Ophthalmology Anatomy Flashcards

1
Q

what is covered by the cornea?

A

iris

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2
Q

what are visible the blood vessels in the eyes called?

A

conjunctival vessels

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3
Q

where does the lacrimal fluid collect?

A

lacrimal lake

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4
Q

what are the small holes in the eyelids?

A

lacrimal punctum

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5
Q

what is the raised part of the eyelid that the punctum are on?

A

lacrimal papilla

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6
Q

junction between bulbar and palpebral conjunctiva

A

conjunctival cortex

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7
Q

what is lined by the conjunctiva?

A

sclera

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8
Q

what is the name of the corneoscleral junction?

A

limbus

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9
Q

where is the lacrimal gland located?

A

superolaterally

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10
Q

where is the nasolacrimal duct located?

A

inferomedially

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11
Q

three layers of eye

A

outer fibrous, middle vascular (uvea), inner retina (photosensitive)

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12
Q

two parts of outer fibrous layer

A

sclera and cornea

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13
Q

function of sclera

A

muscle attachment

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14
Q

function of cornea

A

2/3 of refractive power

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15
Q

three parts of uvea

A

iris, ciliary body, choroid

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16
Q

function of iris

A

control pupil diameter

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17
Q

function of ciliary body

A

controls iris, shape of lens, secretion of aqueous humour

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18
Q

function of choroid

A

nutrition and gas exchange

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19
Q

what does anterior segment contain?

A

aqueous humour

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20
Q

what is the anterior segment divided into?

A

anterior and posterior chambers

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21
Q

2 facts about posterior segment

A

posterior 2/3 of the eye, behind lens

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22
Q

what does the posterior segment of the eye secrete?

A

vitreous humour

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23
Q

what is the vitreous body?

A

made up of vitreous humour

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24
Q

path of aqueous humour

A

ciliary body –> posterior chamber –> anterior chamber –> canal of Schlemm –> venous system

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25
Q

what controls the release of aqueous humour into the venous system?

A

iridocorneal angle

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26
Q

artery that supplies the eye

A

ophthalmic artery

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27
Q

nerve that supplies the eye

A

optic nerve (CNII)

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28
Q

2 important branches of ophthalmic artery

A

forehead (scalp) branches and ciliary branches

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29
Q

what 3 veins does the orbit drain into?

A

superior ophthalmic vein, inferior ophthalmic vein, facial vein (anteriorly)

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30
Q

components of fundus

A

optic disc, macula, fovea,

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31
Q

function of fundus

A

posterior area where light is focussed

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32
Q

3 functions of optic disc

A

point of CNII formation, only point of entry/exit for blood vessels and axons of CNII, blind spot

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33
Q

what does the macula contain?

A

greatest density of cones

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34
Q

2 facts about fovea

A

1.5mm diameter depression, area of most acute vision

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35
Q

where is the fovea located?

A

centre of macula

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36
Q

3 layers of retina

A

photoreceptors, ganglion cells, axons of ganglion cells

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37
Q

are there photoreceptors in the optic disc?

A

no

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38
Q

features of fundoscopy

A

optic disc, central artery and vein of retina, nasal retina, temporal retina, branches of retinal vessels, macula of retina

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39
Q

where is light from objects in the left visual field processed?

A

right visual cortex

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40
Q

where is light from objects in the right visual field processed?

A

left visual cortex

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41
Q

transverse axis of eye movement

A

abduction/adduction

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42
Q

vertical axis of eye movement

A

elevation/depression

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43
Q

anteroposterior axis of eye movement

A

intorsion/extorsion

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44
Q

movement of lateral rectus

A

abduction of eyeball

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45
Q

nerve supply of lateral rectus

A

CNVI

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46
Q

movement of medial rectus

A

adduction of eyeball

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47
Q

nerve supply of medial rectus

A

CNIII

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48
Q

movement of superior oblique

A

depression of eyeball in adduction

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49
Q

nerve supply of superior oblique

A

CNIV

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50
Q

movement of inferior oblique

A

elevation of eyeball in adduction

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51
Q

nerve supply of inferior oblique

A

CNIII

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52
Q

movement of superior rectus

A

elevation of eyeball in abduction

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53
Q

nerve supply of superior rectus

A

CNIII

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54
Q

movement of inferior rectus

A

depression of eyeball in abduction

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55
Q

nerve supply of inferior rectus

A

CNIII

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56
Q

7 bones that make up the orbit

A

frontal, lacrimal, ethmoid, maxilla, zygomatic, sphenoid, palatine

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57
Q

is the apex of the orbital pyramid anterior or posterior?

