April 2011: C-15873 Paediatric Optometry Part 1

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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
d. Prompt referral to ophthalmology is required The correct answer is D. Since there is a risk of retinoblastoma, a rapid referral is indicated. Even if it is a less serious condition than retinoblastoma, like congenital cataract, then surgery as young as possible will increase the probability of some usable acuity in this eye. 7 12. If the condition shown in Image D is corrected with phacoemulsification surgery, what is the MOST likely management to be undertaken following surgery? a. Refractive correction with occlusion of the operated eye b. Refractive correction with occlusion of the good eye c. Refractive correction without occlusion d. No further management will be undertaken The correct answer is B. If the white pupil is the result of a cataract then, even if early surgery takes place, there is still likely to be dense deprivation amblyopia. If an intraocular implant is not used, then the child will need contact lenses and occlusion. Even if an intraocular implant is used, then there is still likely to be a residual refractive error so that the most likely outcome is refractive correction and occlusion of the good eye.
Page 1 and 2: Detailed Answers IMAGE A: SPH CYL A
Page 3: d. All the above The correct answer

April 2011: C-15873 Paediatric Optometry Part 1

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