OCANZ Quiz 2023 with verified questions and answers

How many Australians have diabetes? 1.7 million What % of diabetes is type 2? 90% 90% What is type 1 diabetes? Immune mediated destruction of B cells What is type 2 diabetes? B cell dysfunction and insulin resistance B cell dysfunction and insulin resistance Who is at risk of type 2 diabetes? >40, waistline >80cmF/>94cmM, south Asian or African descent, polycystic ovaries, gestational diabetes, mental illness medication How is type 2 diabetes diagnosed? Venous plasma glucose >11.1mmol/l, >7.0mmol/l fasting, HbA1c 48 mmol/mol (6.5%) Name diabetic meds types: Metformin, Thiazolidenediones (pioglitazone), suplhonylureas (gliclazide), meglitinides, DPP-4 inhibitors (sitagliptin), glucosidase inhibitors What is prevalence of DR after two decades? 100% type 1, 60% type 2 What are the consequences of microvascular occlusion in DR? Hypoxia -> IRMA and NV What are the consequences of microvascular leakage in DR? Haems, plasma leakage -> oedema and exudates Haems, plasma leakage -> oedema and exudates What is R1? Flame, dot haems, singular blot haem What is R2? CWS, exudates, IRMA, venous changes, x2 blot haems What is R3? NVD, NVW, Rubeosis iridis, pre-retinal haems What are the types of diabetic maculopathy? Focal, diffuse, ischaemic, mixed What do you need to provide medicare treatment? A provider number Who is a green medicare card for? A permanent resident or citizen of Australia Whois a blue medicare card for? Someone waiting for permanent residence - a temporary medicare card What is a RHCA? A reciprocal health care agreement card for certified countries When can't medicare benefits be claimed? For dispensing and adjustments, rx copies, cosmetic surgery, refractive surgery, vocational tests or tests for sports, tests requested by an employer, driving license tests, when testing a spouse or dependant, post-op aftercare What is code 10905? Referred following examination 10910? Sight test for px < 65 10911? Sight test for px > 65 10912? Early test with significant change in visual function 10913? Early test with new signs or symptoms 10914? Early test progressive disorder 10915? Examination of diabetic px 10918? Second consultation 0921? CL consultation NOT VALID IF WEARING FOR COSMETIC, WORK, SOCIAL, SPORTING OR PSYCHOLOGICAL PURPOSES ? Domiciliary 10940 and 10941? Visual fields testing 10942? Low Vision Assessment 10943? Children's vision assessment aged 3-14 10944? FB removal What is the standard for Australian / NZ sunglasses? AS/NZS 1067 What is the standard mark for welding protection? AS/NZS 1338.1 What is the standard mark for filters against UV? AS/NZS 1338.2 What is the standard mark for protection against IR radiation? 1338.3 What is the minimum a px records should be kept for? 7 years or until the age of 25, whichever is the longest Which state quotes a minimum of 10 years? Western Australia What is the ocular marking HT? Heat tempered What is the ocular marking CT? Chemically tempered What letters would be on a medium impact device? I and F What letters would be on a high impact device? V and B What letter would be on an extra high impact device? A What letters would be on specs for molten metals or hot solids? M or 9 What are visual standards for cars and motorcycles? Uncorrected VA no worse than 6/12 better eye - license allowed if adequate correction with specs, Corrected VA no worse than 6/24. 110 degrees horizontally with 10 degrees above and below midline, scotoma within 20 degrees of fixation What are the visual standards for a HGV? Uncorrected VA is worse than 6/9 in better eye or 6/18 either eye - conditional license if correctable. Visual field 140 degrees within 10 degrees above and below the midline, no field loss/scotoma, hemianopia, quadrantanopia likely to impede driving What are the visual standards for a train driver? Can't be worse than 6/9 in best eye, can't be worse than 6/18 either eye. No visual field defect, not monocular, normal colour vision, no diplopia What are the visual standards for an electrician? Adequate colour vision - anomalous colour vision may be acceptable, D15 test. What are category A conditions for firefighters? BCVA less than 6/9 binocularly, less than 6/18 either eye, uncorrected distance less than 6/36 binocularly, BC NVA less than N5, visual fields less than 120 degrees in the horizontal field each eye, protan defect, significant deutan defect, retinal detachment, diplopia, night blindness, corneal scarring, monocular vision What are category B conditions for firefighters? Mild deutan defect, cataracts, progressive or recurring eye disease What are visual standards for the police? May need good colour vision and no refractive surgery - needs referring to specialist if either of these criteria met If an occupational patient fails ishihara what is the next step? Occupational lantern test What are the visual standards for the armed forces? MRV1, MRV2, MRV3 What are the standards in MRV1? Unaided 6/12, aided 6/6, no greater than 6PD horizontal, 1PD vertical What are the standards for MRV2? Unaided 6/24, aided 6/9, rx -1.00 to +2.25 no greater than 1DC, no greater than 6PD horizontal or 1PD vertical What are the standards for MVR3? Unaided 3/60 Aided 6/12, up to +/- 7.00D What are the standards for a pilot? 