistant: Resistant to shattering or splintering. impact resistant plastic is made so that it will not break into small pieces. Polycarbonate is impact resistant making it a very safe lens to wear.

Infrared (IR) Radiation (760 – 3000nm) Infrared Rays are radiant energy, or heat waves, not considered harmful under normal conditions. These heat rays cannot be seen but can be felt. If you are exposed to intense sunlight for a lengthy period of time (a day at the beach, for example) without infrared protection, you may experience a burning or stinging sensation in your eyes and a sense of fatigue. Infrared rays can be especially discomforting if you wear contact lenses. If your sunglasses fail to stop infrared light, it can be absorbed by your contacts, causing them to “warm up”

Melanin Polarized lenses: “The three main concerns eyecare professionals have with sunlight are UV radiation, Blue light, and Glare. This trio of challenges is often not addressed by most sun lenses, and those that do address them don’t necessarily address them well. Polarized Melanin Lens gives ultimate protection against all three. Ultra-violet light is the high-energy, invisible light ranging from approximately 190nm to 380nm. The UVA portion (315nm to 380nm) is considered harmful to the eye-causing problems such as sunshine or brown cataracts, increased pterygium, and photokeratitis. Sources of UV include direct exposure from the sun and computer monitor as well as reflective surfaces such as water, sand, and snow. Blue light, or more accurately the blue and violet portion of the visible light spectrum, is the high-energy visible light (HEV), which research is beginning to indicate is a contributing factor to age-related macular degeneration (AMD). Visible glare is caused by sunlight reflected off surfaces such as water, roads, car windshields, snow, and sand. Polarized Melanin Lenses will be well suited to your active outdoor patients who are looking for a comfortable sun lens that is impact-protective and absorbs harmful light radiations. Consider it for boaters, hunters, skiers, hikers, forest rangers, police officers, or anyone who spends a good deal of time out-doors.” *

Mirrored Coating: Also called Flash Coating, it is applied to the outside of the lens and can be applied over any base color. New laboratory processes have created coatings that adhere better to the surface of the lens, are less susceptible to scratching, and are available in an expanded palate of colors. Mirror coated lenses absorb anywhere from 10 percent to 60 percent more light than uncoated lenses, depending on the type and degree of coating. The light transmission is further reduced by the base tint of the lens. Due to its reflective property, any mirrored lens will appear darker since it will reflect a certain amount of light trying to reach the eye. A mirrored lens will also add an extra buffer against glare. This makes them ideal for outdoor uses such as skiing. Care and Cleaning: Because most mirror coatings are applied to the surface of the lens, extra care must be taken when cleaning a mirrored lens to prevent scratching and other damage to the surface. Lens cleaning cloths should be used rather than abrasive cotton or paper towels. Dawn dishwashing soap is a good cleaner, but don’t use other household cleaners such as Windex.

Photochromic: Able to change lens color or darkness/density depending upon the degree of exposure to light.

Polarized Lenses block out virtually all Ultra Violet Rays. These lenses help to eliminate haze and glare, while increasing visibility. Colors appear more vibrant while others are subdivided to give the wearer true view without the irritating sun. Excellent for driving!

Progressive lenses -Also Known as No-Line Bifocals.  The progressive multifocals have a distance viewing area in the upper area of the lens, down to where the near correction begins.

Reading Glasses have lenses with stronger powers because they incorporate both the distance and near powers to concentrate power for easy reading for the wearer.

Sun Lenses are lenses that have a dark tint or a coating. These lenses help reduce light transmission and come in many colors such as yellow, blue, mirror etc.

Super Mirrored Coating: Mirror coatings on eyeglass lenses serve the dual purposes of fashion and function. The best selling colors of silver, gold and blue have different properties and manage different needs, and other colors serve niche needs. These fashionable and functional coatings however, have had limited appeal because of four major drawbacks:

· Mirrored lenses scratch easily
· Repeated cleaning of mirrors will eventually wear the coating off the lenses
· Mirrors are difficult to keep clean
· Backside reflections cause visual discomfort

Poker Mirror: The Poker Mirror is a hard mirror coat over a slight tint, designed to be worn indoors. The purpose is to obscure the eye while still allowing enough light to pass through the lens to see while playing poker, or engaging in similar activities. The anti-reflective coating on the back helps reduce distracting reflections from the back surface of the lens.

Polished edges= Instead of leaving the edge of the lens with the matte finish from the edger, it can be polished. This is only recommended for clear glasses. With a polished lens on sunglasses you can get chromatic aberrations within the lens from the light coming into the edge of the lens.  Also lenses with polished edges are difficult to keep in a wrapped frames for sunglasses.

Polycarbonate- Polycarbonate lenses or “Poly” are “impact resistant” thinner and lighter in weight than traditional plastic eyeglass lenses, they also offer ultraviolet (UV) protection and scratch resistance. In addition, they are very impact resistant. This extra toughness makes them the lenses of choice for children’s glasses, sports eyewear and safety glasses.

TD-2 Coating: While the regular polycarbonate, and top-mount polycarbonate lenses have a factory-applied scratch-resistant coating, it is not as hard as the TD-2 coating. The TD-2 coating does add about 2-3 days to the turn around time on your prescription order. One thing to note, is a TD-2 coated lens cannot be tinted.

Transitions-The leader in plastic photochromic lenses to the industry. Transitions continue to develop the technology for changing lenses.

Trifocal – Lenses in which which there are 3 areas to correct vision. Distance, intermediate and near.

Trivex: offers strength and impact-resistance, light weight and thinness, and quality optics. TRIVEX lens material lets you prescribe a single lens with the qualities of many.  This revolutionary lens material combines the key lens attributes your patients are looking for while offering the superior optics you demand.  Only the finest lenses provide tri-performance. TRIVEX is the world’s first tri-performance lens material; meaning it offers a triple combination of features never before found in a single material.  Superior Optics.  Impact Resistance.  Ultra light Weight.  This breakthrough in technology is specifically designed to deliver the most comprehensive performance of any lens material, anywhere.

Ultraviolet (UV) Radiation: Solar radiation is formed by visible and invisible light waves. Measured in nanometers, it has three wave lengths that reach and affect your eyes: Ultraviolet, Visible Lights, and Infrared Radiation. The shorter the wavelength, the more damage to your eyes.Studies show that long term exposure to UV rays may cause eye diseases, including cataracts. In addition, short-term exposure can cause temporary conditions such as “snow blindness”, Ultraviolet radiation can be divided into three categories.

UVC (200 – 290 nm)-UVC is absorbed by the atmospheric ozone layer and never reaches your eyes.

UVB (290 – 320 nm)-UVB is a physically painful form of ultraviolet radiation. These are the sun’s “tanning rays” which are absorbed by the cornea. Exposure to UVB can temporarily damage the cornea. This band of radiation causes cancer and burning of the eye and has been linked to damage of the lens inside the eye.

UVA (320 – 380 nm)- UVA rays are absorbed by the lens of your eye. The resulting damage heals slowly, if at all. About one percent of all UVA rays penetrate the retina, which cannot repair itself. These rays, which cause sun tanning and wrinkles, pass through the outer structure of the eye and are absorbed by your eye’s lens. The resulting damage heals slowly, it at all. Extended exposure to UVA rays can lead to the formation of cataracts.

Protection from harmful UV radiation is becoming more and more important as the earth’s ozone layer continues to be depleted. Clouds, Smog, Haze do not block out  UV rays. You can get higher exposure to UV radiation on snow, sand, water, or concrete, and high altitudes. Excessive exposure to UV radiation today can cause eye problems tomorrow.

UV Filter (coating) This coating is a filter for the harmful UV radiation. The coating is either put on the lens or is imbedded into the lens to protect your eyes for the harmful effect of the sun’s UV radiation.

Resources

• Eyeglass Lenses
• Heavy Glare

Tags: Education, Lenses
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Managed Care Terminology

Written by Cathy on November 6, 2008 – 11:15 am -

AAPCC – see Adjusted Average Per Capita Cost.

ABC – see Activity-Based Costing.

Abuse – When used as a legal term in the business of healthcare, it normally refers to actions that do not involve intentional misrepresentations in billing but which, nevertheless, result in improper conduct. Consequences can result in civil liability and administrative sanctions. An example of abuse is the excessive use of medical supplies. (Also see Fraud, OIG, FBI, and Compliance)

Access – The patient’s ability to obtain medical care. The ease of access is determined by such components as the availability of medical services and their acceptability to the patient, the location of health care facilities, transportation, hours of operation and cost of care. An individual’s ability to obtain appropriate health care services. Barriers to access can be financial (insufficient monetary resources), geographic (distance to providers), organizational (lack of available providers) and sociological (e.g., discrimination, language barriers). Efforts to improve access often focus on providing/improving health coverage.

Accountable Health Plan (AHP) – AHPs can be IDSs, MCOs, Health Networks, partnerships or joint ventures between practitioners, providers or payers that would assume responsibility for delivering medical care and managing the funds required to pay for the services rendered. Physicians and other providers would work for, contract with or own these health plans. When an IDS or hospital group or IPA operates one or more health insurance benefit products, or a managed care organization acquires a large scale medical delivery component, it qualifies as an Accountable Health System or Accountable Health Plan.

Accountable Health Partnership – An organization of doctors and hospitals that provides care for people organized into large groups of purchasers.

Accreditation–The process by which an organization recognizes an institution as meeting predetermined standards

Accrual – The amount of money that is set aside to cover expenses. The accrual is the plan’s best estimate of what those expenses are, and (for medical expenses) is based on a combination of data from the authorization system, the claims system, lag studies, and the plan’s prior history.

ACR – see Adjusted Community Rate.

Actively-at-Work – Describes insurer’s policy requirement indicating that coverage will not go into effect until the employee’s first day of work on or after the effective date of coverage. May also apply to dependents disabled on the effective date.

Activities of Daily Living (ADL’s, ADL) – An individual’s daily habits such as bathing, dressing and eating. ADLs are often used as an assessment tool to determine an individual’s ability to function at home, or in a less restricted environment of care.

Activity-Based Costing (ABC) - Activity-based costing defines healthcare costs in terms of a healthcare organization’s processes or activities. The costs are then associated with significant activities or events. It relies on the following 3 step process: 1) Activity mapping, which involves mapping activities in an illustrated sequence; 2) Activity analysis, which involves defining and assigning a time value to activities; and, 3) bill of activities, which involves generating a cost for each main activity.

Actuarial – Refers to the statistical calculations used to determine the managed care company’s rates and premiums charged their customers based on projections of utilization and cost for a defined population.

Actuarial Equivalent – Relates to the statistical calculation of risk and used to describe a health plan that has an equivalent statistical calculation of risk as another plan. For example, under Medicare rules, A plan sponsor must offer a prescription drug plan that is actuarially (a term relating to the statistical calculation of risk) the same or better than the Medicare Part D prescription drug pl

Actuarial Soundness–The requirement that the development of capitation rates meet common actuarial principles and rules.

Acute Care – A pattern of health care in which a patient is treated for an acute (immediate and severe) episode of illness, for the subsequent treatment of injuries related to an accident or other trauma, or during recovery from surgery. Specialized personnel using complex and sophisticated technical equipment and materials usually give acute care in a hospital. Unlike chronic care, acute care is often necessary for only a short time.

Adjudication – Processing claims according to contract.

Adjusted Admissions – Adjusted admissions are equivalent to the sum of inpatient admissions and an estimate of the volume of outpatient services. This is a measure of all patient care activity undertaken in a hospital, both inpatient and outpatient. This estimate is calculated by multiplying outpatient visits by the ratio of outpatient charges per visit to inpatient charges per admission.

Adjusted Average Per Capita Cost (AAPCC)–The estimated average fee-for-service cost of Medicare benefits for an individual by county of residence. It is based on the following factors: age, sex, institutional status, Medicaid, disability, and end stage renal disease status. HCFA uses the AAPCCs as a basis for making monthly payments to TEFRA contractors.

Adjusted Community Rate or Rating (ACR) – Health plans and insurance companies estimate their ACRs annually and adjust subsequent year supplemental benefits or premiums to return any excess Medicare revenue above the ACR to enrollees. This are the estimated payment rates that health plans with Medicare risk contracts would have received for their Medicare enrollees if paid their private market premiums, adjusted for differences in benefit packages and service use. ACR is a rating by community influenced by certain group demographics. Estimated payment rates that health plans with Medicare risk contracts would have received for their Medicare enrollees if paid their private market premiums, adjusted for differences in benefit packages and service use. Health plans estimate their ACRs annually and adjust subsequent year supplemental benefits or premiums to return any excess Medicare revenue above the ACR to enrollees. See Adjusted Average Per Capita Cost, Medicare Risk Contract. See also Community Rating.

Adjusted Drug Benefit List – A small number of medications often prescribed to long-term patient. Also called a drug maintenance list. A health plan, CMS or 3rd party administrator can modify it from time to time. See also Drug Formulary, Formulary.

Adjusted Per Capita Cost (APCC) – Medicare benefits estimation for a person in a given county using sex, age, institutional status, Medicaid disability, and end stage renal disease status as a basis.

Adjusted Payment Rate (APR) – The Medicare capitated payment to risk-contract HMOs. For a given health plan, the APR is determined by adjusting county-level AAPCCs to reflect the relative risks of the plan’s enrollees.DL – see Activities of Daily Living.

Administrative Code Sets – Code sets that characterize a general business situation, rather than a medical condition or service. Under HIPAA, these are sometimes referred to as non-clinical or non-medical code sets. Compare to medical code sets.

Administrative Costs – Costs related to utilization review, insurance marketing, medical underwriting, agents’ commissions, premium collection, claims processing, insurer profit, quality assurance programs, and risk management. Administrative costs also refer to certain allowable costs on hospital CMS cost reports, usually considered overhead. Rules exist which disallow certain expenses, such as marketing. Costs not linked directly to the provision of medical care. Includes marketing, claims processing, billing, and medical record keeping, among others.

Administrative Services Organization (ASO) – An entity that contracts as an insurance company with a self-funded plan but where the insurance company performs administrative services only and the self-funded entity assumes all risk.

Administrative Services Only (ASO) – A relationship between an insurance company or other management entity and a self-funded plan or group of providers in which the insurance company or management entity performs administrative services only, such as billing, practice management, marketing, etc., and does not assume any risk. The client bears the financial risk for the claims. Clients contracting for ASO can include health plans, hospitals, delivery networks, IPAs, etc. A provider system wishing to capitate might contract with a TPA for ASO for certain services for which the provider group does not want to bring in house. This is a form of outsourcing. See also TPA.

Administrative Simplification – Title II, Subtitle F, of HIPAA which authorizes HHS to: (1) adopt standards for transactions and code sets that are used to exchange health data; (2) adopt standard identifiers for health plans, health care providers, employers, and individuals for use on standard transactions; and (3) adopt standards to protect the security and privacy of personally identifiable health information.

Administrative Supervision – A situation in which a health plan’s operations are placed under the direction and control of the state commissioner of insurance or a person appointed by the commissioner.

Admission Certification – Methods of assuring that only those patients who need hospital care are admitted. Certification can be granted before admission (preadmission) or shortly after (concurrent). Length-of-stay for the patient’s diagnosed problem is usually assigned upon admission under a certification program.

Admissions Per 1,000 – Number of patients admitted to a hospital or hospitals per 1,000 health plan members. An indicator calculated by taking the total number of inpatient and/or outpatient admissions from a specific group, e.g., employer group, HMO population at risk, for a specific period of time (usually one year), dividing it by the average number of covered members in that group during the same period, and multiplying the result by 1,000. This indicator can be calculated for behavioral health or any disease in the aggregate and by modality of treatment, e.g., inpatient, residential, and partial hospitalization, etc.

Adverse Selection–The problem of attracting members who are sicker than the general population, specifically, members who are sicker than was anticipated when developing the rates of reimbursement for medical costs.

Affiliation – An agreement between two or more otherwise independent entities or individuals that defines how they will relate to one another. Agreements between hospitals may specify procedures for referring or transferring patients. Agreements between providers may include joint managed care contracting.

Agent – A person who is authorized by an MCO or an insurer to act on its behalf to negotiate, sell, and service managed care contracts.

Age/Sex Factor – Underwriting measurement representing the medical risk costs of one population compared to another based on age and sex factors.

Age/Sex Rates (ASR) – Also called table rates, they are given group products’ set of rates where each grouping, by age and sex, has its own rates. Rates are used to calculate premiums for group billing and demographic changes are adjusted automatically in the group.

Age-at-Issuance Rating – A method for establishing health insurance premiums whereby an insurer’s premium is based on the age of individuals when they first purchased health insurance coverage. This is an older form of actuarial assessment.

Age-Attained Rating – Similar to the above, this method for establishing health insurance premiums whereby an insurer’s premium is based on the current age of the beneficiary. Age-attained-rated premiums increase in price, as the purchasers grow older.

Agency for Health Care Policy and Research (AHCPR) – The agency of the Public Health Service responsible for enhancing the quality, appropriateness and effectiveness of health care services.

Aggregate Margin – This is computed by subtracting the sum of expenses for all hospitals in the group from the sum of revenues and dividing by the sum of revenues. The aggregate margin compares revenues to expenses for a group of hospitals, rather than one single hospital.

