Candidate 17     Passed                                                      Centre: Leicester
                                                                                                    Date:  Nov, 2002

  • Inner retinal defect/pathology causes blue-yellow defect (T or F)
  • Can toxins cause bilateral centro-caecal scotoma
  • Can D15 test reliably detect tritanopes
  • Does a distance telescope as a low visual aid help mobility.
  • Can a low visual aid for distance be converted to work for near by simply 

  • adding caps
  • Is a superior altitudinal defect the most common in glaucoma
  • Is a Maddox wing used to measure tropias
  • Does a Maddox wing measure vergences
  • Can lang stereotests be used for very young children
  • On which of the following might you use different plus adds for near in each 

  • eye - unilateral Horners, unilateral Adies, Argyll-Robertson pupils, unilateral aphakia, anisometropia, unilateral pseudophakia (other eye normal)
  • Corneal topography- mcqs I forget about reflective versus projected
  • Can saccades be measured by videophotography
  • Do saccades occur in 0.001secs
  • Protective glasses- are they made of PMMA, can laminated safety glasses take 
  • Spherical correction, when laminates shatter do they have sharp edges
  • Is corneal curvature in reduced eye 7.8mm
  • Is base curve in plus meniscus lenses on posterior surface
  • Does a spherocylindrical lens have one spherical and one cylindrical surface
  • PRK uses a laser with a halogen diatomic molecule
  • PRK causes a photochemical reaction
  • Xanthophyll absorbs blue light
  • Usually abnormal VEP in amblyopia
  • Neutral density filter doesn't decrease VA in amblyopia
  • Some crap about lateral inhibition of ganglion cells in amblyopia
  • Are congruous field defects usually cortical 


Station 1
Hruby lens on table. what is this? Draw a ray diagram of it.

Station 2 
Line drawing of lacrimal apparatus straight from Kanski. what is this? 
What is labelled A (inferior canaliculus), What is labelled E (valve of 

Station 3
FFA. Describe the principles of this test. what does it show (it was either 
ink blot CSR or PED).

Station 4
B scan. What is this. describe its principles. what structures are 
involved. (the gain was awful-could have been a weather photo of a 
snowstorm- it was probably a large retinoblastoma involving most of vitreous 
cavity with calcification on its head-ie behind lens)

Station 5
CT orbits. What is this. What does it show (bilateral lacrimal gland 
swelling). what symptoms would the patient have?

Station 6
Biometry print out- what is this (i think). which is the most accurate 
reading and why (left eye as lower standard deviation), to aim for emmetropia 
which lens would you choose for the right eye? If the A constant was 119 
instead of 118 how would the dioptric power of the lens change (the biometry 
was only done for an a constant of 118 so you had to understand the formula 
rather than read it off)

Station 7 
Hess chart. what is this? describe its principles. what does it show? 
Acute cranial nerve 6 palsy (no muscle sequelae)

Station 8
Humphrey Visual fields of right and left eyes (sides were labelled). What 
is this? What does it show? (left superior arcuate defect with nasal step, 
right superior hemispheric defect with some points detected around the blind 
spot) Where is the lesion?


Case one 
Visual fields. At very start detected left sensory inattention (very young 
man) by flapping hands with patient having both eyes open looking straight at 
me. Then progressed to uniocular field testing with targets (I had my own 
made from bits and bobs from staples the office superstore as I couldn't find 
any company that sold hat pins) it became apparent at this stage that the 
patient couldn't move his right arm to cover his eye (I advise all candidates 
to bring orthoptic patches to look smooth here - I didn't have them). I 
didn't map out much of a field defect there was certainly no sharp midline 
cut off. my diagnosis right parietal lesion with left field defect. 
questions- did i think the defect was congruous, what was the significance of 
it being not, what is the use of red targets.

Case two
Ocular motility. asked to do cover test. i would advise get in fast and do 
cover test for near without glasses then straight for versions and saccades. 
you don't have time for doing near then distance with glasses on then off. 
obviously say ideally you would like to and some clinical situations and 
examiners may ask for it but in the vast majority getting rid of the glasses 
and just doing near accentuates the defect and gets to the point fast. 
patient had right hypertropia and esophoria. didn't fit with any neurological 
condition i knew (i said) and i felt must be mechanical. question- what type 
of mechanical problem would you think it is? My answer ted. Is there anything 
else you would like to do? T got myself a bit lost and started talking about 
a thyroid eye disease exam rather than mentioning how I would confirm a mechanical versus 
neurological exam (ie ductions versus versions, forced duction, slow 
saccades). As I talked about TED I was asked to demonstrate lagophthalmos.

Case 3
Binocular indirect ophthalmoscopy. Patient was sitting in chair. I offered to use the 
couch but was told I was fine to do it with him sitting. findings - naevus at disc possibly 
pigment stippling at macula. show how you would examine his superonasal 
retina. Show how you would indent (given indenter but not actually allowed to 
use it- gave a talk through). merits of 20d versus 28d lens. Who would use a 
28d (answer paeds). Examine his other eye. No red reflex-indicates dense block 
as indirect powerful-time up

Case 4
Direct-nasal chorioretinal scar. what could be the cause? its a little big 
for toxoplasma but that could be a cause-so any cause of 
chorioretinitis?-yes-examine the anterior segment of the other eye that will 
give you the diagnosis. It was a shell. dx trauma evisceration followed by 
sympathetic ophthalmitis.

Case 5
Focimeter. bifocals. how does it work. straight forward station.

Case 6
von Helmholtz keratometer. Big controversy over this station and multiple 
complaints from candidates. I think it may not have been counted. External 
assessor from Edinburgh had pages of candidates complaints about this. I was 
asked about optics of the device. what would be the significance of a k 
reading of 47.

Case 7
Pupils. Bilateral Holmes-Adie though no light near dissociation detected. So 
your dx is bilateral Holmes-Adies is it? -yes- What else would you like to 
do?-deep tendon reflexes, slit lamp for vermiform movements, pilo.-So you 
would examine for deep tendon reflexes in the clinic would 
you?-yes-really?-yes. so you put pilocarpine in both eyes would you?

Case 8
Slit lamp. Beam decentered, and focus out at start. Examine cornea, 
retroilluminate to look for zonules (lens subluxed superiorly), what depth is 
the angle.


Retinoscopy - nearly went down I think - remember that the aim is not to only 
get the prescription right but to demonstrate the you can do retinoscopy well 
as you can't do a subjective with a child and the consequence could be 
amblyopia so take the time to not leap onto subjective fast before showing 
that you can do an accurate retinoscopy. obviously you don't want to leave 
yourself with only 3 minutes at the end to do all of your subjective either.

More experience