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Ancillary tests in practice.

This article assesses the use, features and practical applications of ancillary tests commonly used in practice.

A 13-year-old patient attends for a contact lens fitting. Baseline refraction: R -2.00DS L -2.75DS. Unaided visions one week later: R 6/6+1 L 6/6+3.

01 Based on the history and images above, what treatment has been undertaken in the right eye?

a) Corneal crosslinking treatment for keratoconus

b) Pre and post corneal graft

c) Pre and post laser refractive surgery

d) Orthokeratology

02 In relation to treatment aims, which of the following is false?

a) To slow down myopia progression

b) To be free of spectacles

c) To be free of contact lenses during waking hours

d) To permanently correct myopia

03 Which of the following parameters is not usually measured with the equipment used to obtain the images shown?

a) Pupil diameter

b) Horizontal visible iris diameter

c) Corneal endothelial cell count

d) Corneal astigmatism

An 80-year-old female patient with a history of hypertension presents for a routine sight test.

04 What type of visual field defect is shown in the image?

a) Left homonymous hemianopia

b) Right homonymous inferior quadrantanopia

c) Bitemporal inferior quadrantanopia

d) Bilateral nasal step

05 Based on the patient history and images, which of the following is the most likely cause of the defect?

a) Left parietal lobe lesion

b) Right parietal lobe lesion

c) Lesion at optic chiasm

d) Glaucoma

06 Which of the following statements is false?

a) The normal monocular visual field is approximately 60[degrees] superior and nasal, 70[degrees] inferior and 90[degrees] temporal

b) Post-chiasmal lesions produce homonymous defects which respect the vertical midline

c) The Esterman test is performed monocularly using the patient's reading prescription

d) Visual field testing is useful to assess defects arising from glaucoma, neurological pathology and retinal disease

A 65-year-old patient presents with visual acuities of R 6/6 L 6/36. The patient had bilateral cataract surgery five years ago. Optical coherence tomography (OCT) is shown for the left eye.

07 What is the likely diagnosis?

a) Full thickness macular hole

b) Lamellar hole

c) Geographic atrophy at macula

d) Cystoid macular oedema

08 Which of the following statements is false?

a) Differential diagnosis in this case includes a partial thickness hole

b) OCT scans are useful to indicate the presence of vitreomacular traction and the extent of the lesion

c) The majority of cases are due to ocular trauma

d) The lesions are more common in females in their 50s and 60s

09 Which of the following statements about OCT is false?

a) OCT angiography is useful for assessing neovascular membranes in age-related macular degeneration

b) OCT angiography requires an injection of contrast dye

c) OCT can be used to assess the anterior chamber angle

d) OCT is useful in glaucoma screening and monitoring

A 40-year-old patient presents with intraocular pressures (IOP) of R 23mmHg L 23mmHg and central corneal thicknesses (CCT) of R 570[micro]m L 580[micro]m.

10 Which of the following statements about the instrument shown is false?

a) The applanated area is 3.06mm in diameter

b) It takes the ocular pulse into account, hence only one reading is required

c) It follows the Imbert Fick law

d) To get the correct reading, the outer edges of the mires must be aligned

11 Which of the following instruments is not used to measure IOP?

a) Tono-Pen

b) Goldmann applanation tonometer

c) iCare rebound tonometer

d) Pachmate

12 Which of the following factors would cause IOP to be overestimated?

a) Reduced corneal rigidity

b) Increased CCT

c) Post laser refractive surgery

d) Too little fluorescein during applanation tonometry

* Prashant Shah is an experienced optometrist and CET author with postgraduate diplomas in ophthalmology and in clinical optometry.

* Yashita Shah is an experienced optometrist working in independent practice. She holds a postgraduate diploma in ophthalmology.

Prashant Shah MCOptom, PGDipOphth, DipCIinOptom and Yashita Shah MCOptom, PGDipOphth

Caption: Image A

Caption: Image B

Caption: Image C

Caption: Image D
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Title Annotation:VRICS
Author:Shah, Prashant; Shah, Yashita
Publication:Optometry Today
Date:Aug 1, 2021
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