Aggregate PPS Operating Margin/Aggregate Total Margin – This is computed by subtracting the sum of expenses for all hospitals in the group from the sum of revenues and dividing by the sum of revenues. A PPS operating margin or total margin that compare revenue to expenses for a group of hospitals, rather than a single hospital.

Aggregate Stop Loss Coverage – The form of excess risk coverage that provides protection for the employer against accumulation of claims exceeding a certain level. A type of stop-loss insurance that provides benefits when a group’s total claims during a specified period exceed a stated amount. This is protection against abnormal frequency of claims in total, rather than abnormal severity of a single claim.

AHCPR – see Agency for Health Care Policy and Research.

AHP – see Accountable Health Plan.

Aid to Families with Dependent Children (AFDC) – The federal AFDC program provides cash welfare to: (1) needy children who have been deprived of parental support and (2) certain others in the household of such child. States administer the AFDC program with funding from both the federal government and state. The Personal Responsibility & Work Responsibility Act of 1996, enacted in August 1996, replaced AFDC with a new program called Temporary Assistance for Needy Families (TANF).

Affiliated Provider–a health care provider or facility that is part of the Managed Care Organization’s network, usually having formal arrangements to provide services to the MCO’s member.

All Inclusive Visit Rate – Aggregate costs for any one patient visit based upon annual operating costs divided by patient visits per year. This rate incorporates costs for all services at the visit.

Allowable Charge – The maximum charge for which a third party will reimburse a provider for a given service. An allowable charge is not necessarily the same as either a reasonable, customary, maximum, actual, or prevailing charge.

Allowed Amount – Maximum dollar amount assigned for a procedure based on various pricing mechanisms. Also known as a maximum allowable.

Allowed Charge – This is the amount Medicare approves for payment to a physician, but may not match the amount the physician gets paid by Medicare (due to co-pay or deductibles) and usually does not match what the physician charges patients. Medicare normally pays 80 percent of the approved charge and the beneficiary pays the remaining 20 percent. The allowed charge for a nonparticipating physician is 95 percent of that for a participating physician. Non-participating physicians may bill beneficiaries for an additional amount above the allowed charge. The CMS intermediary in each state publishes these rates.

Allowable Costs – Covered expenses within a given health plan. Items or elements of an institution’s costs, which are reimbursable under a payment formula. Both Medicare and Medicaid reimburse hospitals on the basis of only certain costs. Allowable costs may exclude, for example, luxury travel or marketing. CMS publishes an extensive list of rules governing these costs and provides software for determining costs. Normally the costs which are not reasonable expenditures, which are unnecessary, which are for the efficient delivery of health services to persons covered under the program in question are not reimbursed. The most common form of cost reimbursement is the “cost report” methodology used for DRG-exempt services, such as many out-patient hospital based programs, long-term care and skilled nursing units, physical rehab, psychiatric and substance abuse inpatient programs. Some specialty hospitals receive all of their CMS reimbursement as cost based reimbursement.

All Patient Diagnosis Related Groups (APDRG) – An enhancement of the original DRGs, designed to apply to a population broader than that of Medicare beneficiaries, who are predominately older individuals. The APDRG set includes groupings for pediatric and maternity cases as well as of services for HIV-related conditions and other special cases.

All-Payer System – A system in which prices for health services and payment methods are the same, regardless of who is paying. For instance, in an all-payer system, federal or state government, a private insurer, a self-insured employer plan, an individual, or any other payer could pay the same rates. The uniform fee bars health care providers from shifting costs from one payer to another. See cost shifting.

Alternative Delivery Systems–A phrase used to describe all forms of health care delivery except traditional fee-for-service, private practice. The term includes HMOs, PPOs, IPAs, and other systems of providing health care.

Ambulatory Care–All types of health services that are provided on an outpatient basis, in contrast to services provided in the home or to persons who are hospital inpatients.

American National Standards Institute – see ANSI.

Ancillary Services (Ancillary Charges) – Supplemental services, including laboratory, radiology, physical therapy, and inhalation therapy that are provided in conjunction with medical or hospital care.

Anniversary Date – The beginning of an employer group’s benefit year. The first day of effective coverage as contained in the policy Group Application and subsequent annual anniversaries of that date. An insured has the option to transfer from an indemnity plan (which may have maximum benefit levels) to an HMO.

Anonymized Data – Previously identifiable data that have been deidentified and for which a code or other link no longer exists. A provider, third party or investigator would not be able to link anonymized information back to a specific individual.

Anonymous Data – Under HIPAA, this refers to data that were collected without identifiers and that were never linked to an individual. Coded data are not anonymous.

ANSI – The American National Standards Institute. A national organization founded to develop voluntary business standards in the United States.

Antiselection – The tendency of people who have a greater-than-average likelihood of loss to seek healthcare coverage to a greater extent than individuals who have an average or less-than-average likelihood of loss. Also known as Adverse Selection.

Antitrust – A legal term encompassing a variety of efforts on the part of government to assure that sellers do not conspire to restrain trade or fix prices for their goods or services in the market.

Any Willing Provider (or Any Willing Doctor or Hospital) – A requirement that a health plan contract for the delivery of health care services with any provider in the area who would like to provide such services to the plan’s enrollees. However, the doctor, hospital, or other health care provider must also to accept the plan’s terms and conditions related to payment and that meets other requirements for coverage.

Any Willing Provider Laws – Laws that require managed care plans to contract with all health care providers that meet their terms and conditions.

APCC – see Adjusted Per Capita Cost.

APDRG – see All Patient Diagnosis Related Groups.

APR - see Adjusted Payment Rate.

Appeal – This is a process that a patient and provider begin to demand that a payer or health plan actually pay for a service that has been denied payment. A special kind of complaint a patient or provider may make if they disagree with certain kinds of decisions made by Medicare, insurers or health plans. Patients can appeal if they request health care services, supplies or prescriptions that they think they should be able to get paid for by their health plans, or for requested payment for health care already received, or whenever Medicare or health plans denies these requests. Patients can also appeal when they are already receiving coverage and Medicare or the plan stops paying. There are specific processes your Medicare Advantage Plan, other Medicare Health Plan, Medicare drug plan, or the Original Medicare plan must use. Each insurer, HMO, or health plan has their own policies that patients must follow when they ask for appeals. Normally, appeals involve deadlines, timelines, paperwork and require tenacity.

Appeals Review Committee – The MCO committee that reviews member appeals related to medical management or coverage determinations.

Application Integrators – Software that transparently provides application-to-application functionality, primarily through data conversion and transmission, while eliminating the need for custom programming. Also referred to as application integration gateway, application interface gateway, integration engine, and intelligent gateway. This type of software is key to developing networks of information systems, making client-specific information available in real time to all members of an IHDS. Also see HIPAA.

Appropriateness – Appropriate health care is care for which the expected health benefit exceeds the expected negative consequences by a wide enough margin to justify treatment. This term is not to be confused with “usual and customary” or “approved” service. The extent to which a particular procedure, treatment, test, or service is clearly indicated, not excessive, adequate in quantity, and provided in the setting best suited to a patient’s or member’s needs. See also Medically Necessary.

Approval – A term used extensively in managed care and, to many, implies the primary process of “managing” managed care. Approval usually is used to describe treatments or procedures that have been certified by utilization review. Can also refer to the status of certain hospitals or doctors, as members of a plan. Can describe benefits or services, which will be covered under a plan. Generally, approval is either granted by the managed care organization (MCO), third party administrator (TPA) or by the primary care physician (PCP), depending on the circumstances.

Approved Charge – Limits of expenses paid by Medicare in a given area of covered service. Charges approved by payment by private health plans. Items that are likely to be reimbursed by the insurance company.

Approved Health Care Facility, Hospital or Program – A facility or program authorized to provide health services and allowed by a given health plan to provide services stipulated in contract.

ASO – see Administrative Services.

ASR – see Age/Sex Rates.

Assignment of Benefits – Method used when a claimant directs that payment be made directly to the health care provider by the health plan. In the Medicare Plan, this means a doctor or supplier agrees to accept the Medicare-approved amount as full payment. It can save patients money if their doctor accepts assignment. Patients still pay their share of the cost of the doctor’s visits.

Assisted Living – Broad range of residential care services, but does not include nursing services. Normally lower in cost than nursing homes.

At-Risk – Term used to describe a provider organization that bears the insurance risk associated with the healthcare it provides.

Attestation – The requirement that the attending physician certify, in writing, the accuracy and completion of the clinical information used for DRG assignment. See also Physician Attestation.

Audit of Provider Treatment or Charges – A qualitative or quantitative review of services rendered or proposed by a health provider. The review can be carried out in a number of ways: a comparison of patient records and claim form information, a patient questionnaire, a review of hospital and practitioner records, or a pre- or post-treatment clinical examination of a patient. Some audits may involve fee verification. Something we had better get used to being subjected to since this is usually first type or “first generation” managed care approach.

Autoassignment or Auto Assignment – A term used with Medicaid mandatory managed care enrollment plans. Medicaid recipients who do not specify their choice for a contracted plan within a specified time frame are assigned to a plan by the state.

Authorization – Any document designating any permission. In health care, authorization may refer to “authorization to disclose” private information, “authorization to treat” or “authorization to pay”, as in “pre-authorization” required by many insurance companies and health plans. In the case of pre-authorization, the managed care organization may require approval prior to the receipt of care. (Generally, this is different from a referral in that, an authorization can be a verbal or written approval from the MCO whereas a referral is generally a written document that must be received by a doctor before giving care to the beneficiary.) The HIPAA Privacy Rule requires authorization or waiver of authorization for the use or disclosure of identifiable health information for research (among other activities). The authorization must indicate if the health information used or disclosed is existing information and/or new information that will be created. The authorization form may be combined with the informed consent form, so that a patient need sign only one form. An authorization must include the following specific elements: a description of what information will be used and disclosed and for what purposes; a description of any information that will not be disclosed, if applicable; a list of who will disclose the information and to whom it will be disclosed; an expiration date for the disclosure; a statement that the authorization can be revoked; a statement that disclosed information may be redisclosed and no longer protected; a statement that if the individual does not provide an authorization, s/he may not be able to receive the intended treatment; the subject’s signature and date. See also HIPAA, Privacy and Pre-authorization.

Autoassignment – A term used with Medicaid mandatory managed care enrollment plans. Medicaid recipients who do not specify their choice for a contracted plan within a specified time frame are assigned to a plan by the state.

Auto-Enrollment – The automatic assignment of a person to a health insurance plan, typically done under Medicaid plans.

Autonomy – An ethical principle which, when applied to managed care, states that managed care organizations and their providers have a duty to respect the right of their members to make their own decisions about the course of their own lives.

Average Length of Stay (ALOS) – Refers to the average length of stay per inpatient hospital visit. Figure is typically calculated for both commercial and Medicare patient populations.

Average Wholesale Price (AWP) – Commonly used in pharmacy contracting, the AWP is generally determined through reference to a common source of information. Average cost of a non-discounted item to a pharmacy provider by wholesale providers. Drug manufacturers commonly publish suggested wholesale prices.

Avoidable Hospital Condition – Medical diagnosis for which hospitalization could have been avoided if ambulatory care had been provided in a timely and efficient manner.

Balance Billing – The practice of billing a patient for the fee amount remaining after insurer payment and co-payment have been made. Under Medicare, the excess amount cannot be more than 15 percent above the approved charge.

Base Capitation – Specified amount per person per month to cover healthcare cost, usually excluding pharmacy and administrative costs as well as optional coverages such as mental health/substance abuse services.

Base Year Costs – In Medicare, the amount a hospital actually spent to render care in a previous time period. Depending on the hospital’s Medicare cost reporting period, the base year was the fiscal year ending on or after September 30, 1982 and before September 30, 1983 for hospitals in operation at that time. Recent legislation has made dramatic changes in cost reporting opportunities for healthcare providers, limiting these reimbursements.

Bed Days – Number of inpatient hospital days per 1,000 health plan members for a specified period, usually annual.

Behavioral Health, Behavioral Healthcare – An umbrella term that includes mental health, psychiatric, marriage and family counseling, addictions treatment and substance abuse. Services are provided by a myriad of providers, including social workers, counselors, psychiatrist, psychologists, neurologists and even family practice physicians. Many states have “parity” laws that attempt to require that behavioral health insurance coverage be provided “on par” to physical health coverage.

Behavioral Offset – This is the change in the number and type of services that is projected to occur in response to a change in fees. A 50 percent behavioral offset suggests that 50 percent of the savings from fee reductions will be offset by increased volume and intensity of services.

Benchmark – A goal to be attained. These goals are chosen by comparisons with other providers, by consulting statistical reports available or are drawn from the best practices within the organization or industry. Benchmarks are used in quality improvement programs to encourage improvement of care, efficiencies or services. Benchmarks are also used for length of stay comparisons, costs, utilization review, risk management and financial analysis. The benchmarking process identifies the best performance in the industry (health care or non-health care) for a particular process or outcome, determines how that performance is achieved, and applies the lessons learned to improve performance.

Beneficiary , also called Eligible, Enrollee, or Member – The name for a person who has health care insurance through Medicare, Medicaid, health insurance or health benefits plan. Individual who is either using or eligible to use insurance benefits, including health insurance benefits, under an insurance contract. Any person eligible as either a subscriber or a dependent for a managed care service in accordance with a contract. An individual who receives benefits from or is covered by an insurance policy or other health care financing program.

Beneficiary Liability – The amount beneficiaries must pay providers for Medicare-covered services. Liabilities include copayments, deductibles, and balance billing amounts. CMS has very strict rules about health providers billing patients for their liabilities. Cost based facilities are not allowed to charge non-payment by beneficiaries to bad debt unless a clear history of collection activity is recorded.

Benefits–The payment for, or health care services provided under terms of a contract with a MCO.

Beneficence – An ethical principle which, when applied to managed care, states that each member should be treated in a manner that respects his or her own goals and values and that managed care organizations and their providers have a duty to promote the good of the members as a group.

Benefit Design – The process an MCO uses to determine which benefits or the level of benefits that will be offered to its members, the degree to which members will be expected to share the costs of such benefits, and how a member can access medical care through the health plan.

Benefit Limitations – Any provision, other than an exclusion, which restricts coverage in the Evidence of Coverage, regardless of medical necessity. Limitations are often expressed in terms of dollar amounts, length of stay, diagnosis or treatment descriptions.

Benefit Package – Aggregate services specifically defined by an insurance policy or HMO that can be provided to patients. The services a payer offers to a group or individual. The package will specify include cost, limitation on the amounts of services, and annual or lifetime spending limits.

Benefit Payment Schedule – List of amounts an insurance plan will pay for covered health care services.

Benefit Period – Normally refers to the “benefit period” that begins the day the patient goes to a hospital or skilled nursing facility (SNF). According to Medicare, the benefit period ends when the patient haven’t received any hospital care (or skilled care in a SNF) for 60 days in a row and if the patient goes into a hospital or a SNF after one benefit period has ended, a new benefit period begins. Patients are normally expected to pay the inpatient hospital deductible for each benefit period.

Benefits – Benefits are specific areas of Plan coverage’s, i.e., outpatient visits, hospitalization and so forth, that make up the range of medical services that a payer markets to its subscribers. Also, a contractual agreement, specified in an Evidence of Coverage, determining covered services provided by insurers to members.

Billed Claims – Fees submitted by a health care provider for services rendered to a covered person. Fees billed and fees paid are rarely synonymous.

Biometric Identifier – Identifying information based on a physical characteristic (e.g., a fingerprint). Confidentiality laws and HIPAA privacy rules refer to biometric identifiers.

Bioterrorism or Biological Warfare – The unlawful use, wartime use, or threatened use, of microorganisms or toxins to produce death or disease in humans. Often viewed as the preferred choice of warfare of less powerful groups of people in attempt to wage war or protect themselves from more powerful groups or nations. However, biological agents could be used by individuals or by powerful nations as well.

Blended Rating – For groups with limited recorded claim experience, a method of forecasting a group’s cost of benefits based partly on an MCO’s manual rates and partly on the group’s experience.

Block Grant – Federal funds made to a state for the delivery of a specific group of related services, such as drug abuse related services.

Board Certified (Boarded, Diplomate) – Describes a physician who has passed a written and oral examination given by a medical specialty board and who has been certified as a specialist in that area.

Board Eligible – Describes a physician who is eligible to take the specialty board examination by virtue of being graduated from an approved medical school, completing a specific type and length of training, and practicing for a specified amount of time. Some HMOs and other health facilities accept board eligibility as equivalent to board certification, significant in that many managed care companies restrict referrals to physicians without certification.

Bonus Payment – An additional amount paid by Medicare for services provided by physicians in Health Professional Shortage Areas. Currently, the bonus payment is 10 percent of Medicare’s share of allowed charges. This is not to be confused with other payments to hospitals, such as the disproportionate share payment or the settlement made to facilities at the end of a cost report year.

Bundled Payment – A single comprehensive payment for a group of related services. Bundled payments have become the norm in recent years and CMS and other payers investigate unbundled services closely. Unbundling service charges has been a common form of fraud as defined by CMS.

Business Associate – Under HIPAA rules, this term refers to an outside person/entity that performs a service on behalf of the health care provider (including a researcher) or the health care institution during which individually identifiable health information is created, used, or disclosed. For example, web hosting or data storage companies will be business associates if they receive protected health information. In addition, third parties that handle billing for a research study, or recruitment and screening, will also be business associates. Certain exceptions apply.

