Entrance Tests

Question 1

Examples of a few more entrance tests..

Answer 1

Hirschberg and Krimsky

Near Point of Convergence

Accommodative Amplitude

Stereopsis

Worth 4 Dot

Question 2

What is the Hirschberg test?

Answer 2

A penlight is held straight in front of a patients face at about 50 cm. the patient is instructed to fixate on the penlight with both eyes open. Occlude one eye at a time to observe the corneal reflex.

Rough objective and measurement of a deviation/strabismus. Evaluating the visual axes OU under binocular conditions at near.

Question 3

Hirschberg test is useful in what type of patients?

Answer 3

Young and uncooperative

Question 4

Should the Hirschberg test be done with or without glasses?

Answer 4

Without

Question 5

3 possible corneal reflex positions

Answer 5

Center of the pupil

Nasal to the pupil

Temporal to the pupil

Question 6

What is a strabismus?

Answer 6

When there is different corneal reflexes in the two eyes

Question 7

In the absence of the strabismus, the corneal reflex should be…

Answer 7

Centered in both eyes

Question 8

recording of Hirschberg test example

Answer 8

Hirschberg: no strabismus or ortho
Hirschberg: 44pd LET; Krimsky 45pd LET

Question 9

What is the Krimsky test?

Answer 9

Use prisms to determine the angle of deviation seen on the Hirshberg test.

Question 10

In Krimsky, prisms are placed in front of the ___________ ____ until the corneal reflexes are symmetrical.

Answer 10

Fixating eye

Question 11

Base out prism is used for _______

Answer 11

Esotropia

Question 12

Base in prism is used for ________

Answer 12

Exotropia

Question 13

What is NPC?

Answer 13

Near Point of convergence

Question 14

What is the point of NPC?

Answer 14

To determine the ability to converge and maintain fusion.

Question 15

Conditions for NPC

Answer 15

Done with correction

Good lighting

And star at at about 40 cm

Question 16

What objects are/can be used for NPC?

Answer 16

A penlight/transilluminator, red glass, and a near accommodative target

Question 17

NPC Prodecure

Answer 17

Instruct pt to look at the light

Ask pt to tell if it’s single of double, if double move object away

Move object towards pt while paying attention to pt eyes

record break point and recovery

Question 18

What is the break point of NPC?

Answer 18

The distance at which the pt sees double or you see an eye lose fixation

Question 19

What is the recovery point in NPC?

Answer 19

The distance at which the double vision becomes single vision, either by pt discretion or where you notice fixation

Question 20

Normal NPC finding

Answer 20

Break 2.5cm/Recovery 5cm

Question 21

If the NPC is abnormal..

Answer 21

Repeat with red glass over right eye (or red green glasses); then repeat a 3rd time with an accommodative target

Question 22

When should the NPC be repeated numerous times? Why?

Answer 22

When the pt has convergence insufficiency problems.

Because there will be changes in the NPC each time because of fatigue!

Question 23

NPC recording example

Answer 23

NPC sc light: 10cm/15cm, OD out, suppression
Red/Green: 15cm/20cm, OD out, suppression
Accommodative: 12cm/16cm, OD out suppression

Question 24

What is Amplitude of Accomodation?

Answer 24

Measures a pt’s ability to accommodate (in diopters)

Question 25

Conditions of Amplitude of Accomodation

Answer 25

Pt wears correction,
Near point accommodative target,
Occluder,
Illumination

Question 26

Push up Method of Accomodation

Answer 26

Tell pt to occlude one eye,
Tell pt to look at a row of letters,
Tell pt to keep the letters clear,
Slowly most the letters closer to pt until pt reports blur

Measure the distance

Question 27

Pull away method of Accomodation

Answer 27

Occlude one eye, tell pt to look at row of letters
Tell pt to keep letters clear
Hold letters/target very close to the pt open eye, about 0.5cm
Pt should report blur, so tell pt to say when pt reports clarity.

Measure distance in cm

Question 28

Recording Accomodation

Answer 28

method use (Push up or pull away)
Amplitude of Accomodation for each eye (D)

Ex. Amp of Accomodation: 9D OD, 10D OS

Question 29

Why measure Accomodation?

Answer 29

It decreases with age.

Affected by medications.

Trauma causing iris tear (damage)

Alcohol

Glaucoma can affect it

Diabetes, multiple sclerosis