A

posterior

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58
Q

is the base of the orbital pyramid anterior or posterior?

A

anterior

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59
Q

what are the 4 margins of the base of the orbital pyramid?

A

lateral, medial, superior, inferior

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60
Q

axis of orbit

A

anterolateral

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61
Q

axis of eyeball

A

anterior

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62
Q

blowout fractures involve…

A

medial wall and orbital floor

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63
Q

where is the outside of the orbit most likely to fracture?

A

suture

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64
Q

two parts of orbicularis oculi

A

palpebral and orbital

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65
Q

function of orbital part of orbicularis oculi

A

forced closing of the eye

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66
Q

function of palpebral part of orbicularis oculi

A

blinking

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67
Q

nerve supply of orbicularis oculi

A

CNVII

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68
Q

6 ligaments of eyelids

A

lateral palpebral, medial palpebral, superior tarsus, inferior tarsus, tendon of LPS, orbital septum

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69
Q

superior tarsus muscle aka

A

Mueller’s muscle

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70
Q

tarsal glands aka

A

Meibomian glands

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71
Q

function of Meibomian glands

A

lipid secretion

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72
Q

innervation of the lacrimal gland

A

CNVII (parasympathetic)

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73
Q

where does lacrimal fluid collect?

A

lacrimal lake

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74
Q

where does lacrimal fluid drain?

A

lacrimal puncta

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75
Q

where does lacrimal fluid go after draining through the lacrimal puncta?

A

lacrimal sac and nasolacrimal duct

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76
Q

insertion of rectus and oblique muscles

A

sclera

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77
Q

origin of rectus muscles

A

common tendinous ring

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78
Q

origin of oblique muscles

A

sphenoid bone

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79
Q

origin of LPS

A

lesser wing of sphenoid

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80
Q

insertion of LPS

A

skin and tarsus of superior eyelid

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81
Q

afferent nerve involved in blink reflex

A

CNV1

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82
Q

efferent nerve involved in blink reflex

A

CNVII

83
Q

oculocardiac reflex

A

reflex bradycardia in response to tension on extraocular muscles or pressure on eyes

84
Q

4 sympathetic reflexes of the eye

A

open eyes wider, pupillary dilatation, emotional lacrimation, focus on far objects

85
Q

3 parasympathetic reflexes of the eye

A

pupillary constriction, reflex lacrimation, focus on near objects

86
Q

innervation of LPS

A

CNIII (sympathetic)

87
Q

muscle that constricts pupil

A

sphincter pupillae

88
Q

muscle that dilates pupil

A

dilator pupillae

89
Q

sphincter pupillae fibres encircle…

A

internal circumference of iris

90
Q

origin of dilator pupillae

A

external circumference of iris

91
Q

insertion of dilator pupillae

A

internal circumference of iris

92
Q

which end of dilator pupillae is mobile?

A

internal circumference of iris

93
Q

non-physiologically enlarged pupil

A

mydriatic pupil

94
Q

non-physiologically constricted pupil

A

miotic pupil

95
Q

fixed-dilated/blown pupil indicates…

A

CNIII pathology

96
Q

fixed pin-point pupil indicates…

A

opiate drugs

97
Q

sensory component of pupillary light reflex

A

ipsilateral CNII

98
Q

motor component of pupillary light reflex

A

bilateral CNIII

99
Q

light reflex in stimulated eye

A

direct

100
Q

light reflex in non-stimulated eye

A

consensual

101
Q

3 steps of first neurones in light reflex

A
  1. retinal ganglion cells pass via ipsilateral optic nerve
  2. decussate in optic chiasm
  3. synapse in pretectal nucleus in midbrain
102
Q

path of second neurones in light reflex

A

pretectal nucleus to Edinger-Westphal nucleus

103
Q

path of third neurones in light reflex

A

Edinger-Westphal nucleus via CNIII (inferior division) to synapse in ciliary ganglion

104
Q

path of fourth neurones in light reflex

A

supply sphincter pupillae muscles via short ciliary nerves

105
Q

what does ciliary muscle do in far vision?

