LAST MINUTE REVISION – ONE LINERS

„„ Minimum angle of resolution is 30–60 seconds of arc.

„„ Snellen’s chart measures Minimum Resolvable visual acuity.
„„ On Snellen’s chart, each letter subtends an angle of 5 minutes from their respective distance at the nodal point of eye.
„„ Pelli-robson chart is used to measure the Contrast sensitivity.
„„ Gonioscopy is based on the principle of Total internal reflection.
„„ Objects seen through prism are displaced towards the Apex of the prism.
„„ There are 4 Purkinje images, 4th is inverted.
„„ Total power of eye is 58.6 D, Power of cornea is 43-44D, power of lens is 16-19D.
„„ Maximum refractive power is in the Anterior surface of cornea.
„„ Maximum refractive index is in the centre (Nucleus) of lens.
„„ Angle kappa is formed between the visual axis and the pupillary axis of the eye, usually 5 degrees.
„„ Angle kappa is negative in myopia – Pseudoesotropia and positive in hypermetropia – Pseudoexotropia.
„„ A child at birth is Hypermetropic (+ 2 to + 3D).
„„ Foster fuch spots, Lacquer cracks, Supertraction, Posterior staphyloma are features of Pathological/degenerative myopia
(Myopia >6D).
Most common complication of myopia is Rhegmatogenous retinal detachment.

/e
„„
„„ Spherical concave (diverging) lenses are used for treatment of myopia and Spherical convex (converging) lenses are used
for the treatment of hypermetropia.
„„ LASIK – Argon fluoride (EXCIMER) laser is used – 193 nanometer wavelength, Photoablation.
ReLEx and SMILE are the latest surgeries for myopia using Femtosecond laser.
„„
„„
„„
„„
„„
,2
Regular astigmatism is if the principal meridian are perpendicular to each other.
Irregular astigmatism if the principal meridian are not perpendicular to each other.
Deep anterior chamber, jet black pupil, hypermetropia, Jack in the box phenomenon, Pin cushion defect – seen in Aphakia.
Aniseikonia – change in shape or size of image.
„„ Retinoscopy/shadow test/ skiascopy, Refractometry are objective tests for refraction.
H
„„ Jackson’ cross cylinder test and astigmatic fan test are used for refinement of cylindrical error.
„„ Duochrome test and pinhole test are used for refinement of spherical error.
„„ Movement of red reflex against the retinoscope indicates >1D myopia, when retinoscopy done at the usual distance of
C

1 meter.
„„ Size of a pinhole is 1 mm and it is used to neutralixe refractive errors till 4D.
„„ Presbyopia occurs due to physiological insufficiency of accommodation and is treated with use of convex lenses over the
existing myopia correction – Add for near.
SO

„„ Spasm of accommodation leads to Pseudomyopia, also by strong Miotics.

„„ During accommodation the ciliary muscle contracts leading to decrease of the ciliary ring diameter with relaxation of the
cliary zonules leading to reduced tension, causinf increase in the anterior curvature of lens – change in shape of lens.
„„ Amblyopia is loss of vision without any associated organic cause.
„„ Occlusion therapy is done to prevent amblyopia.
„„ Amaurosis is the term used for complete loss of vision in one or both eyes in the absence of ophthalmological signs.

Chapter 2  • Optics

31
 Salient Features of Common Cycloplegic and Mydriatic Drugs
S.No. Name of the drug Age of the Dosage of Peak Time of Duration Period Tonus
patient when instillation effect performing of action of post- allowance
indicated retinoscopy cycloplegic
test
1. Atropine sulphate <5 yearsQ TDS × 3 day 2–3 days 4th day 10–20 After 3 1DQ
(1% ointment) days weeks of
retinoscopy
2. Homatropine 5–8 years One drop every 60–90 After 90 48–72 After 3 0.5DQ
hydrobromide 10 minutes for six minutes minutes of hours days of
(2% drops) times instillation of retinoscopy
first drop
3. Cyclopentolate 8–20 years One drop every 80–90 After 90 6–18 After 3 0.75DQ
hydrochloride (1% 15 minutes for minutes minutes of hours days of
drops) three times instillation of retinoscopy
first drop

/e
4. Tropicamide Not used as One drop every 20–40 — 4–6 hours — —
(0.5%, 1% drops) cycloplegic for 15 minutes for minutes
retinoscopy; three to four
used only as times
mydriatic)
5. Phenylephrine
(5%, 10%)
Used only as
mydriatic 15 minutes
,2
One drop every 30–40
minutes
— 4–6 hours — —
H
Frequent Causes of Decreased VisionQ
Causes of gradual, painless and progressive diminution of vision
C

Age less than 40 years Age more than 40 years

• Refractive error* • Presbyopia*
• Keratoconus* • Age-related cataract*
• Corneal dystrophy* • Chronic simple glaucoma (primary open-angle glaucoma*)
SO

• Developmental cataract • Dry age-related macular degeneration (ARMD)

B • Juvenile glaucoma
• Retinitis pigmentosa*
• Diabetic retinopathy*
• Corneal dystrophies*
O • Compressive optic neuropathy
• Hereditary macular degeneration*
• Retinitis pigmentosa*
• Drug-induced maculopathy or optic neuropathy*

N *Usually bilateral but can be asymmetrical

Sudden and painless causes of diminution of vision
U Unilateral
• Retinal detachment
Bilateral
• Bilateral occipital infarction
S • Retinal vascular occlusion
• Vitreous hemorrhage
• Atypical optic neuritis
• Grade IV hypertensive retinopathy with macular star
P • Retinal hemorrhage
• Exudative age-related macular degeneration (ARMD)
• Toxic optic neuropathy
• Posterior uveitisQ

A • Subluxation or dislocation of the lens

Diminution of vision associated with pain and/or an acute red eye
G UveitisQ
Corneal ulcerQ
EndophthalmitisQ
Retrobulbar neuritis
E Acute angle-closure glaucomaQ

32
 IMAGE-BASED QUESTIONS
There are multiple probable questions that can be asked 3. Infant in the image is most likely suffering from:
on a single image. a. Accomodative esotropia
b. Essential infantile esotropia
Question number 1 is based on Image 1. c. Bilateral blue dot cataract
d. Internuclear ophthalmoplegia

Question number 4 is based on Image 4.