Broker – A salesperson who has obtained a state license to sell and service contracts of multiple health plans or insurers, and who is ordinarily considered to be an agent of the buyer, not the health plan or insurer. One who represents an insured in solicitation, negotiation, or procurement of contracts of insurance, and who may render services incidental to those functions. By law, the broker may also be an agent of the insurer for certain purposes such as delivery of the policy or collection of the premium.

Cafeteria Plan – Arrangements under which employees may choose their own benefit structure. Sometimes these are varying benefit plans or add-ons provided through the same insurer or 3rd party administrator, other times this refers to the offering of different plans or HMOs provided by different managed care or insurance companies.

Call Center – See Referral Center.

Capital Costs – Capital costs usually involve equipment and physical plant costs, not consumable supplies. Included in these costs can be interest, leases, rentals, taxes and insurance on physical assets like plant and equipment. Capital costs are usually reimbursed to cost based facilities through submission of these costs on annual cost reports to the CMS intermediaries. Depreciation schedules apply.

Capital Expenditure Review – A review of proposed capital expenditures of hospitals or providers to determine the need for, and appropriateness of, the proposed expenditures. The review is usually done by a designated regulatory agency and has a sanction attached that prevents or discourages unneeded expenditures. Often this is related to CMS or Medicare and the willingness of the federal government to provide allowances for capital costs.

Capital Cost Report – Similar to the above review but normally produced retrospectively rather than prospectively.

Capitation–A dollar amount established to cover the cost of health care services delivered for a person during a specified length of time. The term usually refers to a negotiated per capita rate to be paid periodically to a health care provider by a MCO. The provider is then responsible for delivering or arranging the delivery of all health services required by the covered person under the conditions of the provider contract. This term may also refer to the amount paid to a MCO > by HCFA or a State.

Capped Fee – See Fee Schedule.

Captive Agents – Agents that represent only one health plan or insurer.

Carrier – An insurer; an underwriter of risk that finances health care. Also refers to any organization, which underwrites or administers life, health or other insurance programs. When an employer has a “self-insured” plan, the carrier (such as Aetna or Blue Cross) may not serve as carrier in this case, but may serve only as “third party administrator”.

Carve-In – A generic term that refers to any of a continuum of joint efforts between clinicians and service providers; also used specifically to refer to health care delivery and financing arrangements in which all covered benefits (e.g., behavioral and general health care) are administered and funded by an integrated system.

Carve Out–One or more services excluded from those required to be provided under the capitation rates. These services may be paid on a fee-for-service or other basis.

Case Management–A process and technique to manage the care of specific health care needs (often multiple) in a way that is designed to achieve the optimum patient outcome in the most cost-effective manner.

Case Manager–A nurse, doctor, or social worker who works with patients, providers and insurers to coordinate all services deemed necessary to provide the patient with a plan of medically necessary and appropriate health care.

Case Mix – The mix of patients treated within a particular institutional setting, such as the hospital. Patient classification systems like DRGs can be used to measure hospital case mix. Measurement reflecting servicing needs, uses of hospital capabilities, and the general rate of hospital admissions. The types of inpatients a hospital or post acute facility treats. The more complex the patients’ needs, the greater the amount spent for patient care. Case mix is generally established by estimating the relative frequency of various types of patients seen by the provider in question during a given time period and may be measured by factors such as diagnosis, severity of illness, utilization of services, and provider characteristics. See also DRG.

Case-Mix Adjustment – See Risk Adjustment.

Case-Mix Index (CMI) – The average DRG weight for all cases paid under PPS. The CMI is a measure of the relative costliness of the patients treated in each hospital or group of hospitals. A measure of the relative costliness of treating in an inpatient setting. An index of 1.05 means that the facility’s patients are 5 % more costly than average. See also DRG.

Case Rate – Flat fee paid for a client’s treatment based on their diagnosis and/or presenting problem. For this fee the provider covers all of the services the client requires for a specific period of time. Also bundled rate, or Flat Fee-Per-Case. Very often used as an intervening step prior to capitation. In this model, the provider is accepting some significant risk, but does have considerable flexibility in how it meets the client’s needs. Keys to success in this mode: (1) properly pricing case rate, if provider has control over it, and (2) securing a large volume of eligible clients.

Case Severity – A measure of intensity or gravity of a given condition or diagnosis for a patient. May have direct correlation with the amount of service provided and the associated costs or payments allowed.

Catastrophic Coverage for Drugs – A specific term used in the Medicare Part D plans that refers to the event of a beneficiary’s total drug costs reaching a certain maximum (in 2006 that maximum was $5451.25, for example), after which the beneficiary pays a small coinsurance (like 5%) or a small co-payment for covered drug costs until the end of that calendar year.

Catastrophic Health Insurance – Policy that provides protection primarily against the higher costs of treating severe or lengthy illnesses or disabilities. Normally these are “add on” benefits that begin coverage once the primary insurance policy reaches its maximum.

Categorically Needy – Medicaid eligibility based on defined indicators of financial need by families with children and pregnant women, and to persons who are aged, blind, or disabled. Persons not falling into these categories cannot qualify, no matter how low their income. The Medicaid statute defines over 50 distinct population groups as potentially eligible, including those for which coverage is mandatory in all states and those that may be covered at a state’s option. The scope of covered services that states must provide to the categorically needy is much broader than the minimum scope of services for other groups receiving Medicaid benefits.

Catastrophic Health Insurance – Health insurance, which provides protection against the high cost of treating severe or lengthy illnesses or disability. Generally such policies cover all, or a specified percentage of, medical expenses above an amount that is the responsibility of another insurance policy up to a maximum limit of liability.

CCA - See Cost Consequence Analysis.

CCN – See Community Care Network.

CCP – See Coordinated Care Plan.

CDT - see Current Dental Terminology.

Centers for Medicare and Medicaid Services (CMS) – The Centers for Medicare & Medicaid Services (CMS) is a Federal agency within the U.S. Department of Health and Human Services. Programs for which CMS is responsible include Medicare, Medicaid, State Children’s Health Insurance Program (SCHIP), HIPAA and CLIA. Formerly was HCFA. Centers for Medicare & Medicaid Services has historically maintained the UB-92 institutional EMC format specifications, the professional EMC NSF specifications, and specifications for various certifications and authorizations used by the Medicare and Medicaid programs. CMS is responsible for oversight of HIPAA administrative simplification transaction and code sets, health identifiers, and security standards. CMS also maintains the HCPCS medical code set and the Medicare Remittance Advice Remark Codes administrative code set.

Certificate of Authority (COA) – Issued by state governments, it gives a health maintenance organization or insurance company its license to operate within the state.

Certificate of Coverage (COC) – Outlines the terms of coverage and benefits available in a carrier’s health plan.

Certificate of Creditable Coverage – A written certificate issued by a group health plan or health insurance issuer (including an HMO) that states the period of time that the beneficiary was covered by that health plan. These certificates are often required by plans prior to waiving or reducing the preexisting clauses in new coverages. Also see Pre-Existing.

Certificate of Need (CON) – In some states, a state agency must review and approve certain proposed capital expenditures, changes in health services provided, and purchases of expensive medical equipment. Before the request goes to the state, a local review panel (the health systems agency or HSA) must evaluate the proposal and make a recommendation. CON is intended to control expansion of facilities and services by preventing excessive or duplicative development of facilities and services. Many states have sunsetted or eliminated their CON processes and requirements.

Certified Health Plan – A managed health care plan, certified by the Health Services Commission and the Office of the Insurance Commissioner to provide coverage for the Uniform Benefits Package to state residents. Regulations vary by state since some states require only HMOs to certify but not PPOs, IPAs or MSOs. Increasingly these regs are becoming more consistent state by state.

CF - See Conversion Factor.

Chain of Trust Agreement – Referred to in HIPAA rules, this is a contract needed to extend the responsibility to protect health care data across a series of sub-contractual relationships.

CHAMPUS – Civilian Health and Medical Program of the Uniformed Services, a federally managed health benefit plan. Also see TRICARE.

Charges – These are the published prices of services provided by a facility. CMS requires hospitals to apply the same schedule of charges to all patients, regardless of the expected sources or amount of payment. Controversy exists today because of the often wide disparity between published prices and contract prices. The majority of payers, including Medicare and Medicaid, are becoming managed by health plans that negotiate rates lower than published prices. Often these negotiated rates average 40% to 60% of the published rates and may be all-inclusive bundled rates.

CHC - See Community Health Center.

CHIN - See Community Health Information Network.

Chronic Care or Chronic Case – Long term care of individuals with long standing, persistent diseases or conditions. It includes care specific to the problem as well as other measures to encourage self-care, to promote health, and to prevent loss of function.

Churning – The practice of a provider seeing a patient more often than is medically necessary, primarily to increase revenue through an increased number of services. Churning may also apply to any performance-based reimbursement system where there is a heavy emphasis on productivity (in other words, rewarding a provider for seeing a high volume of patients whether through fee-for-service or through an appraisal system that pays a bonus for productivity).

Claim – A request by an individual (or his or her provider) to that individual’s insurance company to pay for services obtained from a health care professional. An itemized statement of healthcare services and their costs provided by a hospital, physician’s office, or other provider facility. Claims are submitted to the insurer or managed care plan by either the plan member or the provider for payment of the costs incurred.

Claimant – The person or entity submitting a claim.

Claim Form – An application for payment of benefits under a health plan.

Claims Administration -  The process of receiving, reviewing, adjudicating, and processing claims.

Claims Examiners – Employees in the claims administration department who consider all the information pertinent to a claim and make decisions about the MCO’s payment of the claim. Also known as claims analysts.

Claims Investigation – The process of obtaining all the information necessary to determine the appropriate amount to pay on a given claim.

Claims Review – The method by which an enrollee’s health care service claims are reviewed prior to reimbursement. The purpose is to validate the medical necessity of the provided services and to be sure the cost of the service is not excessive.

Claim Status Codes – A national administrative code set that identifies the status of health care claims. This code set is used in the X12N 277 Claim Status Inquiry and Response transaction, and is maintained by the Health Care Code Maintenance Committee.

Class Rating - See Community Rating by Class.

CLIA – See Clinical Laboratory Improvement Amendments

Clinical Data Repository – That component of a computer-based patient record (CPR) which accepts, files, and stores clinical data over time from a variety of supplemental treatment and intervention systems for such purposes as practice guidelines, outcomes management, and clinical research. May also be called a data warehouse.

Clinical Decision Support – The capability of a data system to provide key data to physicians and other clinicians in response to “flags” or triggers which are functions of embedded, provider-created rules. A system that would alert case managers that a client’s eligibility for a certain service is about to be exhausted would be one example of this type of capacity. Also a key functional requirement to support clinical or critical pathways.

Clinical Laboratory Improvement Amendments (CLIA) – CMS regulates all laboratory testing (except research) performed on humans in the U.S. through the Clinical Laboratory Improvement Amendments (CLIA). In total CLIA covers approximately 175,000 laboratory entities. The Division of Laboratory Services, within the Survey and Certification Group, under the Center for Medicaid and State Operations has the responsibility for implementing the CLIA Program. The objective of the CLIA program is to ensure quality laboratory testing. Although all clinical laboratories must be properly certified to receive Medicare or Medicaid payments, CLIA has no direct Medicare or Medicaid program responsibilities.

Clinical or Critical Pathways – A “map” of preferred treatment/intervention activities. Outlines the types of information needed to make decisions, the timelines for applying that information, and what action needs to be taken by whom. Provides a way to monitor care “in real time.” These pathways are developed by clinicians for specific diseases or events. Proactive providers are working now to develop these pathways for the majority of their interventions and developing the software capacity to distribute and store this information.

Clinical Practice Guidelines or Management – A utilization and quality management mechanism designed to aid providers in making decisions about the most appropriate course of treatment for a specific clinical case. The development and implementation of parameters for the delivery of health-care services to plan members.

Clinic Model - See Consolidated Medical Group.

Clinic Without Walls (CWW) – Similar to an independent practice association and identical to a practice without walls (PWW). Practitioners form CWWs and PWWs when they want the economies of scale and bargaining power offered by centralizing some administrative functions, but still choosing to practice separately. Many of these were formed to allow practitioners the ability to effectively contract with managed care. See Group Practice Without Walls

Closed Access–A managed health care arrangement in which covered persons are required to select providers only from the plan’s participating providers.

CMA - See Cost Minimization Analysis.

CMI – See Case-Mix Index.

CMP - See Competitive Medical Plan.

CMS (formerly HCFA) – See Centers for Medicare and Medicaid Services.

CMS-1450 - The uniform institutional claim form. See Centers for Medicare and Medicaid Services.

CMS-1500 – The uniform professional claim form. See Centers for Medicare and Medicaid Services.

CMS Hearing Officer - An individual designated by CMS to conduct the appeals process for a claim dispute.

COA - See Certificate of Authority.

COB – See Coordination of Benefits.

COBRA – See Consolidated Omnibus Budget Reconciliation Act.

COC - See Certificate of Coverage.

Coded Data – Data are separated from personal identifiers through use of a code. As long as a link exists, data are considered indirectly identifiable and not anonymous or anonymized. Coded data are not covered by the HIPAA Privacy Rule, but are protected under the Common Rule.

Code Set – Under HIPAA, this is any set of codes used to encode data elements, such as tables of terms, medical concepts, medical diagnostic codes, or medical procedure codes. This includes both the codes and their descriptions.

Coding – A mechanism for identifying and defining physicians’ and hospitals’ services. Coding provides universal definition and recognition of diagnoses, procedures and level of care. Coders usually work in medical records departments and coding is a function of billing. Medicare fraud investigators look closely at the medical record documentation, which supports codes and looks for consistency. Lack of consistency of documentation can earmark a record as “upcoded” which is considered fraud. A national certification exists for coding professionals and many compliance programs are raising standards of quality for their coding procedures.

COI - see Cost of Illness Analysis.

Co-Insurance (Coinsurance) – A cost-sharing requirement under a health insurance policy that provides that the insured will assume a portion or percentage of the costs of covered services. Health care cost which the covered person is responsible for paying, according to a fixed percentage or amount. A policy provision frequently found in major medical insurance policies under which the insured individual and the insurer share hospital and medical expenses according to a specified ratio. A type of cost sharing where the insured party and insurer share payment of the approved charge for covered services in a specified ratio after payment of the deductible. Under Medicare Part B, the beneficiary pays coinsurance of 20 percent of allowed charges. In a Medicare Prescription Drug Plan, the coinsurance will vary. Many HMOs provide 100% insurance (no coinsurance) for preventive care or routing care provided “in network”.

Common Rule – Under HIPAA, it outlines the necessity of obtaining informed consent from patients.

Community Care Network (CCN) – This vehicle provides coordinated, organized, and comprehensive care to a community’s population. Hospitals, primary care physicians, and specialists link preventive and treatment services through contractual and financial arrangements, producing a network that provides coordinated care with continuous monitoring of quality and accountability to the public. While the term, Community Care Network (CCN), often is used interchangeably with Integrated Delivery System (IDS), the CCN tends to be community based and non-profit.

Community Health Center (CHC) – An ambulatory health care program (defined under section 330 of the Public Health Service Act) usually serving a catchment area which has scarce or nonexistent health services or a population with special health needs; sometimes known as the neighborhood health center. Community Health Centers attempt to coordinate federal, state and local resources into a single organization capable of delivering both health and related social services to a defined population. While such a center may not directly provide all types of health care, it usually takes responsibility to arrange all medical services needed by its patient population.

Community Health Information Network (CHIN) – An integrated collection of computer and telecommunication capabilities that permit multiple providers, payers, employers, and related healthcare entities within a geographic area to share and communicate client, clinical, and payment information. Also known as community health management information system.

Community Rating – Setting insurance rates based on the average cost of providing health services to all people in a geographic area, without adjusting for each individual’s medical history or likelihood of using medical services. A method of calculating health plan premiums using the average cost of actual or anticipated health services for all subscribers within a specific geographic area. Under the HMO Act, community rating is defined as a system of fixing rates of payment for health services which may be determined on a per person or per family basis and may vary with the number of persons in a family, but must be equivalent for all individuals and for all families of similar composition. With community rating, premiums do not vary for different groups of subscribers or with such variables as the group’s claims experience, age, sex or health status. Although there are certain exceptions, in general, federally-qualified HMOs must community rate. The intent of community rating is to spread the cost of illness evenly over all subscribers rather than charging the sick more than the healthy for coverage.

Community Rating by Class (CRC); Class Rating – For federally qualified HMOs, the Community Rating by Class (CRC) is adjustment of community-rated premiums on the basis of such factors as age, sex, family size, marital status, and industry classification. These health plan premiums reflect the experience of all enrollees of a given class within a specific geographic area, rather than the experience of any one employer group.

Comorbid Condition – A medical condition that, along with the principal diagnosis, exists at admission and is expected to increase hospital length of stay by at least one day for most patients.

Competitive Bidding – Can be viewed by some as a pricing method that elicits information on costs through a bidding process to establish payment rates that reflect the costs of an efficient health plan or health care provider. Competitive bidding is also the process of offering reduced rates to health plans to obtain exclusive contracts from payers.

Complaint -  A health plan member’s expression that his expectations regarding the product or the services associated with the product have not been met. Also see Grievance and Appeal.

