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OCANZ Written Exam New 2024- 2025 Latest Version
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When referring for glaucoma, what is the least important test? (Visual acuity, IOP, CCT and one other) --------- Correct Answer ---------- ????? VA Which is the following would be irresponsible to allow optical assistants to carry out A look through a px's file to get their spec rx B triage red eyes and advice pxs on medical aids they can take C answer phone calls and organise clinic --------- Correct Answer ---------- B triage red eyes and advice pxs on medical aids they can take Which of the following would be considered unprofessional A calling a px by their first name amongst a crowded waiting area B showing them a photo of their fundus and discussing it w them C showing an abnormal finding on their file to a practitioner outside of the clinic/store ---- ----- Correct Answer ---------- ???? Which of the following causes recurrent corneal erosions? a) epithelial basement membrane dystrophy b) schnyder's c) crocodile shagreen --------- Correct Answer ---------- a) epithelial basement membrane dystrophy What corneal layer do the follwoing happen? schnyder's and crocodile shagreen --------- Correct Answer ---------- Stroma An elderly lady complaining of a reduction in vision and affected optic discs tells you she had raised ESR when it was tested. What diagnosis is more likely because of this? a) Papilloedema b) Retrobulbar optic neuritis c) AION c) NAION --------- Correct Answer ---------- c) AION An overweight middle aged lady who takes meds (she is not sure why but says it's to do with being too fat) has an golden glistening obstruction at a bifurcation. What further investigations are required? a) investigation of the carotid artery b) full blood work up with GP c) ESR checked --------- Correct Answer ---------- b) full blood work up with GP What is Sheard's criterion? --------- Correct Answer ---------- Prism needed = 2/3 (phoria)
- 1/3 (compinsating fusional vergence)
eg: pt has 6 XP and BO to blur is 6, the prism needed is 2/3 (6) - 1/3 (6) = 2 BI What is Percival's criterion? --------- Correct Answer ---------- Prism needed = 1/ (greater limit of BI or BO range) - 2/3 (lesser limit of BI or BO range) eg: pt has 6 XP and BO ranges of 6/10/8 and BI range of 21/26/22, prism needed = 1/ (21) - 2/3 (6) = 3 BI What is the leading cause of blindness in Australia A cataract B DR C ARMD D RP --------- Correct Answer ---------- ARMD Which part of the optic nerve is thinnest A temporal B superior C inferior D nasal --------- Correct Answer ---------- Temporal A contact lens wearer that is 25 years old, what is the most likely cause of SPK? (Mucin balls, solution toxicity, tear film stability and one other) --------- Correct Answer ---------- Tear film instability What is Ketotifen used for? --------- Correct Answer ---------- antihistamine and mast cell stabilizer Patient is a +2.50 hyperope with a +1.00D add, what is the least likely prescription for this patient? (Multifocal, bifocal, 2 separate pairs and one other) --------- Correct Answer ---------- ??????? Baseball hit in the eye, limited elevation of the eyes, what would the cause be? --------- Correct Answer ---------- Blow out fracture Which of the following is a dry eye sign? Hyperosmolarity, lysozyme decrease --------- Correct Answer ---------- Hyperosmorality What can tear film hyperosmorality cause? --------- Correct Answer ---------- hyperosmolarity can induce tear film instability by modifying the interaction between tear film lipids and proteins, damaging the epithelial cell membranes, triggering inflammation, and stimulating corneal nerves 25 year old with stargardts disease requests assistance with reading tasks, lighting at work and travel, which of the following professional below will assist him- occuptational therapist, orientation instructor,
