Candidate 32
Date: November, 2004
Centre: Plymouth
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• Practice refraction as it is crucial, at least 100 refractions before exams.

• I used these books: Frank and Elkington, contact lens chapter in an old edition of American Academy (1995-96), relevant chapters in Kanski and Fiona Rowe’s clinical orthoptics book.  My library had them so I did not buy any.

• I hardly think you need more than that for the OSE and MCQs.  For the more obscure MCQs, there is no way you can prepare anyway.  I did not use Chua’s or Bhan’s Part 2 books, so I cannot comment.

• Only one course is enough, the rest is up to you to work hard.  Certainly I know a lot of people who did not attend any and still passed first time round.  I only went to Nottingham, which was worthwhile, but definitely over-hyped and overpriced.  If you have money to spare, you could also go to Dundee, Bradford and Cardiff.  Other courses are a waste of money from hearsay.

I thought many of the MCQs were obscure and ambiguous.

1. Contrast sensitivity

Peak, spatial frequency of Vistech and Pelli-Robson, decrease with age due to lens opacities, directly proportional to spatial resolution
2. Purkinje shift
Blue clearer at dawn? Red clearer at dusk?
3. Tonometer
Do you need BSV? Something about Mackay-Marg tonometer
4. Optic nerve field defects

5. Retrochiasmal field defects

6. Measurement of torsion

Bagolini lenses, Maddox double rod

7. Correction of presbyopia

8. Contraindications to bifocals

3D of oblique astigmatism in both eyes, vertigo, 4 prism dioptre of vertical phoria

9. 78D

10. Reflection

Depends on: angle of incidence, wavelength, refractive index between 2 media

11. Absolute refractive index

Affected by material composition, temperature, can never be less than 1

12. Use of 4 prism dioptre

13. 20D

14. Magnification of direct and indirect

15. Instruments which produce erect image

Astronomical telescope, microscope, keratoscope, 90D and pinhole camera

16. Galilean telescope

17. Hand held magnifier

Field of view, should be worn with near add

18. Initial investigations of epiphora

Fluorescein, puncta, schirmer’s, CT-scan

19. Lees screen

20. Initial investigations of a young child with ptosis

VA, VF, Fundus, EOMs

21. Synoptophore

Can it measure tropia and phoria?

22. Nystagmus
Can be unilateral, always abnormal

23. Anisocoria

Always an afferent pathway problem, can be assessed by RAPD

24. Reduced eye movements

25. Catoptric images

Position is the result of refraction, tapetoretinal reflex

26. Keratometer

27. Humphrey

28. Toric transposition

29. Chromatic abberation

Minimised by polarising doublets

30. Pupil of 6 mm

These factors have a significant impact on aberration: diffraction, chromatic aberration, spherical aberration, blue light being refracted more

31. Polarising light

Contains dichroic crystals, arranged horizontally, haldinger’s brushes, examine contact lens defects

32. Fluorescein angiography

33. Red-free of direct

RNFL defects better seen with tinted lenses

34. Optics of slit lamp

35. Maddox rod

36. Optics of Jackson X-Cyl

The circle of least confusion moves, should not caused any prismatic effect if used well

37. Neutralisation with a cross

38. Material used for anti-reflective coatings

39. Focimeter

40. ECCE sutures

Astigmatism induced

41. Placido’s disc

Needs to be mounted on slit lamp, quantitative measure of anterior corneal surface, image formed is erect and real

42. Colour vision

TED can cause fluctuation, D-15 can measure tritan axis, Ishihara can measure acquired colour defect, outer retinal layer dysfunction causes blue-yellow defect

43. Pharmacological testing for Adie’s and Horner’s

44. Soft contact lenses

Diamter larger than cornea, H2O2 as disinfectant, does not require keratometry, does not require fluorescein to assess fit

45. Polycarbonate glasses

Scratch easily, photochromic lenses

46. Assessment of astigmatism

Stenopaiec slit, block and fan, X-Cyl

47. Causes of red desaturation

48. Presentation of thyroid eye disease


See candidate 30


Overall friendly examiners.  A couple of poker-faced ones but not vicious.

Station 1
Baush & Lomb keratometry.  The examiners were aware that most people were less familiar with this type as opposed to Javal-Schiotz.  Only had to do one eye and asked to write down values.  My examiners seemed hardly interested in the actual values and there were then obvious questions on the principles of keratometry.

Station 2
Focimeter.  Straightforward if you know how to it.  As expected, they then asked questions on the optics and how you would determine prism power.

Station 3
A young man with physiological anisocoria.  Questions on the clinical features of adie’s pupil and pharmacological testing for both adie’s and horner’s.

Station 4
Examine ocular motility including cover test.  A relatively easy case of CPEO.  Questions were on the differential diagnosis if it was not CPEO i.e. other restrictive causes.

Station 5
Slit lamp.  Young lady.  Asked to examine RE first.  Central stromal dot-like opacities with a central area of what looked like a sub-epithelial plaque to me.  Asked to demonstrate sclerotic scatter.  Then differential diagnosis.  Said herpetic scarring and then something clicked and I quickly added a form of corneal dystrophy.  Asked to examine other eye.  That eye has had a penetrating keratoplasty.  Told how I would assess the endothelium  i.e. specular reflection and to demonstrate it.  I was told by more knowledgeable colleagues that it was stromal corneal dystrophy, not sure what type.

Station 6
Asked to use white pin straight away for left eye.  Then asked how I would examine right eye without pins and to demonstrate i.e. look at my face and counting fingers.  Middle-aged man with bilateral inferior altitudinal defects.  Differential diagnosis.

Station 7
Direct: a case of superior BRVO with an obvious area of AV nipping near the disc.  Asked about diagnosis.  Then surprisingly asked about investigations and management although its not supposed to be the case for Part 2.  Then further questions about the various filters.

Station 8
Patient was a middle-aged man and was only mid-dilated.  I used a 20D.  He was cooperative but I was finding it difficult to get a clear fundal view in some peripheral positions.  The posterior pole looked normal to me.  Slight sense of panic although outwardly calm.  I reported that I could not find any gross fundal abnormalities.  They looked at me expressionless and as the bell rang, quickly asked about the magnification for the 20D and 28D.
I seriously thought I had bombed this station.  I still don’t know what it was.  My technique was reasonable and perhaps is the most important in terms of scraping a pass.

Practical Refraction

82 lady who was a WRVS volunteer in the hospital.  Bilateral pseudophake and previous left yag capsulotomy.  Initially worried given her age and smallish pupil, but she was very cooperative and gave quick answers.

RE: -1.50/+0.75X170
LE: +0.75/+2.00X35

6/4 after objective refraction and hardly had to change anything for subjective.  Had time to do Maddox rod and discuss with the examiner the various options for presbyopic correction.


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