What are the 3 conditions you must report to CDC?
Gonorrhea, Chlamydia and Syphilis
What does AOA want Comprehensive exams should be done on children?
6 months of age > 3 years of age > Right before Grade 1 > 2 years after that
Which lens possess the most amount of reflection based on its incident surface?
Polycarbonate
Note: Index of medium is proportional to reflection from a lens.
With DEM what characterizes Poor Automaticity?
Low Horizontal
Low Vertical
Normal Ratio
Normal Errors
With DEM what characterizes Poor Oculomotor?
Low Horizontal
Low Ratio
High Errors
Normal Vertical
Symblepharon
Partial or full adhesion from palpebral and bulbar conjunctiva
Epicapsular star
Congenital pigment on the anterior lens
Degenerative Retinoschisis
- Separation within the neurosensory retina most frequently between the outer plexiform layer and the inner nuclear layer.
- Most commonly located in the inferior temporal quadrant of the retina.
- Visual field testing may show an absolute scotoma corresponding to the area of the retinoschisis.
Posterior Scleritis
- A serious, potentially blinding condition that typically presents in patients under the age of 40.
- Inflammation can occur in both anterior and posterior segments either simultaneously or separately.
- Patients usually present with discomfort and pain, decreased visual acuity, restricted ocular movement, and mild proptosis.
- Most cases are idiopathic in nature, but can be associated with systemic conditions (Rheumatoid arthritis, and Wegener’s granulomatosis).
- Associated ocular findings include shallowing of the anterior chamber, exudative detachments of the retina and/or choroid, CHOROIDAL FOLDS, myositis, proptosis, and optic disc swelling.
Actinic Keratosis
- A precursor to squamous cell carcinoma.
- Appears as flat, scaly, dry skin that does not heal.
- May also be observed as a nodular or papillomatous-like lesion.
- More frequently observed in people with lightly pigmented skin with excessive exposure to ultraviolet light.
- Suspicious lesions should be biopsied.
PXF
Systemic Exfoliative condition, where lens dislocation and PXF Glaucoma can occur.
Signs
Trans-Illumination Defect
Ring exfoliated ring on anterior lens
Deposition of exfoliated material in the angle
Treatment
None, however topical glaucoma medication.
PCIOL insertion with capsular bag tightening.
Follow up
6 to 12 months. If glaucoma then 1 to 3 months due to IOP fluctuation.
Which of the two lenses, SiHy or Hydrogel, causes more protein formation?
Hydrogel
Which of the two lenses, SiHy or Hydrogel, causes more lipid deposition?
SiHy
Major reason why purchasing OT readers than Rx’d readers is ?
Generic PD is used and therefore visual discomfort many occur
What is the follow up of a patient with traumatic hyphema?
Daily basis for 3 days and then 4 weeks after initial hyphema to conduct Gonioscopy
You suspect Horner’s syndrome in your patient. What will the instillation of Cocaine do to both eyes and what is the purpose of Hydroxyamphtamine?
Cocaine = NO dilation of the horner’s eye and dilation of the good functioning eye.
Hydroxyamphtamine = tests for pre-ganglionic function.
Assuming no refractive error, which of the following color vision anomalies would possess the POOREST level of acuity?
A dichromat B deuteranope C trichromat D rod monochromat
D. Rod Monochromat
Since the pt is only using Rods and not cones, thus a lower Visual Acuity.
If your patient complains of epiphora, which of the following tests will help you determine if there is an obstruction of the lacrimal drainage system?
A. The Schirmer’s II test
B. The Jones I dye test
C. Phenol red thread test
D. Tear break-up time test (TBUT)
B. The Jones I dye Test
Note: TBUT = Mucin deficiency, Phenol Red = Dry eye, Schirmer’s = Basal tear evaluation
The denial of vision loss in patients with blindness is known as which of the following phenomenon?
A. Blindsight
B. Charles Bonnet syndrome
C. Malingering
D. Hysteria
E. Anton's syndromeE. Anton’s Syndrome
Patients with severe vision loss (such as cortical blindness) can often be unaware of their visual deficit. This denial of blindness is known as Anton’s syndrome, or visual anosognosia. In these cases, patients will act as if their vision is unaffected. They tend to run into walls, bump into objects, and walk around without the precautions that a blind person would take. When confronted about their vision loss and behavior, patients will make excuses such as “the lighting is poor” or “these glasses must be an old prescription.” This syndrome mostly occurs in patients with blindness due to occipital lobe disease, but it may also occur subsequent to cataracts, retinopathies, and optic nerve disease. The explanation of the mechanism and anatomy responsible for Anton’s syndrome is widely unknown and unclear. Typically, after several weeks or months, patients eventually become aware of their visual deficits.
Blindsight is the opposite of visual anosognosia. These patients have some visual function but are unaware of it and deny its existence. They lack awareness of visual stimuli, but respond to it.
Charles Bonnet syndrome occurs in patients with severe vision loss who experience hallucinatory images. These patients are completely aware the objects that they are seeing are not real, and there is no history of mental disorder.
