Twintech Semester 8

SAMPLE ANSWER FOR ESSAY QUESTIONS ON CLINICAL CASE CONFERENCE (BMA 3421)

QUESTION 1

CASE OF MONOCULAR APHAKIC

ADVANTAGES OF CL OVER SPECS DISADVANTAGES OF CL OVER SPECS

1. IMPROVE VISUAL FIELD2. ELIMINATE ANISEIKONIA3. COSMETICALLY BETTER

1. RISK OF INFECTION2. COSTLY3. COMPLEX PROCEDURE

FACTORS TO BE CONSIDERED WHEN CHOOSING MATERIAL, DESIGN & POWER

1. MATERIAL = HIGH OXYGEN PERMEABILITY OR HIGH DK VALUE2. DESIGN = MULTIFOCAL CL, ASPHERIC3. POWER = VERTEX DISTANCE & EFFECTIVITY

QUESTION 2

GLAUCOMA SUSPECT

SUITABLE TEST SUITABLE ADVICE

1. MEASURE/ESTIMATE THE ANTERIOR CHAMBER ANGLE

2. MEASURE IOP3. ESTIMATE THE CD/RATIO4. PERIMETRY USING

HUMPHREY VISUAL FIELD ANALYSER

1. MUST BE SEEN BY EYE SPECIALIST

2. MUST NEVER FAILS TO ATTEND FUTURE APPOINTMENT

3. IF MEDICATION PRESCRIBED, MUST USE PROPER CARE

4. MUST INFORM OF ANY NEW SYMPTOMS

QUESTION 3

Effendy Hashim 21 August 2010

Twintech Semester 8

CHARACTERISTICS OF LOOSE FITTING SOFT CL

CENTRATION 1. DO NOT COVER THE WHOLE LIMBUS 2. LARGE SAG (DOWNWARD DECENTRATION)

MORE THAN 1 MM

RELOCATION (AFTER BLINK)

1. DECENTRED INFERIORLY (LOW RIDING)2. LARGE LAG (LATERAL MOVEMENT) MORE

THAN 2 MM

MOVEMENT ON UPGAZE BLINK

1. MOVES FAST & FREELY 2. DO NOT COVER THE SUPERIOR LIMBUS

PUSH-UP TEST 1. FREELY MOVING 2. RAPID RECOVERY

COMFORT 1. UNCOMFORTABLE, EDGE IS WRINKLING AND INTERACTING MORE WITH THE LIDS

2. UNSTABLE VISION, CLEAR ONLY AFTER BLINK

QUESTION 4

LATENT HYPEROPIA & INTERMITTENT ESOTROPIA

PLAN & REMEDIAL

1. PRESCRIBE GLASSES OF FULL CYCLOPLEGICS REFRACTION2. LEFT EYE OCCLUSION THERAPY

QUESTION 5

ADVANCE OPEN-ANGLE GLAUCOMA NEED LOW VISION CARE

Effendy Hashim 21 August 2010

Twintech Semester 8

(A) MAGNIFICATION REQUIRED = REQUIRED DISTANCE VA

__________________ PRESENT DISTANCE VA

MAGNIFICATION = OLD OBJECT DISTANCE______________________NEW OBJECT DISTANCE

(B)