Image 1
1. Identify the ocular surgery being done in the image:

/e
a. Lasik b. Keratoplasty
c. SMILE d. FLACS
Image 4
4. Instrument shown in the image is used for:
Question number 2 is based on Image 2.
,2



a. Adjustment of refraction
b. Refinement of cylindrical correction
c. Refinement of spherical correction
d. Binocular balancing

Question numbers 5 to 7 are based on Image 5.

H
C
SO

Image 2
2. The optical procedure being done is used for:
a. Objective refraction
b. Subjective adjustment of cylinder Image 5
c. Binocular balancing of vision
d. Subjective refinement of cylinder 5. All of the following can be seen in the above image, except:
a. Foster Fuchs spots b. Chorioretinal atrophy
c. Lacquer cracks d. Peripapillary atrophy
Question number 3 is based on Image 3. 6. The following complications can be seen in a patient with
the above fundus image, except:
a. Rhegmatogenous retinal detachment
Chapter 2  • Optics

b. Primary angle closure glaucoma

c. Vitreous hemorrhage
d. Foveal Retinoschisis
7. All of the following are true about the patient with the above
fundus image (PGI style):
a. The patient has a myopia of 7D
b. The axial length is 23 mm
c. Concave Contact lens are superior to spectacles for myopia
correction in the patient
d. It can be associated with Marfan syndrome
Image 3
e. It has a prevalence of about 10% 33
Most Recent Questions of 2017-2018 are given at the end
 Question number 8 is based on Image 6. 10. The optical instrument seen in the image is used for
a. Testing contrast sensitivity
b. Testing visual acuity in infants
c. Subjective refinement of refraction
d. Testing visual acuity in pre-school children
11. Identify the optical instrument shown in the image.
a. Landolt’s C ring chart
b. Keeler log MAR crowded test
Image 6 c. Sjögren’s hand figure test
8. Diagnose the refractive condition of the given eye. d. Allen pre-school hand picture test
a. Simple myopic astigmatism
b. Hypermetropia
Question number 12 is based on Image 9.
c. Emmetropia
d. Mixed astigmatism

Question number 9 is based on Image 7.

/e
Image 7
,2
Image 9
12. Optics of a 15 years old patient shown below, what is the
diagnosis based on the optics:
a. Astigmatism
(AIIMS Nov 2017)
H
b. Aphakia
9. A 16 year old male come complaining of severe, gradual,
c. Hypermetropia
progressive loss of vision in both eyes. He gives history of
wearing spectacles since 5 years of age, with last refraction d. Myopia
being done 6 months back. On retinoscopy, a refractive error
C

of -8D spherical error is seen. On B scan, the above result Question number 13 is based on Image 10.
was obtained. What can be seen in the B-scan image?
a. Posterior staphyloma
SO

b. Chorioretinal atrophy
c. Vitreous hemorrhage
d. Rhegmatogenous retinal detachment

Question numbers 10 and 11 are based on Image 8.

Image 10
13. Above is a common instrument used in ophthalmology. In
order to view the entire retina what is the power of lens you
would like to attach to the instrument: (AIIMS Nov. 2016)
a. +90 D
b. +78 D
c. –58 D
Image 8 d. +20 D
34
Most Recent Questions of 2017-2018 are given at the end
 MULTIPLE CHOICE QUESTIONS
Visual Acuity – Tests 25. Which component of the eye has maximum refractive index?
a. Anterior surface of lens  (AIIMS 2010)
14. Distance of patient while reading Snellen chart is b. Posterior surface of lens
(Recent pattern Nov/Dec 2016) c. Centre of lens
a. 6 feet b. 25 cms d. Cornea
c. 6 meters d. 25 feet
26. Alpha angle is the angle between:
15. The angle in minutes subtended by the topmost letter in
a. Pupillary axis and optical axis
Snellen chart when viewed from a distance of 6 meter is
b. Visual axis and optical axis
 (AIIMS May 2016)
c. Centre of eyeball rotation and line of fixation
a. 60 b. 5
d. None of the above
c. 1 d. 50
27. Visual axis is: (Recent Pattern 2015-16)
16. Type of visual acuity used in Snellen chart testing
a. Centre of cornea to retina
a. Minimum visible  (Recent pattern Nov/Dec 2016)
b. Minimum resolvable b. Object to fovea
c. Minimum discriminable c. Centre of lens to cornea
d. Minimum hyperacuity d. None
28. Normal axial length of the eye– (Recent Pattern 2015)
a. 18 mm b. 20 mm

/e
Optics c. 24 mm d. 28 mm
29. Newborn eye with respect to refractive error is–
17. Which of the following describes image seen through a (Recent pattern Nov/Dec 2016)
prism? (Recent pattern 2014) a. Emmetropic b. Hypermetropic

a. Inverted
c. Near the apex

a. 40 D
c. 4 D
b. Tilted
d. Near the base
18. Focal length of 0.25 m power of lens is–

b. 1/4 D
d. 25 D
,2
(Recent pattern 2015)
c. Myopic

Refractive Errors
d. Astigmatic

30. The most common cause of myopia is: (DPG 2010)

H
19. What is the power of a lens if the focal length is 0.75 m? a. Increase in length of the eyeball
 (Recent pattern Nov/Dec 2016) b. Increase in thickness of the lens
a. 1.3 D b. 2.3 D c. Increase in viscosity of aqueous humor
c. 3.3 D d. 4.3 D d. Increase in viscosity of vitreous humor
C