Compliance – Accurately following the government’s rules on Medicare billing system requirements and other federal or state regulations. A compliance program is a self-monitoring system of checks and balances to ensure that an organization consistently complies with applicable laws relating to its business activities. (See also Fraud, FBI, OIG, and DOJ)

Compliance Date – This is specified date by which health plans and providers are to be in compliance with rules. Under HIPAA, this is the date by which a covered entity must comply with a standard, an implementation specification, or a modification. This is usually 24 months after the effective data of the associated final rule for most entities, but 36 months after the effective data for small health plans. For future changes in the standards, the compliance date would be at least 180 days after the effective data, but can be longer for small health plans and for complex changes.

Complication – A medical condition that arises during a course of treatment and is expected to increase the length of stay by at least one day for most patients.

Composite Rate – Group rate billed to all subscribers of a given group.

Comprehensive Major Medical Insurance – A policy designed to provide the protection offered by both a basic and major medical health insurance policy. It is generally characterized by a low deductible, a co-insurance feature, and high maximum benefits.

Comprehensive Outpatient Rehabilitation Facility (CORF) – A facility that mainly provides rehabilitation services after an illness or injury, and provides a variety of services including physician’s services, physical therapy, social or psychological services, and outpatient rehabilitation.

Computer-Based Patient Record (CPR) – A term for the process of replacing the traditional paper-based chart through automated electronic means; generally includes the collection of patient-specific information from various supplemental treatment systems, i.e., a day program and a personal care provider; its display in graphical format; and its storage for individual and aggregate purposes. Also called “digital medical record”. See also Electronic Medical Record.

CON - See Certificate of Need.

Concurrent Review – Review of a procedure or hospital admission done by a health care professional (usually a nurse) other than the one providing the care, during the same time frame that the care is provided. Usually conducted during a hospital confinement to determine the appropriateness of hospital confinement and the medical necessity for continued stay. See also Utilization Review, Medical Necessity, Appropriate and Continued Stay Review.

Confidentiality – The protection of individually identifiable information as required by state or federal law or by policy of the healthcare provider.

Consent – See Authorization, and also see Informed Consent.

Consolidated Medical Group – A large single medical practice that operates in one or a few facilities rather than in many independent offices. The single-specialty or multi-specialty practice group may be formed from previously independent practices and is often owned by a parent company or a hospital. Also known as a Medical Group Practice or Clinic Model.

Consolidated Omnibus Budget Reconciliation Act (COBRA) – Federal law that continues health care benefits for employees whose employment has been terminated. Employers are required to notify employees of these benefit continuation options, and, failure to do so can result in penalties and fines for the employer. An act that allows workers and their families to continue their employer-sponsored health insurance for a certain amount of time after terminating employment. COBRA imposes different restrictions on individuals who leave their jobs voluntarily versus involuntarily (Department of Labor, 2002).

Consumer Health Alliance – Regional cooperatives between government and the public that will oversee the new payment system. Once all health insurance purchasing cooperatives (HIPPC’s), the alliance would make sure health plans within a region conformed to federal coverage and quality standards, and oversee costs within any mandated budget.

Continued Stay Review – A review conducted by an internal or external auditor to determine if the current place of service is still the most appropriate to provide the level of care required by the client.

Continuous Quality Improvement (CQI) – An approach to health care quality management borrowed from the manufacturing sector. It builds on traditional quality assurance methods by putting in place a management structure that continuously gathers and assesses data that are then used to improve performance and design more efficient systems of care. Also known as quality improvement (QA) and total quality management (TQM). See Quality Improvement.

Contract – A legal agreement between a payer and a subscribing group or individual which specifies rates, performance covenants, the relationship among the parties, schedule of benefits and other pertinent conditions. The contract usually is limited to a 12-month period and is subject to renewal thereafter. Contracts are not required by statute or regulation, and less formal agreements may be made.

Contract Year – A period of twelve (12) consecutive months, commencing with each Anniversary Date. May or may not coincide with a calendar year.

Contract Provider – Any hospital, physician, skilled nursing facility, extended care facility, individual, organization, or agency licensed that has a contractual arrangement with an insurer for the provision of services under an insurance contract.

Contributory Program – Program where the employee and the employer or the union shares the cost of group coverage.

Conversion – In group health insurance, the opportunity given the insured and any covered dependents to change his or her group insurance to some form of individual insurance, without medical evaluation upon termination of his group insurance

Conversion Factor (CF) – The dollar amount used to multiply the Relative Value Schedule (RVS) of a procedure to arrive at the maximum allowable for that procedure.

Conversion Factor Update – Annual percentage change to a conversion factor, either set annually by the government or by the formula reflecting actual expenditure growth from two years falling below or above the original target rate. See Conversion Factor, Sustainable Growth Rate, Sustainable Growth Rate System.

Conversion Privilege – The right of an individual insured under a group policy to certain kinds of individual coverage, without a medical examination, upon termination of his association with the group.

Coordinated Care Plans (CCPs) – The Medicare+Choice delivery option that includes HMOs (with or without a point-of-service component), preferred provider organizations (PPOs), and provider-sponsored organizations (PSOs).

Coordination of Benefits (COB) - Process for determining the respective responsibilities of two or more health plans that have some financial responsibility for a medical claim. A coordination of benefits, or “non-duplication,” clause in either policy prevents double payment by making one insurer the primary payer, and assuring that not more than 100 percent of the cost is covered. Standard rules determine which of two or more plans, each having COB provisions, pays its benefits in full and which becomes the supplementary payer on a claim. Provision regulating payments to eliminate duplicate coverage when a claimant is covered by multiple group plans. The procedures set forth in a Subscription Agreement to determine which coverage is primary for payment of benefits to Members with duplicate coverage. Also called Cross-Over.

Coordination of Care – This term is often used as a synonym for managed care. To some, coordinated care sounds less intrusive or directive than managed care, although in practice, the policies are the same.

Competitive Medical Plan (CMP)–A status, established by TEFRA and granted by the Federal government, to an organization that meets specific requirements enabling that organization to obtain a Medicare risk or cost based contract.

CORF - See Comprehensive Outpatient Rehabilitation Facility.

Corporate Compliance Committee – The hospital or MCO committee that monitors and guides all compliance activities, including appointment of a corporate compliance officer, approval of compliance program policies and procedures, review of the organization’s annual compliance plan, evaluation of internal and external audits to identify potential risks, and implementation of corrective and preventive actions.

Corporate Compliance Director – An executive level health plan manager who is responsible for overseeing the plan’s compliance with state and federal laws.

Cost-Benefit Analysis (or Evaluation) – An analytic method in which a program’s cost is compared to the program’s benefits for a period of time, expressed in dollars, as an aid in determining the best investment of resources. For example, the cost of establishing an immunization service might be compared with the total cost of medical care and lost productivity that will be eliminated as a result of more persons being immunized. Cost-benefit analysis can also be applied to specific medical tests and treatments.

Cost Consequence Analysis (CCA) – A form of analysis that compares alternative interventions or programs in which the components of incremental costs and consequences are listed without aggregation.

Cost Containment – Control of inefficiencies in the consumption, allocation, or production of health care services that contribute to higher than necessary costs. Inefficiencies are thought to exist in consumption when health services are inappropriately utilized; inefficiencies in allocation exist when health services could be delivered in less costly settings without loss of quality; and, inefficiencies in production exist when the costs of producing health services could be reduced by using a different combination of resources. Cost containment is a word used freely in healthcare to describe most cost reduction activities by providers.

Copayment–A cost-sharing arrangement in which a member pays a specified charge for a specified service (e.g., $10 for an office visit). The member is usually responsible for payment at the time the service is rendered.

Cost Contract–A TEFRA contract payment methodology option by which HCFA pays for the delivery of health services to members based on the HMO’s reasonable cost. The plan receives an interim amount derived from an estimated annual budget, which may be periodically adjusted during the course of the contract to reflect actual cost experience. The plan’s expenses are audited at the end of the contract to determine the final rate the plan should have been paid.

Cost Sharing–A general set of financing arrangements in which a covered member must pay a portion of the costs associated with receiving care. (See also copayment, coinsurance and deductible).

Deductible–A specified amount of money a member must pay before insurance benefits begin. Usually expressed in terms of an “annual” amount.

Diagnosis Related Groups (DRG)–A system of classification for inpatient hospital services based on diagnosis, age, sex, and the presence of complications. It is used as a means of identifying costs for providing services associated with a diagnosis and as a mechanism to reimburse hospital and selected other providers for services rendered.

Employer Mandate–Under the Federal HMO Act, describes conditions when federally qualified HMOs can mandate or require an employer to offer at least one federally qualified HMO plan of each type (IPA/network or group/staff). (Sunsetted in 1995).

EQRO (External Quality Review Organization)–States are required to contract with an entity that is external to and independent of the State and its HMO and HIO contractors to perform an annual review of the quality of services furnished by each HMO or HIO contractor.

Exclusive Provider Organization (EPO)–A term derived from the phrase preferred provider organization (PPO). However, where a PPO generally extends coverage for non-preferred provider services as well as preferred provider services, an EPO provides coverage only for contracted providers; hence, the term exclusive. Technically, many HMOs can also be describedEPOs.

Experience Rating–The process of setting rates partially or in whole on evaluating previous claims experience for a specific group or pool of groups.

Federal Medicaid Managed Care Waiver Program–The process used by States to receive permission to implement managed care programs for their Medicaid or other categorically eligible beneficiaries.

Federal Qualification–A status defined by the HMO Act, conferred by HCFA after conducting an extensive evaluation of the HMO’s organization and operations. An organization must be federally qualified or be designated as a CMP (competitive medical plan) to be eligible to participate in Medicare cost and risk contracts. Likewise, an HMO must be federally qualified or State plan defined to participate in the Medicaid managed care program.

Fee-For-Service (FFS)–A payment system by which doctors, hospitals and other providers are paid a specific amount for each service performed as identified by a claim for payment.

Fiscal Soundness–The requirement that managed care organizations have sufficient operating funds, on hand or available in reserve, to cover all expenses associated with services for which they have assumed financial risk.

Gatekeeper–An arrangement in which a primary care provider serves as the patient’s agent, arranges for and coordinates appropriate medical care and other necessary and appropriate referrals.

Group or Network HMO–An HMO that contracts with one or more independent group practice to provide services to its members in one or more locations.

Guaranteed Eligibility–A defined period of time (3-6 months) that all patients enrolled in prepaid health programs are considered eligible for Medicaid, regardless of their actual eligibility for Medicaid. A State may apply to HCFA for a waiver to incorporate this into their contracts.

Health Maintenance Organization (HMO)–An entity that provides, offers or arranges for coverage of designated health services needed by members for a fixed, prepaid premium. There are three basic models of HMOs: group model, individual practice association (IPA), and staff model.

HEDIS–The Health Plan Employer Data and Information Set is a set of performance measures developed to support health plan and Medicaid agency efforts to improve the health status of Medicaid beneficiaries, support the strengthening of health care delivery systems for the Medicaid population, promote standardization of managed care reporting across public and private sectors, and promote the application of performance measurement technology across Medicaid programs.

HIO–An entity that contracts on a prepaid, capitated risk basis to provide comprehensive health services to recipients.

Individual Practice Association (IPA) model HMO–An HMO that contracts with individual practitioners or an association of individual practices to provide health care services in return for a negotiated fee. The individual practice association, in turn, compensates its physicians on a per capita, fee schedule, or other agreed basis.

Insolvency–A legal determination occurring when a managed care plan no longer has the financial reserves or other arrangements to meet its contractual obligations to patients and subcontractors.

Licensing–A process most States employ, which involves the review and approval of applications from HMOs prior to beginning operation in certain areas of the State. Areas examined by the licensing authority include: fiscal soundness, network capacity, MIS, and quality assurance. The applicant must demonstrate it can meet all existing statutory and regulatory requirements prior to beginning operations.

Lock-in–A contractual provision by which members except in cases of urgent or emergency need, are required to receive all their care from the network health care providers.

Managed Care–A system of health care that combines delivery and payment; and influences utilization of services, by employing management techniques designed to promote the delivery of cost-effective health care.

Managed Health Care Plan–An arrangement that integrates financing and management with the delivery of health care services to an enrolled population. It employs or contracts with an organized system of providers which delivers services and frequently shares financial risk.

Medicare Supplement Policy–A health insurance policy that pays certain cost not covered by Medicare such as coinsurance, deductibles.

Network Model HMO–A health care model in which the HMO contracts with more that one physician group or IPA, and may contract with single and multi-specialty groups that work out of their own office facility. The network may or may not provide care exclusively for the HMO’s members.

Open Access–A term describing a member’s ability to self-refer for specialty care. Open access arrangements allow a member to see a participating provider without a referral from another doctor. Also called open panel.

Open Enrollment Period–A period during which subscribers in a health benefit program have an opportunity to select among health plans being offered to them, usually without evidence of insurability or waiting periods.

Outcome measurement–A process of systematically measuring individual or collective clinicaltreatment and response to that treatment.

Out-of -pocket expenses–Costs borne by the member that are not covered by health care plan.

PCCM–A Primary Care Case Management program is a Freedom of Choice Waiver program, under the authority of section 1915(b) of the Social Security Act. States contract directly with primary care providers who agree to be responsible for the provision and/or coordination of medical services to Medicaid recipients under their care. Currently, most PCCM programs pay the primary care physician a monthly case management fee in addition to receiving fee-for-services payment.

Peer Review–The evaluation of the quality of the total health care provided by Plan medical staff by equivalently trained medical personnel.

Peer Review Organization (PRO)–An organization established by the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) to review quality of care and appropriateness of admissions, readmissions and discharges for Medicare and Medicaid.

PHP–A Prepaid Health Plan is a entity that either contracts on a prepaid, capitated risk basis to provide services that are not risk-comprehensive services, or contracts on a non-risk basis. Additionally, some entities that meet the above definition of HMOs are treated as PHPs through special statutory exemptions.

Point-Of-Service Plan–A health services delivery organization that offers the option to its members to choose to receive a service from participating or a nonparticipating provider. Generally the level of coverage is reduced for services associated with the use of non-participating providers.

Preferred Providers–Physicians, hospitals, and other health care providers who contract to provide health services to persons covered by a particular health plan.

Preferred Provider Organization–A health care delivery system that contracts with providers of medical care to provide services at discounted fees to members. Members may seek care form non-participating providers but generally are financially penalized for doing so by the loss of the discount and subjection to copayments and deductibles.

Premium –Money paid out in advance for insurance coverage.

Prepayment–A method of paying for the cost of health care services in advance of their use.

Preventive health care–Health care that seeks to prevent or foster early detection of disease and morbidity and focuses on keeping patients well in addition to health them while they are sick.

Primary Care Network (PCN)–A group of primary care physicians who share the risk of providing care to members of a given health plan.

Primary Care Provider (PCP)–The provider that serves as the initial interface between the member and the medical care system. The PCP is usually a physician, selected by the member upon enrollment, who is trained in one of the primary care specialties who treats and is responsible for coordinating the treatment of members assigned to his/her plan. (See Gatekeeper)

Professional Review Organization–An organization which reviews the services provided to patients in terms of medical necessity professional standards; and appropriateness of setting.

QARI –The Quality Assurance Reform Initiative was unveiled in 19993 to assist States in the development of continuous quality improvement systems, external quality assurance programs, internal quality assurance programs, and focused clinical studies.

Qualified Medicare Beneficiary (QMB)–A person whose income level is such that the state pays the Medicare Part B Premiums, deductibles and copayments.

Quality Assurance–A formal methodology and set of activities designed to access the quality of services provided. Quality assurance includes formal review of care, problem identification, corrective actions to remedy any deficiencies and evaluation of actions taken.

Reinsurance–An insurance arrangement whereby the MCO or provider is reimbursed by a third party for costs exceeding a pre-set limit, usually an annual maximum.

Risk Adjustment–A system of adjusting rates paid to managed care providers to account for the differences in beneficiary demographics, such as age, gender, race, ethnicity. Medical condition, geographic location, at-risk population (i.e. homeless), etc.

Risk Contract–A contract payment methodology between HCFA and an HMO or CMP that requires the delivery of (at least) all covered services to members as medically necessary in return for a fixed monthly payment rate from the government and (often) a premium paid by the enrollee. The HMO is then liable for those contractually offered services without regard to cost. (Note: Medicaid beneficiaries enrolled in risk contracts are not required to pay premiums.)

Shared Savings–A provision of most prepaid health care plans where at least part of the providers’ income is directly linked to the financial performance of the plan. If costs are lower than projections, a percentage of these savings are referred to the providers.

Staff Model HMO–This model employs physicians to provide health care to its members. All premiums and other revenues accrue to the HMO, which compensates physicians by salary.

Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA)–The Federal law that created the current risk and cost contract provisions under which health plans contract with HCFA.

Utilization Management–The process of evaluating the necessity, appropriateness and efficiency of health care services against established guidelines and criteria.

Utilization Review (UR)–A formal review of utilization for appropriateness of health care services delivered to a member on a prospective, concurrent or retrospective basis.

More Terminology Available:

Pohly’s Net Guide

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Optical Glossary

Written by Cathy on October 30, 2008 – 12:49 pm -

20/20 -the expression for normal eyesight (or 6/6 in countries where metric measurements are used). This notation is expressed as a fraction. The numerator (1st number) refers to the distance you were from the test chart, which is usually 20 feet (6 meters). The denominator (2nd number) denotes the distance at which a person with normal eyesight could read the line with the smallest letters that you could correctly read. For example, if your visual acuity is 20/100 that means that the line you correctly read at 20 feet could be read by a person with normal vision at 100 feet. The Snellen chart, which consists of letters, numbers, or symbols, is used to test visual acuity (sharpness of eyesight). A refraction test is used to determine the amount of correction needed for a prescription when treating refractive error such as astigmatism, myopia, or hyperopia. See “Refraction Test”.

