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II. Diagnosing and Prescribing > Final > Flashcards

Final Flashcards

1
Q

Are most children born more myopic of hyperopic?

A

hyperopic

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2
Q

What causes a hyperopic shift in vision?

A

gradient index goes away (decreases spherical aberrations)

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3
Q

What is axial hyperopia due to?

A

short axial length

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4
Q

What is refractive hyperopia due to?

A

low power cornea

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5
Q

What is the type of hyperopia that cannot be overcome by accommodation?

A

absolute

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6
Q

What is the type of hyperopia that is within the range of accommodation?

A

facultative

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7
Q

What is the type of hyperopia that is concealed by a spasm of accommodation?

A

latent

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8
Q

What is the type of hyperopia that is revealed by routine refraction (dry)?

A

manifest

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9
Q

What is the type of hyperopia that is revealed by cycloplegic refraction?

A

wet

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10
Q

At what age does hyperopia increases for a second time?

A

about 55 years old

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11
Q

What symptoms worsen with near work for hyperopes?

A
  1. headache (frontal or occipital)
  2. asthenopia
  3. fatigue, sleepy
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12
Q

What are the unique aspects about hyperopic refractions?

A
  1. unstable retinoscopy
  2. monocular subjective usually takes least amount of plus correction
  3. binocular sphere check should take more plus than monocular
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13
Q

What are the common binocularity/cover test results for hyperopes +1.00 to +3.00 when uncorrected?

A
  1. often eso, distance and near
  2. high phoria with symptoms
  3. constant tropia with suppression with no symptoms
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14
Q

What are the common near test results for hyperopes +1.00 to +3.00 when uncorrected?

A
  1. BCC: variable, often high add
  2. NRA/PRA: NRA over +2.75
  3. dynamic: variable, high positive lag
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15
Q

What percentage of patients are over +3.00?

A

less than 3%

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16
Q

What are the common signs and symptoms of a over +3.00 hyperope?

A
  1. headache
  2. asthenopia
  3. strabismus more likely
  4. amblyopia more likely
  5. other developmental delays because motor development difficult
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17
Q

Where should you start for your retinoscopy for a hyperope?

A

make sure “E” is blurry before

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18
Q

If your patient is hyperopic and ortho or exo uncorrected, what should be watched for after correction is given?

A

high exophoria/exotropia

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19
Q

What are the drops given to children for a cycloplegic refraction? 1. Adults? 2

A
  1. cyclopentolate

2. two drops of 1% tropicamide

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20
Q

What is usually not rechecked while doing a cycloplegic refraction?

A

cyl

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21
Q

What is expected for a cycloplegic refraction of a hyperope? 1. What is this due to? 2

A
  1. +0.50 or more plus

2. latent hyperopia or loss of tonic accommodation

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22
Q

What is expected for a cycloplegic refraction of a myope? 1. What is this due to? 2

A
  1. +0.25 to +0.50

2. loss of tonic accommodation

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23
Q

What is expected for a cycloplegic refraction of a emmetrope? 1. What is this due to? 2

A
  1. +0.25 to +0.50

2. loss of tonic accommodation

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24
Q

If phoria is not a problem for the patient what should be prescribed to a hyperope relative to the manifest Rx?

A

+0.25 or +0.50 less than

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25
Q

If phoria is a problem for the patient what should be prescribed to a hyperope relative to the manifest Rx?

A

full Rx

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26
Q

What are common outcomes or steps to take when prescribing for a hyperope?

A
  1. full Rx may not be accepted unless takes steps over several glasses to get to full
  2. may only be useful at near
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27
Q

What is the most significant effect of a hyperopic Rx for a patient?

A

comfort

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28
Q

Why are a smaller eye size for glasses preferred for a hyperopic Rx?

A
  1. less weight

2. better cosmetic appearance

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29
Q

What is an average corneal curvature?

30
Q

What percentage of Americans are myopic? 1. When does it usually present in children? 2. What gender is more likely to be myopic? 3

A
  1. 33%
  2. 8 to 11 years
  3. girls
31
Q

What type of activities reduce the odds of developing myopia?

A

outdoor activities

32
Q

What are the key features of myopia?

A
  1. distance blur, near clear
  2. longer axial length or higher corneal power
  3. high AC/A
  4. high accommodative lag
  5. accommodation may reduce due to misuse
  6. near phoria less exo when corrected
33
Q

If you refract at a longer distance than you fit for glasses is the Rx over or under minused?

34
Q

At what Rx is the vertex distance essential and has a large impact on the glasses?

A

+- over 5D

35
Q

What is the best way to measure the vertex distance?

A

with a distometer

36
Q

What are the signs and symptoms of an over minused patient?

A
  1. headaches
  2. asthenopia
  3. esophoria
  4. blur on BI vergences at distance
  5. NRA over +2.75
37
Q

When is the only time you would give less minus than their manifest Rx?

