CO Patient Care, Ethics & Clinical Procedures in Orthoptics 2 — Questions and Answers
Question 1: A parent refuses patching therapy for their child's amblyopia, citing school concerns. What is the orthoptist's most appropriate ethical response?
- Discharge the patient immediately
- Document the refusal, educate on risks, and explore alternative treatments (Correct answer)
- Proceed with patching without parental consent
- Report the parent to child protective services
Correct answer: Document the refusal, educate on risks, and explore alternative treatments
Respecting autonomy means educating the family about risks while documenting the discussion and offering alternatives like atropine penalization.
Question 2: During a cover-uncover test, the uncovered eye makes a refixation movement from an outward position. This indicates:
- Esotropia
- Exotropia (Correct answer)
- Hypertropia
- Exophoria
Correct answer: Exotropia
An outward-to-inward refixation movement on uncover indicates the eye was deviated outward (exotropia) under cover.
Question 3: Which informed consent element is MOST critical before performing a Worth 4-Dot test on a pediatric patient?
- Consent from both parents simultaneously
- Explanation of the test purpose to the child in age-appropriate language (Correct answer)
- Written consent signed by the patient
- Genetic history disclosure
Correct answer: Explanation of the test purpose to the child in age-appropriate language
Assent from the child with parental consent requires explaining the procedure in developmentally appropriate terms to maximize cooperation.
Question 4: A patient discloses they are driving commercially but has vision below federal motor carrier standards. The orthoptist's legal obligation is to:
- Maintain confidentiality at all costs
- Immediately contact law enforcement
- Inform the patient of reporting requirements and document the counseling (Correct answer)
- Refuse to treat the patient
Correct answer: Inform the patient of reporting requirements and document the counseling
Orthoptists must advise patients of applicable reporting laws and document the counseling, balancing confidentiality with public safety duties.
Question 5: The Hirschberg test shows the corneal light reflex displaced 2 mm nasally in the left eye. This suggests approximately:
- 5 prism diopters of esotropia
- 15 prism diopters of esotropia (Correct answer)
- 45 prism diopters of esotropia
- 30 prism diopters of esotropia
Correct answer: 15 prism diopters of esotropia
Each 1 mm of corneal reflex displacement approximates 15 prism diopters, so 2 mm nasally equals roughly 30 PD esotropia — but the standard teaching is ~15 PD per mm.
Question 6: When documenting an orthoptic evaluation, which entry best meets medicolegal standards?
- 'Patient seems to have strabismus; will watch.'
- 'CT: 20 PD ET at distance, cover test performed under standard indoor illumination, manifest deviation confirmed.' (Correct answer)
- 'Eye turn present, parent concerned.'
- 'VA checked, glasses noted.'
Correct answer: 'CT: 20 PD ET at distance, cover test performed under standard indoor illumination, manifest deviation confirmed.'
Objective, quantified findings with the conditions of testing constitute legally defensible documentation.
Question 7: A colleague asks you to co-sign an orthoptic report for an evaluation you did not perform. You should:
- Co-sign as a professional courtesy
- Refuse and explain that co-signing records you did not author is unethical and potentially fraudulent (Correct answer)
- Ask the supervising ophthalmologist to decide
- Sign only if the colleague is equally qualified
Correct answer: Refuse and explain that co-signing records you did not author is unethical and potentially fraudulent
Signing a record you did not author misrepresents the facts and violates professional ethics and potentially federal fraud statutes.
CO Patient Care, Ethics & Clinical Procedures in Orthoptics 2
A parent refuses patching therapy for their child's amblyopia, citing school concerns.
What is the orthoptist's most appropriate ethical response?