Abbe Value: Is a measurement to the degree of which light is dispersed with an existing lens. The average range of an ophthalmic lense is between 30 to 60. The higher the abbe value the less chromatic aberration will be found in the lens, adversely the lower the abbe value there is a greater dispersion of light causing more chromatic aberration when viewing through the periphery of the lens.

ABOC Certification Certification is professional distinction — official and public recognition of your achievement that you have met a national set of standards as a qualified and competent optician or contact lens technician. Certification is official assurance to the public that you will handle their eye wear needs competently and carefully; certification is recognized by employers as a standard of competence.

AC/A Ratio- accommodative convergence / accommodative (measured in prism diopters/diopters). The convergence response of an individual (amount the eyes turn inward) in relation to the amount of stimulus of accommodation (eye focusing). The normal ratio is 4:1.

Accommodation- (eye focusing) the eye’s ability to adjust its focus by the action of the ciliary muscle, which increases the lens focusing power. When this accommodation skill is working properly, the eye can focus and refocus quickly and effortlessly, which is similar to an automatic focus feature on a camera. The ciliary muscles must contract to adjust for near vision, which causes the eye’s crystalline lens, which is flexible, to be squashed. For distant vision, the ciliary muscle must relax and the eye’s crystalline lens is stretched out.  The ability of the eye to accommodate does decrease with age due to the crystalline lens becoming less flexible causing a condition called presbyopia. (See “Presbyopia”).

Accommodative Fatigue- This clinical condition is also called Ill-Sustained Accommodation. It is the inability of the eye to adequately sustain sufficient focusing over an extended time period. The most common sign or symptom is blurred vision after prolonged near work such as reading and using a computer. In addition, such patients often have asthenopia (eyestrain), general fatigue, headaches and nausea, excess tearing, and an unusual sensitivity to light. Clinical signs include: normal amplitude of accommodation, decreased PRA, and the patient generally fails the +/-2.00 D flipper test. Plus lenses (glasses or contacts) and vision therapy are effective in treating this condition.

Accommodative Esotropia- (clinical condition) when an individual is focusing on a near object and his or her eyes are turning inward too much. It is caused by either uncorrected hyperopic refractive error and/or a high accommodative convergence/accommodation (AC/A) ratio. The average age of onset is 2 1/2 years. It is most noticeable when the child is tired or sick. This is treated with plus lenses (glasses or contacts) to help straighten the eyes. In some cases, vision therapy and corrective lenses are prescribed. (Please note that Accommodative Esophoria is a condition similar to accommodative esotropia but lesser in extent.)

Accommodative Excess (AE)-  This clinical condition is also called accommodative spasm. It is an over focusing, over stimulation of the focusing action of the crystalline lens causing an inability to relax the focusing system which may result in blurry vision when focusing at distance objects. Other symptoms include holding near work closer than normal, headaches with near work (such as reading or using a computer), eyestrain associated with near work, and possible double vision. Clinical signs include: patient accepts more minus on accommodative rock but blurs with plus lenses, lower NRA than PRA, dynamic retinoscopy findings indication of over accommodation and/or slow relaxation of accommodation, and reduced or erratic distance visual acuity. Treatment includes a low plus lens and/or vision therapy.

Accommodative Infacility- a clinical condition in which the individual has difficulty changing eye focus from distance to near. Symptoms include eyestrain associated with near work (such as reading or using a computer), periodic blurring of distance vision especially following sustained near visual work, tendency to hold near work closer than expected, headaches with near work, and possible double vision. Clinical signs include: patient will have difficulty with both the plus and the minus lens (fails +/- 2.00 D flipper test), low PRA and NRA, and poor recoveries on Bell Retinoscopy. Vision therapy is an effective treatment option.

Accommodative Insufficiency (AI)- This clinical condition is also called non-presbyopic accommodative insufficiency. It is an under focusing, a lack of focusing ability at a near distance. Symptoms include eyestrain, blurred vision, occasional or constant when doing near work (such as reading or using a computer), occasional unusual sensitivity to light, excess tearing, headaches, and general fatigue. Clinical signs include: patient will have difficulty with a minus lens, low amplitude of accommodation, low PRA and higher NRA.Vision therapy is an effective treatment option.

Accommodative Vergence- a convergence response (to turn the eyes inward) which occurs as a direct result of accommodation (eye focusing). (See “Vergence”)

Acuity- clearness of eyesight. Depends on the sharpness of images and the sensitivity of nerve elements in the retina. (See “Near Acuity” and “Distance Acuity”)

Add (or add power): If there is a value under the ‘add’ heading, then you have a bifocal (or Progressive) prescription.

After-image- the eye’s ability to still see an image during eye blinks and even after the viewed object is no longer present. The most common example is seeing light after the flash of a camera.

Albinism – pigmentation is deficient or absent. May occur in skin, hair, and eyes. Ocular albinism is a pigmentation deficiency occurring mainly in the eyes. Individuals with albinism including ocular albinism commonly have decreased visual acuity (20/70 -20/200), strabismus, photophobia, and nystagmus. There is no known treatment. Individuals may benefit from low-vision aids. Treatment options for strabismus and nystagmus does apply to these individuals.

Alignment- proper fusing (uniting) of images to each eye.

Amblyopia- (clinical condition) reduced visual acuity (poorer than 20/20) which is not correctable by glasses or contacts and is not caused by structural or pathological anomalies. This condition is often called “lazy eye” because it is typically the result of disuse. It is usually marked by blurred vision in one eye and favoring one eye over the other. About two percent of the population is affected.

Types of functional (reversible) amblyopia:

• refractive- anisometropia (the two eyes have different refractive powers), or other amblyopiogenic refractive errors (hyperopia, myopia, or astigmatism)
• strabismic- misalignment of the two eyes in which they point in different directions
• form deprivation (may also be referred to as  amblyopia ex anopsia)- caused by conditions that prevent light from entering the eye. These may include congenital ptosis (droopy eyelid), corneal opacity, or cataract.

Ametropia- any optical error such as hyperopia, myopia, or astigmatism. Also called refractive error.

Amplitude of Accommodation (AA)- a measurement of the eye’s ability to focus clearly on objects at near distances. This eye focusing range for a child is usually about 2-3 inches. For a young adult, it is 4-6 inches. The focus range for a 45-year-old adult is about 20 inches. For an 80-year-old adult, it is 60 inches.

Aniseikonia- a difference in the size or shape of two visual images when the images should be the same size and/or shape.

Anomalous Retinal Correspondence (ARC)- a type of retinal projection, occurring frequently in strabismus, in which the foveae (center of the retina that produces the sharpest eyesight) of the two eyes do not facilitate a common visual direction; the fovea of one eye has the same functional direction with an extrafoveal (non-fovea) area of the other eye

Anisometropia- the condition in which the two eyes have different refractive

ANSI Standard Z87.1: The new standard is now called the ANSI Z87.1-2003 standard, and is performance driven with two levels of performance for non-plano (prescription) lenses.

- Basic Impact
- High Impact
• The new standard requires that prescription safety frames must meet the lens retention (High Velocity and High Mass) test requirement with 2.0mm lenses.
Please be aware that an employee subjected to High Impact may not be adequately protected if wearing lenses tested only for Basic Impact. Description of the new ANSI testing requirements:
High Impact Level Prescription Lenses
• Must not be less than 2.0mm thick.
• The lenses shall be capable of resisting impact from a 6.35mm (1/4 in.) steel ball traveling at 45.7 m/s (150 ft/s).
• Marking by manufacturer with “W” as a trademark would look
like this: W+ Basic Impact Level Prescription Lenses.
• Basic Impact lenses shall be a minimum 3.0mm thick except those lenses having a plus power of 3.00D or greater shall have a minimum thickness of 2.5mm (no change from the 1989 standard).
• Basic Impact lenses are not tested to stringent High Impact requirements.
• They will NOT be marked with a “+”
• Protectors with Basic Impact lenses will be delivered to the wearer bearing a Warning Label indicating that the protector only meets the Basic Impact Standard.

ANZI Prescription Frames
• All prescription safety frames must meet High Velocity and High Mass impact resistance tests while retaining the lenses.
• The frame will be marked with Z87-2.
• All frames marked with Z87-2 can be used for Basic Impact and High Impact protection.

ANZI Side shields
• Lateral protection shall be assessed using a rotation point 10mm behind the corneal vertex, which means that shields must now provide more coverage.

Aperture Rule- a stick-like instrument used in vision therapy to develop convergence and divergence (eye teaming) skills.

Asthenopia- eyestrain, symptoms include excessive tearing, itching, burning, visual fatigue, and headache. It can be caused from an uncorrected refractive error, accommodation (eye focusing) disorder, binocularity (eye teaming) disorder, or by extended, intense use of the eyes.

Astigmatism Astigmatism is one of a group of eye conditions known as refractive errors. Refractive errors cause a disturbance in the way that light rays are focused within the eye. Astigmatism often occurs with nearsightedness and farsightedness, conditions also resulting from refractive errors. Astigmatism is not a disease nor does it mean that you have “bad eyes.” It simply means that you have a variation or disturbance in the shape of your cornea. Astigmatism usually occurs when the front surface of the eye, the cornea, has an irregular curvature. Normally the cornea is smooth and equally curved in all directions and light entering the cornea is focused equally on all planes, or in all directions. In astigmatism, the front surface of the cornea is curved more in one direction than in the other. This abnormality may result in vision that is much like looking into a distorted, wavy mirror. The distortion results because of an inability of the eye to focus light rays to a point.

If the corneal surface has a high degree of variation in its curvature, light refraction may be impaired to the degree that corrective lenses are needed to help focus light rays better. At any time, only a small proportion of the rays are focused and the remainder are not, so that the image formed is always blurred. Usually, astigmatism causes blurred vision at all distances. Some people with very high degrees of astigmatism may have cornea problems such as keratoconus.

Astigmatism is very common. Some experts believe that almost everyone has a degree of astigmatism, often from birth, which may remain the same throughout life. The exact reason for differences in corneal shape remains unknown, but the tendency to develop astigmatism is inherited. For that reason, some people are more prone to develop astigmatism than others.

Automated refractor – also called auto refractor. This method determines the eye’s refractive error and the best corrective lenses to be prescribed by using a computerized device that varies its optical power mechanically and prints out the results.

Axis: As mentioned above, a special cylindrical lens is needed in order to correct astigmatism. Not only does the strength of the cylindrical lens need to be specified, but the lens itself must be rotated into a specific position in order to provide the proper vision correction. The axis represents the amount of rotation of the cylindrical lens in degrees ranging from 1 to 180.

Base-The base is to the prism what the axis is to the cylinder. As you know, a prism is shaped like a triangle. The thicker the triangle at its base, the stronger the power. Much like the axis specifies the direction of rotation of the cylindrical lens for astigmatism, the prism must also be rotated into a specific position. But the rotation of the prism is simply specified as ‘base in’ or ‘base out’ (where ‘in’ means towards the nose) or ‘base up’ or ‘base down’. Only these four positions exist as opposed to the 180 positions that can be specified for a cylindrical lens. However, orientations between these four positions can be specified by using combinations of horizontal and vertical prisms in the same lens.

Base Curve: The base curve is the front curve of any lens. The higher the base curve (8-12 base) the more curved the lenses is thus making the frame more curved.

Base-Down (BD) Prism- a wedge-shaped lens which is thicker on one edge than the other. The thicker edge (base) is turned down. Prisms bend light (opposite direction from its thicker end) so the base-down prism turns the light upward thus causing the eye to also move up. This prism is used to measure an eye misalignment and/or treat a binocular dysfunction (eye teaming problem). Prisms are sometimes added to glasses to help improve eyesight due to a misalignment or visual field loss.

Base-In (BI) Prism- a wedge-shaped lens which is thicker on one edge than the other. The thicker edge (base) is turned inward, closest to the nose. Prisms bend light (opposite direction from its thicker end) so the base-in prism turns the light outward (toward the ear) thus causing the eye to also move outward. This prism is used to measure an eye misalignment and/or treat a binocular dysfunction (eye teaming problem). Prisms are sometimes added to glasses to help improve eyesight due to a misalignment or visual field loss.

Base-Out (BO) Prism- a wedge-shaped lens which is thicker on one edge than the other. The thicker edge (base) is turned outward, closest to the ear. Prisms bend light (opposite direction from its thicker end) so the base-out prism turns the light inward (toward the nose) thus causing the eye to also move inward. This prism is used to measure an eye misalignment and/or treat a binocular dysfunction (eye teaming problem). Prisms are sometimes added to glasses to help improve eyesight due to a misalignment or visual field loss.

Base-Up (BU) Prism- a wedge-shaped lens which is thicker on one edge than the other. The thicker edge (base) is turned up. Prisms bend light (opposite direction from its thicker end (base)) so the base-up prism turns the light downward thus causing the eye to also move down. This prism is used to measure an eye misalignment and/or treat a binocular dysfunction (eye teaming problem). Prisms are sometimes added to glasses to help improve eyesight due to a misalignment or visual field loss.

Bridge Size: Is the distance between the lenses on any frame. Smaller bridge fits smaller noses.

Bifocal Glasses- used to correct vision at two distances, composed of two ophthalmic lenses such as a plus lens for near vision and a minus lens for distance vision.

Bi-lateral Integration/ Gross Motor Coordination- visual guidance of body movements and the coordination between both sides of the body.

Binocular Fusion Dysfunction- a clinical condition in which the eyes are not working as a team. Vision therapy is an effective treatment option. (See “General Binocular Vision Disorder”)

Binocular Vision- the simultaneous use of the two eyes.

Binocularity- the ability to use both eyes as a team and to be able to fuse (unite) two visual images into one, three-dimensional image (See “Convergence” and “Divergence”).

Bi –Ocularity- using both eyes, but not together as a team.

Blue Blur Is the condition of unclear vision due to the blue light waves being short and scattering easily in the visible light spectrum. A blue blocker lens is recommended to remedy this aversion in visual acuity.

Blurred Vision- lack of visual clarity or acuity.

Botulinum Toxin Type A (Oculinum, Botox^®)- an injection of this poison has been used as an alternative to conventional surgery in selected strabismic patients. It causes a temporary paralysis of an extraocular muscle that leads to a change in eye position. This change has been reported to result in long-lasting and permanent alteration in eye alignment. Although one injection is often sufficient to produce positive results, one-third to one-half of patients may require additional injections. This technique has been most successful when used in adults with small-angle misalignments. It is not commonly used in children. This treatment is also used in patients who have blepharospam (an uncontrollable eye lid spasm).

Break Point- the point at which a person can no longer fuse (unite) two images into one. A blur point will occur before the this point.

Cataract: are the leading cause of blindness worldwide Approximately 20.5 million Americans age 40 and older have cataracts. Cataracts are the clouding of the eye’s clear lens-similar to a window that is “fogged” with steam. When the lens becomes cloudy, light rays cannot pass through it easily and vision becomes blurry. Cataracts are not a growth or a film over the eye. Cataracts start out small (mild) and have little effect on vision at first. But as the cataract grows (becomes denser), so does the impact on vision. How quickly the cataract develops varies among individuals, and may even be different between the two eyes. Most age-related cataracts progress gradually over a period of years. Other cataracts, especially in younger people and people with diabetes, may progress rapidly over a short time. It is not possible to predict exactly how fast cataracts will develop in any given person.

Cheiroscope- an instrument used in orthoptics/vision therapy to train binocular skills and accommodation skills. The Keystone Correct-Eye Scope is an example of a Cheiroscope.

Ciliary Body – a structure directly behind the iris of the eye and contains the ciliary muscle.

Ciliary Muscle- a band of muscle and fibers that are attached to the lens that controls the shape of the lens and allows the lens to accommodate (change focus).

Clip-On: Is a small device that holds colored lenses in front our your regular prescription eyewear. The normally come in grey amber and copper.

Comitant Strabismus- a condition in which the magnitude of deviation remains essentially the same in all positions of gaze and with either eye fixating.

Computer Vision Syndrome (CVS)- the complex of eye and vision problems related to near work that are experienced during or related to computer use. Its symptoms include eyestrain, dry or burning eyes, blurred vision, headaches, double vision, distorted color vision, and neck and backaches. The condition is caused by various internal and external factors. Treatment options may include prescription glasses and/or vision therapy.

Cone – a receptor cell which is sensitive to light and is located in the retina of the eye. It is responsible for color vision.

Conjunctivitis- an inflammation of the conjunctiva, the transparent layer covering the inner eyelid and the white portion (sclera) of the eyeball. Conjunctivitis can be caused by a virus, bacteria, or fungus (infectious conjunctivitis, or “pink eye”, may be contagious); by allergies to pollen, fabrics, animals, or cosmetics (allergic conjunctivitis); or by air pollution or noxious fumes such as swimming pool chorine (chemical conjunctivitis). Symptoms include red or watery eyes, blurred vision, inflamed inner eyelids, scratchiness in the eyes, or (with infectious conjunctivitis) a puss like or watery discharge and matted eyelids. Conjunctivitis is usually treated with antibiotic eye drops and/or ointment.

