OPTOMETRY COUNCIL OF AUTRALIA AND NEW ZEALAND Competency in Optometry Examination SECOND PAPER 12 SEPTEMBER 2007 Perusal time:

10 minutes Time allowed: THREE hours Candidates should answer ALL questions. All questions are of equal value.

1.

A patient presents for contact lens fitting. The clinical findings are: Spectacle refraction RE -5.00/-2.00 x 180 (Vertex distance = 12 mm) Keratometry RE 45.00 D (7.5 mm) along 90 and 43.00 D (7.85 mm) along 180 HVID = 12.0 mm, Pupil size = 5.0 mm a) What is an appropriate contact lens order for this patient if you prescribe a soft spherical contact lens? Express your answer as BOZR/LD/BVP. (4 marks)

b) What is an appropriate contact lens order for this patient if you prescribe a soft toric contact lens, assuming 10 degrees nasal rotation of the lens on eye? Express your answer as BOZR/LD/BVP. (4 marks) c) If you dispense a rigid spherical lens, what BOZR will give the best fit for the central cornea? (2 marks)

2.

Prospective contact lens patients should be informed about both the risks and benefits of contact lens wear. Outline the factors that you should routinely discuss with patients under the following headings: a) c) Potential visual benefits of contact lens wear Risks to eye health associated with contact lens wear (3 marks) (2 marks) (3 marks) (2 marks)

b) Financial costs associated with contact lens wear d) Responsibilities of a patient who wears contact lenses

3.

Explain how to differentiate contact lens induced epithelial microcysts from epithelial fluid vacuoles, tear film debris and mucin balls. (10 marks)

4.

A two-stage hydrogen peroxide care system is sometimes referred to as the 'gold standard' of soft lens care. By describing the components of this and other soft lens care products, give your opinion on whether this is a reasonable statement. (10 marks)

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5.

A 73-year-old man presents to you and reports seeing a flying saucer in front of the right eye for the past few days, worse when he is lying down. Past ocular history includes a cataract extraction two years ago. You proceed with checking his vision and you find that vision with pinhole is 6/6 in the right eye. His retina is attached and anterior segments are quiet. a) What is the most likely diagnosis for his symptom? b) What may be the predisposing factors? Name three (3). c) What would be your management plan? (2 marks) (3 marks) (2 marks)

d) What is the incidence of retinal detachment following cataract surgery? Which patients are at greater risk? (3 marks)

6.

A patient with early macular degeneration returns to see you for re-examination. a) List the tests that you would use to establish if there is any sign of disease progression. (2 marks)

b) What signs would you expect to notice on these tests if there was any clinically significant disease progression, and what would be your management plan? (4 marks) c) If no disease progression was noted, what should the management plan be? (4 marks)

7.

A 24-year-old university student with Staargardts disease presents to your practice. Best spectacle correction is: R -2.00 DS 6/24+2 L -2.00 DS 6/30-2 He wishes to see lecture presentations from the front row of the classroom. Calculate an appropriate telescope power to trial for this task. Show your working, and list assumptions you have made as part of your calculations. (10 marks)

8.

A patient with macular degeneration presents to your practice. Best spectacle correction is: R -2.00 DS 6/30+2 L -2.00 DS 6/380 With a +4D spectacle addition her near visual acuity is: R N20, L > N64, Both eyes N20 at 25 cm She wishes to read labels and prices at her local supermarket. Calculate an appropriate hand magnifier power to trial for this task. Show your working, and list assumptions you have made as part of your calculations. (10 marks)

9.

All optometrists have a range of legal responsibilities relevant to the practice of optometry. What are your major responsibilities to your practice staff and to your professional colleagues? (10 marks)

10. a) What are the symptoms and signs of a convergence insufficiency? b) Describe a vision therapy program to manage this binocular vision anomaly.

(5 marks) (5 marks)

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11. a)

Patient A is evaluated using the Hirschberg test. There is normal vision in the right eye and a strabismus of the left eye. The reflex in the left eye is displaced temporally by approximately 5 mm from the centre of the cornea. Stating the correlation you used, give the amount and direction of the deviation in the left eye in prism dioptres. (3 marks)

b) Patient B has a strabismus. With a red Maddox rod in front of the right eye, the patient reports that the vertical red streak is seen to the left of the spotlight target at 6m. What does this mean and what is being measured? (4 marks) c) You use Bagolini striated lenses in front of the right and left eyes of Patient C with the axes at 45 and 135 respectively. Describe three (3) possible responses from the patient and explain what these responses mean. (3 marks)

12. For each part of this question, choose the ONE most appropriate answer. Write your answer in the examination booklet. a) You measure the surface power of a lens with a Geneva lens measure. The refractive index of the lens is 1.80. Your measurement is +6.00 DS. The true surface power is likely to be: A B C D +6.00 D +6.25 D +4.00D +9.00D

b) Which one of the following claims can be made for the optical performance of well designed low power aspheric lenses? A B C D c) It is worse than the performance of lenses made with spherical surfaces. It is about the same as the performance of lenses made with spherical surfaces. It is a little better than the performance of lenses made with spherical surfaces. It is much better than the performance of lenses made with spherical surfaces.

What is the prismatic effect at a point 10 mm below and 5 mm inwards from the optical centre of the lens R +1.00 DS/-2.00 DC x 90? A B C D 1 BD, 0.5 BO 1 BU, 0.5 BI 0.5 BD, 1.0 BO 0.5 BU, 1.0 BI

d) What is the back vertex power of a spectacle lens made in a material of refractive index 1.50 with surface powers +10.00 D and -4.00 D, and centre thickness 6.0 mm? A B C D +5.00 D +6.00 D +6.50 D +7.50 D (10 marks)

13. a)

Compound the prisms 2

BO and 4

BD into a single prism for the right eye.

(5 marks)

b) If the prism in part a) is split evenly between right and left eyes, what is the amount of prism in front of each eye? (5 marks)

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14. a)

The prescription +2.00 DS/+2.00 DC x 135 is made as a lens with a -4.00 D toric base curve. Disregarding lens thickness, what is the power of the front surface? (5 marks) Transpose the prescription +3.00 DS/-4.00 DC x 50 into crossed cylinder and positive cylinder forms. (5 marks)

b)

15. Explain the following terms related to spectacle lenses. a) Base curve for a range of lens powers b) Distortion (10 marks) 16. Someone brings in a pair of progressive addition spectacles to be duplicated. They belong to a bed-ridden patient, who has not been to your practice previously. Explain how you would determine the power and fitting parameters for the spectacles. (10 marks)

17. a)

Describe the correct way to measure the addition of progressive addition spectacle lenses with a back surface addition using a vertometer. (5 marks) b) Explain the following terms related to bifocals: curved top bifocals, segment depth. (5 marks)

18. An industrial workplace requires the frequent manual pouring of strong alkali chemicals. As the local optometrist, you are asked to provide advice about various aspects of eye safety in this workplace. Outline your advice regarding the following: a) b) c) d) Eye protection for those workers pouring the chemicals The provision of first-aid facilities in the workplace The appropriate first-aid training of workers The likely injuries suffered by a worker exposed to an alkali splash injury (2 marks) (3 marks) (3 marks) (2 marks)

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