EITHER BASED ON THE LOGARITHMIC PROGRESSION TABLE USING THE JUMP METHOD TO GET THE MAGNIFICATION REQUIRED FOR NEAR

OR

USING THE FORMULA TO CALCULATE

MAGNIFICATION = PRESENT NEAR VA____________________REQUIRED NEAR VA

QUESTION 6

COMMON DRY EYE SYNDROME

PHYSIOLOGICAL BASES POSSIBLE CAUSES

1. TEAR FILM PROPERTIES (AQUEOS, LIPID, MUCIN)

2. TEARS PRODUCTION

1. LESS PRODUCTION OF AQUEOS – SCHIMER TEST

2. MUCIN CONTAMINATED WITH LIPID– TBUT

QUESTION 7

INTERMITTENT BLUR @ DISTANCE & NEAR

Effendy Hashim 21 August 2010

Twintech Semester 8

POSSIBLE CAUSES CONFIRMATION TEST

1. REFRACTIVE ERROR OF HYPERMETROPIA

2. ACCOMMODATION ANOMALY 3. DECOMPENSATED

HETEROPHORIA

1. REFRACTION/CYCLO REFRACTION

2. NPA/FACILITY/ AMPLITUDE / NRA/PRA

3. COVER TEST /MADDOX / NFV /PFV

QUESTION 8

KERATOCONUS

RGP CL FITTING TECHNIQUE

1. ELIMINATE CENTRAL BEARING BY FITTING APICAL CLEARANCE2. MID-PERIPHERAL BEARING BY THREE-POINT TOUCH3. SMALL OPTIC ZONE DIAMETER 5-6 MM WITH NORMAL OVERALL

DIAMETER4. BASE CURVE WILL BE FLATTER THAN CORNEAL APEX WITH MORE

FLATTENING IN THE PERIPHERAL

ADVANTAGES OF RGP DISADVANTAGES OF RGP

1. IMPROVE VA2. GOOD TEARS EXCHANGE

1. RISK OF INFECTION OR ABRASION

2. DISCOMFORT3. INSTABILITY-EASILY POP OUT

QUESTION 9

ADVICE FOR MYOPE & EARLY PRESBYOPE ON LASIK COMPARE TO CL

LASIK CL

1. SURGICAL – IRREVERSIBLE 1. NON-SURGICAL –

Effendy Hashim 21 August 2010

Twintech Semester 8

2. HANDLING FREE3. RISK OF SURGICAL

OMPLICATION4. SHORT-TERM EXPENSIVE5. POST-LASIK VISUAL

DISTURBANCE DURING NIGHT

REVERSIBLE2. NEEDS HANDLING3. RISK OF INFECTION4. LONG-TERM COSTLY5. POSSIBILITY OF

MONOVISION

QUESTION 10

CYCLOPENTOLATE VS ATROPINE

PROPERTIES CYCLOPENTOLATE ATROPINE

OPTOMETRIC USAGE 1. O.5% % 1.0 % SOLUTION

2. 3 DROPS IN 10 MINUTES INTERVAL

1. 1% SOLUTION & 0.5 % OINTMENT

2. 1 DROP b.i.d. FOR 3 DAYS PRIOR TO EXAM

MECHANISM OF ACTION

1. BLOCKS THE ACTION OF ACETYLCHOLINE TO RELAX IRIS SPHINCTER MUSCLE

2. BLOCK CHOLINERGIC STIMULATION OF CILIARY MUSCLE

1. BLOCK THE ACTION OF ACETYLCHOLINE

2. NON-SPECIFIC BINDING TO THE VARIOUS MUSCARINIC RECEPTORS

PHARMACOKINETICS1. RAPID ONSET

OF ACTION PRODUCING MAX MYDRIATICS AND

1. LONGER ONSET OF ACTION AFTER 30 MINS TO 1-3 HOURS

2. DURATION OF CYCLOPLEGIA IS

Effendy Hashim 21 August 2010

Twintech Semester 8

CYCLOPLEGIA IN 15-60 MINS

2. DURATION OF CYCLOPLEGIA 24 HOURS

6-12 DAYS

SAFETY PROFILE CNS EFFECTS ; CONFUSION, ATAXIA, PERSONALITY CHANGES & DISORIENTATION

1. CAUTION WITH DOWN’S SYNDROME & PT ON ANTI-CHOLINERGIC DRUG

2. CNS EFFECTS OF DRYNESS OF MOUTH, TACHYCARDIA, FEVER, SEIZURE & DEATH

Effendy Hashim 21 August 2010