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FS Lectures > Ophthalmology: Ophthalmology and Naval Aviation > Flashcards

Ophthalmology: Ophthalmology and Naval Aviation Flashcards

1
Q

Types of Cataracts

A
  • Nuclear Sclerotic
  • Cortical
  • Posterior Subcapsular
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2
Q

Symptoms of cataracts

A

Decreased VA

Both with bright light and issues with glare during nightime

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3
Q

Nuclear Sclerotic Cataracts

A

Yellow-brown nucleus from aging

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4
Q

Cortical Cataracts

A

Whitish clefts or spokes

From aging or trauma

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5
Q

Posterior Subcapsular

A

Central posterior frothy plaque with night-time glare and halo complaints

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6
Q

Treatment for Cataracts

A

Surgical with IOL (intra-ocular lens)

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7
Q

True/False

All patients with cataracts require a waiver

A

True

If vision is 20/20 BCVA or better and pt has a negative glare test, they can continue flying without surgery requirement (may need Ophtho follow-up every 6 months due to risk of progression)

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8
Q

Pilot with cataract and BCVA less than 20/20…

A

…disqualified from flying until successful surgical removal

Note: waiver to SG 1 may be considered after surgery, provided VA returns to 20/20, is within refraction limits, and Glare test is negative (normal)

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9
Q

True/False

Post-surgery waivers for lens implant (during cataract surgery) are usually given to patients with multi-focal lenses

A

False

NO multi-focal lenses in order to be considered

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10
Q

Three classes of photopigment found in retinal cone cells

A
  • Red
  • Green
  • Blue
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11
Q

Genes that specify the ____ and _____ sensitive photo-pigments are located on the X chromosome

A

Red and Green

Remember: ordering Red and Green chile in New Mexico is called “Xmas”

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12
Q

The gene that specifies the _____ photo-pigment is located on chromosome 7

A

Blue

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13
Q

Protanopia

A

Red Defect

First described

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14
Q

Deuteranopia

A

Green Defect

Second described

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15
Q

Tritanopia

A

Blue Defect

Third described

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16
Q

All 3 photo-pigments intact, but one has reduced sensitivity

A

Anomolous Trichromatism

MOST COMMON

  • Red = protanomaly*
  • Green = deuteranomaly*
  • Blue = tritanomaly*
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17
Q

True/False

Monochromatism (one functioning photo-pigment) is rare

A

True

Roughly 0.003%

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18
Q

Dichromatism

A

Two functioning photo-pigments

  • Red defect = protanopia*
  • Green defect = deuteranopia*
  • Blue defect = tritanopia*
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19
Q

Red-Green Color Deficiency

A

Protan and Deutan defects

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20
Q

True/False

Women have a higher prevalence of red-green color deficiency

A

False

  • Prevalence in men = 8%*
  • Prevalence in women = 0.40%*
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21
Q

PIP passing requirements

A

12 of 14 correct (testing for color vision)

Remember: 8% of males fail PIP

Note: PIP stands for pseudoisochromatic plates

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22
Q

How many seconds per slide while conducting a PIP

A

3 seconds

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23
Q

How many males fail a FALANT

A

approx. 5%
* Only allowed for aviators who have been “grand-fathered” in*
* FALANT stands for Farnsworth Lantern*

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24
Q

Pass for FALANT

A

First run 9/9 = pass

  • Need 16/18 to pass “second run” (tests two and three if < 8/9 on the first)*
  • Note: 2 seconds to view each presentation as opposed to PIP which is 3 seconds per slide*
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25
Q

Computerized Color Testing

A

Rabin Cone Contrast Test (CCT) - USAF aviation standard

Waggoner Computerized Color Vision Test (WCCVT) - world wide civilian use

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26
Q

Uncorrected VA varies with class

SG1 20/?

A

SG1 20/100

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27
Q

Pass for CCT

A

55+ in each eye

Note: monocular testing

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28
Q

Pass for WCCVT

A

“Mild” or “Normal” (computer generated)

Note: binocular testing

29
Q

Hardest color vision test to pass

A

PIP

FALANT is easier (5% fail compared to 8%)

30
Q

FALANT is ___% sensitive for CVD

A

35% (allows mild to pass)

Computer tests are 99% sensitive/specific

31
Q

Ways applicants “cheat” color vision testing

A
  • X-chrome contact lens
  • Tinted glasses
  • Wrong lighting
  • Wrong test distance
  • Memorizing test
32
Q

Uncorrected VA varies with class:

SG1 = 20/?

A

SG1 20/100

33
Q

Uncorrected VA varies with class:

SG2 = 20/?

A

SG2 20/200

34
Q

Uncorrected VA varies with class:

SG3 20/?

A

SG3 20/400

35
Q

True/False

Rotary Wing Aircrew must have 20/100 uncorrected VA (same as SG1)

A

True

36
Q

True/False

Amblyopia is typically waived for applicants

A

False

Pathologic vision loss is also NOT waived for any class (i.e., optic neuritis, retinopathy, etc.)

37
Q

“Goodlite” for SNA (uncorrected)

A

20/40-0

38
Q

Goodlite (BCVA) for SNA and Aviators

A

20/20-0

39
Q

“Goodlite” for SNFO, Aircrew, etc.

