VISIT 4 Flashcards

Question

coopervision misight scls

Answer 1

o Designed for myopia progression o Work like concentric ringed multifocals – low levels of add e.g. +1.00 to prevent axial elongation o Fit the exact same way as any other SCL o May take some time to adapt to mild blur o Again not 100% effective in slowing down the rate of myopia progression

Answer 2

Reduced VA (both distance and near) * Severely Impaired colour vision * RAPD * VF Defect * Impaired Contrast Sensitivity

Answer 3

 Explain that the visual outcome will not be worse if referral is delayed  Give an information leaflet for them to digest at their leisure & discuss with family  UV protection & smoking  Ensure px is aware they can return before recall if symptoms worsen; give name incase they decide they would like referred or have any questions

Answer 4

Cataract explanation: cataracts are formed when the clear lens inside your eye becomes cloudy or misty. It’s a gradual process which generally happens as we get older. It is generally a natural part of the ageing process and anyone who lives a long life will go onto develop cataracts. Cataracts develop very slowly and will cause your vision to worsen over time. When this happens, we can send you to the hospital for a simple procedure to remove to cloudy lens and replace it with a new clear lens. The surgery is generally very successful and is a quick day procedure under local anaesthetic.

Answer 5

 1mm PDs  1mm heights  2 degrees tilt from horizontal

Answer 6

 Horizontal & vertical within 1mm  Tilt – no more than 2 degrees from horizontal

Answer 7

 The static FoV provided by a positive spectacle lens is less than the apparent FoV implied by the empty spectacle frame  This means hyperopes suffer from a decrease in FoV There will be an area around the edge of a lens from which no light can enter the eye – a ring scotoma

Answer 8

* When changing form specs to CLs, the retinal image size is larger in myopia but smaller in hypermetropia

Answer 9

SM= correct retinal image size/ uncorrected retinal image size or SM= power factor X Shape factor

Answer 10

* Aphakia * Cornea with high DC * Keratoconus * Post-Graft Surgery * Better vision with high rx * More durable - up to 1 yr wear Health: * High o2 permeability * Doesn’t dry out tear film due to 0% water content * Resistant to protein deposits

Answer 11

will have a negative tear film then it would have a plus over refraction

Answer 12

approx. 2mm smaller than HVID measurement

Answer 13

– Fluorine monomer added to SA, lower surface charge so better wetting and less deposits – although attracts lipids and mucus. Susceptible to scratching and lens flexure

Answer 14

BOZR = flat K – (flat k-steep k / 3)

Answer 15

 BOZD = area with Rx (periphery of lens is for stabilisation)  BOZD must be > pupil size in scotopic (dim light) to ensure pupil is smaller than BOZD in all lighting conditions  If pupil > BOZD = issue with flare / haloes around lights  High myopes may need larger BOZDs to avoid flare

Answer 16

0.25DS over Rx = 0.05 BOZR change

Answer 17

 Increase in diameter by 0.5 = flatten BC by 0.05 o Increased diameter = increased sag o Because cornea is aspheric, increasing diameter = steepening lens, therefore you need to flatten it to keep Rx same

Answer 18

BOZD The size of the optic on the back surface of the lens. It's used to prevent flare from unwanted reflections.

Answer 19

 Demyelination may be caused by MS or be idiopathic, usually, age range 20-50 years,  75% patient’s female Symptoms  Subacute monocular (usually) vision loss; typically progresses over less than 7 days  Some patients experience tiny white or coloured flashes/sparkles (phosphenes)  Pain on eye movement  Frontal H/A and tenderness of globe may be present Signs  VA 6/18-6/60, rarely worse  Impaired colour vision / red desaturation  RAPD if unilateral  VF defect; central scotoma  Disc appearance normal or swollen, pale optic nerve & veins

Answer 20

 Urgent referral to HES – CMGs + GGC  Confirm diagnosis – MRI/CT  High dose IV steroids (prednisolone) within first week of symptoms onset = better prognosis  Systemic investigation to determine if underlying MS

Answer 21

 Retrobulbar neuritis – normal appearance of the OD, at least initially o Most common type in adults o Frequently associated with MS o Other causes: tuberculosis, syphilis, viral infections  Papillitis – disc hyperaemia/oedema, occasionally PP flame-shaped haemorrhages o Most associated with diabetes  Neuroretinitis – papillitis and a macular scar o 66% caused by cat scratch

Answer 22

PVDs occur due the contraction and constriction of the vitreous typically due to liquification of the vitreous gel and collagen fibre matrix with time, but can also happen as a result of trauma.

