Comprehensive Medical Eye Examination

Question 1

State the purpose of the comprehensive medical eye examination

Answer 1

To reveal both existing and potential eye problems, even in the absence of specific symptoms.

Question 2

Name 3 reasons why a regular comprehensive eye examination may be beneficial.

Answer 2

1. Certain eye diseases cause no symptoms until they are too advanced for the effective treatment.
2. Eye health is an important indicator of general health.
3. Individuals who are at high risk for developing certain eye diseases can be monitored.

Question 3

Name the 5 principle areas covered by the history-taking interview

Answer 3

Chief complaint and present illness; ocular history; general medical and social history; family ocular and medial history; allergies, medications vitamins and supplements

Question 4

How should you respond to a patients request for medical advice or a diagnosis of the patients condition?

Answer 4

Refer the patient to the ophthalmologist for a diagnosis or medical advice, even if you think you know the answer.

Question 5

Define visual acuity.

Answer 5

The ability to discern fine visual detail

Question 6

A patients visual acuity measures 20/40. What does that first number represent? What does the second number represent?

Answer 6

The first number represents the distance in feet at which the test was preformed (distance of patient from chart). The second number indicates that the patient can read at 20 feet what a normal eye can read at 40 feet.

Question 7

You have measured a patients visual acuity without eyeglasses in place. The measurement was 20/60 in the right eye and 20/40 in the left eye. How would you write this patients visual acuity in the office record?

Answer 7

VISION
OD 20/60 Without correction
OS 20/40 Without correction

Question 8

What information is given by the pinhole acuity test?

Answer 8

The pinhole acuity test can reveal whether a patient’s below-normal visual acuity is the result of a refractive error or is due to some other cause.

Question 9

Give 2 reasons for including the near acuity test in the comprehensive examination

Answer 9

The patient complains that reading or other close work is difficult. There is reason to believe that the patient’s ability to accommodate is insufficient or impaired.

Question 10

Which 3 principal properties of the visual systems are evaluated by the ocular alignment and motility examination?

Answer 10

Eye movement (motility), eye alignment, fusional ability

Question 11

Name the 6 cardinal positions of gaze

Answer 11

Right and up, right, right and down, left and up, left, left and down.

Question 12

State the purpose of the prism and alternate cover test.

Answer 12

To measure the extent of misaligned eye’s deviation.

Question 13

State the purpose of the worth 4-dot test

Answer 13

To determine whether the eyes are perfectly aligned and, if so, whether the brain acknowledges the visual information from both eyes or suppresses the information from one eye; the test will also reveal diplopia.

Question 14

State the purpose of the titmus stereopsis test.

Answer 14

To determine whether the patient has fine depth perception and to quantify it in terms of binocular cooperation.

Question 15

What is the difference between a manifest and latent deviation?

Answer 15

A manifest deviation (tropia) is an ocular misalignment that is clearly evident on inspection.

A latent deviation (phoria) is an ocular misalignment that reveals itself with special testing because ordinarily it is prevented from becoming apparent by the patient’s normal fusion ability.

Question 16

What importance binocular pupillary response to light does the swinging-light test check?

Answer 16

Afferent pupillary defect.

Question 17

State the purpose of the visual field examination.

Answer 17

To measure the expanse and sensitivity of vision surrounding the direct line of sight (peripheral vision).

Question 18

During the confrontation field test, where do the patient and examiner fixate?

Answer 18

On each other’s uncovered eye

Question 19

What does the amsler grid test determine?

Answer 19

The presence and location of defects in the central portion of the visual field.

Question 20

Why is the measurement of intraocular pressure a critical part of the comprehensive eye examination?

Answer 20

For early detection of abnormal intraocular pressure a glaucoma, which may be present long before patients notice any symptoms such as vision loss.

Question 21

What are the 2 principles by which tonometers measure intraocular pressure?

Answer 21

Applanation and indentation

Question 22

Why is the pachymetry important?

Answer 22

Accurate measurement for the corneal thickness is necessary for diagnosis of many corneal diseases and aberrations such as corneal edema, keratoconus, and irregular astigmatism. Pachymetry has been found to be an important parameter in the diagnostic evaluation of glaucoma.

Question 23

State the purpose of the external eye examination.

Answer 23

To assess the ocular adnexa, external globe, and anterior chamber

Question 24

Describe the purpose of the flashlight test and state the 2 principal reasons it is preformed.

Answer 24

To estimate the depth of the anterior chamber and chamber angle; to alert the physician to avoid dilating the pupil as it may precipitate an attack of acute-angle closure.

Question 25

State 4 possible uses of the biomicroscope (slit lamp).

Answer 25

To obtain a magnified view of the patient’s ocular adnexa and anterior segment structures; to preform applanation tonometry with the Goldman tonometer; to examine the Fundus ; to preform gonioscopy.

Question 26

Describe the 78 D and 90 D handheld lenses and their use.

Answer 26

Non contact lenses used with a slit lamp that examine the optic nerve head and small areas of the posterior retina, macula, and vitreous.

Question 27

Define gonioscopy.

Answer 27

A special viewing method for examination of the anterior chamber angle; employs a mirrored or high-plus contact lens.

Question 28

Name the 2 types of ophthalmoscopes. How do they differ?

Answer 28

1. The direct ophthalmoscope is a handheld instrument with a light-and-mirror system that affords an upright, monocular survey of a narrow field of the ocular fundus magnified 15-fold.
2. The indirect ophthalmoscope is worn on the physician’s head and consists of a binocular viewing device and an adjustable lighting system wired to a transformer power source; the binocular system allows for a stereoscope view of the fundus.

Question 29

Name the 2 tests used to evaluate color vision.

Answer 29

Pseudoisochromatic color plates, 15-hue (farnsworth-Munsell D-15) test.

Question 30

What is the purpose of the schirmer test?

Answer 30

To measure the patient’s tear output.

Question 31

What is the purpose of staining the ocular surface with dye?

Answer 31

The purpose is to test the structural integrity of the corneal epithelium. Defects seen with corneal abrasions or punctate staining in dry eye disease are common examples of staining.

Question 32

Describe the corneal sensitivity test and its purpose.

Answer 32

The examiner touches the central portion of the cornea with a sterile wisp of cotton to determine whether the patient has normal corneal sensation.

Question 33

Describe the purpose of exophthalmometry.

Answer 33

To measure the position of the eyeball in relation to the bony orbital rim surrounding it and record the existence of proptosis.