Lissamine green; what does it stain? --------- Correct Answer ---------- Lissamine green stains dead and degenerate cells, yet does not stain healthy epithelial cells. (NaFl permeates into the intercellular space associated with any epithelial cellular disruption) Is gonio indicated with Hyphaema? --------- Correct Answer ---------- no What is prenticies rule? --------- Correct Answer ---------- P (prism dioptres =c (decentration in cm) x F(power of lens in dioptres) What is the most preventable cause of AMD? --------- Correct Answer ---------- Smoking 15 years old attends eye examination, best Va's R6/6, L 6/24 (told ambloypic). Which occuptation should he NOT pursue: a/ Train driver, B/ construction worker, c/ Electrician, d/ Dentist --------- Correct Answer ---------- a/ Train driver RGP fit with lens riding high and bubbles underneath. What is the bubbles underneath- name? What is the cause? How would you change the fit? Rewrite the prescription, base curve/power/diameter according to change in fit. 0.05 base curve change the rx by 0.25, 0.5mm diam change etc...all the rules of thumb --------- Correct Answer ---------- DimpleVeil RGP too steep - reduce total diameter, flatten Change BOZR by 0.1mm then change power of 0.50D to keep NaFL pattern? Increase TD by 0.1mm then flatten BOZR by 0.05mm Picture of GPC, differential diagnosis, treatment Treatment method for GPC? --------- Correct Answer ---------- improve lens hygeine Increase lens replacement frequency DD if possible Reduce modulus of lens material (Swap to hydrogel lens, be aware more difficult to handle) Manage lid margin disease If sever - topical Mast cell stabalisers Colour vision: What careers can you do if you have a defect? What is the fail criterion for D15. What test would you do to confirm ishihara? --------- Correct Answer ---------- Fail criterion is 2 or more diagonal crossings D15 can classify but not grade severity
63 year old elderly woman with purple loss in vision for past 3 weeks, she is experiencing jaw claudication. a) What is your diagnosis? b)What is your systemic and optometric management? c) Patients prognosis? --------- Correct Answer ---------- GCA evaluating visual acuity, pupils (looking for a relative afferent defect), intraocular pressures, anterior segment examination, motility examination (looking for ocular misalignment and/or evidence of cranial neuropathies), and a dilated fundus examination (evaluating for signs of optic nerve or retinal ischemia) Visual fields testing ESR (erythrocyte sedimentation rate), high then indicated inflamation CRP (C reactive protein) - produced by liver with inflamation platelets temporal artery biopsy prog good if no CRAO or AAION, better prognosis the sooenr steroids are started Patient burnt with laser. Management --------- Correct Answer ---------- NSAID or Anti VEGF depending on severity Name of drops post cataract and percentages post op. --------- Correct Answer ---------- Different ophthals do different things. Ideally you want an antibiotic eg chloramphenicol for 1 month qid and a steroid eg maxidex for 1 month qid start tapering after 1 week ie 4 then 3 then 2 then 1 drop then an NSAID eg voltaren bid for a month Visual fields: inferior nasal step, what other defects cause this effect, management. ------ --- Correct Answer ---------- Glaucaom or disc druse, if arcuate consider BRVO Tree branch hit the patient in the eye, diagnosed as RCE which is failing to heal and is uncomfortable. What to do? (Bandage contact lens, debridement and 2 others) --------- Correct Answer ---------- Punctal occlusion>bandage contact lens> Patient with a prescription of +4.50, PD of 60mm, seg height of 20mm each eye. Spectacles arrive from the lab with optical centers cut at 62mm and a seg height in the right eye of 21mm. What would be the prismatic effect and in what direction? --------- Correct Answer ---------- How many times a day would you dose a prostaglandin for glaucoma? (One a day, twice a day, three times a day or four times a day) --------- Correct Answer ---------- od