20. What is sturm’s conoid? (Recent pattern 2015) 31. Foster fuch’s spots are seen in– (Recent Dec. 12 Pattern)
a. Distance between two focal points created by differential a. Hypermetropia b. Myopia
refractive power of lens or cornea in different meridians. c. Astigmatism d. None
b. Pattern of alignment of rays due to a cylindrical lens 32. Which is the most common complication of pathological
SO

c. Method of calculating IOL power myopia? (DPG 10)

d. Tool in diagnosis of myopia a. Glaucoma b. Cataract
21. Centre of biconvex lens is called– (Recent pattern 2015) c. Haemorrhage d. Retinal detachment
a. Focal point b. Optical center 33. Which of the following is used for treatment of Myopia–
c. Epicentre d. Focal distance  (JIPMER 04)
a. Nd: YAG Laser b. Excimer Laser
Refractive System of Eye c. Argon laser d. Holmium laser
34. In senile nuclear cataract what type of myopia is seen–
22. Normal eye power is– (Recent pattern 2014)
 (Recent pattern Nov/Dec 2016)
a. + 6 D b. + 43 D
c. + 60 D d. + 17 D a. Curvature myopia b. Index myopia
23. Maximum contribution to the refractive power of the eye is c. Axial myopia d. Positional myopia
35. Maximum correction of myopia can be done by–
Chapter 2  • Optics

by: (Nov AIIMS 2016)

a. Anterior surface of cornea a. Radial keratotomy  (Recent pattern 2013)
b. Anterior surface of lens b. LASIK
c. Posterior surface of cornea c. Photorefractive keratotomy
d. Posterior surface of lens d. Orthokeratology
24. Most important factor determining convergence of light 36. About degenerative myopia which of the following is true:
rays on the retina is : (Recent pattern 2014)  (AIIMS 2014, 2013)
a. Length of the eyeball a. Myopic degeneration can lead to retinal detachment
b. Refractive power of the lens b. It is more common in men than women
c. Curvature of the cornea c. Less than -6 D
d. Physical state of the vitreous d. Optic disc swelling is seen 35
Most Recent Questions of 2017-2018 are given at the end
 37. Scarpa’s Staphyloma is seen in (Recent pattern 2013-14) 49. Aniseikonia means– (Recent pattern 2016)
a. Retinal Detachment b. Myopia a. Difference in the axial length of the eyeballs
c. Glaucoma d. Iridocyclitis b. Difference in the size of cornea in both eyes
38. The wavelength of laser (in nanometers) for shaping cornea c. Difference in the size of pupil in both eyes
in refractive surgery is: (All India 2012) d. Difference in the size of image formed by the two eyes
a. 193 nm b. 451 nm 50. Treatment of choice for aniseikonia– (Recent pattern 2013)
c. 532 nm d. 1064 nm a. Orthoptic exercise
39. A lady wants Lasik surgery for her daughter. She asks for b. Spectacles
your opinion. All the following things are suitable for c. Surgery
performing lasik except d. Contact lens
a. Myopia of –4 diopters 51. Which of the following is a sign of Aphakia–
b. Age of 15 years a. Shallow anterior chamber  (Recent pattern 2015)
c. Stable refraction for 1 year b. White pupillary reflex
d. Corneal thickness of 600 microns c. Absent 1st and 2nd Purkinje images
40. Which of the following type of lens is used for the treatment d. Iridodonesis
of myopia? (Recent pattern 2015)
52. Jack in box scotoma is seen after correction of Aphakia by–
a. Converging lens b. Diverging lens
 (Recent Dec. 12 Pattern)
c. Cylindrical lens d. Toric lens
a. IOL b. Spectacles
41. 1 mm change axial length of the eyeball would change the
c. Contact lens d. None
refracting power of the eye by– (Recent pattern 2015)

/e
53. A 55-year-old male with a limbal scar presents to the
a. 1D b. 2D
ophthalmology clinic with markedly defective vision for
c. 3D d. 4D
near and far. Clinical examination reveals a wide and deep
42. Pseudopapillitis is seen in – (Recent pattern 2014)
anterior chamber, irido­donesis and a dark pupillary reflex.
a. Myopia


b. Hypermetropia
c. Squint
d. Presbyopia
43. Shortening of 2 mm of axial length of eyeball causes 
,2
(Recent pattern Nov/Dec 2016)


A vision of 6/6 is achieved with correcting lens of +11D.
Which of the following is the most likely diagnosis.

a. Aphakia
c. Hypermetropia
b. Pseudophakia
(All India 2012)

d. Posterior Dislocation of Lens

54. A 35 year old male complains of vision distortion. The
H
a. 3D myopia b. 6D myopia
distortion increases progressively in both the meridians
c. 3D hypermetropia d. 6D hypermetropia
on wearing his spectacles. All of the following are correct
44. Regular astigmatism means: (Recent pattern 2015)
regarding the patient’s problem except: (AllMS Nov 2014)
a. The two meridians are perpendicular
C

a. It is also called pincushion distortion

b. The two meridians are parellel
b. It is due to wearing of cylindrical glasses
c. Asymptomatic astigmatism
c. It is due to asymmetrical convex lenses in both the eyes
d. Astigmatism after cataract surgery
d. It is aniseikonia
45. Which type of refractive error is seen in keratoconus– 
SO

a. Irregular astigmatism  (Recent pattern 2015)

b. Regular astigmatism Determination of Refractive Errors
c. Myopia
d. Hypermetropia 55. Shadow test is used in – (Recent pattern 2015)
46. What is irregular astigmatism – (Recent pattern 2015) a. Keratometry
a. Perpendicular principal meridians b. Ophthalmoscopy
b. Non perpendicular principal meridians c. Gonioscopy
c. Any of the above d. Retinoscopy
d. None of the above 56. Retinoscopy is done on a 0.5D myopia patient at a distance
47. Astigmatism is due to– (Recent pattern 2014) of 1 metre. Movement of the image will be– (AIIMS Nov 01)
a. Irregularity of curvature of cornea a. Move with the mirror
b. Irregularity of curvature of lens b. Move opposite to the mirror
c. Forward displacement of the lens c. No movement of image with mirror
d. Backward displacement of lens d. Image can move to any side
48. Anisometropia means– (Recent pattern 2016) 57. No movement of Red reflex in retinoscopy–
a. Difference in corneal curvature in both meridian a. No refractive error  (Recent pattern 15)
b. High difference of refractive error between the two eye b. Myopia of 3D
c. Subluxation of one of the lens c. Myopia of 1D
d. Difference in image size of 2% in both eyes d. Hypermetropia