A

relaxes

106
Q

what does ciliary muscle do in near vision

A

contracts

107
Q

innervation of ciliary muscle

A

CNIII

108
Q

three types of tears

A

basal, reflex, emotional

109
Q

basal tears

A

corneal health, clean, nourish and hydrate avascular cornea, contain lysozymes to hydrolyse bacterial walls

110
Q

reflex tears

A

extra tears in response to mechanical or chemical stimulation

111
Q

afferent nerve of reflex tears

A

CNV1 (from cornea/conjunctiva)

112
Q

efferent nerve of reflex tears

A

CNVII (parasympathetic)

113
Q

branch of CNVII that carries parasympathetic axons to lacrimal gland

A

greater petrosal nerve

114
Q

3 steps of route of presynaptic sympathetic axons from CNS to head and neck

A
  1. exit spinal cord at T1
  2. ascend within sympathetic chain
  3. synapse in superior cervical ganglion
115
Q

4 steps of route of postsynaptic sympathetic axons from CNS to head and neck

A
  1. enter external and internal carotid nerves
  2. pass onto surface of external and internal carotid arteries
  3. carried to organs of head and neck from branches of these arteries
  4. ophthalmic artery carries axons to the orbit
116
Q

what do the parasympathetic ganglia in the head supply?

A

eye, lacrimal gland, salivary glands

117
Q

what does the vagus nerve supply?

A

organs of neck, chest and abdomen as far as midgut

118
Q

what do the sacral spinal nerves supply?

A

hindgut, pelvis, perineum

119
Q

do parasympathetic fibres synapse in the ciliary ganglion?

A

yes

120
Q

do sympathetic fibres synapse in the ciliary ganglion?

A

no

121
Q

where is the ciliary ganglion located?

A

bony orbit

122
Q

what fibres contribute to the ciliary ganglion?

A

CNIII

123
Q

where does CNIII connect with CNS?

A

junction of midbrain and pons

124
Q

what sinus does CNIII pass through?

A

cavernous sinus

125
Q

what does CNIII supply?

A

somatic motor to majority of extraocular muscles, presynaptic parasympathetic axons to ciliary ganglion

126
Q

2 divisions of CNIII

A

superior and inferior

127
Q

4 layers of meninges

A

dura mater, arachnoid mater, subarachnoid space, pia mater

128
Q

sensory supply of dura mater

A

CNV

129
Q

function of dura mater

A

encloses venous sinuses

130
Q

what does arachnoid mater contain?

A

arachnoid granulations

131
Q

what is in the subarachnoid space?

A

circulating CSF and blood vessels

132
Q

what does pia mater adhere to?

A

brain and entering/leaving vessels/nerves

133
Q

how to access CSF

A

lumbar puncture at L3/4/5 IV disc levels

134
Q

where does subarachnoid space end inferiorly?

A

L2

135
Q

what does the subarachnoid space communicate with at specific areas in the brain?

A

ventricles

136
Q

6 ventricles of the brain

A

right lateral, left lateral, midline 3rd, midline 4th, cerebral aqueduct, central canal

137
Q

8 steps of CSF circulation

A
  1. secreted by choroid plexus
  2. through right and left lateral ventricles
  3. through midline 3rd ventricle
  4. through cerebral aqueduct
  5. through midline 4th ventricle
  6. mainly into subarachnoid space, but some into central canal
  7. reabsorbed in arachnoid granulations
  8. into dural venous sinuses
138
Q

function of arachnoid granulations

A

reabsorb CSF

139
Q

Monro-Kellie hypothesis

A

if one structure in the brain increases in volume, the others must decrease in volume to compensate

140
Q

what percentage of patients with ICP report visual problems?

A

65-75%

141
Q

at what ICP is intervention required?

A

> 20mmHg

142
Q

optic discs specifically due to raised ICP

A

papilloedema

143
Q

what can brain herniate through in raised ICP?

A

dural septae

144
Q

4 sections of cranial cavity created by dural septae

A

falx cerebri, falx cerebelli, diaphragma sellae, tentorium cerebelli

145
Q

what nerve is damaged in a ‘down and out’ eye?

A

CNIII

146
Q

what nerve is damaged if the eye cannot move inferomedially?

A

CNIV

147
Q

what nerve is damaged in medial deviation of the eye?

A

CNVI

148
Q

which component of the blood-ocular barrier is located in the anterior segment of the eye?

A

blood-aqueous barrier

149
Q

which component of the blood-ocular barrier is located in the posterior segment of the eye?

A

blood-retinal barrier

150
Q

is epithelium hydrophilic or hydrophobic?

A

hydrophobic/lipophilic

151
Q

is stroma hydrophilic or hydrophobic?

A

hydrophilic/lipophobic

152
Q

3 major functions of CSF

A

mechanical protection, homeostatic function, circulation

153
Q

specialised cells that secrete CSF

A

choroidal cells

154
Q

networks of capillaries in the walls of brain ventricles

A

choroid plexus

155
Q

what ions are transported in CSF secretion?