Thimerosal is a common allergen and has recently become more of a concern as it is found in many vaccines as a preservative. What component of thimerosal renders it toxic?
a. Arsenic b. Copper c. Mercury d. Titanium e. Lead
c. Mercury
Thimerosal is an organic compound that contains mercury. Thimerosal is used as a preservative because it is necessary to prevent bacterial growth, especially in multi-dose vials of vaccines, to ensure that the vaccination does not become contaminated. If injected, a contaminated vaccine can result in death. However, recent investigations have revealed that, even in very small quantities, mercury can be neuro-toxic. This is especially true in young infants who require more vaccinations than were necessary in the past. As such, the FDA is attempting to limit, if not eliminate, the number of vaccines containing thimerosal.
Thimerosal was also once utilized by many companies as a preservative in contact lens cleaning solutions. However, many patients were sensitive to this component and suffered allergic or toxic reactions to the solution. It is now rarely, if at all, utilized by manufacturers of contact lens solutions. BAK, polyquad, and hydrogen peroxide are all good disinfectants currently used in contact lens cleaning solutions. People who suffer from allergies or have sensitive eyes are encouraged to use a hydrogen peroxide-based cleaning solution, as it does not contain any preservatives.
A patient uses Wellbutrin® to help manage his depression. Which of the following side effects is MOST commonly associated with this medication?
a. Deep vein thrombosis b. Urinary incontinence c. Thoughts of suicide d. Bloody sputum e. Alopecia
c. Thoughts of suicide
Wellbutrin® is a medication targeted at managing depression as well as seasonal affective disorder. People who take Wellbutrin® may experience side effects which include but are not limited to: tachycardia, confusion, hallucinations, suicidal thoughts, restlessness, erratic behavior or thoughts, insomnia, skin reactions such as a rash, among others. Studies have shown that Wellbutrin®, along with several other anti-depressant medications, increase the tendency of suicidal risk and behavior among children, adolescents and young adults. There does not appear to be an increased risk for persons older than 24 years of age.
When performing argon laser trabeculoplasty (ALT), which of the following BEST describes the anatomical location in which the aiming beam should be focused?
a. Scleral spur b. Schwalbe's Line c. Non-pigmented trabecular meshwork d. Junction of pigmented and non-pigmented trabecular meshwork e. Pigmented trabecular meshwork
d. Junction of pigmented and non-pigmented trabecular meshwork
The following describes the proper procedure for performing argon laser trabeculoplasty (ALT):
- Instillation of topical anesthetic and topical hypotensive agent (usually alpha-agonist) is the initial step
- A gonioscopy lens is placed on the eye with the semi-circular lens at 12 o’clock in order to view the inferior angle (usually the easiest area to see)
- The pigmented portion of the trabecular meshwork is identified
- The aiming beam should be focused at the junction of the pigmented (filtering trabecular meshwork) and non-pigmented (non-filtering) trabecular meshwork
Your 62 year-old female patient presents with complaints of a dark spot in the center of her vision in her right eye. A dilated fundus examination reveals a full-thickness macular hole with a small surrounding cuff of subretinal fluid and yellow deposits at the base of the defect. There is no observable posterior vitreous detachment. What stage would you categorize this macular hole?
a. Stage 4
b. Stage 2
c. Stage 1
d. Stage 3
d. Stage 3
Stage 3 macular holes typically have the following appearance:
- A full-thickness macular hole (350-600um) is present, having a smooth-edged appearance and a small, surrounding, donut-shaped cuff of subretinal fluid
- Yellow deposits can be observed at the base of the neuroretinal defect, along with perifoveal cystic changes
- At this stage an operculum may be present, but vitreofoveal separation still has not occurred
When analyzing a gas-permeable lens, you measure base curves of 7.58 and 7.84 with a radiuscope, and -1.00 and -2.50 on lensometry. What type of toric gas-permeable contact lens design do you have?
a. Back surface (base curve) toric
b. Front surface (F1) toric
c. Spherical power effect (SPE) bitoric
d. Thin-flex
e. Cylinder power effect (CPE) bitoric
c. Spherical power effect (SPE) bitoric
In order to determine which design of toric gas-permeable contact lens you have once the lens has been analyzed, the difference in base curve (BC) values and contact lens power (CLP) readings must be calculated first.
??BC1 = 7.58 = 337.5/7.58 = 44.50
?BC2 = 7.84 = 337.5/7.84 = 43.00
?Change in BC = 1.50 D ??
CLP1 = -1.00
?CLP2 = -2.50 ?
Change in CLP = 1.50 D ??
The differences in base curves and contact lens powers for the above gas-permeable contact lens are equal (both 1.50 D), indicating that the design of the lens is a spherical power effect (SPE) bitoric type. ??
If the change in BC does not equal the change in CLP, the lens type may either be a base curve toric or cylinder power effect (CPE) bitoric. The way to tell these two apart is that if 3/2 change in BC = change in CLP, then it may be considered a base curve toric.