36
Most Recent Questions of 2017-2018 are given at the end
 58. Methods to measure error of refraction are all except– 68. A 50 year old man complains of problem in his near vision.
 (Recent pattern 13) His vision is N-18 for both eyes which improved to N-6 on
a. Retinoscopy b. Refractometry adding + 1 D sphere. Which would be the best immediate
c. Keratometry d. Binocular balancing management of this patient? (AIIMS 2014)
59. Distance from which retinoscopy should be performed a. Refractive correction with near add
 (Recent pattern 2013) b. Cataract surgery
a. 25 cm b. 33 cm c. Refractive correction under atropine
c. 50 cm d. 100 cm d. Radial keratotomy
60. Jackson’s crosscylinder test is used for– 69. True statement about accommodation: (PGI May 2013)
a. Subjective verification  (Recent pattern 2015) a. Mainly occurs due to change in curvature of posterior
b. Subjective refinement surface of lens
c. Subjective balancing b. Helps to improve stereopsis
d. Objective refining c. It is abolished by sympathomimetic drugs
61. The most convenient form of cross cylinder is a combination d. Produced due to an increase in curvature of the anterior
of– (Maharashtra 10, Recent Question 2016) surface of the lens
a. –0.5 Diopter sphere with +1 Diopter Cylinder e. Elasticity of capsule has bearing on accomodation
b. +0.5 Diopter sphere with –1 Diopter Cylinder 70. All are true about presbyopia except: (PGI Nov 2011)
c. +0.25 Diopter sphere with +0.5 Diopter Cylinder a. Common in young age group
d. –0.25 Diopter sphere with +0.5 Diopter Cylinder b. Not able to see near objects

/e
62. Duochrome test is for– (Recent pattern Dec. 12) c. Spectacles having unifocal or bifocal lens should be used
a. Subjective verification of refraction d. Correction of refractive error should be done
b. Subjective refinement of refraction e. Failure of accomodation
c. Subjective binocular balancing
71. Spasm of accommodation (Recent pattern 2016)
d. None

63. Lensometer detects:
a. Correct power of glasses
b. IOP power
c. Corneal topography
d. Biochemical constitution of lens
,2
(Recent pattern 2015)




a. Caused by 1% tropicamide
b. Caused by Pilocarpine
c. Masquerades as myopia
d. Treatment is with Pilocarpine
H
Miscellaneous
Accommodation and Its Anomalies 72. Oculus Dexter refers to (Recent pattern 2013)
a. Left Eye b. Right Eye
64. A 30 year old man has 6/5 vision each eye, unaided. His
C

c. Both Eyes d. None of the above

cycloplegic retinoscopy is +1.0 D sph. at 1 metre distance.
73. Ciliary musles are embryologically derived from
His complaints are blurring of newsprint at 30 cm, that
clears up in about 2 minutes. The most probable diagnosis (AIIMS Nov 2012)
a. Neural ectoderm b. Mesoderm
SO

is: (All India 2006)

a. Hypermetropia c. Surface ectoderm d. Neural crest
b. Presbyopia 74. Which of the following is not a derivative of neural
c. Accommodative inertia ectoderm? (AIIMS Nov 2013)
d. Cycloplegia a. Retina b. Dilator pupillae
65. Treatment of presbyopia– (Recent pattern 2013) c. Sphincter pupillae d. Ciliary muscles
a. LASIK b. Concave lens 75. For refraction in a hypermetropic child, which is the best
c. Convex lens d. Radial keratotomy drug– (Recent pattern 2014)
66. Patient with open angle glaucoma with 7D of myopia, a. Phenylephrine
complains of blurring of vision on administration of b. Atropine ointment
pilocarpine. What is the reason for the blurring?  c. Atropine drops
a. Small pupil  (Recent pattern 2015) d. Homatropine
Chapter 2  • Optics

b. Increased myopia asymmetry 76. Concentration of tropicamide used in retinoscopy

c. Increased hypermetropic asymmetry ` (Recent pattern 2014)
d. Increased astigmatism a. 0.01 b. 0.02
67. Muscles responsible for accommodation are innervated by c. 0.03 d. 0.04
nerves passing through? (Recent pattern 2013) 77. Which of the following are not cycloplegic drugs:
a. Pre-tectal nucleus (AIIMS Nov 2013)
b. Edinger-westphal nucleus a. Atropine b. Phenylephrine
c. Nucleus ceruleus c. Tropicamide d. Pilocarpine
d. Dorsal nucleus e. Cyclopentolate
37
Most Recent Questions of 2017-2018 are given at the end
 78. Short acting mydriatics are: (AIIMS Nov 2011) Most Recent Questions 2017-2018
a. Atropine b. Homatropine
c. Tropicamide d. Phenyephrine 83. Prescription of presbyopic lens to a 50 year old emmetropic
e. Cyclopentolate individual is (Recent pattern 2017)
79. Which of the following is not a criteria for blindness a. +0.50
according to NPCB (AIIMS Nov 2016) b. +1.00
a. Vision 6/60 or less, with best possible spectacle correction c. +1.50
in the better eye d. +2.00
b. Vision <4/60 in the better eye 84. What will be the prescription for spectacles in a patient
c. Inability of person to count fingers from distance of 20 feet having Simple myopic with the rule astigmatism?
or 6 feet a. –0.5D at 180°  (Recent pattern 2017)
d. Diminution of field vision to 20 degrees b. +0.5D at 180°
80. A 10-year-old complaints of headache. His best corrected c. –3.0D at 90°
visual acuity in the right eye is 6/36 and in the left eye is 6/6.
d. +2.0D at 90°
Retinoscopy show +5D in right eye and +1D in left eye. All
85. Which of the following is the best in case of an Amblyopia?
other ocular examination is normal. What is the possible
diagnosis? (Recent pattern 2012) a. Occlusion therapy (MCI Dec 2017)
a. Optic neuritis b. Cortical blindness b. Penalization
c. Amblyopia c. Malingering c. Surgery
81. Amaurosis fugax is due to – (Recent pattern Dec. 12) d. Defer treatment till 10 years of age