What is the most prominent side effect of suddenly stopping a steroid eye drop? --------- Correct Answer ---------- You can get rebound inflammation What is not required to be done at every follow up with Glaucoma? Iops Visual fields Goniscopy Corneal thickness --------- Correct Answer ---------- Pachymetry (as it is for diagnosis not management) Who is most appropriate to refer a px with a conjunctival lymphoid tumour to Ophthalmologist Oncologist Haematologist GP --------- Correct Answer ---------- ophthalmologist What is Hutchinson's sign and what is it a sign of? --------- Correct Answer ---------- nasociliary skin lesions for ocular inflammation and corneal sensory denervation in acute herpes zoster ophthalmicus. Pressures of 22mmHg in each eye, what else is needed in order to manage the patient? (Pachymetry, gonioscopy, visual fields and OCT) --------- Correct Answer ---------- Pachymetry One pupil (OD) bigger than the other, what is wrong? (Sympathetic pathway of OD, sympathetic pathway of OS, parasympathetic pathway of OD and parasympathetic pathway of OS) --------- Correct Answer ---------- one or both pupils to be abnormally dilated with delayed constriction disorder of the parasympathetic nervous system innervation to the iris sphincter and ciliary muscle Causes include viral infection, trauma, vasospasm due to migraine, ocular surgery, tumors, and possibly chronic cough Hypersensitivity to pilocarpine What is the most common cause of proptosis? --------- Correct Answer ---------- Graves disease
- What is the biggest complication of thyroid eye disease? --------- Correct Answer ----- ----- Exposure keratitis In which patient is diabetic retinopathy more common? (Type 1 for 4 years, type 2 non- insulin for 4 years, type 2 insulin defendant for 10 years and one other? --------- Correct Answer ----------
All the following cause vortex keratopathy except for? (Wilsons disease, chloroquine, fabry's disease and amiodarone) --------- Correct Answer ---------- What is Fabrys disease? --------- Correct Answer ---------- Fabry disease is a lysosomal enzyme (alpha-galactosidase A) deficienc causing Cornea verticillata, the most typical ocular sign in Fabry disease What is Wilsons disease? --------- Correct Answer ---------- Wilson's disease is a genetic disorder in which copper builds up in the body and cause fleichers ring Which would be the most common cause of amblyopia? (Accommodative eso, alternating eso, anisometropia of more than 2D and one other) --------- Correct Answer - --------- anisometropia
- Which colour vision test determines the type and severity? --------- Correct Answer -- -------- Farnsworth Munsell Fm Signs of primary open angle glaucoma --------- Correct Answer ---------- IOP High cup:disc ratio Cup:disc ratio asymmetry between eyes (usually considered significant if greater than 0.2) Vertical elongation of cup Focal neuro-retinal rim thinning or notching Vessel bayonetingBeta-zone peripapillary atrophy Disc hemorrhage 6 week post cataract op, visual acuity has decreased. What could the cause be? --------- Correct Answer ---------- CMO Patient bumping into things and has ARMD, what would be the most appropriate referral? (Orientation and mobility, ophthalmologist, occupational therapist and one other) --------- Correct Answer ---------- Orientation and mobility Prostaglandin analogues have what possible side effects to the eye? --------- Correct Answer ---------- eyelash growth, eye color and eyelid skin, stinging, blurred vision, eye redness, itching, burning. What is an advantage of positive cylinder form? --------- Correct Answer ---------- 4year old with patching 2hrs a day not improving VA on last 2 consecutive visits. What is most urgent requirement cIncrease to 6hrs Start suppression therapy Start atropine penalisation Rule out underlying pathology --------- Correct Answer ----------
history given, explain cataract surgery in lay mans terms, what are the post surgical complications to look out for? --------- Correct Answer ---------- Cataract Cause of visual complaint Compramising Lifestyle Driver Anisometropia Visual Acuity Other Ocular Pathology General Health and Medications Patient wants to have operation Year old with high plus anisometropia. Explain 5 reasons why contact lenses are a better option than spectacles. In spectacles - RE +0.50DS LE +7.50DS in contact lenses RE +1.00DS LE +9.00DS --------- Correct Answer ---------- 1. cosmesis/comfort/weight
- spectacle magnification
- field of view (no ring scotoma)
- Less convergence needed in contact lenses (opposite of myope) 5 Less accomodation neeed in contact lenses ((opposite of myope))
