Geriatric Optometry MT II - Examination

What are typical refractive changes encountered in older pts?

ATR astigmatism, refraction towards hyperopia

For smaller pupils, what can you do as far as retinoscopy?

Move closer - but remember working dist

For media opacities, what can you do as far as retinoscopy?

Use a spot retinoscope

Why do pts see diplopia in the phoroptor after subjective refraction?

Loss of peripheral fusion - most important factor in keeping img single

T/F - SRx tends to be stable in older pts, unless there is pathology, so keep SRx near habitual.

True

What is the best test to know if the pt has a constant or intermittent eye turn?

Randot stereo (constant strab cannot do randot)

What vergence component can be treated in older pts?

Fusional - the ONLY component that can be Tx'd in older pts (test w/ Von Graefe)

You should expect >__ cm break and >__ cm recovery in NPC.

9, 7

You should expect high (XP/EP) at near with older pts.

XP

You should expect what kind of tropia with older pts?

intermittent XT at near

You should expect low (BI/BO) vergence ranges.

BO

T/F - You should expect various levels of suppression in older pts.

True

T/F - You should expect CI due to decompensated phoria.

True

T/F - Intermittent diplopia should not be expected in older pts.

False - intermittent diplopia is a common complaint

T/F - VT is not recommended for older pts w/ CI.

False - very successful esp for CI

T/F - You can use fixation disparity for Rxing prism.

True

What apparatus used outside the phoroptor is used for Rxing prism?

Maddox rod (in free space)

What does the total deviation on VFs measure?

Compares VF to normals

What does the pattern deviation on VFs measure?

Filter out generalized depression from total deviation

What is the difference between a limbal girdle vs arcus?

The girdle "hugs" the limbus, while arcus has an area of clearing

What is the proper course of action to take if you cannot get a good view of the post seg during the DFE?

B scan or refer to specialist

What vitamins are recommended for dry eye?

Vitamins A, C, E - "ACE"

What is the significance of a CPAP machine and dry eye?

Used for sleep apnea - if not a tight seal, will blow air into eyes and cause dry eye

What color does cataracts affect?

Blue

Which of the following will a healthy old person get normal results with?
- D-15
- HRR
- Ishihara

HRR and Ishihara (D-15 will show minor problems bu not absolute problems like a true tritanope)

What is a PHP? What is it used for? How long does it last, and how many degrees?

Preferential Hyperacuity Perimeter. Detects/monitors ARMD (conversion to wet). 5 minutes, 14 degrees.

PHP is a (subjective/objective) measure of what type of acuity?

subjective, hyperacuity (vernier acuity)

What does RAM stand for? What is it used for?

Retinal Acuity Meter - for eval potential VA after cat surg

The "high" setting on the BAT simulates...

direct overhead sunlight

The "medium" setting on the BAT simulates...

partially cloudy day

The "low" setting on the BAT simulates...

bright ovehead commercial lighting

No improvement on the BAT indicates...

no opacity

Decr VA on the BAT indicates...

opacity

Incr VA on the BAT indicates...

pinhole effect

T/F - Elderly are more visually impaired than hearing impaired.

False - more hearing impaired

(Lower/Higher) pitched sounds are worse for the elderly?

higher

T/F - Use of the stethoscope for hearing impaired elderly is not recommended.

True

T/F - Address the caregiver first, then the patient.

False - patient first, then caregiver

While doing BVAs, you find that even pinhole won't improve your elderly patient's 20/80 VAs OD, OS. What should you do next?

Slit lamp

What is the JND? What is the "rule of thumb" in relation to this?

Just Noticeable Difference. Take denominator of BVA and divide by two to see how many diopters to change, i.e. 20/100, go in 0.50D steps.

According to the lecture, what are the three more common cataracts in the elderly?

Cortical spoking
Nuclear sclerosis
Posterior subcapsular

Which is age-related, pigment dispersion or pseudoexfoliation?

Pseudoexfoliation

Where does cortical spoking usually begin?

Inferior-nasal quadrant

Cortical spoking is due to...

UV light

T/F - Cortical spoking is possible in both the anterior and posterior cortex.

True

Cortical spoking is a (fast/slow) progressing type cataract - f/u usually in ___ months.

slow, 6-12

Cortical spoking affects VAs until about __% opacity.

93

Grade 1 cortical spoking is characterized by __ to __% opacification.

0-25

Grade 2 cortical spoking is characterized by __ to __% opacification.

25-50

Grade 3 cortical spoking is characterized by __ to __% opacification.

50-75

Grade 4 cortical spoking is characterized by __ to __% opacification.

75-100

T/F - Cortical spoking can be graded by both the area opacified and the degree/density of the opacification.

True

T/F - NSCs are always symmetric.

False - can be asymmetric

T/F - NSCs can be white in color.

True - rapidly progressing or traumatic NSCs

Trace NSC characterized by 20/__ VAs and what color?

~20/20, slight yellowing

1+ NSC characterized by what VAs and what color?

20/25-20/30, yellow

2+ NSC characterized by what VAs and what color?

20/30-20/40, yellow-orange

3+ NSC characterized by what VAs and what color?

20/50-20/60, orange

4+ NSC characterized by what VAs and what color?

>20/80, brown

PSCs are usually what color?

Whitish, but if present w/NSC will appear brown

PSCs are due to...

migration and thickening of lens epithelial cells in the posterior subcapsular area

T/F - PSCs are associated with vacuoles.

True

T/F - PSCs are age-related only.

False - can be secondary to trauma, chronic uveitis, systemic steroid use.

T/F - PSCs can be caused by acute uveitis.

False - chronic uveitis

T/F - It is possible to have good acuity while reading and in bright light, but have poor VA chart acuity with PSCs.

True

A __% dense PSC can cause a decrease in VA.

3