/e
a. TIA b. Tobacco 86. Stenopaeic slit can be used for all except (AIIMS May 2018)
c. Optic neuritis d. Papilloedema a. Finchams test
82. About Degenerative myopia which of the following is true: b. Iridectomy
 (AIIMS May 2013, May 2004) c. Corneal tattooing




a. Myopic degeneration can lead to retinal detachment
b. It is amore common in men than women
c. Less than -6 D
d. Optic disc swelling is seen
,2

d. Axis of cylindrical refractory error
87. What is the refractive status of a newborn?  (MCI Dec 2017)
a. Myopic
c. Astigmatic
b. Hypermetropic
d. Emmetropic
H
C
SO

38
Most Recent Questions of 2017-2018 are given at the end
 ANSWERS TO IMAGE-BASED QUESTIONS
1. Ans. (c)  SMILE (High Myopia is the most common cause predisposing to
Ref: American academy of ophthalmology, aao.org RRD.)
Option b – Primary open angle glaucoma, pigmentary glau-
SMILE is a minimally invasive, FLAPLESS procedure, FDA coma are seen as complications/associations of high myopia.
approved for treatment of myopia from –1.00 D to –8.00 D (The anterior chamber is deeper in myopia due to increased
with ≤ –0.50 D of cylinder. axial length.)
Using femtosecond laser, an intrastromal (corneal) lenticule Option c – Vitreous hemorrhage is the most dreaded
is cut, which is then removed through small 2 mm incisions complication, it can be retinal, vitreous or Choroidal.
(being seen in the image). Bowman’s layer is preserved. Option d – Foveal Retinoschisis (splitting of retina) occurs
2. Ans. (d)  Subjective refinement of cylinder with posterior staphyloma, which is a sign of pathological
myopia.
Ref: Khurana optics 2nd/153
The instrument seen in the image is the Jackson cross cylinder 7. Ans. (a) The patient has a myopia of 7D/, (c) Concave
(over the trial frame) – which is used for subjective refinement Contact lens are superior to spectacles for myopia correction
of cylinder. in the patient/(d) It can be associated with Marfan syndrome
Option a/b – the patient with the above fundus image has
3. Ans. (b)  Essential infantile esotropia Pathological myopia.

/e
Ref: Pradeep sharma 2nd/189 Such cases have Myopia >6D and Axial length >26mm.
In the image – the left eye of the infant has been patched – Option c – in high Myopia, contact lenses are a better treatment
option than spectacles as they avoid peripheral distortion and
Occlusion therapy – done to prevent amblyopia – strabismic
minification produced by the strong concave spectacle lenses.
amblyopia occurs in large angle squint as in a case of non-
accommodative Essential infantile esotropia.
Option a - Accommodative esotropia requires spec­
correction to overcome the refractive error.
,2
tacle

Option c - Bilateral cataract does not require occlusion – if

unilateral congenital cataract – anti-amblyopia therapy is a
Option d – Systemic associations of High Myopia are
•• Marfan syndrome
•• Prematurity
•• Noonan syndrome
•• Pierre-Robin syndrome
must. •• Ehlers-Danlos syndrome
H
•• Stickler syndrome
4. Ans. (b)  Refinement of cylindrical correction •• Down syndrome
The instrument seen in the image is the Astigmatic fan.
Option e – Pathological Myopia has a prevalence of 2-3% in
C

All the lines of the fan should look similar. If some of

the lines appear clearer than others, it indicates inaccurate the general population.
astigmatic correction, thus used for refinement of cylindrical 8. Ans. (c)  Emmetropia
error after retinoscopy and subjective adjustment by the Trial
The image is being formed on the retina, with both meridians
SO

and error method.

having the same refraction.
5. Ans. (c)  Lacquer cracks
9. Ans. (a)  Posterior staphyloma
Option a – a dark red circular patch at the macula, due to
In the image (at the marked arrows, the posterior layers are
subretinal neovascularization and Choroidal hemorrhage
seen to be bulging at those points, confirming the diagnosis
(white arrow).
of Posterior staphyloma (pathognomonic sign) and thus
Option b – due to the abnormal excessive growth of the eye, Pathological myopia. The retinoscopy values also correlate.
choroid, retina and vitreous undergo degenerative changes.
Initially, a tigroid/tessellated fundus appearance is seen – 10. Ans. (d)  Testing visual acuity in pre-school children
larger Choroidal vessels are visible. Sjögren’s hand test is used for testing Visual acuity in verbal
Then, white atrophic patches (visible sclera) are seen (black pre-school children (2-3 years of age group).
arrow).
Chapter 2  • Optics

Option c – cannot be seen here, they are fine criss crossing 11. Ans. (c)  Sjögren’s hand figure test
lines. Its obvious through the image. All that needs to be remembered
Option d – peripapillary atrophy / temporal myopic crescent – is the list of visual acuity test to rule out the bogus option d –
due to thinned or absent RPE. (green arrow) there is no test like Allen pre-school hand picture test.

6. Ans. (b)  Primary angle closure glaucoma 12. Ans. (d)  Myopia
The above image is most likely a case of Pathological/ Ref: AK Khurana 6th edition Pg.no 38
Degenerative myopia (as explained in the previous question). Image is formed in front of retina, so it is myopia.
Option a – RRD is related to the severity of myopia, being
much more common in high myopes. 13. Ans. (d)  +20 D
Ref: Yanoff & Ducker 4th edition Pg no 89 39
 •• Instrument is indirect ophthalmoscope.
•• Condensing lens commonly used is 20D biconvex lens.
Power of eye 60D
•• Magnification = =
Power of lens 20D
= 3 times

ANSWERS TO MULTIPLE CHOICE QUESTIONS

14. Ans. (c)  6 meters 21. Ans. (b)  Optical center
Ref: AK kurana 4/e, p 13 Ref: John Forrester, Andrew Dick, Paul McMenamin, William
•• Snellen Chart can be used to measure visual acuity, usually Lee (1996). The Eye: Basic Sciences in Practice. London: WB
read from a distance of 6 m./20 feet Saunders Company Ltd. P. 28 ISBN 0-7020-1790-6
The point in the middle of a biconvex lens is called optical
15. Ans. (d)  50 center.
Ref: Parson 20th/96
22. Ans. (c)  + 60 D
In Snellen’s chart, the largest letter (topmost row) will subtend
Ref: A.K. Khurana 3rd/e p. 54; Parson’s 20th/e p. 52