Answer 23

used for hypertension develop corneal microdeposit in a whorl like pattern within the corneal epithelium (Vortex Keratopathy) - increased glare and haloes. if optic neuritis or aion - refer Deposits are reversible with withdrawl. can get anterior sub capsular opacities

Answer 24

treats epilepsy 1/3 of Px suffer a visual field defect with onset from 1 month to several years. The defect is an asymptomatic pre-dominantly nasal concentric peripheral field loss sparing the macula and temporal area. Defect persist after withdrawal of medication. Colour vision, contrast sensitivity and VA can be affected

Answer 25

Corticosteroids affect the crystalline lens when used over prolonged periods. Steroid cause the formation of posterior sub-capsular cataracts. These opacities typically bilateral and irreversible. Px tend to report photophobia, reading problems and difficulty with glare. Steroid have the potential in susceptible individual to raise IOP and cause glaucomatous damage. Optic disc oedema is a rare

Answer 26

is used to rheumatoid arthritis Hydroxychloroquine is safer and rarely associated with toxicity. Patient at risk of toxicity are those on treatment for five years or longer. Corneal deposits (vortex keratopathy) as early as 3 weeks. Chloroquine an induce in 1-2% of Px retinal and macular changes. Premaculopathy: consists of early functional and structural changes prior to visible fundus signs – High res OCT/ FAF to assessment macula pigment density. Early maculopathy: VA 6/9-6/12 and subtle macular disturbance. Progression of maculopathy: moderate to severe reduction in VA (6/36-6/60) bulls eye macular lesion – island of pigment surrounded by depigmented area of RPE atrophy

Answer 27

used to treat breast cancer or prophylactically in strong FH. Tamoxifen is associated with bilateral superficial maculopathy (yellow/white crystal like opacities surrounding macula. Crystalline deposits It affects VA with associated CMO. Reversible if detected early enough. Mild to moderate tritanomalous CV defect and central scotomas within Amsler chart area. Corneal deposits (vortex keratopathy).

Answer 28

Tamsulosin

Answer 29

are anti-depressants associated mydriasis and thus blurred vision in particular difficulties with near vision. dry eye

Answer 30

the yellow cards at the rear of the BNF or by downloading the Yellow Card from the MHRA website or submitting a report online. A yellow card report should be completed independently or if preferred in consultation with patient medical prescriber when its suspected than an OAR may be related to a drug or combination of drugs. Inform Px GP of course of action. Practitioners should be deterred even if it seems to be an isolated case or some details requested by the yellow card are not known.

Answer 31

 Covers systemic adverse reactions to ocular medicines and ocular reactions to systemic medication  Online form filled about by members of the public of healthcare professionals  Particularly important for new drugs – marked by black triangle

Answer 32

Covers adverse incidents mainly relating to CLs and care products, including CL comfort drops

Answer 33

lengthening of eyelashes, iris hyperpigmentation, redness and irritation, CMO, anterior uveitis (rare)

Answer 34

hyperaemia, irritation, dry eye and other systemic side effects miotic pupil

Answer 35

ciliary muscle spasm, miotic pupils, VF constriction, brow ache, heart block and increased risk of retinal detachment

Answer 36

Subconjunctival, vitreous or retinal haemorrhages

Answer 37

Dry eye Reduced accommodation Mydriasis

Answer 38

for Osteoporosis Eye inflammation – scleritis and keratitis Rarely optic neuritis

Answer 39

for anxiety Intermittent blurring Photophobia Mydriasis

Answer 40

Objective: to quantify the distance phoria method: 1. SVD rx in trial frame 2. Place MR in front of RE 3. Grooves placed horizontally (measures horizontal phoria) = appear as a vertical streak to the patient. 4. Dim room lights and switch on chart spotlight. 5. Px sees a spot light and a vertical red line. o If only sees one target = suppression. 6. Is the vertical red line to the right, left or straight through the spot? Þ With SOP the vertical red line appears R of spot (uncrossed images). Add Base OUT prism until alignment. Þ With XOP the vertical red line appears L of spot (crossed images). Add Base IN prism until alignment. Repeat with MR grooves vertical (measures vertical phoria) = horizontal streak to the patient. 1. Is the horizontal red line above, below or straight through the spot? 2. With L/R the horizontal red line appears above spot. 3. Add Base DOWN prism to LE (or BU to RE) until alignment. 4. With R/L the horizontal red line appears below spot. 5. Add Base UP prism to LE (or BD to RE) until alignment.

