B9 Flashcards
Offers a high level of magnification and a wider field of view than a traditional ophthalmoscope, but they only offer one view of the interior of the eye
Monocular indirect ophthalmoscope
Projects three elements into the eye, rather than one, allowing the optometrist to get a 3D rendition of the interior of the eye which allows for a more thorough examination.
BIO
Created by the inflow and outflow of aqueous in the
anterior chamber of the eye.
IOP
T/F: IOP is performed in every exam of the human eye
True
When is Goldmann tonometry used?
-Follow up visits with patients who are on medication,
especially steroids, which may cause a significant and damaging increase in IOP.
-Post operatively IOP to make sure the inflammation from the surgical trauma has not caused a pressure spike.
What is the average number of drops of Pred Forte 1.0% does it take before the average patient will experience a pressure spike?
238
The gold standard of IOP
Goldmann tonometry
What does it mean if the mires are too thin?
- not enough dye
What does it mean if the mires are too thick?
- too much dye.
- —You need to have the patient set back and blink a few times and then wait 10-15 seconds for the dye to clear.
- the patient is watering
What is pressure measured in?
MmHg
Name 3 times you will see a patient where there is not a need to check the IOP
- ) Contact Lens Follow up for proper fitting of a CL
- ) When the patient complaint is they need you to recheck their spectacle rx
- )Anytime you are seeing a patient for a refractive follow up
What is one reason you would consider an IOP taken by Non-Contact Tonometry to be more accurate than Goldmann tonometry?
Post refractive surgical patients
T/F: Studies indicate that after 15 seconds or sooner on dry eye patients the cornea will dry and become significantly thinner which will alter your findings
True
With fundus Biomicroscopy, what is the orientation of the image?
The image is inverted and reversed from its actual location
Is fundus bio a contact or noncontact retinal evaluation?
Non-contact
If someone holds their breath, will they have a high or low IOP reading?
High
Will you have an overestimation or underestimation if your mires are too thin?
Underestimation
If you see lots of green spots what does this mean?
Where in the eye will there be more of a concentration
How would you treat this?
- allergic reaction to the fluorescence
Inferiorly
Give them artificial tears
What happens if someone has a ring around the cornea after performing?
When is this common?
You applied too much pressure on are on the cornea for too long
Common in older patients due to sensitive corneas
Used to scan lids, lashes, conj., and iris
Diffuse
Size of diffuse
Height: full
Width: 3-8mm
When do you use a parallelpipped?
To scan tissues when you want to see specific layers of tissue
Size of parallepipped
Height: full
Width: 5-7mm
—smaller than diffuse but larger than an optic section
T/F: the larger the angle that the lighthouse is extended the more tissue you will see
True
What is an optic section used for?
- noticing thinning of the cornea and measuring van Herrick angles
Size of optic section
Height: full
Width: narrow as possible without turning off the light
What is specular reflection used for?
To analyze the corneal endothelial cells and looking at the structures of the anterior and posterior lens capsule
What is retroillumination used for?
Seeing peripheral iridotamies and cataract spiking in cataracts
What is indirect illumination used for?
Checking the anterior chamber
When a patient notices curves and/or gaps in the beam when observing the macula with a Watzke-Allen Beam Test
+ Watzke Allen sign
When doing a fundus bio if you go to the ST what are you actually looking at?
IN
T/F: Tangential traction of photoreceptors from a central foveal dehiscence as the causative mechanism in the development of the majority of macular holes.
True
T/F: Careful interpretation of the Watzke-Allen sign may offer a technique for preoperatively determining visual prognosis
True
Testing for Watzke Allen sign will help you….
Confirm your diagnosis and offer the retinal surgeon some idea of post op VA potential
Which of the following (+) Watzke-Allan do you think would be a predictor for a favorable Post Op surgical outcome for a macular hole?
A. Beam is reported as thinned in both vertical and horizontal orientations when placed directly over the center of the macular hole.
B. Beam is reported as broken in both vertical and horizontal orientations.
C. Beam is reported as broken in one orientation and thinned in the other.
D. Beam is reported as kinked but not thinned or broken
A
Which of the following is a (+) Watzke-Allan?
A.-Beam is reported as thinned in both vertical and horizontal orientations when
placed directly over the center of the macular hole.
B.-Beam is reported as broken in both vertical and horizontal orientations.
C.-Beam is reported as broken in one orientation and thinned in the other.
D.-Beam is reported as kinked but not thinned or broken
E.-All of the above
E- all of the above
Which of the following (+) Watzke-Allan do you think would be a predictor for an unfavorable Post-Op outcome for a macular hole?
A.) Beam is reported as thinned in both vertical and horizontal orientations when
placed directly over the center of the macular hole.
B.) Beam is reported as broken in both vertical and horizontal orientations.
C.) Beam is reported as broken in one orientation and thinned in the other.
D.) Beam is reported as kinked but not thinned or broken
B. Beam reported as broken in both vertical and horizontal orientations
How does a surgeon treat a macular hole?
With a vitrectomy (this is the best way)
How is a vitrectomy performed?
The vitreous is removed that is pulling on the macula and a gas bubble is placed in the eye
What does the gas bubble in the eye for a vitrectomy help with?
Helps flatten the macular hole and holds it in place while the eye heals
What lenses are best for viewing the macula and ONH
60 or 78D
What lenses are useful for viewing lesions in the peripheral retina
90 Super field or the 90D ocular maxfield
Usually you will identify lesions in the peripheral retina with your ____ You will then want a better look with the ____lens
BIO better look with the 90D
T/F: you want the patient to look in the direction of the lesion
True
If someone has a lesion at 12 o clock position where do you want them to look when doing fundus micro
Straight up
When the biomicroscopy lens is centered over the pupil and the fundus is visualized, move the slit lamp _______ until the lesion can be seen.
Downward
T/F: Once the fundus is in focus, move the slit lamp in the same
direction of the lesion
False. The image is inverted so move it in the opposite direction
When identifying landmarks during fundus micro how do we describe size and location?
-use the patients optic disc as a reference point (helpful because the optic disc typically won’t change over time)
When its hard to establish a landmark, what do you do?
Use the optic nerve transillumination with parallellepiped slit image off to either side
What filter dramatically enhances the appearance of blood vessels as well as preretinal, intraretinal and subretinal blood.
Red free filter
If someone has a nevus when you use a red free filter will it still be present?
No
If someone has a hemorrhage will it still be present after using a red free filter
Yes
Eye care practitioners missed almost ____times as many optic disc hemorrhages through slit-lamp biomicroscopy than via fundus photograph observation.
5 times
Where do optic disc hemorrhages often appear?
Near areas of peripapillary atrophy, notching
or nerve fiber layer defects.
Optic disc hemorrhages are a risk factor for progression in all forms of ____
Glaucoma
Two-thirds of glaucomatous optic disc hemorrhages appear____
Inferotemporally
If glare is diffuse how do you want to move the condensing lens
Move the lens laterally toward the image side with the diffuse glare
With glare as one hot spot what do you do to get rid of it
Move the lens to the eyebrow
- then move the light source body slightly out of center click away form the optical path of the camera
- move your thumb away from the patients face
As you move the light source farther from the center click, what happens
The image becomes dimmer and makes it difficult to see
If you want to see the different parts of the retina doing fundus bio what do you want the patient to do
Look in the different directions or by moving the fixation light
