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FS Lectures > Ophthalmology: Ophthalmology and Naval Aviation > Flashcards

Ophthalmology: Ophthalmology and Naval Aviation Flashcards

(69 cards)

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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
Computerized Color Testing
Rabin Cone Contrast Test (CCT) - USAF aviation standard Waggoner Computerized Color Vision Test (WCCVT) - world wide civilian use
26
Uncorrected VA varies with class SG1 20/?
SG1 20/100
27
Pass for CCT
55+ in each eye *Note: **monocular** testing*
28
Pass for WCCVT
"Mild" or "Normal" (computer generated) *Note: **binocular** testing*
29
Hardest color vision test to pass
PIP *FALANT is easier (5% fail compared to 8%)*
30
FALANT is \_\_\_% sensitive for CVD
35% (allows mild to pass) *Computer tests are 99% sensitive/specific*
31
Ways applicants "cheat" color vision testing
* X-chrome contact lens * Tinted glasses * Wrong lighting * Wrong test distance * Memorizing test
32
Uncorrected VA varies with class: SG1 = 20/?
SG1 20/100
33
Uncorrected VA varies with class: SG2 = 20/?
SG2 20/200
34
Uncorrected VA varies with class: SG3 20/?
SG3 20/400
35
True/False Rotary Wing Aircrew must have 20/100 uncorrected VA (same as SG1)
True
36
True/False Amblyopia is typically waived for applicants
False *Pathologic vision loss is also NOT waived for any class (i.e., optic neuritis, retinopathy, etc.)*
37
"Goodlite" for SNA (uncorrected)
20/40-0
38
Goodlite (BCVA) for SNA and Aviators
20/20-0
39
"Goodlite" for SNFO, Aircrew, etc.
20/20-3
40
Stereo Vision is required for...
SG1, SNFS, Helo aircrew *NO waivers considered for aviators in actual control of aircraft*
41
"Pass" for stereo vision: AFVT Verhoeff Randot
AFVT = line "D" (25 arcsec) Verhoeff = 8/8 Randot = 40 arcsec
42
Waiver requests for defective stereo vision must include a complete exam with _________ from waiver guide filled out entirely.
ocular motility worksheet
43
Risk factors for retinal detachment
* Myopia \> -8.00 D * Age * Head Trauma * Diabetes * Lattice Degeneration of peripheral retina
44
Symptoms of Retinal Detachment
* Curtain of blur * Flashing lights * Floaters * VA loss * Macular detachment * Peripheral Field Loss
45
Retinal Detachment Waivers can be requested ____ to ____ weeks following laser treatment
4-6 weeks *Note: 3 month wait for intraocular surgery*
46
Central Serous Retinopathy
47
Symptoms of CSR
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
Disposition for CSR
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
Waiver Requirements for CSR
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
Limits for phorias Class I
6 Esophoria 6 Exophoria 1.5 Hyperphoria Note: no waivers for SNA applicants outside limits
51
Class II/III limits for phorias
NOHOSH or NOTOSP
52
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
True *Note: waivers considered for Class II and III (Helo/SAR = NO waivers)*
53
Pterygium (extends to the cornea) less than 1mm is NCD (waivers considered for greater than 1 mm if asymptomatic with VA 20/20)
54
Pinguecula * Benign growth (plural = pingueculae) similar to a callus except on the conjunctiva* * Note: pinguecula can become pterygiums*
55
"Surfer's eye" or "Farmer's Eye"
aka Pterygium *People who spend long hours in the sun or in dusty/dry conditions are at increased risk*
56
Possible risk of pterygium surgery
Astigmatism (refractive error causing blurry or distorted vision)
57
Treatment for allergic conjunctivitis
Prescription ophthalmic antihistamines and mast cell stabilizers *OTC or prescription vasoconstrictors/decongestants/corticosteroids are NOT approved*
58
High IOP without any vision loss or nerve cupping
Ocular HTN
59
Optic nerve disease characterized by a pattern of VF loss and optic atrophy associated with cupping of the optic nerve
Glaucoma
60
True/False Laser treatment to angle/iris is acceptable for Glaucoma waiver
True Note: open angle glaucoma requiring incisional surgery will NOT be considered
61
True/False Narrow angle glaucoma will be considered for waiver after surgical OR laser treatment
True *Unlike open angle glaucoma where incisional surgery is CD without a possible waiver*
62
General Waiver considerations for Glaucoma
Minimal visual field loss (without miotic pressure drops) *Acceptable drops = prostaglandins, B-blockers (must be asymptomatic), and carbonic anhydrase inhibitors*
63
Keratoconus
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
Fleischer Ring (seen in Keratoconus)
65
True/False Keratoconus is CD in applicants and designated personnel
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
Retinal Vascular Occulsion
67
**Iris Synechiae** (iris-lens adhesion) Seen in **Anterior Uveitis**: pt with pain and photophobia, ciliary flush, **anterior chamber cells** and flare-WBCs/protein
68
Etiology of Anterior Uveitis
* Trauma * Systemic Inflammatory Disease (Reiter's, Sarcoid, Ankylosing Spondylitis, RA) * Systemic Infection (Syphilis/TB) * Idiopathic (50% - initial, 30% recurrent)
69
Waiver Guidelines for Anterior Uveitis
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)*

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