latent hyperopia

Question 1

what is a side effect of dilantin

Answer 1

can affect the EOMs

Question 2

manifest hyperopia

Answer 2

the amount of hyperopia that is found on subjective refraction

Question 3

latent hyperopia

Answer 3

the remaining hyperopia compensated for by the tonicity of the CB (cyclo hyperopia)

Question 4

absolute hyperopia

Answer 4

the amount of hyperopia that cannot be overcome by accommodation (Add)

Question 5

facultative hyperopia

Answer 5

the amount of hyperopia that can be overcome by accommodation. for example if a patient has 4.00D of hyperopia and only 1.00D of accommodation, the absolute hyperopia is 3.00D and facultative hyperopia is 1.00D

with accommodation

Question 6

if a 10yo patient with CC of headaches when reading has +0.50 OU on refraction and +2.00 OU on cycloplegic refraction, what is the best initial RX

Answer 6

+2.00 OU for reading only
the patients chief complaint is reading, therefore the full cyclo will allow for normal accommodative demand at near and will likely alleviate the patient’s asthenopia symptoms

+2.00 full time wear would not be recommended because this would blur the child for distance. she does not have any accommodative ET, if so, this RX would be required

+0.50 for reading only is likely not enough plus

+0.50 for distance only is not correct bc she is not complaining of distance blur

no glasses is not an option bc she is symptomatic and school performance is suffer

+2.00D for distance only is not good bc see above

Question 7

dynamic retinoscopy

Answer 7

objective measure of the accommodative response at near

examples are MEM, and Notts method

Question 8

MEM

Answer 8

performed with the patient wearing dry distance refraction while focusing on a near target on the ret head. the dr uses a vertical ret stark to look for with or against motion

Question 9

with motion on MEM

Answer 9

lag of accommodation (if you have to add plus)

Question 10

against motion on MEM

Answer 10

lead of accommodation (If you have to add minus)

Question 11

a lead on MEM will be ___number

Answer 11

minus

Question 12

a lag on MEM with be ___numbers

Answer 12

plus

Question 13

what must you be careful with in latent hyperopes

Answer 13

don’t over plus them at distance

Question 14

patients who have to accommodate to see the distance will likely have a higher _____ of accommodation

Answer 14

lag

Question 15

what does distance do for convergence

Answer 15

adds convergence

Question 16

normal MEM

Answer 16

+0.25 to +0.50 (small lag)

Question 17

abnormal MEM

Answer 17

> +0.50 or any minus

Question 18

things that warrant a cycloplegic refraction

Answer 18

suspicion of latent hyperopia
suspicion of pseudomyopia
accommodative ET or EP
variable retinoscopy or refraction findings
VA not at expected level
symptoms do not seem to be related to manifest eye strain

Question 19

what is the far point for a patient who wears +2.00D glasses at a vertex distance of 15mm?

Answer 19

48.5cm behind the cornea

when a patient has been optically corrected for ametropia, the far point of the eye will coincide with the secondary focal point of the correcting lens. for hyperopes, the far point is considered virtual (behind the eye), while for a myope, the far point is real (in front of the eye between the cornea and infinity)

the far point for this patient is located at the secondary focal point of the +2.00D lens, which is located at a distance of 1/2.00D=50cm. because the spectacle lens sits 15mm (1.5cm) from the cornea, the far point is 20-1.5cm=48.5cm behind the cornea (since this patient is a hyperope)

Question 20

the following drops should be utilized for a cyclo refraction

Answer 20

• topical anesthetic
• 2 drops cyclopentolate
  
  • 1% if >1yo
  • 0.5% if <1yo
• phenylepherine or tropicamide for mydriasis
• perform refraction 30m later

Question 21

cyclo in special population children

Answer 21

consider using only tropicamide 1% if a child has the potential for an increased reaction to cycloplegic agents, such as low birth weight, downs syndrome, cerebral palsy, trisomy 13 and 18, or other central nervous system disorders

Question 22

a hyperope states that his single vision glasses work better when he pulls them further down on his nose for reading. How should his RX be changed?

Answer 22

increase in plus sphere

increasing the vertex distance of spectacle lenses will lead to an increase in the effective plus power of the lenses.