Station 1
Direct Ophthalmoscopy:
Right Superotemporal Branch Retinal Vein Occlusion with Macular Oedema. Asked about use of various filters on the Direct Ophthalmoscope. 

Station 2
Indirect Ophthalmoscopy:
Left Choroidal Melanoma Excision. Asked about different lenses, use of 28 D. How can you tell if you are looking through the correct side of the lens? What difference does that make? Proper position for examination the superotemporal retina (from the opposite side) 

Station 3
Keratometry:
Javal-Schiotz keratometer, principle, other types. Meridian or axis? Are you sure? 

Station 4
Focimetry: 
Bifocals. Which axis for incision? Will you rely on focimeter? No, keratometer. Steep axis surgery. 

Station 5
Pupil:
Bilateral Adie's in a middle aged lady. Pathways for consensual reflex. Tests for Adie's. Principle of using diluted pilocarpine (denervation hypersensitivity) 

Station 6
Ocular Motility:
Cover tests in a lady with Thyroid Eye Disease. Left hyperphoria. What are other possible manifestations with reference to muscle imbalance in TED? (Restrictive myopathy of IR, MR) 

Station 7
Visual Fields:
Left homonymous hemianopia in a young lady. Red and white pins were available at the station. Site of lesion? Causes of bitemporal hemianopia? 

Station 8
Slit-lamp examination:
Endothelial pigmentation in a middle aged gentleman. Demonstrate various illumination techniques. Calibrate tonometer. 
 

TIPS FOR MRCOphth Part 2
MCQs: 

• Elkington is the basic text. No surprises here. 

OSEs:

• Course notes are great, particularly Dundee. Remember to memorize the PRINCIPLES of each test. Dundee notes are excellent for this. 

OSCEs: 

• Chua's sections on OSCEs (as well as OSEs) are great. 
• For direct ophthalmoscopy, remember to set the focus wheel at +8 dioptres to examine anterior segment first. 
• For Indirect Ophthalmoscopy, setup the indirect meticulously, before calmly approaching the patient.
• For Focimetry, remember that near add is to be measured from the opposite side (see Elkington). 
• For keratometry, remember to use the term MERIDIAN, and not axis, (follow Chua's technique). 
• For pupil examination, ask for dim illumination and BIO, and remember to check near synkinesis. 
• For visual fields, have a basic system for the initial go, and then be ready to refine further with pins. 
• For SLE, Chua's tips and viva on filters should be memorized. F
• or cover/uncover, keep an occluder and near target handy. 

Refraction: 

• Read The Retinoscopy Book, by Corbay. 
• Also, formulate and rehearse a time-efficient routine, but be prepared for the patient not being able to do some of the steps, eg, the duochrome etc. In that case, you should have a fall-back plan, eg, to go to the plus 0.50 blur test straightaway. 
• Do not assume that the patients have been selected with a view of demonstrating all the refraction techniques. Otherwise, you may find yourself stumped and wasting time on a low-output test. 

Suggested routine for Refraction: 

• Quick history (one minute). Age, Occupation, Hobbies, Current eye problems, History of squint or lazy eye, spectacle wear. 
• Examination. Best corrected visual acuity. IPD and centre trial frame. 
• Objective refraction. Corbay technique, negative cylinder retinoscopy. Should take a maximum of five minutes for both eyes. Avoid power cross if you are likely to be confused in the stress of the exam, and record directly from the trial frame. Mention working distance (and Gross/Net). 

Subjective Refraction: 

• Quick duochrome. If you take too much time, the patient may become too confused to respond properly. 
• Cross Cylinder 
• Muscle balance with Maddox rod, including application of prisms to neutralize phoria 
• Near add