Convergence- the ability to use both eyes as a team and to be able to turn the eyes inward to maintain single vision up close.

Convergence Excess (CE)- a clinical condition in which the eyes have a tendency to turn excessively inward when viewing an object at a near distance. Symptoms may include visual fatigue while reading or using a computer, occasional blurred or double vision, and inability to comprehend or concentrate while reading. Clinical signs include: greater esophoria at near than distance, high AC/A ratio, and a high lag of accommodation. Can be improved with vision therapy and/or glasses. (See “Esophoria”)

Convergence Insufficiency (CI)- (clinical condition) the inability of the eyes to turn inward and/or sustain an inward turn. Symptoms include eye strain with reading and using a computer, headaches, loss of comprehension, difficulty concentrating, blurred or double vision, and eye fatigue. Clinical signs include: near point of convergence of greater than 4 inches (10 cm), greater exophoria at near than at distance, and low AC/A ratio. Vision therapy is an effective treatment option.

Cornea- the transparent, blood-free tissue covering the central front of the eye (over the pupil, iris, and aqueous humor) that initially refracts or bends light rays as light enters the eye. Contact lenses are fitted over the cornea.

COVTT- Certified Optometric Vision Therapy Technician. To be certified an individual must be employed by a Fellow (FCOVD), provide documentation of 2000 hours or 2 years of direct clinical experience in vision therapy; or 1000 hours of clinical experience if the individual holds an AA degree or higher with emphasis in the behavioral sciences. Submit written answers to a series of Open Book Questions dealing with various aspects of vision function, testing and therapy. Pass an extensive written and oral examination evaluating the candidate’s knowledge and clinical abilities in behavioral vision, vision development and vision therapy. COVTTs must obtain at least 6 hours of continuing education annually in functional / developmental / behavioral vision care.

Contrast: Contrast is the difference in brightness between the light and dark areas of a picture, such as a photograph or video image. A high contrast lens gives you great visual acuity between light and dark areas in your view.

CR-39 (plastic) The advantages of plastic is that it is lightweight and easily tinted to just about any color. One of the disadvantages is that those lenses scratch easily.

Chromatic Aberration: is caused by a lens having a different refractive index for different wavelengths of light (the dispersion of the lens). Longitudinal and lateral chromatic aberration of a lens is seen as “fringes” of color around the image, because each color in the optical spectrum cannot be focused at a single common point on the optical axis. Since the focal lengthof a lens is dependent on the refractive index n, different wavelengths of light will be focused on different positions. Chromatic aberration can be both longitudinal, in that different wavelengths are focused at a different distance from the lens; and transverse or lateral, in that different wavelengths are focused at different positions in the focal plane (because the magnification of the lens also varies with wavelength).

Crystalline Lens- transparent disc located behind the iris which changes shape to focus on objects at different distances from the eye.

Cycloplegic Refraction- one method available to eye doctors to determine the eye’s refractive error and the best corrective lenses to be prescribed if needed. The eye is dilated with the muscles of accommodation (eye focusing muscles) being temporarily paralyzed with specialized eye drops or spray (Atropine, Homatropine, Cyclogyl, or Mydriacyl). This is a good method for non-responsive or non-communicative patients such as young children. The technique of retinoscopy is used with this method. (See “Retinoscopy”)

Cylinder Lens- an ophthalmic lens that has at least one non-spherical surface. Used to correct astigmatism. The values are typically from -0.75 to -1.25. The cylinder measurement is given with a “-” sign. (Please note that the sign for myopia (nearsightedness) is also “-”.)

Cylinder: If there is no value under the cylinder heading, then you have a very simple prescription. If there is a value under this heading, then you have astigmatism. The majority of optometrists write the cylinder value with a minus sign in front while the majority of ophthalmologists (physicians who specialize in the eye) write the cylinder value with a plus sign in front. Regardless of which way this is written, your glasses will be made the exact same way — these are just two different ways to write the same spectacle prescription. Like sphere power, the cylinder power is also measured in diopters.

Day and Night (Photochromatic Lenses): New Photochromatic lenses are so smart they go from clear indoors to as dark as sunglasses outdoors. Their advanced technology adjusts to changing light, so you see clearly and more comfortably in virtually any light condition.Indoors, Photochromatic lenses are as clear as your regular eyeglasses. Outdoors, they quickly darken, getting as dark as sunglasses if necessary. They work so well, in a recent clinical study, four out of five eyeglass wearers preferred Photochromatic to their regular lenses, and photochromatic provide 100% UV protection.

Depth Perception- the ability to judge relative distances of objects.

Depth Perception Test- a test to measure the ability of the vision system to discern the relative distances of various objects. (Also called a “Stereopsis Test”)

Developmental Disorder- when a delay in an individual’s normal development has occurred.

Developmental Vision Analysis- more comprehensive than a routine eye exam, examination will evaluate all of the patient’s visual abilities such as visual acuity, eye focusing skills, eye teaming skills, eye tracking skills, visual motor skills, and visual perceptual skills.

Diopter: A unit of measurement of the optical power of lenses. For example; if a person has a prescription of -4.00, that person has 4 diopters of power in their lens. Diopters generally are measured in quarter steps like -4.00, -4.25, -4.50. Some doctors refine their measurements down to twelfth steps like -4.00, -4.12, -4.62. Diopters are also used to measure prism.

Diplopia- a single object is perceived as two rather than one; double vision.

Direct Occlusion- covering the non-amblyopic eye. (See “Inverse Occlusion” and “Occlusion”)

Directionality/Laterality- directionality relates to the awareness of the relationship of one object in space to another / laterality relates to the internal awareness of the two sides of the body. Directionality/Laterality can also be called spatial relations.

Directionality/Laterality Disorder- a condition in which an individual has poor development of left/right awareness. Symptoms of this disorder include confusion of right and left direction and letters and/or numbers reversals. Vision therapy is a helpful treatment option.

Distance Acuity- the eye’s ability to distinguish an object’s shape and details at a far distance such as 20 feet (6 meters).

Divergence- the ability to use both eyes as a team and be able to turn the eyes out toward a far object.

Divergence Excess (DE)- (clinical condition) the eye’s tendency to drift out relative to the direction of a distant object being viewed.Symptoms include: double vision at distance, headaches, eyestrain, nausea, dizziness, and blurred vision. Clinical signs include: exophoria greater at distance than near, high AC/A ratio, and reduced positive fusional vergence at distance. Can be improved with vision therapy.

Divergence Insufficiency (DI)- (clinical condition) the eye’s tendency to turn more inward than necessary when viewing a distant object. Symptoms include: double vision, headaches, eyestrain, nausea, dizziness, and blurred vision. Clinical signs: esophoria greater at distance than near, low AC/A ratio, and reduced negative fusional vergence at distance. Treated with corrective lenses and vision therapy.

Dominant Eye- the eye that “leads” it partner during eye movements. Humans also have dominant hand, foot, eye, and side of the brain (not necessarily all on the same side).

Duction Test- a test of the eye’s ability to turn inward or outward while maintaining single, binocular vision with the gradual introduction of progressively stronger base-in or base-out prisms.

Dysphoneidesia- inability to “sound out” words and poor sight recognition of words. Dysphoneidesia is a subtype of dyslexia. Its characteristics are a combination of the other two forms of dyslexia: Dysphonesia and Dyseidetic.

Dysphonesia- inability to “sound out” words. Dysphonesia is a subtype of dyslexia. Children with this form of dyslexia have difficulty sequentially analyzing and remembering what and where the sounds are in words. The resulting phonemic processing problems make it difficult to sound out new words, learn phonics, and make them dependent on their sight vocabulary. When they come to an unknown word they will often substitute a word using context clues. For example, “pony” for “horse”, even though the substituted word doesn’t look or sound anything like the original word. When spelling unknown words it is often difficult  to determine what the original word is. For example, they may write “fmlue” for “familiar” or “lap” for “lamp”. They cannot learn phonics because they cannot process where the sounds are. Their short term sequential auditory memory can be poor and result in repeating “8167″ as “8671″, or remember to go to their room but forgetting to get the item requested.

Dyseidetic- poor sight recognition of words. Dyseidetic is a subtype of dyslexia. Children with this form of dyslexia have trouble analyzing and remembering written symbols. They continue to confuse the orientation. For example, they will write numbers and letters backwards long after other children have mastered these skills. They often confuse letter sequences in reading, and in spelling often get all the letters but in the wrong sequence (spelling “dose” for “does”,  “on ” for “no”, etc.). Their visual memory for words is poor, and after learning a new word they may fail to recognize that same new word later in the sentence. They have trouble learning to read and spell phonetically irregular words. For example, they may read ” laugh” as “log” and spell it as “laff”, both of which are phonetically consistent. Their spelling will have many mistakes, but will be phonetically consistent and one can usually tell what the word was they were trying to spell. When they are attempting to read an unknown word they will usually attempt to sound it out and do so very slowly.

Dyslexia – a specific language-based disorder. The individual has difficulty with letter or word recognition, spelling, reading, writing, and sometimes naming pictures of objects. Dyslexia varies in degree from mild to very sever. It is caused by an inability of the brain’s language centers to decode print or phonetically make the connection between the word’s written symbols and their appropriate sounds. Dyslexia is not caused by a vision disorder. Children often are of normal or above normal intelligence. Dyslexia cannot be cured and will never be outgrown. Appropriate teaching methods can be taught to help those with dyslexia overcome their weakness. The Dyslexia Determination test which is used by many optometrists who specialize in vision related vision problems investigates if the patient has one of the three forms of dyslexia: Dyseidetic – poor sight recognition of words, Dysphonesia- inability to “sound out” words, and Dysphoneidesia – a combination of characteristics from both types. Vision therapy is NOT considered a direct treatment for dyslexia.

Eccentric Fixation- the deviating eye does not use the central foveal (center of the retina that produces the sharpest eyesight) area for fixation. Commonly, individuals with amblyopia and some individuals with strabismus will have this visual adaptation. In esotropia, the eccentrically located retinal point used for fixation is usually in the nasal retina. In exotropia, the eccentrically located retinal point used for fixation is usually in the temporal retina. Vision therapy is a treatment option for those with amblyopia and/or strabismus. It is not a treatment option for an individual with a fovea that has been destroyed.

Emmetropia- normal vision, no correction needed.

Esophoria (Eso)- (clinical condition) a tendency of the eyes to want to turn more inward than necessary when an individual is viewing an object at near or at distance, which may cause the individual to experience eyestrain and other symptoms. Symptoms of basic esophoria include: eyestrain, headaches, blurred or double vision, apparent movement of print, and difficulty concentrating on and comprehending reading material. Clinical signs of basic esophoria include: AC/A ratio is normal, equal esophoria at distance and near, and normal near point of convergence. Sometimes esophoria is caused by a refractive error such as hyperopia (farsightedness), and glasses or contacts can correct the problem alone. However, sometimes vision therapy is needed to to help re-train the eyes to function more appropriately. (See “Convergence Excess” and “Divergence Insufficiency”)

Esotropia (ET)- (clinical condition) a condition in which an eye is turned either constantly or intermittently inward toward the nose. Esotropia is a type of strabismus. It is caused by a reduction in visual acuity, reduced visual function, high refractive error, traumatic brain injury, oculomotor nerve lesion, or eye muscle injury. Treatment options may include one or more of the following: glasses or contacts, bi-focal lenses, prisms, vision therapy, surgery, or Botulinum Toxin Type A (Oculinum, Botox^®) injections. In some cases, esotropia is caused by a refractive error such as hyperopia (farsightedness), and glasses or contacts alone may allow the eyes to straighten. Vision therapy is most appropriate when there are small degrees of misalignment. Surgery, to re-position or shorten the eye muscles, may be required for high degrees of misalignment. If surgery is required, a combination of surgery and vision therapy often yields the best results.

Exophoria (Exo)- (clinical condition) a tendency of the eyes to want to turn more outward than necessary when an individual is viewing an object at near or at distance, which may cause the individual to experience eyestrain and other symptoms. Symptoms of basic exophoria include: eyestrain, headaches, blurred or double vision, apparent movement of print, and difficulty concentrating on and comprehending reading material. Clinical signs of basic exophoria include: normal AC/A ratio, equal exophoria at distance and near, and decreased near point of convergence. Vision therapy is an effective treatment option. (See “Convergence Insufficiency” and “Divergence Excess”)

Exotropia (XT)- (clinical condition) a condition in which an eye is either constantly or intermittently turned outward toward the ear. Exotropia is a type of strabismus. It may also be called divergent strabismus, wandering eye, or wall eye(s). It is caused by a reduction in visual acuity, reduced visual function, high refractive error, traumatic brain injury, oculomotor nerve lesion, or eye muscle injury. Treatment options may include one or more of the following: glasses or contacts, bi-focal lenses, prisms, vision therapy, surgery, or Botulinum Toxin Type A (Oculinum, Botox^®) injections. Vision therapy is most appropriate when there are small degrees of misalignment. If surgery is required, a combination of surgery and vision therapy often yields the best results.

Extraocular Muscles- the muscles attached to the outside of the eyeball which control eye movement. Each eye has six muscles (lateral rectus, medial rectus, superior oblique, inferior oblique, superior rectus, and inferior rectus) that are coordinated by the brain.

Eye Hand Coordination- the ability of our eyes to guide our hands, also called visual motor integration.

Eye Size: Is the horizontal measurement of the lens on any frame. Larger eye size fits bigger heads.

Eye Trac- (equipment) an electronic testing and recording system of eye movements as in reading.

Eye Tracking- the ability of the eyes to smoothly and effortlessly follow a moving target.

Facility of Accommodation- a measure of the ease and speed of the eye(s) to change focus.

Figure-Ground- the ability to recognize distinct shapes from their background, such as objects in a picture, or letters on a chalkboard.

Fine Motor Skills- the ability to coordinate hand and finger movements.

Fixation- the ability to direct and maintain steady visual attention on a target. Fixations are a form of pursuits.

Fixation Disparity (FD)- over-convergence or under-convergence, or vertical misalignment of the eyes under binocular (both eyes) viewing conditions small enough in magnitude so that fusion is present.

Flat Light: When light is “flat,” the slope looks like a white, empty canvas, and it’s impossible to read the snow surface clearly. Ruts, bumps, ice, even rocks and thin patches disappear. And if you’re out in an open expanse, it’s hard to determine the pitch of the slope as your depth perception shrinks to nil.

Floaters- also known as spots, are usually clouded or semi-opaque specks or particles within the eye that are seen in the field of vision. The eyes are filled with fluid which maintains the shape of the eye, supplies it with nutrition and aids in the focusing of light. Often, particles of protein or other natural materials are left floating or suspended in this fluid when the eye is formed before birth. If the particles are large or close together, they cast shadows which make them visible. This is particularly true when nearsightedness occurs or becomes more severe. In most cases this is normal but floaters can also be caused by certain injuries, eye disease or deterioration of eye fluid or its surrounding structures.

Form Constancy- the ability to recognize two objects that have the same shape but different size or position. This ability is needed to tell the difference between “b” and “d”, “p” and “q”, “m” and “w”.

Frame Measurements: What do the numbers located on the bridge and temples of the frames mean?

Example:

The numbers on the frame reflect the SIZE MEASUREMENTS in millimeters (mm).

1st Number (ex.54) = the width of the lenses
2nd Number (ex.38) = the distance between the Top of the lenses to the bottom.
3rd Number (ex.59) = the diagonal distance of the lens
4th Number (ex.18) = the distance of the bridge between the lenses
5th Number (ex.140) = the length of the temple arm including the portion going behind the ear

Fusional Vergence- a convergence response which serves to maintain (fusion) the union of images from each eye into a single image. The eyes will turn with a slow smooth tonic movement or a fast jumping movement called phasic.

Fusional Vergence Dysfunction- see “General Binocular Vision Disorder”.

Fusion- the union of images from each eye into a single image.  There are three degrees of fusion. 1^st degree fusion is the superimposition of two dissimilar targets. 2^nd degree fusion is flat fusion with a two-dimensional target. 3^rd degree fusion is depth perception (stereopsis) with a three-dimensional target.

Fusion Test- determines the eyes ability to unite the images from each eye into a single image.

General Binocular Vision Disorder- inability to efficiently utilize and/or sustain binocular vision. Symptoms include eyestrain, headaches, decreased comprehension, inability to concentrate while reading, excessive tearing, and blurred vision. A patient will have difficulty with both base-in and base-out prisms. Vision therapy is an effective treatment option.

Glare: Reflected glare by light reflected off smooth, shiny surfaces blocking vision. The number one cause of automotive accidents is glare. A polarized lense is your best defense against blinding glare.

Grilamid Nylon Frames: No other material has the flexibility, remarkable toughness, and exceptional resistance to sun lotions. These elements allow our design team to combine the frame material’s light weight, impact resistance, flexibility in variable temperature and overall comfort to create models that are durable and surpass all expectations.

Heterophoria- tendency of the eyes to deviate from their normal position for visual alignment. This condition may be observed when one eye is covered.

Heterotropia- the eyes are abnormally turned.

High index 1.56: Thinner and lighter than regular plastic good for higher prescriptions. Can easily tinted into sunglasses.

High index 1.60: Thinner and lighter than 1.56 high index. These lenses already come with a scratch coat. Great choice for higher prescriptions.