/e
an angle of 5 minutes at the nodal point when viewed from
a distance of 60 meter from the eye. Those in the subsequent
23. Ans. (a)  Anterior surface of cornea
lines will subtend an angle of 5 min if they are 36, 24, 18, 12, 9,
6 meter from the eye. Ref: Cornea by Mannis /145
So, the answer is 50 minutes with the application of On average anterior cornea has refractive power of +48D of
trigonometry which says,
Tan (angle) = Height of letter/distance of viewing
16. Ans. (b)  Minimum resolvable
Ref: Khurana optics 2nd/43
,2 convergence and posterior cornea –5D of divergence.
24. Ans. (c)  Curvature of the cornea
Ref: Optics of the human eye, p 15-20
Cornea is the most important refracting medium responsible
H
for convergence of light rays to the retina because of its
17. Ans. (b)  Near the apex
curvature and difference in refractive index from air to comea.
Ref: Khurana optus 2nd /24
25. Ans. (c)  Centre of lens
The prism produces displacement of the objects seen through
C

it towards apex (away from the base). Ref: Optics of the human eye, p 15-20

18. Ans. (c)  4D 26. Ans. (b)  Visual axis and optical axis
Ref: Parson Ophthalmology 21 /e p. 49
st
SO

27. Ans. (b)  Object to fovea

D= 1 = 1 = 4D
f 0.25m Ref: AK Khurana’s 6th edition Pg.no 31

19. Ans. (a)  1.3 D Line joining fixation point, nodal point and fovea.

Ref: Khurana optics 2nd/16 28. Ans. (c)  24 mm

D = 1/f meters Ref: Physics of human body 22nd/e p. 642

So, 29. Ans. (b)  Hypermetropic

D= 1 = 4 = 1.3D Ref: Mehra KS, Khare BB, Vaithilingam E. Refraction in full-
0.75 3
termbabies. Br. J. Ophthalmol. 1965; 49:76–277
20. Ans. (a)  
Distance between two focal points created by In newborn, eyes are hypermetropic by + 2 to + 3D.
differential refractive power of lens or cornea in
different meridians 30. Ans. (a)  Increase in length of the eye ball
Ref: A Simple Instrument for Explanation of sturm’s Conoid Ref: Khurana 4th edition, p 32
George S. Zugsmith. X. George S. Zugsmith
31. Ans. (b)  Myopia
It is an optical condition in which refractive power of cornea
and lens is not the same in all meridians therefore instead of Ref: Khurana optics 2nd/76
single focal point there are two focal points separated by focal •• Seen in pathological myopia/degenerative myopia (Myopia
interval, this is called sturms conoid The distance between two > 6D or Axial length > 26 mm)
focal points is called sturms conoid interval.
40
32. Ans. (d)  Retinal detachment 42. Ans. (b)  Hypermetropia
•• Most common complication of myopia is macular degenera- Ref: Khurana 4th/e p. 29–30
tion, followed by rhegmatogenous retinal detachment. •• Pseudopapillitis is seen hypermetropia.
•• “Retinal detachment is the most dreaded and one of the most
common complications of myopia”. Duke –Elder 43. Ans. (d)  6D hypermetropia
•• Most common cause of rhegmatogenous retinal detachment Ref: AK Khurana’s 6th edition Pg.no 35
is pathological myopia 1mm shortening of eyeball produce 3D hypermetropia.
33. Ans. (b)  Excimer Laser 44. Ans. (a)  The two meridians are perpendicular
Ref: Parson’s 20th/e p. 74 t (8.1); Khurana optics 2nd Ref: Eikington optics 4th p 115
•• Principal meridians at 90° to each other regular astigma-
34. Ans. (b)  Index myopia
tism°
Ref: American academy of ophthalmology, BSCS Section 11/page 43 •• Principal meridians at 90° to each other but donot lie at or
•• In early stages, progressive hardening of lens nucleus causes near 90° or 180° oblique astigmatism
an increase in refractive index of lens causing a myopic shift
45. Ans. (a)  Irregular astigmatism
(Index myopia)
Because of irregular corneal surface and conical cornea,
35. Ans. (b)  LASIK irregular astigmatism usually occurs.
Ref: Yannof & Ducker 2nd/e p. 786

/e
46. Ans. (b)  Non perpendicular principal meridians
•• Correction of myopia: Extraction of clear lens (–16 to –18
Ref: Elkingtion optics 4th/115
D) > Phakic IOL (> –12 D) > LASIK (upto –12 D) > Radial
keratotomy & PRK (–2 to 6 D). •• Irregular astigmatism – principal meridians are not at 90° to
each other

Ref: Kanski 7/e, chapter 14

•• “Rhegmatogenous retinal detachment (RD) is much more
common in high myopia, the pathogenesis including
,2
36. Ans. (a)  Myopic degeneration can lead to retinal detachment

increased frequency of posterior vitreous detachment, lattice

47. Ans. (a)  Irregularity of curvature of cornea
Ref: Khurana optics 2nd /79
•• Most common cause of astigmatism is abnormalities of
curvature of cornea. It is usually congenital
H
degeneration, asymptomatic atrophic holes. Macular holes •• Lenticular astigmatism is rare, seen in lenticonus (cone
and occasionally giant retinal tears. The prevalence of retinal shaped lens), congenital tilling, oblique placement,
detachment appears to be related to the severity of myopia.” traumatic subluxation of lens)
•• Optic disc swelling (pseudopapillitis) seen in hypermetropia. 48. Ans. (b)  High difference of refractive error between the
C

37. Ans. (b)  Myopia two eye

Ref: Clinical ophthalmology By Sandeep Saxena (Jaypee) 2/e, p 445 Ref: A.K. Khurana 3rd/e p. 62; Parson’s 20th/e p. 77
‘The presence of posterior staphyloma (Scarpa’s Staphyloma) is Anisometropia is term used when dioptric power of both eyes
SO

pathognomonic of pathologic myopia’ are not the same, significant if > 2.5D difference.