- Picture of an eye with blepharitis (collorettes along the lashes and mucous discharge). What would you diagnose, give differential diagnoses, what is the general cause of this condition and what is the management of this condition? --------- Correct Answer ---------- Lid hygiene Warm compresses avoidance of cosmetics, especially eye liner and mascara Weak evidence to suggest antibacterials help. DD- conjunctivitus's, eyelid traumas Given a visual field plot indicating a left temporal quadrantic defect. Asked whether the test was reliable or not, asked what the scientific name for the defect would be, name 2 conditions that would cause this type of defect, management of these conditions? --------
- Correct Answer ---------- left superior homonymous quadrantanoipa indicating legion in optical radiations (meyers loop) Female presents with a dilated pupil (OD) which doesn't respond to direct or consensual pupil tests. The deep tendon reflex is also absent. What pupil abnormality would you diagnose, give differential diagnoses, what additional tests would you want to perform to confirm the diagnosis. --------- Correct Answer ---------- one or both pupils to be abnormally dilated with delayed constriction disorder of the parasympathetic nervous system innervation to the iris sphincter and ciliary muscle
Causes include viral infection, trauma, vasospasm due to migraine, ocular surgery, tumors, and possibly chronic cough Hypersensitivity to pilocarpine Photo of inferior BRVO, explain what has happened (4marks) Explain patients prognosis (6marks). --------- Correct Answer ----------
- Obese patient experiencing headaches and blurred vision. Fundus photographs show papilloedema. What is the diagnosis, what other screening tests would you do, what would you ever this patient for? --------- Correct Answer ----------
- 27 year old male experiencing pain behind the eye, vision is slightly reduced, no systemic issues to take note of, optic nerve is slightly hyperaemic. What is your diagnosis, what additional tests would you perform, what systemic treatment would be necessary? --------- Correct Answer ----------
- A patient has a BCVA of OD plano 6/6 OS - 0.75 6/9 and wants to be a pilot. What are the requirements he would need to meet to be a pilot and what other options does he have? --------- Correct Answer ---------- Patient has a laser burn from working in a chemistry lab. What color vision defect would this patient present with? How would you diagnose this? What causes acquired colour vision defects What is the most common acquired colour vision defect? --------- Correct Answer ---------
- Use Ishihara to screen, 122 year old male with itchy eyes and stringy mucopurelent discharge for the past 1 week. Patient says that this has also happened before once. There is a picture of the lids which show moderate crusting of upper and lower lids/lashes that extends slightly onto lids. a)What is your diagnosis? b)What is your differential diagnosis? c)What caused this to occur? d)What is your management? --------- Correct Answer ---------- Recurrent Bacterial Conjunctivitis DD - epidemic keratoconjunctivitis (e.g. adenovirus) Herpes (simplex or zoster) Chlamydial infection, allergy Contamination of the conjunctival surface with bacteria Bleph Bathing lids and lid hygiene
What does BRÜCKNER TEST allow? and how is it done? --------- Correct Answer -------- -- Early detection of amblyopia in very young children that is not possible to perform other tests on. Looking at the difference in retinal transillumination using a direct ophthalmosocope at a distance ~0.5m Describe Hirchberg Test --------- Correct Answer ---------- using pupil reflexes to determine if strabismus is present Describe Kappa test? --------- Correct Answer ---------- using monocular pupil reflex to determine if eccentric fixation present A 50 year old myope presents to you. She mainly wears contact lenses - RE - 3.50 and LE - 3.75. Her spectacle prescription is as follows: RE - 3. LE - 3.50 Add +1.00 R+L Discuss four different ways to correct her spectacle prescription. List one advantage and one disadvantage of each. --------- Correct Answer ---------- 1. monvision contact lenses (stereo, price)
- RR over contact lenses (glasses and lenses, price)
