CO Patient Care, Ethics & Clinical Procedures in Orthoptics 3 — Questions and Answers
Question 1: A 4-year-old with unilateral amblyopia shows no improvement after 3 months of full-time patching. Before changing therapy, the orthoptist should FIRST:
- Switch to atropine penalization immediately
- Verify refractive correction is current and patch compliance is adequate (Correct answer)
- Order MRI of the orbits
- Discharge the patient
Correct answer: Verify refractive correction is current and patch compliance is adequate
Treatment failure is most commonly due to non-compliance or uncorrected refractive error, both of which must be ruled out before escalating therapy.
Question 2: During prism and alternate cover testing, you neutralize a deviation with 35 PD base-out. This measures the:
- Manifest deviation only
- Total deviation (manifest + latent) (Correct answer)
- Fusional vergence amplitude
- AC/A ratio
Correct answer: Total deviation (manifest + latent)
Alternate cover testing dissociates fusion, revealing the total deviation including any latent component.
Question 3: Which behavior by an orthoptist represents a breach of professional boundaries?
- Recommending the patient see an ophthalmologist for surgical evaluation
- Accepting a small gift basket from a grateful family
- Initiating a personal social media friendship with a current patient (Correct answer)
- Discussing a difficult case with a supervising physician
Correct answer: Initiating a personal social media friendship with a current patient
Social media relationships with current patients blur the professional boundary and can compromise objectivity and confidentiality.
Question 4: The synoptophore is used clinically to measure:
- Intraocular pressure
- Angle of deviation and grades of binocular vision simultaneously (Correct answer)
- Corneal topography
- Retinal nerve fiber layer thickness
Correct answer: Angle of deviation and grades of binocular vision simultaneously
The synoptophore measures the objective angle of strabismus and assesses simultaneous perception, fusion, and stereopsis.
Question 5: A patient in your waiting room collapses and becomes unresponsive. As a healthcare professional, your FIRST action should be:
- Call the ophthalmologist to assess ocular injuries
- Activate the emergency response system and begin CPR if no pulse (Correct answer)
- Document the incident before acting
- Ask bystanders to move the patient outside
Correct answer: Activate the emergency response system and begin CPR if no pulse
Activation of emergency services and initiation of CPR per BLS protocol takes priority in any cardiac or respiratory arrest situation.
Question 6: A patient requests their orthoptic records to send to a specialist. Under HIPAA, you must comply:
- Only after the specialist requests the records directly
- Within 30 days of the patient's written request
- Within 60 days, with one 30-day extension if documented (Correct answer)
- Only if the treating ophthalmologist approves
Correct answer: Within 60 days, with one 30-day extension if documented
HIPAA mandates record release within 30 days, with a possible 30-day extension if the covered entity notifies the patient in writing.
Question 7: For a patient with intermittent exotropia, the distance deviation is 30 PD and the near deviation is 10 PD. This pattern is MOST consistent with:
- Basic intermittent exotropia
- Convergence insufficiency type intermittent exotropia
- Divergence excess type intermittent exotropia (Correct answer)
- Simulated divergence excess
Correct answer: Divergence excess type intermittent exotropia
Divergence excess type is characterized by a deviation at distance significantly larger than at near (typically ≥10 PD difference).
CO Patient Care, Ethics & Clinical Procedures in Orthoptics 3
A 4-year-old with unilateral amblyopia shows no improvement after 3 months of full-time patching.
Before changing therapy, the orthoptist should FIRST: