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II. Diagnosing and Prescribing > Final > Flashcards

Final Flashcards

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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 ā€œEā€ 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
If phoria is a problem for the patient what should be prescribed to a hyperope relative to the manifest Rx?
full Rx
26
What are common outcomes or steps to take when prescribing for a hyperope?
1. full Rx may not be accepted unless takes steps over several glasses to get to full 2. may only be useful at near
27
What is the most significant effect of a hyperopic Rx for a patient?
comfort
28
Why are a smaller eye size for glasses preferred for a hyperopic Rx?
1. less weight | 2. better cosmetic appearance
29
What is an average corneal curvature?
42.50
30
What percentage of Americans are myopic? 1. When does it usually present in children? 2. What gender is more likely to be myopic? 3
1. 33% 2. 8 to 11 years 3. girls
31
What type of activities reduce the odds of developing myopia?
outdoor activities
32
What are the key features of myopia?
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
If you refract at a longer distance than you fit for glasses is the Rx over or under minused?
over (-)
34
At what Rx is the vertex distance essential and has a large impact on the glasses?
+- over 5D
35
What is the best way to measure the vertex distance?
with a distometer
36
What are the signs and symptoms of an over minused patient?
1. headaches 2. asthenopia 3. esophoria 4. blur on BI vergences at distance 5. NRA over +2.75
37
When is the only time you would give less minus than their manifest Rx?
symptoms of over-minused
38
Is it easier for a child or an adult to reduce minus Rx because they are over-minused?
child
39
Why should progressive myopes never be under minused?
progress myopia faster
40
What is the reason for pseudomyopia?
ciliary muscle spasm so accommodation making an emmetrope or hyperope appear myopic
41
What is having different amounts of refractive error between the two eyes called? 1. When is it clinically significant? 2
1. anisometropia | 2. 1.00D sphere difference
42
What is having two different types of refractive error (ie myopia and hyperopia) between the two eyes called?
antimetropia
43
What might the signs and symptoms be for a patient with OD: -0.50 DS and OS: -3.00 DS?
1. few complaints 2. possible exo at near 3. no stereo until corrected
44
What might the signs and symptoms be for a patient with OD: -0.50 DS and OS: +3.00 DS?
1. few complaints, maybe some fog 2. possible complaints at near 3. amblyopia likely (OS suppressed)
45
What is it called when the patient cannot see well in one meridian?
meridional amblyopia
46
What percentage of the population has anisometropia? 1. At what age does it increase? 2
1. 2 to 6% | 2. 5 years
47
What can induce anisometropia? 1. What is the best way to correct this? 2
1. refractive/cataract surgery | 2. contact lens
48
What is a difference in image size due to correction called? 1. What are the symptoms of this? 2
1. aniseikonia | 2. nausea, dizziness, distortions
49
What are the possible causes of asthenopia of headaches in anisometropia patients?
1. accommodation 2. induced lateral and vertical prism 3. aniseikonia
50
What are some key features that present in an anisometropia patient?
1. amblyopia and/or suppression 2. reduced stereo 3. induced phoria, lateral or vertical 4. asthenopia or headache
51
Are axial anisometropia patients better corrected with glasses or contacts?
glasses
52
What is important to tell the patient about using their glasses when they are anisometropes?
turn head, not eyes (helps avoid induced prism)
53
What does the use of contact lenses eliminate in anisometropia?
1. aniseikonia | 2. induced vertical or lateral prism of glasses
54
What are reasonable alternatives if an anisometropia patient is complaining of induced vertical prism with their bifocal?
1. 2 Rx's, one for distance and one for near 2. CL and readers 3. monovision CL's 4. slab off
55
What are ways to reduce induced vertical and lateral prism in a patient that still wants or needs to wear glasses?
1. use small eye size 2. fit Rx very close to eyes 3. avoid progressive bifocals
56
What produces aniseikonia?
1. correcting refractive anisometropia with glasses 2. correcting axial anisometropia with CLs 3. retinal stretching
57
What are the sources of total ocular astigmatism?
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
What are the types of astigmatism?
1. compound hyperopic 2. compound myopic 3. simple hyperopic 4. simple myopic 5. mixed
59
What does regular astigmatism refer to? 1. Irregular? 2
1. meridians 90deg apart | 2. meridians not 90deg apart
60
What does with-the-rule astigmatism refer to? 1. Against-the-rule? 2. Oblique? 3
1. 180deg (vertical meridian steeper) 2. 90deg (horizontal meridian steeper) 3. 35/135deg
61
What percentage of the population has astigmatism? 1. Which type appears to be hereditary? 2
1. 15-20% of population | 2. high oblique astigmatism
62
What are the key symptoms of astigmatism?
1. meridional blur 2. monocular diplopia 3. asthenopia 4. headaches
63
What causes the headaches seen with astigmatism?
1. fluctuations in accommodation | 2. squinting of lids
64
What is the order from easiest astigmatism to see with to hardest?
1. axis 180 2. axis 90 3. oblique axis
65
When is squinting to help eliminate astigmatism most useful?
axis 180
66
If visual acuity does not improve to 20/20+ after astigmatism corrected what should be considered?
1. irregular astigmatism | 2. meridional amblyopia
67
What should always be the first choice regarding children and their astigmatism?
full correction
68
What should be done to demonstrate the astigmatism that you will be giving a patient?
trial frame with patient walking around
69
What is a major benefit of contact lens correction for astigmatism?
full corrections without adaptation problems
70
When making a cut in cylinder power, what must also be adjusted?
sphere
71
If an astigmatic patient needs a movement in axis of the cyl, where should it move towards?
90 or 180 meridians

II. Diagnosing and Prescribing (2 decks)

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