Sample Test Questions
Binocular Vision and Pediatrics
Mitchell Scheiman
Quiz
The best method for testing visual acuity in an infant (baby) is
The Snellen Acuity Chart
The Lea Symbol Chart
The Tumbling “E” chart
The fixation preference test
Which of the following suggest that the patient has amblyopia?
The patient freely alternates without intervention on the part of the examiner
The non-preferred eye holds fixation for less than 3 seconds, but not through a blink or smooth pursuit.
The non-preferred eye can hold fixation for at least 5 seconds, through a smooth pursuit, or through a blink
Your 5 year old patient presents with 10 prism diopters of esophoria at distance and 20 prism diopters of intermittent esotropia at near. The refractive error is +1.00 OD and OS and the child has 20/.20 visual acuity in both eyes with the glasses. With the glasses the cover test is ortho at distance and 10 esophoria at near. The best diagnosis for this patient is:
Accommodative esotropia secondary to hyperopia and high AC/A ratio
Accommodative esotropia secondary to hyperopia
Accommodative esotropia secondary to high AC/A ratio
Accommodative exotropia secondary to hyperopia and high AC/A ratio
With a 2-year-old child we would usually prescribe eyeglasses if the degree of myopia is greater than
-0.50
-0.75
-1.00
-1.25
Which of the following examination findings (all performed at 40 cm) would be characteristic of a patient with a receded NPC, ortho at distance and 10 exophoria at near
Which of the following tests does not assess negative fusional vergence?
PRA
Binocular accommodative facility with –2.00 lenses
Binocular accommodative facility with +2.00 lenses
Vergence facility with base-in prism
A 16 year-old patient presents a complaint of intermittent diplopia when looking at distance objects. The cover test examination at distance is 10 esophoria and at near ortho. The history clearly indicates that the patient has had this problem for many years. The best diagnosis is:
Divergence excess
Divergence insufficiency
Convergence excess
Convergence insufficiency
You perform MEM retinoscopy on a patient and find -0.50 OD and OS. Which of the following diagnoses would you suspect?
You find the following test results. Distance cover test Ortho Near cover test 6 exophoria AC/A ratio 3/1 Base in @ near 12/20/11 Base out @ near 8/12/8 Amplitude 12 D What will the negative fusional vergence @ near finding be through +1.00 lenses?
11/15/11
5/9/5
15/23/14
9/17/8
A patient is viewing a target at 33 cm while you perform the cover test. The distance phoria is 1 esophoria and the patient’s IPD (interpupillary distance) is 66 mm. The AC/A ratio is 4/1. Predict the phoria at near.
5 exophoria
7 exophoria
10 exophoria
12 exophoria
15 exophoria
Which of the following would be considered a significant Rx?
OD: +0.75, OS: +0.75
OD: +0.25-0.75x180 OS: +0.25-0.75x180
OD: -0.25, OS: -0.50
OD: +pl – 1.00x15, OS: +0.25-1.00x165
none of the above would be considered a significant Rx
Which of the following statements is true about the use of prism to treat binocular vision disorders?
Base out prism is used to treat exodeviations
When prism is prescribed to treat an esodeviation, we do not expect the eye to change alignment through the prism
The goal of prism correction is to increase the compensatory fusional reserve
Prism is more useful with horizontal than with vertical deviations
A patient is struggling to perform the base-in procedure with HTS. Which of the following would be helpful to make the task easier for the patient?
Have the patient view the target through -1.00 OU
Have the patient try and get the feeling of crossing his eyes
Have the patient view the target through 4 base out
Have the patient cover one eye during the procedure
Case TWO A 15-year-old 10th grader presented with a history of asthenopia associated with short periods of reading. VA(Distance, uncorrected): OD: 20/20, OS: 20/20 Near Point of Convergence: Penlight: 5 cm / 7.5 cm Cover Test (Distance): Ortho Cover test (Near): 4 exophoria Subjective: OD: plano, OS: plano -1.00 Gradient: Ortho Base In Vergence (Near): 6/12/6 Base Out Vergence(Near) 5/9/7 NRA: +1.50 PRA: -1.50 Accommodative amplitude(push up): OD: 13D,OS: 13D Monocular Accommodative facility OD: 12 cpm, OS: 12 cpm Binocular Accommodative Facility: 0 cpm, difficulty with both +/-2.00 MEM Retinoscopy: +0.25 OU For CASE Two the diagnosis is:
convergence insufficiency
convergence excess
fusional vergence dysfunction
accommodative infacility
Case TWO A 15-year-old 10th grader presented with a history of asthenopia associated with short periods of reading. VA(Distance, uncorrected): OD: 20/20, OS: 20/20 Near Point of Convergence: Penlight: 5 cm / 7.5 cm Cover Test (Distance): Ortho Cover test (Near): 4 exophoria Subjective: OD: plano, OS: plano -1.00 Gradient: Ortho Base In Vergence (Near): 6/12/6 Base Out Vergence(Near) 5/9/7 NRA: +1.50 PRA: -1.50 Accommodative amplitude(push up): OD: 13D,OS: 13D Monocular Accommodative facility OD: 12 cpm, OS: 12 cpm Binocular Accommodative Facility: 0 cpm, difficulty with both +/-2.00 MEM Retinoscopy: +0.25 OU For CASE Two what is the most appropriate treatment sequence?
Rx +1.00 for reading and have patient return in 4 weeks for a follow-up visit
Rx plano with a +1.00 add and have patient return in 4 weeks for a follow-up visit
Rx OD: plano with 2 base-in and OS: plano with 2 base-in and have patient return in 4 weeks for a follow-up visit
Rx home-based vision therapy to expand fusional vergence
Rx home-based vision therapy to improve accommodative function