April 2011: C-15873 Paediatric Optometry Part 1

8. Which one of the following is an advantage of the chart design shown in PANEL I of Image C?
a. The spacing of the optotypes and the lines follows a geometric progression
b. The same number of optotypes are presented on each line
c. There are equal crowding affects on each of the lines of acuity
d. All the above
The correct answer is D. Panel I shows a Bailey-Lovie design of letter chart. 6 Compared with
Snellen charts, the Bailey-Lovie design has several important advantages including the letter size
and inter-letter and inter-line spacing progress logarithmically from one line to the next and the
same number of optotypes are presented on each line. These features mean that there are similar
crowding effects and task difficulty on each line.
9. Which one of the following differences in chart design between the charts shown in PANEL I of
Image C and PANEL II of Image C is TRUE?
a. The optotypes in PANEL I are 5x4 in size whilst the optotypes in PANEL II are 5x5 in
size
b. The optotypes in PANEL I follow a logarithmic progression whilst the optotypes in PANEL
II follow an arithmetic progression
c. The optotypes in PANEL I have less crowding effects than the optotypes in PANEL II
d. The optotypes in PANEL I are suitable for children under the age of 4 years
The correct answer is A. The Bailey-Lovie chart uses letters that are slightly narrower than they are
tall (5x4) whereas the Kay pictures are 5x5 in dimensions, following the Sloan design. The
optotypes in both Panel I and Panel II follow a logarithmic progression and should induce similar
crowding effects although a casual inspection might suggest less inter-optotype spacing in panel I,
which could result in more crowding. It is easier to standardise the legibility of letters than pictures,
although pictures like the Kay ones or the Lea pictures (not show) may be necessary for some
children under the age of 4 years.
IMAGE D:
10. Which one of the following statements about the condition shown in Image D is FALSE?
a. This could be a congenital cataract
b. This could be retinoblastoma
c. This could be bilateral myopia
d. This could be a persistent pupillary hyperplastic vitreous
The correct answer is C. A white pupil (leukocoria) should always be taken seriously, although
sometimes a dilated fundoscopy shows this to be a false alarm. A true white pupil, like that shown
in the image, could have several causes, including congenital cataract, persistent pupillary
hyperplastic vitreous, retinal detachment, or of most concern retinoblastoma. Assuming that the
child is fixating the camera properly, it is not likely to be bilateral myopia.
11. What is the MOST appropriate management for the condition shown in Image D?
a. No management is required, review in 6 months
b. No management is required, review in 1 year
c. Routine referral to ophthalmology is required