6/9 corrected, 6/6 or better when tested with both eyes, no greater than +/-5D, N5 with correction, N14 without correction What level of amblyopia is significant? 0.1 or more logMAR, greater than 1 line snellen, What is the expected VA of a 2 year old? 6/12-6/9 with Cardiff Cards or SG What is the expected VA of a 1 year old? 6/18 Cardiff/Keeler What is the expected VA of a 6 month old? 6/36-6/30 Keeler or Cardiff What is the expected VA of a 3 month old? 6/90-6/60 When would you prescribe the full rx to a child? Reduced likelihood of emmotropisation children with Down Syndrome / Cerebal Palsy. Strabismus. Previous spec wear chance to adjust to rx. What is the equation for back vertex distance? Fc = F/(1-dF) What bifocal seg is best for myopes and why? D segs as induce less jump What bifocal seg is for hypermetropes and why? Round segs, less prismatic effect at near What sizes are D segs available in? 25,28,35,40,45 What size are R segs available in? 22,24,25,28,30,38,40,45 What is the equation for calculating inset? Mono distance CD - mono near CD What is the equation for calculating different sized round segs? D1-D2 = 2xdp/add What is slab off? Removes base down prism from the lower part of the more negative lens. Name 7 types of eye protection. Eyecup goggles, eyeshield, faceshield, safety clip ons, spectacle eye protector, wide vision goggle, wide vision spectacles What is the LTF of grade 0 tinted specs? 80%-100% What is the LTF of grade 1 tinted specs? 43%-80% What is the LTF of grade 2 tinted specs? 18%-43% What is the LTF of grade 3 tinted specs? 8% - 18% What is the formula for calculating true surface power? Ftrue = Fnom x (ntrue-1)/(nnom-1) What is n for nominal index on lens measure? 1.53 What are the different plate designs in an Ishihara test? Demonstration, Transformation, Vanishing, Hidden, Diagnostic What can the D15 test be used for? Classifying type of a defect What is the purpose of 100 hue test? Classifying type and severity What is Sheard's criterion? Fusional reserve must be at least 2 x demand. Prism needed = 2/3(phoria) - 1/3(BO to blur) What is the 1:1 Rule? Base in recovery should be at least equal to the amount of esophoria, base out prism needed = (esophoria - BI recovery)/2 What is Percival's rule? Comfort zone is in the middle third of the width of clear single vision, prism needed = 1/3(Greater of lateral range blur limit BI or BO) - 2/3(less of lateral range blur limit) When will patients adopt a face turn? Horizontal deviation In a left lateral rectus palsy what head turn would be expected and why? Head will be turned to the left which deviates the eyes to the right away from muscle weakness When will a px adopt an elevation or depression? In A or V patterns What is a base out prism test? 20 base out prism in front of one eye, other eye should shift to take up fixation then first eye take up compensatory movement. Which intermittent esotropias require surgery? Near, distance, cyclic, non specific How would you manage a constant esotropia with an accommodative element? Order full rx, treat amblyopia, surgery if cosmetically poor What is a consecutive esotropia? Eso in a px who initially had an exo as a result of surgical over correction often intentional What are the types of esophoria? Convergence excess, divergence weakness, non-specific What are the types of exophoria? Convergence weakness, divergence excess, non-specific List 5 ways accommodation can be defective. 1 - Presbyopia, 2 - Accommodative insufficiency, 3 - accommodative fatigue, 4 - accommodative inertia, 5 - accommodative paralysis What is the normal range of AC/A ratio? 3 - 5 What can cause a limitation of movement? 1) neurogenic, 2) mechanical 3) myogenic What muscles cause an A eso? LR and IO What muscles cause an A exo? IR and MR What causes V eso? SO What causes V exo? SR What muscles are affected by a IIIrd nerve palsy? Medial, inderior and superior recti, inferior oblique, sphincter pupillae, ciliary muscle, levator What muscle is affected by a IVth nerve palsy? Superior oblique What muscle is affected by a VIth nerve palsy? Lateral Recturs What is the most common congenital muscle palsy? 4th nerve What will be the appearance of a 4th palsy? Eye hypertropic and esotropic What is the hallmark of a convergence excess esophoria? Greater at near than distance What is the hallmark of divergence weakness esophoria? Greater at distance than near What is the hallmark of a convergence weakeness exo? Greater at near with convergence insufficiency What is the hallmark of divergence excess exo? Greater at distance than near What are typical fusional reserves for base out near fixation? 