Answer 41

Objective: quantifies the near phoria Method: 1. Habitual reading rx and near PD 2. Room lights on and use angle-poise lamp to shine close to towards the Maddox wing targets (arrows, numbers) 3. Look through the horizontal eye slits. 4. Can you see the red and white arrows and numbers? * If only sees one target = suppression 5. To measure horizontal phoria’s, check which number the white arrow points to Þ SOP = odd numbers, Þ XOP = even numbers 6. To measure vertical phoria’s, check which number the red arrow points to Þ R/L = odd numbers, Þ L/R = even numbers

Answer 42

If RE sees bottom marker and LE sees top marker: o If top marker (LE) is to LHS and bottom marker (RE) is to RHS = uncrossed à SOP deviation so use Base OUT. o If top marker (LE) is to RHS and bottom marker (RE) is to LHS = crossed XOP deviation so use Base IN. Perceived image moves towards apex of the prism

Answer 43

* Check each eye to see which strip they can see * In this example LE sees line at right side, RE sees line at left side * If line on RHS is higher à Correct with Base UP LE * If line on RHS is lower à Correct with Base DOWN LE * If only one marker is deviated, place prism in the affected eye

Answer 44

XOP conditions increase the positive relative convergence ʹ this is done by carrying out a near stereogram where the px fixates on a target in front of the stereogram while attempting to fuse the stereogram. o SOP conditions increase the negative relative convergence ʹ this is done by carrying out a distance stereogram where the px fixates on a target in distance while attempting to fuse stereogram at near.

Answer 45

Myopia and SOP ʹ least possible minus for clear distance vision o Myopia and XOP ʹ Most minus but minimum over correction o Hyperopia and SOP ʹ Max plus Rx without causing blur o Hyperopia and XOP ʹ Consider partial correction o Full Rx can be used in coordination of prism

Answer 46

o Divergence Weakness ʹ Most often due to uncorrected hyperopia, symptoms associated with distance vision unless the hyperopia is high, associated with prolonged use of the eyes and will be less or absent in the morning. o If persists after refractive correction try physiological exercises, Prism if other treatments fail o Convergence Excess ʹ Due to accommodative effort, uncorrected hyperopia, latent hyperopia, spasm of accommodation, psuedomyopia, close working distance o Normal AC/A is 4:1 when over 6 will result in convergence excess, incipient presbyopia o Symptoms ʹ Frontal headache, ocular fatigue, distance focus problem after near work o Unreliable refraction results indicate latent hyperopia as does lower subjective vs retinoscopy Management – Eye exercises – development of PRA – use negative sphere while patient maintain clear SV, relieving prism not appropriate unless AC/A ratio is low.

Answer 47

o Hypertonicity of abductors, uncorrected myopia may build false AC relationship o Symptoms ʹ Less marked in XOP (associated with suppression), Frontal headache with prolonged use of eyes, ocular fatigue, sometimes intermittent diplopia particular for near vision o Management ʹ Improve poor working conditions, adequate illumination and contrast, general health, medication o Full myopic or absolute hyperopic correction will assist in compensation o In hyperopic cases, full Rx may make symptoms worse – partial correction, Full Rx with prisms or exercises, partial Rx with prisms or exercises, Full Rx with negative add o Eye exercises – develop convergent fusional reserves, develop appreciation of physiological diplopia, treat any suppression o Relieving Prism – Simple and effective, aligning prism or CT prism, subjective improvement in near vision, worse when prism removed. o Referral – degree of XOP has to be larger than expected due to accuracy of surgery

Answer 48

o Divergence Excess ʹ Large degree of exophoria at distance which may break into a divergent strabismus, near vision XOP is at least 7pd and is compensated o Symptoms ʹ intermittent diplopia – family may notice divergence of one eye in bright lights, poor healthy,alcohol o Management ʹ Over minus for distance – bifocal to prevent over convergence at near, short term solution white convergent fusional reserves being built up

Answer 49

Esophoria = negative fusional reserves should be measured = BI prism

Answer 50

o Been given previously o Cosmetically unacceptable o Very large difference in Rx = aniseikonia = diplopia sphere plus half cyl

Answer 51

o Convergence excess SOT = additional plus @ near o Convergence insufficiency = additional minus @ near o Divergence excess XOP = minus @ distance