A

sodium, chloride, bicarbonate

156
Q

does CSF secretion depend on other external factors?

A

no

157
Q

where does CSF return to venous circulation?

A

superior sagittal sinus (SSS)

158
Q

how does CSF get into SSS?

A

arachnoid granulations

159
Q

what restricts the blood supply to the brain?

A

blood-brain barrier (BBB)

160
Q

what is the site of the BBB?

A

endothelial cells of capillaries

161
Q

3 components of BBB

A

capillary endothelium, basal membrane, perivascular astrocytes

162
Q

2 parts of the brain that don’t have a BBB

A

circumventricular organs, pineal gland

163
Q

3 types of tumours of choroid plexus, CSF and ventricles

A

colloid cyst, ependymomas, choroid plexus tumours

164
Q

3 types of ventricular haemorrhages

A

epidural haematoma, subdural haematoma, subarachnoid haematoma

165
Q

where is aqueous humour produced?

A

ciliary body

166
Q

what vitamin is a powerful antioxidant in the eyes?

A

vitamin C (ascorbate)

167
Q

two layers of ciliary epithelium

A

pigment epithelium of retina (PE), nonpigmented epithelium (NPE)

168
Q

what ions have a net movement through PE and NPE during aqueous humour production?

A

Cl- and Na+

169
Q

what drugs can be used to block production of aqueous humour?

A

carbonic anhydrase (CA) inhibitors

170
Q

name 2 CA inhibitors

A

dorzolamide and acetazolamide

171
Q

what is the scope of the visual field

A

150 degrees

172
Q

hemiretina from fovea to nose

A

nasal hemiretina

173
Q

hemiretina from fovea to temporal bone

A

temporal hemiretina

174
Q

Hebb’s postulate

A

when an axon of cell A is near enough to excite cell B on a regular basis, its efficiency to excite cell B increases

175
Q

3 steps in pathway for signal transmission

A

photoreceptors –> bipolar cells –> ganglion cells

176
Q

receive input from photoreceptors and project to other photoreceptors and bipolar cells

A

horizontal cells

177
Q

receive input from bipolar cells and project to ganglion cells, bipolar cells and other cells of their own type

A

amacrine cells

178
Q

conversion of electromagnetic radiation to neural signals

A

transduction

179
Q

4 regions of a photoreceptor cell

A

outer segment, inner segment, cell body, synaptic terminal

180
Q

glutamate level in low light levels in dark current channel

A

higher

181
Q

glutamate level in high light levels in dark current channel

A

lower

182
Q

resting membrane potential of a photoreceptor

A

~-20mV

183
Q

potential of sodium and potassium in the dark

A

equal

184
Q

potential of sodium and potassium in response to light

A

potassium is higher

185
Q

2 components of rhodopsin

A

retinal + opsin

186
Q

what is retinal?

A

vitamin A derivative

187
Q

what is opsin?

A

G-protein coupled receptor

188
Q

what does light to do rhodopsin?

A

converts 11-cis-retinal to all-trans-retinal

189
Q

4 steps to molecular mechanism of eyes

A
  1. rhodopsin activates transducin
  2. transducin activates phosphodiesterase
  3. phosphodiesterase hydrolyses cGMP
  4. reduced concentration of cGMP leads to closure of sodium channels
190
Q

what is the high gain mechanism?

A

1 opsin activates 1000 transducin
1 PDE hydrolyses 1000 cGMP

191
Q

which photoreceptor is associated with dark current channels?

A

rods

192
Q

which photoreceptor is associated with light current channel?

A

cones

193
Q

glutamate level in high light levels in light current channel

A

higher

194
Q

glutamate level in low light levels in light current channel

A

lower

195
Q

the ability to distinguish between two nearby points

A

visual acuity

196
Q

what determines visual acuity?

A

photoreceptor spacing

197
Q

which type of photoreceptor is concentrated at the fovea?

A

cones

198
Q

where are rods distributed?

A

all over the eye

199
Q

which type of photoreceptor has high convergence?

A

rods

200
Q

which type of photoreceptor has low convergence?

A

cones

201
Q

which type of photoreceptor has high light sensitivity?

A

rods

202
Q

which type of photoreceptor has low light sensitivity?

A

cones

203
Q

which type of photoreceptor has low visual acuity?

A

rods

204
Q

which type of photoreceptor has high visual acuity?

A

cones