A

symptoms of over-minused

38
Q

Is it easier for a child or an adult to reduce minus Rx because they are over-minused?

39
Q

Why should progressive myopes never be under minused?

A

progress myopia faster

40
Q

What is the reason for pseudomyopia?

A

ciliary muscle spasm so accommodation making an emmetrope or hyperope appear myopic

41
Q

What is having different amounts of refractive error between the two eyes called? 1. When is it clinically significant? 2

A
  1. anisometropia

2. 1.00D sphere difference

42
Q

What is having two different types of refractive error (ie myopia and hyperopia) between the two eyes called?

A

antimetropia

43
Q

What might the signs and symptoms be for a patient with OD: -0.50 DS and OS: -3.00 DS?

A
  1. few complaints
  2. possible exo at near
  3. no stereo until corrected
44
Q

What might the signs and symptoms be for a patient with OD: -0.50 DS and OS: +3.00 DS?

A
  1. few complaints, maybe some fog
  2. possible complaints at near
  3. amblyopia likely (OS suppressed)
45
Q

What is it called when the patient cannot see well in one meridian?

A

meridional amblyopia

46
Q

What percentage of the population has anisometropia? 1. At what age does it increase? 2

A
  1. 2 to 6%

2. 5 years

47
Q

What can induce anisometropia? 1. What is the best way to correct this? 2

A
  1. refractive/cataract surgery

2. contact lens

48
Q

What is a difference in image size due to correction called? 1. What are the symptoms of this? 2

A
  1. aniseikonia

2. nausea, dizziness, distortions

49
Q

What are the possible causes of asthenopia of headaches in anisometropia patients?

A
  1. accommodation
  2. induced lateral and vertical prism
  3. aniseikonia
50
Q

What are some key features that present in an anisometropia patient?

A
  1. amblyopia and/or suppression
  2. reduced stereo
  3. induced phoria, lateral or vertical
  4. asthenopia or headache
51
Q

Are axial anisometropia patients better corrected with glasses or contacts?

52
Q

What is important to tell the patient about using their glasses when they are anisometropes?

A

turn head, not eyes (helps avoid induced prism)

53
Q

What does the use of contact lenses eliminate in anisometropia?

A
  1. aniseikonia

2. induced vertical or lateral prism of glasses

54
Q

What are reasonable alternatives if an anisometropia patient is complaining of induced vertical prism with their bifocal?

A
  1. 2 Rx’s, one for distance and one for near
  2. CL and readers
  3. monovision CL’s
  4. slab off
55
Q

What are ways to reduce induced vertical and lateral prism in a patient that still wants or needs to wear glasses?

A
  1. use small eye size
  2. fit Rx very close to eyes
  3. avoid progressive bifocals
56
Q

What produces aniseikonia?

A
  1. correcting refractive anisometropia with glasses
  2. correcting axial anisometropia with CLs
  3. retinal stretching
57
Q

What are the sources of total ocular astigmatism?

A
  1. corneal toricity (with the rule)
  2. lenticular toricity (against the rule)
  3. variations in refractive index of ocular media
  4. irregular foveal shape
58
Q

What are the types of astigmatism?

A
  1. compound hyperopic
  2. compound myopic
  3. simple hyperopic
  4. simple myopic
  5. mixed
59
Q

What does regular astigmatism refer to? 1. Irregular? 2

A
  1. meridians 90deg apart

2. meridians not 90deg apart

60
Q

What does with-the-rule astigmatism refer to? 1. Against-the-rule? 2. Oblique? 3

A
  1. 180deg (vertical meridian steeper)
  2. 90deg (horizontal meridian steeper)
  3. 35/135deg
61
Q

What percentage of the population has astigmatism? 1. Which type appears to be hereditary? 2

A
  1. 15-20% of population

2. high oblique astigmatism

62
Q

What are the key symptoms of astigmatism?

A
  1. meridional blur
  2. monocular diplopia
  3. asthenopia
  4. headaches
63
Q

What causes the headaches seen with astigmatism?

A
  1. fluctuations in accommodation

2. squinting of lids

64
Q

What is the order from easiest astigmatism to see with to hardest?

A
  1. axis 180
  2. axis 90
  3. oblique axis
65
Q

When is squinting to help eliminate astigmatism most useful?

66
Q

If visual acuity does not improve to 20/20+ after astigmatism corrected what should be considered?

A
  1. irregular astigmatism

2. meridional amblyopia

67
Q

What should always be the first choice regarding children and their astigmatism?

A

full correction

68
Q

What should be done to demonstrate the astigmatism that you will be giving a patient?

A

trial frame with patient walking around

69
Q

What is a major benefit of contact lens correction for astigmatism?

A

full corrections without adaptation problems

70
Q

When making a cut in cylinder power, what must also be adjusted?

71
Q

If an astigmatic patient needs a movement in axis of the cyl, where should it move towards?

A

90 or 180 meridians

II. Diagnosing and Prescribing (2 decks)

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