38. Ans. (a)  193 nm 49. Ans. (d)  Difference in the size of image formed by the two eyes
Ref: Yanoff 3rd/43, 44, 45 Ref: Khurana optics 2nd/84
Corneal Reshaping procedures such as photorefractive •• Aniseikonia is defined as a condition where the images
keratectomy (PRK) and Laser Assisted in Situ Keratomileusis projected on the visual cortex from the two retinae are
(LASIK) are performed by laser in the ultraviolet wavelength abnormally unequal in size or shape.
of 193 nm to 213 nm. The most commonly used laser for such 50. Ans. (d)  Contact lens
procedures is the Argon Fluoride Excimer Laser (ArF) with a
wavelength of 193 nm. Ref: Khurana optics 2nd/e p. 84, Kanski 4th/814
•• Up to 5 percent aniseikonia is well tolerated. For high degree
39. Ans. (b)  Age of 15 years
Chapter 2  • Optics

of aniseikonia, treatment of choice is contact lenses.

Ref: Khurana optics 2nd e/322 •• Aniseikonia due to unilateral aphakia corrected by IOL
Minimum age for any refractive surgery should be at least 18 years implantation.

40. Ans. (b)  Diverging lens 51. Ans. (d)  Iridodonesis

Ref: Elkington optics 4 /143
th Ref: Parson 21st/e /p. 78
•• Tremulousness of iris (iridodonesis) is seen in aphakia.
41. Ans. (c)  3D
52. Ans. (b)  Spectacles
Ref: Essentials of ophthalmology by Kaiser p. 20
Ref: Parson 21st/e p. 276
1mm increase in axial length causes myopia of 3D and 1mm
decrease causes hypermetropia of 3D. Refer text 41
 53. Ans. (a)  Aphakia •• The most convenient form is a combination of a –0.5D
Ref: ‘Clinical Examination in ophthalmology’ by Mukherjee sphere with a + 1.0D cylinder which has an effective strength
(Elsevier, India) 2006/163, 164; Parson’s 21st/78; Theory and of + 0.5D cylinder in one meridian and –0.5D in other.
Practice of Optics and refraction by Khurana 2nd/66, 72 62. Ans. (b)  Subjective refinement of refraction
Markedly defective vision for both near and far, a deep anterior Ref: Khurana optics 2nd/153
chamber, iridodonesis and a dark pupillary reflex all suggest
a diagnosis of Aphakia. A limbal scar further points to the 63. Ans. (a)  Correct power of glasses
likelihood of surgical aphakia. Vision of 6/6 in aphakic eye can
Ref: Yanoff and Duker 4th edition, p89
be achieved with a corrective lens of about 10D or 11D if the
eye was previously emmetropic. Lensometer/vertex meter – detects the vertex power-recipro-
cal of distance between back space of lens and secondary focal
54. Ans. (b)  It is due to wearing of cylindrical glasses point. It rapidly measures power in all meridians and desig-
Ref: khurana optics 2nd/ 46 nates the major meridians to be prescribed.
The distortion increases progressively in both meridians – 64. Ans. (c)  Accommodative inertia
the diagnosis has to be Aphakia, which causes spherical and
Option a– Hypermetropia will not resolve
prismatic aberrations as a side effect of high power convex
spectacles. Option b– Presbyopia usually occurs at around 40 years of age,
On wearing cylindrical lenses i.e. correction of astigmatism, due to physiological insufficiency of accommodation, can not
the distortion should decrease in both the axis, not increase. clear in 2 minutes

/e
Option d– cycloplegia leading to loss of accommodation, will
55. Ans. (d)  Retinoscopy resolve in hours to day depending upon the drug used (10-20
Ref: Khurana optics 2nd/124 days after atropine )
•• Retinoscopy, also called skiascopy or shadow test, is an
Option c– The accommodative system is slow in making

56. Ans. (a)  Move with the mirror

Ref: Khurana optics 2nd/131
,2
objective method of finding out the error of refraction by
the method of neutralization.
a change and represents a case of accommodative inertia.
‘Accommodative inertia refers to the delay in response of
accommodation. Normally an accommodative change occurs
in 1 sec.”
65. Ans. (c)  Convex lens
H
Retinoscopy done at 1m: Ref: Khurana optics 2nd/102–103
Against No movement With Done by supplementing accommodation with convex lens of
appropriate power to overcome problem of near vision.
C

<1D Myopia 1D Myopia >1D Myopia 66. Ans. (b)  Increased myopia asymmetry
Emmetropia
Ref: Manual of ocular diagnosis and therapy p. 270
Hypermetropia
•• Pilocarpine(Cholinergic drug) produces spasm of
SO

57. Ans. (c)  Myopia of 1D accommodation due to contraction of ciliary muscles.

Ref: Khurana optics 2nd/131
•• This results in myopia (pseudomyopia) due to increased
58. Ans. (c)  Keratometry power of lens
Ref: Khurana optics 2nd/123
•• Objective refraction methods are retinoscopy, refractometry Worsening of myopia in already myopic patients.
and auto refractometer
•• Binocular balancing is for conventional subjective refraction. 67. Ans. (b)  Edinger-westphal nucleus
•• Keratometry is for measurement of corneal curvature. Ref. Khurana 4/e, p 292
59. Ans. (d)  100 cm Pathway of accommodation reflex: The afferent impulses
Ref. Khurana optics 2/e, p 166 extend from the retina to the parastriate cortex via the optic
nerve, chiasma, optic tract, lateral geniculate body, optic
Refer text
radiations, and striate cortex. From the parastriate cortex the
60. Ans. (b)  Subjective refinement impulses are relayed to the Edinger- Westphal nucleus of both
Ref: Khurana optics 2nd/150–151 sides via the occipito-mesencephalic tract and the pontine centre.
From the Edinger-Westphal nucleus the efferent impulses travel
61. Ans. (a)  –0.5 Diopter sphere with +1 Diopter Cylinder along the 3rd nerve and reach the sphincter pupillae and ciliary
Ref: Parson 21st/e p. 69 muscle after relaying in the accessory and ciliary ganglions.