- multifocal contact lenses (price, no glasses)
- varifocal (wearing glasses, all distances)
- bifocal (cosmesis + jump, corrects Reading and distance) What is most important to check following a px coming into your practice with pressures of 22mmhg r+l? A time of day reading taken B type of machinery used C central corneal thickness D family history of Glaucoma --------- Correct Answer ---------- Recent onset of Diplopia suspected 4th nerve palsy. Action required Immediate referral to ophthalmologist Treat with prism Review in 1 month Refer for squint surgery --------- Correct Answer ---------- Immediate referral to ophthalmologist 4th nerve (trochlear)- superior oblique
- Slight Diplopia on R lateral gaze and restriction of RE looking temporally. Which nerve is affected? II
VII
VI
III --------- Correct Answer ---------- VI What is most likely in children Astigmatism is likely to increase over 3yrs Moves to against astigmatism with development Is likely to have oblique axis Astigmatism reduces in children over 3 --------- Correct Answer ---------- Optic disc pathology is most likely to cause colour vision problems with Red green Blue yellow Atypical --------- Correct Answer ---------- Red/Green Type 2 D15 colour vision does the following Classifies type and severity of congenital types Classifies type and not severity of congenital type --------- Correct Answer ---------- Classifies type and not severity of congenital type Corneal brown swirl like deposits noted what is least likely to be cause Amiodarone Fabrys Wilsons Chloroquine --------- Correct Answer ---------- Chloroquine If px is non-responsive to cold compress with allergic conjunctivitis what is next option? Chloramphenicol Antihistamine Antiviral --------- Correct Answer ---------- Anti histamine What is with the rule astigmatism --------- Correct Answer ---------- When the steepers meridian is vertical - the minus cyl axis is @180 degrees Child, watery hyperaemic eye started In 1 eye and 2 days later went to the other. Follicles seen on lid eversion and white fine stromal opacities noted nasal cornea. A) what is this B) what is differential diagnosis C) what is your management D) what non optical management do you need to consider? --------- Correct Answer ------ ---- Follicular viral conjunctivitus
Retinal Detachment Signs of Glaucoma --------- Correct Answer ---------- Disc Signs: Asymetric Cupping, Disc Haemorrhage , Increased cuppping, RNFL changes, PPA, NRR thining. Visual field loss characteristic to ONH changes, notching, superior arcuate defect. How is glaucoma diagnosed. --------- Correct Answer ---------- Progression analysis, visual fields and RNFL scanning using OCT Medisoft plot, RE: false +ve 3% fixation losses 7/10 Le: false +ve 7% fixation losses 2/10. What is the reliability of the fields? --------- Correct Answer ---------- Fixation loss higher than about 20% is deemed unreliable. A false positive rate around 20% or higher is considered to indicate low patient reliability Medisoft plot showing a right homonymous hemianopia with macular sparing. What is the full name and classification of the condition? Where in the visual pathway is the loss? --------- Correct Answer ---------- Right homonymous hemianopia with macular sparing indicating a legion in the posterior occipital lobe and optic radiations or optic tracts Medisoft plot showing a right homonymous hemianopia with macular sparing. What is the likely cause? --------- Correct Answer ---------- Vascular episode Tumour Medisoft plot showing a right homonymous hemianopia with macular sparing. What is the appropriate management? --------- Correct Answer ---------- Prisms (field expanders) Managment of cause if possible and review. Patient with horizontal diplopia and a picture of a patient's eyes having problems with right eye adduction but no problems converging to read. What is the neurological lesion and syndrome shown? --------- Correct Answer ---------- Internuclear ophthalmoplegia is caused injury or dysfunction in the medial longitudinal fasciculus (MLF) Patient with horizontal diplopia and a picture of a patient's eyes having problems with right eye adduction but no problems converging to read.