High index 1.67: Thinner and lighter than 1.60. These lenses already come with scratch coating. Also a great choice for high prescriptions.

HTS Computerized Binocular Home Vision Therapy System – a computer program which is prescribed by an eye doctor. The computer program is for improving eye tracking, eye teaming, and/or eye focusing.

Hyperopia: Also known as farsightedness, is usually inherited. Children are often hyperopic which may lessen as an adult. Hyperopia is a refractive error, which results from a disorder rather than from disease. A refractive error means that the shape of your eye does not bend light correctly, resulting in a blurred image.

Hyperphoria- a condition in which one eye has a tendency to point higher than the other eye, causing eyestrain. Sometimes improved by prisms in glasses.

Hypertropia- strabismus, one eye turned in an upward direction.

Hypophoria- a condition in which one eye has a tendency to point lower than the other eye. This condition may be observed when one eye is covered.

Hypotropia- strabismus, one eye turned in a downward direction.

Hysterical Amblyopia- a non specific visual loss with an unknown cause. Upon examination the doctor is unable to find corroborating objective evidence of this abnormality. The most common symptom is an isolated visual acuity impairment, followed by combined visual acuity impairment and visual field constriction, and whereas an isolated visual field constriction occurred most infrequently. Thisvision loss may be due to anxiety or emotional repression. (See “Streff Syndrome”)

Ill-Sustained Accommodation- this clinical condition is also called Accommodative Fatigue. It is the inability of the eye to adequately sustain sufficient focusing over an extended time period. The most common sign or symptom is blurred vision after prolonged near work such as reading and using a computer. In addition, such patients often have asthenopia (eyestrain). Clinical signs include: normal amplitude of accommodation, decreased PRA, and the patient generally fails the +/-2.00 D flipper test. Plus lenses(glasses or contacts) and vision therapy are effective in treating this condition.

Impact Resistant: Resistant to shattering or splintering. impact resistant plastic is made so that it will not break into small pieces. Polycarbonate is impact resistant making it a very safe lens to wear.

Incomitant Strabismus – a condition also known as Noncomitant Strabismus. It occurs when the magnitude of deviation is not the same in the different positions of gaze or with either eye fixating.  There is an abnormal restriction to movement or an over-action of one or more of the extraocular muscles. Generally, the magnitude must change by at least 5 PD to be incomitant (nonconcomitant).

Inverse Occlusion- covering the amblyopic eye. (See “Direct Occlusion” and “Occlusion”)

Iris- the colored part of the eye located between the lens and cornea; it regulates the entrance of light. (See diagram of the eye)

Infrared (IR) Radiation (760 – 3000nm) Infrared Rays are radiant energy, or heat waves, not considered harmful under normal conditions. These heat rays cannot be seen but can be felt. If you are exposed to intense sunlight for a lengthy period of time (a day at the beach, for example) without infrared protection, you may experience a burning or stinging sensation in your eyes and a sense of fatigue. Infrared rays can be especially discomforting if you wear contact lenses. If your sunglasses fail to stop infrared light, it can be absorbed by your contacts, causing them to “warm up”.

Kinesthesia- the sensation of bodily position, presence, or movement resulting chiefly from stimulation of sensory nerve ending in muscles, tendons, and joints.

Lag of Accommodation- a measure of the eye’s ability to focus accurately on a given target. The dioptric difference between the eye’s focusing response and the stimulus to focus.

Latent Hyperopia- hyperopia (farsightedness) is compensated by accommodation and the tonicity (tension) of the ciliary muscle; identified by cycloplegic refraction. In mild cases of hyperopia (farsightedness), the eyes are able to compensate without corrective lenses; otherwise a plus lens (glasses or contacts) is prescribed. Vision therapy is not prescribed. (See “Hyperopia”)

Learning Disability (LD)- a disorder that affects people’s ability to either interpret what they see and hear or to link information from different parts of the brain. Learning disabilities can be divided into five broad categories: speech and language disorders, reading disorder, arithmetic disorder, writing disorder, and attention disorders. The term learning disability does not include children who have learning problems that are primarily the result of visual, hearing, or motor disorders.

Lensometer- also called Verometer, is a device used to measure the refractive power of eyeglasses and contact lenses.

Macula- the most sensitive part of the retina that is about the size of a pinhead and is where our most detailed vision occurs.

Macular Degeneration: is a degenerative disease that robs young and old of central vision.  As a result, children face a lifetime of uncertainty and elders risk the early loss of an independent life.  In addition to the support of long-term efforts in the fields of Stem Cell and Genetic research for an ultimate cure, we are particularly interested in promising near-term, scientific studies designed to inhibit the progression of macular degeneration and restore a measurable amount of vision to all.

Malingering- a voluntary or intentional reduction in visual acuity or other examination data.

Microstrabimus – also called microtropia, monofixation syndrome, and small angle strabismus. A small angle deviation (inward or outward, commonly inward) that is less than five degrees with some amount of stereopsis (depth perception) and anomalous retinal correspondence (ARC). Possible mild amblyopia, eccentric fixation, and/or anisometropia may also be present. It frequently results from the treatment of a larger-angle deviation (esotropia or exotropia) by optical correction, vision therapy, pharmacological agents, and/or extraocular muscle surgery. Treatment for microstrabimus consists mostly of correcting significant refractive errors and any coexisting amblyopia. The use of vision therapy and prisms to establish bifoveal fusion has been successful in selected cases.

Minus (-) Lens- concave lens, stimulates focusing and diverges light. The lens is thinner in the center than the edges. It is used in glasses or contact lenses for people who are nearsighted (myopia).

Monocular Vision- only one eye having useful vision.

Myopia- nearsightedness, an individual will have difficulty seeing clearly at distance. Light entering the eye focuses in front of the retina when the eye is at rest and is corrected with a minus lens. A condition known as high myopia occurs when myopia is greater than 6 diopters. Typically, vision therapy is not prescribed for myopia. For more information and a diagram, please

Nanometers: The measure of the length of a wave of light. One billionth (10-9) of a meter.

Nose pad: One of a pair of pads, usually clear, that rest on either side of your nose and help to support your glasses.

Near Point of Convergence (NPC)- the closest point at which the two eyes can maintain a single united image.

Near Point of Convergence Test- measures the patient’s ability to point the eyes at an approaching object and to keep them fixed on the object as it reaches the patient’s nose.  Normal range is 0 to 4 inches away from the nose.

Negative Relative Accommodation (NRA)- a measure of the maximum ability to relax accommodation while maintaining clear, single binocular vision.

Normal Retinal Correspondence (NRC)- the foveas of the two eyes are corresponding neural points in the visual cortex and binocular vision can occur.

Nystagmus- rhythmic oscillations or tremors of the eyes which occur independent of the normal eye movements. Generally nystagmus is not curable, but it is manageable. Treatments include prescription glasses or contact lenses, prisms, and vision therapy.

Occlusion- to block out light. An eye can be completely or partially blocked. This procedure is used to promote the use of one eye or both eyes. This therapy procedure may be used for people with amblyopia, strabismus, or closed head trauma. It may also be used in a vision therapy program for someone with amblyopia, eye focusing (accommodation) disorder, or poor eye tracking (oculomotor) skill.  An eye patch, black contact, or another device may be used to block out light from an eye. (See “Direct Occlusion” and “Inverse Occlusion”)

Ocular: Ocular is anything of or relating to the eye.

Ocular Motility- pertaining to binocular alignment and eye muscle movement. (See “Binocularity”, “Strabismus”)

Ocular Motor (OM)- general eye movement ability, which include pursuits (to visually track and/or follow moving objects) and saccades (to direct and coordinate eye movement as the eye quickly and voluntarily shift from one target to another).

Ocular Motor Dysfunction- poor eye movement skills. Vision therapy is an effective treatment option.

Oculomotor Skills- the ability to quickly and accurately move our eyes. These are sensory motor skills that allow us to move our eyes so we can fixate on objects (fixation), move our eyes smoothly from point to point as in reading (saccades), and to track a moving object (pursuits). (See “Fixation”, “Pursuits” and “Saccades”)

Oculus Dexter (OD)- right eye.O. D. O. D. simply means ‘right eye’. It is the short form of the latin term ‘oculus dextrous’.

Oculus Sinister (OS)O. S.: O. S. simply means — you guessed it — ‘left eye’. It is the short form of the latin term ‘oculus sinister’.

Oculus Uterque (OU)- both eyes.

O-Seg Bifocal: This lens is similar to the Round Seg, but uses new manufacturing techniques to allow us to put the reading area on the back of the lens, instead of the front, as was done before. This makes the lens more cosmetically appealing, and effectively increases the reading area to the wearer, as it’s closer to the eye.

Ophthalmologist – a physician (doctor of medicine (M.D.) or doctor of osteopathy (D.O.) who specializes in the comprehensive care of the eyes and visual system in the prevention of eye disease and injury. The ophthalmologist has completed four or more years of college premedical education, four or more years of medical school, one year of internship, and three or more years of specialized medical and surgical training and experience in eye care. The ophthalmologist is a physician who is qualified by lengthy medical education, training and experience to diagnose, treat and manage all eye and visual system problems, and is licensed by a state regulatory board to practice medicine and surgery. The ophthalmologist is the medically trained specialist who can deliver total eye care: primary, secondary and tertiary care services (i.e., vision services, contact lenses, eye examinations, medical eye care and surgical eye care), and diagnose general diseases of the body. An ophthalmologist is not trained to provide vision therapy.

Ophthalmoscope- a device used to illuminate the inside of the eye and enlarge the image for examining the retina, optic nerve entrance, arteries, and veins.

Optic Nerve- is a bundle of nerve fiber that connects each eye to the brain and transmits images from the retina to the brain. (Seediagram of the eye)

Optician- is a professional in the field of designing, finishing, fitting and dispensing of eyeglasses and contact lenses, based on an eye doctor’s prescription. The optician may also dispense colored and specialty lenses for particular needs as well as low-vision aids and artificial eyes.

Optometric Vision Therapy (VT)- as defined by the American Optometric Association: Optometric vision therapy is a treatment plan used to correct or improve specific dysfunctions of the vision system. It includes, but is not limited to, the treatment of strabismus (turned eye), other dysfunctions of binocularity (eye teaming), amblyopia (lazy eye), accommodation (eye focusing), ocular motor function (general eye movement ability), and visual-perception-motor abilities.

Optometric vision therapy is based upon a medically necessary plan of treatment which is designed to improve specific vision dysfunctions determined by standardized diagnostic criteria. Treatment plans encompass lenses, prisms, occlusion (eye patching), and other appropriate materials, modalities, and equipment. (Vision therapy can also be called visual or vision training, orthoptics, eye training, or eye exercises.)

Please note that the definition above describes Optometric Vision Therapy, which has been clinically shown to improve certain eye disorders, which are described above. However Optometric Vision Therapy is NOT the same as the Bates Method, vision therapy using Bates, integrated vision therapy, or natural eye exercises. These holistic programs use some form of eye exercises associated with relaxation techniques, which claim to improve nearsightedness, farsightedness, astigmatism, decreasing vision with age, and other disorders. There is virtually no statistical studies/results indicating the success of these methods.

Optometrist – a health care professional who is state licensed to provide primary eye care service.  These services include comprehensive eye health and vision examinations; diagnosis and treatment of eye disease and vision disorders; the detection of general health problems; the prescribing of glasses, contact lenses, low vision rehabilitation, vision therapy, and medications; the performing of certain surgical procedures; and the counseling of patients regarding their surgical alternatives and vision needs as related to their occupations, avocations and lifestyle. The optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete a residency.

Organic Amblyopia- gradual or sudden loss of central vision (partial loss) affecting visual acuity with no treatment options.

Types of organic (irreversible) amblyopia:

• nutritional amblyopia- vision loss caused by low levels of vitamin B12 due to poor nutrition and poor absorption associated with drinking alcohol.
• tobacco-alcohol amblyopia- clinical evidence exists that a nutritional deficiency is the underlying cause of this vision loss; however, many still believe that the toxic effects of alcohol and/or tobacco are contributing factors.
• toxic amblyopia- caused by exposure to toxins such as ethambutol, methyl alcohol (moonshine), ethylene glycol (antifreeze), cyanide, lead, and carbon monoxide.

Orthophoria (ortho)- the absence of either esophoria or exophoria. The eyes do not have a tendency to want to turn more inward than necessary or want to turn more outward than necessary when pointed on an object.

Orthoptics- the science of correcting defects in binocular vision. The technique of eye exercises to correct strabismus (esotropia or exotropia), convergence insufficiency (exophoria), or convergence excess (esophoria), amblyopia, and ocular motility disorders. Orthoptics was pioneered by French ophthalmologist Javal in the mid to late 1800’s. Today ophthalmologists use specialty-trained healthcare professionals called orthoptists to evaluate patients and treat them with orthoptics. In America, the non-surgical technique of orthoptics is less commonly used by ophthalmologists compared to other countries. Orthoptics is a limited form of optometric vision therapy.

Paresis- a paralysis that when occurring in ocular muscles causes double vision when looking in some directions.

Penalization- to prevent sight out of the good eye and force the weaker, amblyopic eye, to function. A filter, eye patch, or eye drops such as atropin or miotics are used on the good eye.

Perceptual Skills- includes the identification, discrimination, spatial awareness, and visual-sensory integration. These are visual cognitive skills used to processes visual information to the brain to be organized and interpreted. (See “Visual Perceptual Disorder”)

Photochromic: Able to change lens color or darkness/density depending upon the degree of exposure to light.

PTS Computerized Perceptual Home Vision Therapy System- a home-based computerized perceptual therapy program, which was designed to enhance visual information processing. The therapy procedures address simultaneous processing, sequential processing and/or speed of information processing. This computer program contains 6 activities that are specifically for the following problems: a weakness with visual information processing skills such as figure-ground, form constancy, spatial relations, visual closure, visual discrimination, visual memory, and visualization skills, slow speed of information processing, and acquired brain injury with perceptual-cognitive deficits. This program is available only from a licensed eye care practitioner.

Perimetry- the measurement of a visual field function (the total area that can be seen while looking straight ahead) using targets of different sizes and brightness (light levels). The visual field is measured in degrees. In a normal eye the peripheral field of vision is about 180 degrees. An instrument called a perimeter is used for mapping all areas of a person’s eyesight, including peripheral (side) vision. Visual field testing can help detect certain patterns of visual loss, indicating specific types of eye diseases or vision conditions. It is the single best test for diagnosing glaucoma.

Peripheral Vision- the ability to see or be aware of what is surrounding us, our side vision. (See “Visual Field”.)

Phasic- fast, jump movement. (See “Fusional Vergence”)

Photophobia- unusual sensitivity to light.

Physiological Diplopia- a normal diplopia (double vision) that occurs when an individual is not pointing his/her eyes on a certain object.

Plano Lens- a lens that has no prescription. No variance between the curvature of the front and back lens surfaces. It is a flat lens.

Pleoptics- a method of eye exercises created to stimulate and train an amblyopic eye. The goal is to have eyesight which is produced by the fovea. (See “Eccentric Fixation”)

Plus (+) Lens- convex lens (thicker in the middle) relaxes focusing and converges light. It is typically used in glasses or contact lenses for people who are farsighted (hyperopic). Although it may also be prescribed for other visual conditions as well.

Polarized Lenses: Light waves traveling freely can vibrate in any direction. When light strikes a horizontal reflecting surface such as water, sand or pavement, it vibrates horizontally creating glare. To the unprotected eye, glare can decrease depth perception., reduce visual acuity and create eye fatigue. These lenses are great by the water or for driving. A good example of how these lenses work. While driving in your car you often see the glare of the dashboard or if you have a white piece of paper on the dashboard for example you see its reflection off the windshield. Having a polarized lens virtually eliminates this reflection and all of this type of glare (horizontal glare). These lenses are laminated and have a polarizing film in side the lens they are available in gray or brown. They are also available in plastic, polycarbonate or glass.

Positive Relative Accommodation (PRA)- a measure of the maximum ability to stimulate accommodation while maintaining clear, single binocular vision.

Polycarbonate- Polycarbonate lenses or “Poly” are “impact resistant” thinner and lighter in weight than traditional plastic eyeglass lenses, they also offer ultraviolet (UV) protection and scratch resistance. In addition, they are very impact resistant. This extra toughness makes them the lenses of choice for children’s glasses, sports eyewear and safety glasses.

Presbyopia: Inability of the eye lens to focus incoming light, resulting in blurred vision at a reading distance and eyestrain. Most people develop presbyopia in their 40s.

Prism This is a box on the prescription form that is rarely filled in. Occasionally, when the two eyes are not properly aligned and looking directly at the same thing, prism can be ground into the lenses in order to re-align them. This can occur with strabismus (i.e. – an eye turn) or in situations where the eyes are properly aligned but are under a tremendous amount of strain in order to keep them aligned. The value under the ‘prism’ heading denotes the strength of the prism.

Prismatic Effect By Lens- when light goes through a wedge shaped lens which is called a prism, it bends. Light is also bent when it does not go through the center of a lens. This is an undesirable effect that can occur in glasses. It commonly occurs when the pupillary distance (PD) is not measured or made correctly.

Progressive lenses: (also, progressive addition lenses or PALs) Multifocal lenses whose corrective powers change progressively throughout the lens. A wearer looks through one portion of the lens for distance vision, another for intermediate vision, and a third portion for reading or close work. Each area is blended invisibly into the next, without the lines that traditional bifocals or trifocals have.