42
68. Ans. (a)  Refractive correction with near addition 76. Ans. (a)  0.01
Ref: Khurana optics 2 /101–103
nd Ref: Parson 21/e, p 152
Here the patient is suffering from presbyopia (50 year old, Tropicamide comes in 0.5% and 1% drops
problem in near vision) thus correction for near vision over 1%=1/100=0.01
correction of distance. For more, refer to bonus page

69. Ans. (d)  Produced... & (e) Elasticity... 77. Ans. (b)  Phenylephrine, (d) Pilocarpine

Ref: Parson 20th/ 58-60 Ref: Khurana optics 2nd/137

Accomodation has no role in stereopsis Phenylephrine not used as cyclopegic for retinoscopy; used as
mydriatic alone or in combination with tropicamide.
Ocular Changes in Accommodation
“The shape of lens at any one time is thus result of a balance 78. Ans. (c)  Tropicamide & (d) Phenyephrine
b/w its own elasticity & that of its capsule. The capsule is more
79. Ans. (b)  Vision <4/60 in better eye
elastic(than lens) & when the ciliary muscle contract the ciliary
body approaches the lens, thus slackening the zonules so that Ref: Parson’s 22nded/pg 562
the capsule relieved of tension, is able to mould the lens into its •• Visual acuity <3/60 or fields <10° is the criteria for blindness
accommodated form” (Parson 20th/ 58) according to World health organization (WHO).
•• Visual acuity <6/60 in better eye or fields <20° – NPCB
70. Ans. (a)  Common in young age group
criteria. (Old guidelines-valid for question in 2016)

/e
Ref: Khurana optics 2nd/ed 100–101
Refer text 80. Ans. (c)  Amblyopia
Ref: Kanski 7th ed/p 744
71. Ans. (c)  Masquerades as myopia
Vision in right eye is 6/36 but the ocular examination is
Ref: Khurana anatomy 2nd/106)
Spasm of accommodation is caused by strong miotics such
as ecothiophate and not generally due to Pilocarpine. The
treatment is with Atropine.
,2
Overacting accommodation leads to focus at near objects,
normal. This there is no organic cause for decreased vision
(Anisometropic amblyopia due to > 2.5D difference in
refractory power between the two eyes).
81. Ans. (a)  TIA
thus induced blurring of vision for far (Pseudomyopia). Ref: Khurana 4th/e p. 306
H
72. Ans. (b)  Right Eye •• Amaurosis fugax is sudden temporary and painless loss of
Ref: Oxford American Handbook of Ophthalmology (Oxford vision due to transient failure of retinal circulation.
University Press) 2010/XVIII; Clinical Examination in •• It may occur in carotid transient ischemic attack (TIA).
C

Ophthalmology by Mukherjee (Elsevier India, 2009)/22 82. Ans. (a)  Myopic degeneration can lead to retinal detachment
Oculus Dexter refers to the right eye and is abbreviated OD Repeat may 2014
SO

Abbreviation Name Refers To 83. Ans. (c)  +1.50

OD Oculus Dexter Right Eye Ref: Khurana Optics and refraction 2nd/101, Elkington optics
OS Oculus Sinister Left Eye 4th/237
OU Oculus Uterque Both Eyes Rough estimate for presbyopic add
45 years: +1.00 to +1.25 D
73. Ans. (b)  Mesoderm 50 years: +1.50 to +1.75 D
55 years: +2.00 to +2.25 D
Ref: Parson 21/e, p 5 (20/e, p 5) In order to focus on an object at a reading distance of
Refer text 25 cm, the emmetropic eye must accommodate by 4 D.
However, for comfortable near vision one-third of the available
74. Ans. (d)  Ciliary muscles accommodation must be kept in reserve. Therefore, the
Ref: Parson 21/e, p 5 (20/e, p 51) patient will begin to experience difficulty or discomfort for
Chapter 2  • Optics

Ciliary muscles are derived from Neural crest and not neural near vision at 25 cm when his accommodation has decayed
ectoderm. to 6 D. This usually occurs between 40 and 45 years of age.
A person experiencing such difficulty and discomfort for near
75. Ans. (b)  Atropine ointment vision due to reduced amplitude of accommodation is said to
Ref: Khurana 4th/e p. 550 be presbyopic.
•• Atropine ointment (1%) is the cycloplegic of choice for 84. Ans. (a)  –0.5D at 180°
refraction in a young child.
Ref: Khurana optics and refraction 2nd/80

43
 With the rule astigmatism – two prinicipal meridian are at
right angles with the vertical meridian being more curved.
Correction requires Convex (+) cylinder at 90° or Concave
(-) cylinder at 180°
In the question Myopic astigmatism is given means the patient
has to be given a concave [diverging (-)] cylindrical lens
85. Ans. (a)  Occlusion therapy

86. Ans. (c)  Corneal tattooing

Ref: Elkington Optics 4th/ 117-118
Uses of Stenopaeic Slit
•• Determination of meridian of optical iridectomy – in
patients with corneal scar or lenticular opacity
•• To diagnose cases of cases of cataract, differentiate between
colored halos caused in Angle closure glaucoma and cataract
by Fincham’s test.
↓ Rectangular aperture 1 mm in width
Slit passed across pupil and 15 mm in length

/e
↓ ↓
Halos break Halos remain intact 87. Ans. (b)  Hypermetropic
↓ ↓ (Ref: Khurana 6th/13)
Cataract Angle closure glaucoma
Eye at birth

,2
•• Determine power and axis of cylinder – The slit aperture
acts as an elongated ‘pin-hole’, only allowing light in the axis
of the slit to enter the eye. Hence, when the slit lies in one
principal axis of the astigmatic eye, the second line focus
is eliminated and the blur of Sturm’s conoid reduced thus
Newborn is Hypermetropic by +2 to +3 D
Anteroposterior diameter is smaller (70% of adult) – 16.5 mm
Corneal horizontal diameter is smaller – 9.5 to 10 mm
Tears are not secreted
AC is shallow
allowing a clearer image to be formed.
H
C
SO

44