What is the aetiology? --------- Correct Answer ---------- In the elderly, typically caused by stroke and is unilateral In young people, commonly caused by multiple sclerosis and may be bilateral Patient with horizontal diplopia and a picture of a patient's eyes having problems with right eye adduction but no problems converging to read. What is the management? --------- Correct Answer ---------- Systemic work up and management Prism Fogging Strabismus surgery 64 y/o F complains of pain on chewing and headaches 2 weeks. Loss of vision in one eye today. a) What is your diagnosis and immediate response? --------- Correct Answer ---------- Refer as emergency for systemic steroids e.g prednisolone 64 y/o F complains of pain on chewing and headaches 2 weeks. Loss of vision in one eye today. you suspect Arteritic AION. What are likely systemic causes and tests required? --------- Correct Answer ---------- ESR (erythrocyte sedimentation rate), high then indicated inflamation CRP (C reactive protein) - produced by liver with inflamation platelets temporal artery biopsy Describe two types of Blepharitis. --------- Correct Answer ---------- Anterior marginal blepharitis (seborhoric- disorder of the ciliary sebaceous glands of Zeis or bacterial - staphylococal exotoxin reaction) Posterior marginal blepharitis (MGD) - abnormal meibomian secretion. What is the management of Blepharitis? --------- Correct Answer ---------- Lid hygiene Warm compresses avoidance of cosmetics, especially eye liner and mascara Weak evidence to suggest antibacterials help. Eye lash growing in touching cornea but lid not turned in. What is the diagnosis and management (pros and cons)? --------- Correct Answer ---------- Trichiasis Removal with forceps (simple, not painful but may return) Electrolysis (time consumigng and painful) Cryosurgery (complications include corneal ulcers visual loss and lid notching)
Bleph Bathing lids and lid hygiene Low evidence to suggest antibacterials can help If corneal involvement or no resolution refer to ophthalmology. Tritan defect on D15, what 4 conditions could cause this? --------- Correct Answer -------- -- Congential Glaucoma AMD Central serous chorioretinopathy What acquired causes are there for red/green deficiencies? --------- Correct Answer ------ ---- Progressive cone dystrophies Retinal pigment epithelium dystrophies Optic neuritis Why would Ishihara not work for identifying a tritan defect? --------- Correct Answer ------- --- identifies proton/deuteron anomalies Other than the D15 what could you use to screen for a tritan defect? --------- Correct Answer ---------- Nagal Anomaloscope (lantern) Describe Adies Pupil --------- Correct Answer ---------- one or both pupils to be abnormally dilated with delayed constriction disorder of the parasympathetic nervous system innervation to the iris sphincter and ciliary muscle Causes include viral infection, trauma, vasospasm due to migraine, ocular surgery, tumors, and possibly chronic cough Hypersensitivity to pilocarpine Describe Horners --------- Correct Answer ---------- Constricted pupil due to sympathetic disorder Also may have ptosis Causes could be lung tumor, carotid artery dissection, or even a congenital malformation Associated with decreased sweating on the effected side Constricted pupil Will not dilate to cocaine A px comes in to the store, he got cement in his eye 10 minutes ago. Outline your work up of this patient
On examination you decide he needs immediate referral. What details would you include in the referral letter? --------- Correct Answer ---------- NaFl examination of the cornea to determine extent and depth of alkaline injury Palpebral fissure checks Initial PH IOP Details in referral letter should include - chemical, duration since initial incident, initial PH, IOP, however immediate emergency attention is required and irrigation. What are potential treatments for diabetic retinopathy? --------- Correct Answer ---------- laser photocoagulation anti vegf vitrectomy How quickly would you refer a patient with proliferative diabetic retinopathy (PDR) or diabetic macula oedema (DMO)? --------- Correct Answer ---------- Urgent to Ophthalmologist (within 4 weeks) unless under review Describe the management of GPC in a silicone hydrogel contact lens wearer. --------- Correct Answer ---------- improve lens hygeine Increase lens replacement frequency DD if possible Reduce modulus of lens material (Swap to hydrogel lens, be aware more difficult to handle) Manage lid margin disease If sever - topical Mast cell stabalisers 28 y/o overweight female has 6/6 vision and IOPs are normal. On examination, she has bilaterally woollen optic discs that are hyperaemic and with flame haems. a) What optometric tests would you perform b) What non-optometric tests would you perform c) What is your primary concern? --------- Correct Answer ---------- Visual fields Pupils Colour Vision Motility Stereo Disc images Primary concern Papilloedema due to raised intercranial pressure, caused by sub arachnoid haemorrhage or space occupying legion, refer emergency HES tests - Urgent neuro imaging (MRI CT) and CBC count, blood sugar, angiotensin- converting enzyme, erythrocyte sedimentation rate What is the typical retina feature of RP? --------- Correct Answer ---------- Bone spicule