Pseudomyopia- the condition Accommodative Excess/Spasm causes an individual to experience blurry distance vision after prolonged near work such as reading or using a computer. The individual may appear to be nearsighted (myopia). Treatment options may include prescription lenses and/or vision therapy.

Ptosis- droopy upper eyelid, causing the eye to remain partially closed.

Pupil- the opening at the center of the iris of the eye. It contracts (dilates) in the dark and when the eye is focused on a distant object.

Pupillary Distance (PD): The distance between the center of your pupils is known as the Pupillary distance, this is measured . Before your prescription lenses are cut into the shape of your frame, the Pupillary distance needs to be measured. This measurement is then used so that the optical center of each lens can be lined up with your pupils in order to give optimal visual clarity. In general, PD measurements fall in the range of 48mm to 73mm. The most common measurements are between 58mm and 68mm.

Pupillary Reflex- the automatic contraction or enlargement of the pupil when confronted with the presence or absence of light, accommodation, or emotional change.

Pupillometer- a device used to measure the distance between the pupils of the eyes, in millimeters, which is a necessary measurement for proper lens prescription. It also measures the diameter of the pupil.

Pursuit Dysfunction- a condition in which the individual’s ability to follow a moving target is inadequate. Vision therapy is an effective treatment option. T

Pursuit Test- measures the eyes ability to follow a moving target.

Pursuits- the eye’s ability to smoothly follow a moving target.

Reading- requires the use of good visual skills, which are distance and near acuity, accommodation skills, binocularity skills (convergence), oculomotor skills (saccadic), peripheral vision, figure-ground, form constancy, spatial relations, visual closure, visual discrimination, visual memory, and visualization.

Refraction Test- determines the eye’s refractive error and the best corrective lenses to be prescribed. There are several methods of performing refraction: Retinoscopy, Automated Refractor, and Subjective Refraction.

Refractive Error- defects in vision caused by the eye’s inability to bend, or refract light and focus it clearly on the retina. Astigmatism, hyperopia, and myopia are common conditions of refractive error, also called ametropia.

Refractive Power- a lens’ ability to bend parallel light rays into focus, as measured by power diopters. In general, the greater the curvature of a lens and the greater the difference between center thickness and edge thickness, the higher the index of refraction and the greater its refractive power. Refractive power can also refer the strength of a person’s contact lenses or glasses.

Refractive Media- the parts of the eye that light travels through before being focused on the retina includes the cornea, crystalline lens, aqueous, and vitreous.

Relative Amblyopia- functional amblyopia can co-exit with a pathology abnormality. Treatment is possible.

Retina- the innermost layer of the eye, a neurological tissue, which receives light rays focused on it by the lens. This tissue contains receptor cells (rods and cones) that send electrical impulses to the brain via the optic nerve when the light rays are present. (Seediagram of the eye)

Retinoscopy- this technique determines the eye’s refractive error and the best corrective lenses to be prescribed. An instrument called a retinoscope which consists of a light, lens, mirror, and handle, is used to shine light into a patient’s eye. There are two types of retinoscope: streak and spot retinoscope. When light is shone into patient’s eye, the light is reflected back (“reflex”). If the reflection is in the same direction (“with movement”) of the retinoscope then the refractive error is hyperopia (farsightedness) and a plus lens is prescribed. If the reflection is in the opposite direction (“against movement”) of the retinoscope then the refractive error is myopia (nearsightedness) and a minus lens is prescribed. The strength of the prescription is determined when the pupil is suddenly filled with light (“neutralized”) with the appropriate lens powers (strength).

Rod- a receptor cell which is sensitive to light and is located in the retina of the eye. It is responsible for night vision (non-color vision in low level light).

Saccades- the eye’s ability to direct and coordinate movement as it quickly and voluntarily shift from one target to another.

Saccades Dysfunction- a condition in which the individual’s ability to scan along a printed page and move his eyes from point to point is inadequate. Symptoms include frequent loss of place while reading, skip or transpose words, and have difficulty comprehending because of an inaccurate eye movement. Vision therapy is an effective treatment option.

Saccadic Test- measures the eyes ability to move quickly and precisely from point to point.

Sclera- the white protective covering of the eye.

Round Seg Bifocal: Unlike the traditional “flat top” or “D” segment bifocal, this lens uses a round reading area, instead of the traditional lined segment. This allows us to rotate the lens to place the reading area in the proper position, giving us more freedom with regard to frame sizes.

Selective Light Filtration: The act of filtering a certain wave of light. An amber or yellow lens often filters the blue wave of light giving a sharper high contrast view of the world.

Slit Lamp (Biomicroscope) – this instrument can examine ocular tissue from the front of the cornea to the back of the lens. A narrow “slit” beam of very bright light produced by a lamp. This beam is focused on to the eye which is then viewed under magnification with amicroscope. A joystick control is employed to enable instrument to be moved left-right and up-down. A chin rest, head rest and fixation target is also required. Some slit lamps have a tilting mechanism to enable the lamp to be directed from different angles.

Spatial Relation- the ability to judge the relative position of one object to another and the internal awareness of the two sides of the body. These skills allow the individual to develop the concepts of right, left, front, back, up, and down. This ability is needed in reading and math. (See “Directionality/Laterality”)

Sphere: The number under the heading ‘sphere’ is the main part of your prescription. The number itself denotes the strength of the lens as measured in diopters. A diopter is a unit of measurement that is simply the inverse of the focal distance of the lens as measured in meters. For example, if a lens has a strength of 2 diopters, then parallel light rays that pass through this lens will focus together at a distance of 1/2 meter (50 cm) away from the lens. If you are near-sighted (i.e. – you have trouble seeing far away but can see fine up close), then you can make a rough calculation of the strength of your glasses.

Squint- to be unable to direct both eyes simultaneously toward a point. Also known as strabismus (turned eye).

Stereopsis- the ability to perceive a three dimensional depth which requires adequate fusion (union) of the images from each eye.

Stereopsis Test- measures depth perception that is dependent on the accuracy of eye teaming.

Strabismus- (clinical condition) turned eye (s), the eyes are misaligned. It is caused by a reduction in visual acuity, reduced visual function, high refractive error, traumatic brain injury, oculomotor nerve lesion, or eye muscle injury. In strabismus, the eyes send conflicting images to the brain, and the brain cannot combine these images as it would in normal vision. The brain compensates by ignoring one image in favor of the other, causing a loss of depth perception. Strabismus in more common in children, and affects four percent of all children (although it may also appear later in life).

It is characterized by using the following categories:

• Strabismus in which only one eye deviates.
• Strabismus in which the deviating eye can change.
• Strabismus which is not present at all times.
• Strabismus which is present at all times.
• Strabismus which occurs at one testing distance but not at another.

Strabismus is also known as squint. It may also be referred to as cross-eyes (convergent- turning inward) or wall eyes (divergent- turning outward). Treatment options may include one or more of the following: optical lenses, bi-focal lenses, prisms, surgery, vision therapy, or Botulinum Toxin Type A (Oculinum, Botox^®) injections.

Streff Syndrome- named after the optometrist who originally described it, Dr. John Streff. This functional vision loss is also known as Non-Malingering Syndrome. Signs include reduced visual acuity in both eyes at distance and near. The visual acuity at near is more reduced than the distance acuity. Frequently patients will have reduced stereopsis, large accommodative lag on dynamic retinoscopy, and a reduced visual field (tubular or spiral field). The syndrome is associated with a visual or emotional stress occurring in the child’s life. It is more prominent in girls (ages 7-13) than boys. Treatment includes a low plus lens and/or vision therapy. This condition is sometimes incorrectly diagnosed by doctors as hysterical amblyopia.

Subconjunctival Hemorrhage – a blood spot on the eye. It occurs when a small blood vessel under the conjunctiva (the transparent coating that covers the inner eyelid and the white of the eye) breaks and bleeds. A common condition caused spontaneously from coughing, heavy lifting, or vomiting. In some cases, it may develop following eye surgery or trauma. It tends to be more common among those with diabetes, hypertension, and taking blood thinners (including aspirin). A subconjunctival hemorrhage is essentially harmless. The blood naturally absorbs within one to three weeks and no treatment is required. If a mild irritation is present, artificial tear drops can be used. You can speed up the healing process by applying cool compresses for the first two days and then warm compresses in the following days.

Subjective Refraction – the procedure in which the patient is asked to report on which lens combination provides the clearest vision. While this is the method of choice for determining prescription in those able to understand the task and respond to the examiner, it is less reliable in children.

Suppression of Binocular Vision- when the brain ignores the image that is seen by one eye. It is the result of weak eye teaming skills (binocularity).

Suppression Test- determines if there is any tendency for the visual processing center of the brain to ignore or suppress visual data from one eye.

Tactile- pertaining to the sense of touch.

Temple Length: Is the length of the “arm” of a pair of glasses, running from the ear to the lens area in Millimeters.

Tonic- slow, smooth tension. (See “Fusional Vergence”)

Tonic Vergence- convergence due to the basic tonicity (tension) of the extraocular muscles, which are responsible, in part, for the distance phoria. Deficient tonic vergence would result in exophoria and excessive tonic vergence results in esophoria. (See “Vergence”)

Tonometry- an instrument that measures the pressure within the eye, which is known as intraocular pressure (IOP).

Tranaglyph- red/green targets used with red/green glasses to develop eye teaming skills.

Tunnel Vision- a constriction of the visual field that is commonly caused by chronic glaucoma, retinal degeneration, a tumor, or a brain disorder that interferes with the fibers that connect the optic nerve to the brain. (Please note that a visual stress,  emotional stress, or emotional trauma can also cause a constriction of the visual field.) (See “Streff Syndrome”.)

Ultraviolet (UV) Radiation: Solar radiation is formed by visible and invisible light waves. Measured in nanometers, it has three wave lengths that reach and affect your eyes: Ultraviolet, Visible Lights, and Infrared Radiation. The shorter the wavelength, the more damage to your eyes.

Ultraviolet Radiation (200 – 380 nm)
Studies show that long term exposure to UV rays may cause eye diseases, including cataracts. In addition, short-term exposure can cause temporary conditions such as “snow blindness”, Ultraviolet radiation can be divided into three categories.

UVC (200 – 290 nm)
UVC is absorbed by the atmospheric ozone layer and never reaches your eyes.

UVB (290 – 320 nm)
UVB is a physically painful form of ultraviolet radiation. These are the sun’s “tanning rays” which are absorbed by the cornea. Exposure to UVB can temporarily damage the cornea. This band of radiation causes cancer and burning of the eye and has been linked to damage of the lens inside the eye.

UVA (320 – 380 nm)
UVA rays are absorbed by the lens of your eye. The resulting damage heals slowly, if at all. About one percent of all UVA rays penetrate the retina, which cannot repair itself. These rays, which cause sun tanning and wrinkles, pass through the outer structure of the eye and are absorbed by your eye’s lens. The resulting damage heals slowly, it at all. Extended exposure to UVA rays can lead to the formation of cataracts.

Protection from harmful UV radiation is becoming more and more important as the earth’s ozone layer continues to be depleted. Contrary to what you might think, clouds do not block out all UV rays. Though thick, heavy clouds absorb most UV radiation, UV will pass through thin clouds, even when the sun’s rays don’t feel hot. And watch out for haze – it doesn’t’t block UV radiation at all. You get higher exposure to UV radiation on snow, sand, water, or concrete, since these surfaces reflect the sun’s rays. You will also get higher UV radiation levels at higher altitudes and at areas closer to the equator. To make matters worse, the damaging effects of long-term UV radiation exposure are cumulative with the consequences not immediately apparent. So beware: excessive exposure to UV radiation today can cause eye problems tomorrow. Therefore, a good pair of sunglasses is essential for enjoying the sun. The filtering qualities of the lenses must be considered so that you have the correct type of lens for your intended use. There is no point in buying lenses designed for high altitude if you use them for everyday urban life.

UV Filter (coating): This coating is a filter for the harmful UV radiation. The coating is either put on the lens or is imbedded into the lens to protect your eyes for the harmful effect of the sun’s UV radiation.

Vectogram- a three-dimensional picture that is used to strengthen the binocularity system. Available in fixed and variable styles to provide base-in and/or base-out training. 3D glasses are used to view the picture.

Vergence- to turn the eyes horizontally (convergence- inward or divergence- outward). Accommodative vergence, fusional vergence,proximal vergence, and tonic vergence are needed to maintain single vision.

Vergence Facility- a measure of the ease and speed of the eyes to change from a converging to diverging position.

Vertigo- a disordered state in which the individual is dizzy or feels that the surrounding environment is whirling.

Visagraph Eye-Movement Recording System – records and measures eye movements while an individual reads. The system also measures reading efficiency. Specially created goggles and a computer program are used.

Visible Light (380 – 760nm) Visible light is that portion of the light spectrum that the eye perceives as color. In this spectrum, protective eyewear deals with glare or the brightness of the sun. Excessive amounts of visible light are irritating to unprotected eyes and can reduce your visual perception by as much as 50%. It can also hinder your eye’s ability to adjust to darkness (night blindness) and cause difficulty in depth perception. The unprotected eye strains to focus (squint), which can cause wrinkles and chromatic aberration. Athletic Optics offers a variety of lens colors to enhance your vision in various lighting conditions. Blue Light (380 – 480nm): Closest to the high energy, UV portion of the visible light spectrum, it focuses in front of the retina rather than on it, which blurs vision, reduces contrast and hinders depth perception.

Vision- the ability to take in information through our eyes and process the information so that it has meaning.

Vision Therapy (VT) - see “Optometric Vision Therapy”

Vision Therapy Technician- one who works under the supervision of an optometrist in evaluating clients and in planning and implementing vision therapy programs. (See “COVTT”)

Vision Therapist- Optometrist or an optometric vision therapy technician who develops and administers vision therapy programs. (Typically this term is referring to a vision therapy technician rather than an optometrist.)

Visual Acuity- sharpness or clearness of eyesight. For more information, please click here. (See “Near Acuity” and “Distance Acuity”, “20/20”)

Visual Analysis- refers to figure-ground, form constancy, spatial relation, visual closure, visual discrimination, visual memory, and visualization.

Visual Closure- the ability to identify or recognize a symbol or object when the entire object is not visible.

Visual Discrimination- the ability to discriminate between visible likeness and differences in size, shape, pattern, form, position, and color. Such as the ability to distinguish between similar words like “ran” and “run”.

Visual Field- the total area that can be seen while looking straight ahead. (See “Tunnel Vision”.) (Note: Perimetry is the method of testing an eye’s field of vision. For more information, please see “Perimetry”.)

Visual Form Dysfunction- difficulty with figure-ground, form constancy, visual closure, and visual discrimination. Symptoms include confusion with similar objects, words, or colors. Vision therapy is a treatment option.

Visual Memory- the ability to recall and use visual information from the past.  (See “Visual Sequential Memory”)

Visual Memory Dysfunction- difficulty with retention, recall, or recognition of things seen. Symptoms can include poor spelling and poor recall of visual information. Vision therapy is a treatment option.

Visual-Motor Dysfunction- the inability to process and reproduce visual images by writing or drawing. Symptoms can include poor pencil grip/writing, poor organization on written page, poor copying/spacing, and excessive erasing. Vision therapy is a treatment option.

Visual-Motor Skills- the ability of our eyes to guide our hands (eye hand coordination, visual-motor integration).

Visual Pathway- route of the nerve impulses from the retina along the optic nerve, and optic nerve radiations to the brain’s sensory cortex that is located at the base of the skull.

Visual Perceptual Disorders- information processing dysfunctions of the visual system. These dysfunctions can be a directionality/laterality disorder, visual form dysfunction, visual memory dysfunction, and visual-motor dysfunction. Vision therapy is a treatment option. (Also see “Perceptual Skills”)

Visual Perceptual Skills- the ability to organize and interpret information that is seen and give it meaning. These information-processing skills include figure-ground, form constancy, spatial relations, visual closure, visual discrimination, visual memory, and visualization.

Visual-Sensory Integration- after visual data is gathered, it is processed and combined in the brain with information from hearing (auditory-visual integration), balance (gross-motor/bilateral integration), posture, and movement (visual-motor integration).

Visual Sequential Memory- ability to recall a sequence of numbers, letters or objects in the order they were originally given.

Visual Skills- are accommodation (eye focusing), binocularity (eye teaming), and oculomotor skills (eye movement), which are neuro-muscular abilities that are controlled by muscles inside and outside of the eye and are networked with the brain.

Visualization- the ability to crate and manipulate mental pictures of an object or concept on the basis of past visual experience and memory. Essential in reading and playing sports.

Wandering Eye(s)- see “Exotropia”.

Wheatstone Stereoscope -an instrument designed to present separate images to each eye. Each eye can see independently. Two plane mirrors are joined at one edge at a 90-degree angle and two target holders, one opposite one mirror and the other, mounted on a screw base which, when turned, synchronously moves the targets toward or away from each other. The Amblyoscope, Troposcope, Synoptophore, and the Bernell Mirror Stereoscope are examples of this design.

Yoked Prisms- a wedge-shaped lens which is thicker on one edge than the other. The prism bases (thicker end) are in the same direction for both eyes (up, down, left, or right). Yoked prisms are used to train or compensate for a binocular dysfunction (eye teaming problem) or a visual field loss. Sometimes used in optometric vision therapy programs.

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