Right Superotemporal Branch
Retinal Vein Occlusion with Macular Oedema. Asked about use of various
filters on the Direct Ophthalmoscope.
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)
principle, other types. Meridian or axis? Are you sure?
Bifocals. Which axis for
incision? Will you rely on focimeter? No, keratometer. Steep axis surgery.
Bilateral Adie's in a middle
aged lady. Pathways for consensual reflex. Tests for Adie's. Principle
of using diluted pilocarpine (denervation hypersensitivity)
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,
Left homonymous hemianopia
in a young lady. Red and white pins were available at the station. Site
of lesion? Causes of bitemporal hemianopia?
in a middle aged gentleman. Demonstrate various illumination techniques.
TIPS FOR MRCOphth Part
Elkington is the basic text.
No surprises here.
Course notes are great, particularly
Dundee. Remember to memorize the PRINCIPLES of each test. Dundee notes
are excellent for this.
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.
Read The Retinoscopy Book, by
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
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).
Quick duochrome. If you take
too much time, the patient may become too confused to respond properly.
Muscle balance with Maddox rod,
including application of prisms to neutralize phoria