30-35D What are typical fusional reserves for base in near fixation? 12-14D What are typical fusional reserves for base out distance fixation? 20-25D What are typical fusional reserves for base in distance fixation? 6-8D What are typical fusional reserves for vertical base? 2-4D How do you perform fusional reserves? Introduce prism gradually, record blur / break / recovery What are exercises to improve esophoria and what is the aim? Aim to improve negative relative convergence - stereograms, bar reading and fusional reserve exercises What are the exercises to improve exophoria and what is the aim? Aim to improce positive relative convergence with stereograms, fusional exercises What causes a high AC/A ratio? Accommodative esotropia What causes a low AC/A ration? More exotropic at near What is the relationship between Ks and corneal astigmatism? 0.1mm = 0.50 astigmatism What can be done to amend an RGP with high decentration? Reduce lens thickness, reduce total diameter, may have excessive amounts WTR astigmatism - back surface toric How can lens movement be increased? Increase BOZR, Decrease BOZD, Decrease TD A px presents with irritated lens, mucus and excessive lens movements as well as lens deposits, investigation shows papillae and follicles on both upper lids and superior corneal staining. What is the cause and management? CLIPC - Cease lens wear, change lens material to lower modulus and more frequent replacement plan, cold compress, reduce WT, improve hygiene, sodium cromglycate What is the management for neovascularisation? Reduce lens wear, cease lens wear for few days, stop EW, increase oxygen permeability, SiH, decrease mechanical stimulation What are successful rxs for OrthoKs? -1.00DS to -4.50DS, up to -1.50DC and possible up to -6.00DS What are the 4 key features of an orthoK lens? Flat central zone, reverse curve zone, peripheral aspheric zone, bevel Describe a typical reverse geometry fit. Central touch, mid peripheral clearance, peripheral alignment, edge lift What should the ideal fitting profile of an ortho Ks be? 4-5mm diameter centrally flattened zone, concentric regular steep zone, peripheral cornea with unchanged geometry How is Horner's pupil diagnosed? 4% cocaine - no dilation with Horner's. Hydroxyamphetamine 1% preganglionic lesion both pupils will dilate, post ganglionic lesion the Horner's pupil won't dilate What are causes of Horner's pupil? Brainstem disease, spinal cord tumour, Pancoast tumour, carotid and aortic aneurysms, neck lesions, cluster headaches, otitis media, cavernous sinus mass, nasopharyngeal tumour How is Adie's pupil diagnosed? Pilocarpine causes abnormal pupil to contract vigorously What is the appearance of Adie's pupil? Larger pupil initially and may be irregular, smaller over time 'Little Old Adie' What drops are often prescribed post cataract? Maxitrol - (dexamethasone, polymyxin, neomycin) and predforte !% What is the incidence of post-cat CMO? 1-2% What is the incidence of post-cat endophthalmitis? 0.1% What is the incidence of retinal detachment post-cat? 0.7-3.6% What is the incidence of raised IOP post-cats? 8% What % of men are deuteranomolous? 5% What is the incidence of PSCLO post-cats? 8% What are type 1 R-G defects? Associated with reduced VA and central field defect. Caused by cone and RPE dystrophies - Stargardts, Chloroquine dystrophy What are type 2 R-G defects? Acquired retinal ganglion cell disease, optic neuropathy What are type 3 defects? Blue-yellow, reduced sensitivity or peripheral field defects - rod dystrophies, retinal vascular disorders, peripheral retinal lesions, retinal nerve fibre defects, macula oedema, What are causes of Roth spots? Endocarditis, leukaemia, anaemia, anoxia, CO poisoning, hypertensive retinopathy, pre-eclampsia, diabetic retinopathy, neonatal birth trauma, shaken baby syndrome What are side effects of cocaine? ACG, reduced vision, CV defects, visual hallucinations, photosensitivity, reduced pupil reactions to light and mydriasis, paralysis of accommodation, exophthalmos, optic neuritis, madarosis, iritis, retinal haems, CRAO How is CMO treated? CAI and steroids, ketorolac (NSAID) What are non-optometric treatment options for keratoconus? Keratoplasty (penetrating or deep lamellar), collagen cross linking What are the advantages and disadvantages of DALK? Advantages - no risk of endothelial rejection, less astigmatism and a structurally stronger, increased availability of graft material Disadvantages: difficult and time consuming, high risk of perforated cornea, interface haze What are the advantages and disadvantages of collagen cross linking? Can be used in early to moderate keratoconus, helps to prevent keratoconus worsening, side effects include: punctate keratitis, corneal epithelium defect, haziness, dry eye, photophobia What are the advantages and disadvantages of penetrating keratoplasty? Advantages: simpler technique, faster Disadvantages: higher rate of astigmatism, more sutures, neovasc, longer visual rehabilitation