revision

Question 1

types of phorias

Answer 1

XOP: Convergence weakness (XOP at near), Divergence Excess (XOP at distance), Non-Specific
SOP: Convergence Excess (SOP at near), Divergence Weakness (SOP in distance), Non Specific
L/R Hyperphoria or R/L Hypophoria
Cyclophoria (look @ BV’s)
Incomitant = diagnosed by underlying cause e.g. L hypophoria in 4th nerve palsy

Question 2

Which way to measure deviation in prisms

Answer 2

ESO = BO
EXO = BI
HYPO = BU
HYPER = BD

Question 3

Normal PFR

Answer 3

Nr: 35 Dioptres BO -> 15 Dioptres BI
Dis: 15 Dioptres BO -> 5 Dioptres BI
Vertical: 3 BD -> 3 BU

Question 4

3rd NP muslces

Answer 4

MR, SR, IR, IO
Superior division: SR + Levator Muscle
Inferior Division: MR, IR, IO, sphincter muscle + ciliary muscle

Question 5

functions of muscles

Answer 5

MR: Adducion
LR: Abduction
SR: Elevation, Intorsion, Adduction
IR: Depression, Exorsion, Adduction
SO: Intorsion, Depression, Abducion
IO: Extorsion, Elevation, Abduction

Question 6

SOT Bigger @ Nr

Answer 6

Fully Accom SOT, Convergence Excess SOT, Partially Accom (present at all times but increases when accom exerted), Near SOT

Question 7

SOT bigger @ dist

Answer 7

Distance SOT

Question 8

SOT same Nr + Distance

Answer 8

Infantile SOT, Acquired (early vs late onset), Acquired with myopia, MicroSOT

Question 9

XOT bigger @ nr

Answer 9

Intermittent Near XOT

Question 10

XOT bigger in distance

Answer 10

Intermittent Distance XOT

Question 11

XOT same Nr + Dist

Answer 11

Intermittent Non-Specific XT, Early Onset XT, Decompensated intermittent XT

Question 12

critical period + sensitive period

Answer 12

critical = 0-2 years old
sensitive = 2-8/10 years old

Question 13

types of ambylopia

Answer 13

strabismic, meridional, stimulis deprivation, aniometropic, ametropic

Question 14

pass mark for logMAR + Kays

Answer 14

logMAR = 0.2
Kays = 0.1

Question 15

excercises for EXO + ESO

Answer 15

EXO = + fusional vergence
ESO = - fusional vergence
Stereograms ( + = hold card at arms legnth and focus on object between eyes and card) (- = hold card at 33cm, fixate in distance target just above card)

Eso = -‘ve = bar reading (add - or reduce + and read), if BIN can read in front of print, if using one eye, bar will hide text)

Exo at near = smooth convergence (NPC), jump convergence (jump from distant to near target ), Dot card (fix on furthest dot and move to near dot while appreciatign double).

prisms EXO = BO, ESO = BI

Question 16

post-op diplopia test

Answer 16

-use single letter e.g. P or D
-Will get diplopia if overcorrected after surgery?

Question 17

DVLA what is driving standard

Answer 17

0.2 Logmar

Question 18

what prism direction for PFR for ESO + EXO

Answer 18

ESO = BI, EXO = BO

Question 19

pupils

Answer 19

PERLLA (pupils equally round and responsive to light + accommodation)
RAPD

Question 20

what diff for lateral incomitance?

Answer 20

5-10 dioptres

Question 21

diff for A vs V patterns?

Answer 21

V = 15 dioptres diff
A = 10 dioptres diff

Question 22

convergence vs accom on RAF rule

Answer 22

Convergence = line + dot, go until double then go back and repeat 3 times
Accom = letter chart, go until blurry then go back to first point clear again and repeat 3 times
tilt downwards

Question 23

deviation size for surgery?

Answer 23

20 dioptres

Question 24

order of limitations TED

Answer 24

IR, MR, SR, LR

Question 25

size of amblyopia

Answer 25

mild: 0.2--.3 LogMAR moderate= 0.3-0.8 logMAR severe: > 0.8 logMAR

Question 26

refractive adaptation period

Answer 26

18-22 wks (PEDIG 2012) Continued improvment unpto 30 weeks (PEDIG 2006) 2 + 1/2 lines improved (Stewart + Motas 2004)

Question 27

patching moderate ambylopia

Answer 27

2 hrs + near tasks ( = 6 hrs) (PEDIG 2003) baseline acuity 0.6-0.7, more hours >7 y/o = 6 hours patching

Question 28

max time for patching

Answer 28

400 hours , 4 hours per day max

Question 29

how much improvement patching

Answer 29

120 hours = 1 line improvement (MOTAS)

Question 30

atropine

Answer 30

blurs around 2-3 lines moderate amblyopia = daily = weekend atropine severe ambylopia = still works (PEDIG 2009) cant use in under 3 y/o 8 minims = 4 weeks

Question 31

sizes of deviations

Answer 31

minimal: <10 dioptres small: 10-20 dioptres moderate: 25-35 dioptres marked: >40 dioptres

Question 32

VA measure (start from 5 right at 0.1 line --> 0 right)

Answer 32

each letter = 0.02 so e.g. 0.1 line: get 5 right = 0.1 get 4 right = 0.12 get 3 right = 0.14 get 2 right = 0.16 get 1 right = 0.18 get 0 right = 0.2

Question 33

normal palpebral fissue height

Answer 33

about 10mm

Question 34

history

Answer 34

What brings you in today? SYMPTOMS = LOFTSEA (Location, Onset, Frequency, Time, Self-treatment, Effect on patient, associations) GH: Health conditions? Allergies? Medications? smoke? POH: Previous issues with eyes? Prev attended HES? glasses or eye turn as a child or wear a patch? FH: Health conditions? Eye conditions? Squint? BH: Any birth abnormalities? Full-term normal delivery? birth weight?

Question 35

what incom px present as

Answer 35

6th = eso worse in distance and side gaze browns = hypo in PP, cant elevate eye 4th = up + in 3rd = down and out

Question 36

What surgery test do you need to do?

Answer 36

Post op diplopia test (like PFR but keep going after they get double)

Question 37

Two management options for consecutive exos

Answer 37

Botox and surgery

Question 38

What does a microtropia mean for patching VA’s?

Answer 38

VAs will never be perfectly equal

Question 39

What is Aniseikonia?

Answer 39

Difference in image sizes due to two very different RX in each eye e.g. RE -7.00 LE: +3.00

Question 40

Anterior Pligiocephaly

Answer 40

Shorter orbit on affected side. This results in malpositioned trochlea. This gives rise to superior oblique under actions on ipsilateral side. In this case, it’s the corresponding over action of the L inferior oblique which is most obvious.