A

20/20-3

40
Q

Stereo Vision is required for…

A

SG1, SNFS, Helo aircrew

NO waivers considered for aviators in actual control of aircraft

41
Q

“Pass” for stereo vision:

AFVT

Verhoeff

Randot

A

AFVT = line “D” (25 arcsec)

Verhoeff = 8/8

Randot = 40 arcsec

42
Q

Waiver requests for defective stereo vision must include a complete exam with _________ from waiver guide filled out entirely.

A

ocular motility worksheet

43
Q

Risk factors for retinal detachment

A
  • Myopia > -8.00 D
  • Age
  • Head Trauma
  • Diabetes
  • Lattice Degeneration of peripheral retina
44
Q

Symptoms of Retinal Detachment

A
  • Curtain of blur
  • Flashing lights
  • Floaters
  • VA loss
  • Macular detachment
  • Peripheral Field Loss
45
Q

Retinal Detachment Waivers can be requested ____ to ____ weeks following laser treatment

A

4-6 weeks

Note: 3 month wait for intraocular surgery

46
Q
A

Central Serous Retinopathy

47
Q

Symptoms of CSR

A

Sudden, painless decrease in central vision or metamorphopsia (distorted vision)

  • Note: usually found in males with type A personalities (think aviators/surgeons)*
  • Idiopathic, associated with recent steroid use*
48
Q

Disposition for CSR

A

CD (waiver considered for designated personnel)

  • Must remain down until complete VA recovery (spontaneous recovery usually within several weeks)*
  • Repeated attacks can lead to permanent vision loss (focal laser ablation of leaks is considered for chronic/recurrent CSR)*
49
Q

Waiver Requirements for CSR

A

Normal Amsler Grid

Asymptomatic vision

Baseline BCVA of 20/20

AMS and copy of last aviation duty exam

Copies of all eye care notes

50
Q

Limits for phorias Class I

A

6 Esophoria

6 Exophoria

1.5 Hyperphoria

Note: no waivers for SNA applicants outside limits

51
Q

Class II/III limits for phorias

A

NOHOSH or NOTOSP

52
Q

True/False

History of eye muscle surgery at ANY age is CD for any aviation billet that requires stereopsis with NO waivers considered for Class 1 applicants

A

True

Note: waivers considered for Class II and III (Helo/SAR = NO waivers)

53
Q
A

Pterygium (extends to the cornea)

less than 1mm is NCD (waivers considered for greater than 1 mm if asymptomatic with VA 20/20)

54
Q
A

Pinguecula

  • Benign growth (plural = pingueculae) similar to a callus except on the conjunctiva*
  • Note: pinguecula can become pterygiums*
55
Q

“Surfer’s eye” or “Farmer’s Eye”

A

aka Pterygium

People who spend long hours in the sun or in dusty/dry conditions are at increased risk

56
Q

Possible risk of pterygium surgery

A

Astigmatism (refractive error causing blurry or distorted vision)

57
Q

Treatment for allergic conjunctivitis

A

Prescription ophthalmic antihistamines and mast cell stabilizers

OTC or prescription vasoconstrictors/decongestants/corticosteroids are NOT approved

58
Q

High IOP without any vision loss or nerve cupping

A

Ocular HTN

59
Q

Optic nerve disease characterized by a pattern of VF loss and optic atrophy associated with cupping of the optic nerve

A

Glaucoma

60
Q

True/False

Laser treatment to angle/iris is acceptable for Glaucoma waiver

A

True

Note: open angle glaucoma requiring incisional surgery will NOT be considered

61
Q

True/False

Narrow angle glaucoma will be considered for waiver after surgical OR laser treatment

A

True

Unlike open angle glaucoma where incisional surgery is CD without a possible waiver

62
Q

General Waiver considerations for Glaucoma

A

Minimal visual field loss (without miotic pressure drops)

Acceptable drops = prostaglandins, B-blockers (must be asymptomatic), and carbonic anhydrase inhibitors

63
Q

Keratoconus

A

Progressive corneal ectasia (thinning/bulging)

  • Findings:*
  • increase in myopia and astigmatism*
  • cone seen on red reflex with dilated pupil*
  • “Fleisher ring” (iron line at cone base)*
64
Q
A

Fleischer Ring (seen in Keratoconus)

65
Q

True/False

Keratoconus is CD in applicants and designated personnel

A

True

CD for applicants, but “case-by-case” for designated personnel

  • Class I aviators require corneal cross-linking treatment at DOD center*
  • Class II-IV may have procedure performed at civilian center*
66
Q
A

Retinal Vascular Occulsion

67
Q
A

Iris Synechiae (iris-lens adhesion)

Seen in Anterior Uveitis: pt with pain and photophobia, ciliary flush, anterior chamber cells and flare-WBCs/protein

68
Q

Etiology of Anterior Uveitis

A
  • Trauma
  • Systemic Inflammatory Disease (Reiter’s, Sarcoid, Ankylosing Spondylitis, RA)
  • Systemic Infection (Syphilis/TB)
  • Idiopathic (50% - initial, 30% recurrent)
69
Q

Waiver Guidelines for Anterior Uveitis

A

3 month wait after off meds (only for single idiopathic or infectious)

Recurrent, severy, posterior, or systemic inflammation elsewhere makes waiver unlikely (typically requires PEB for continued Naval Service)

FS Lectures (9 decks)

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