JCAHPO Imaging 5 — Questions and Answers
Question 1: Which finding on OCT is most associated with vitreomacular traction syndrome?
- Full-thickness macular hole with cuff of fluid
- Posterior hyaloid attached to macula causing inner retinal distortion (Correct answer)
- Subretinal hyperreflective material beneath the fovea
- Disruption of ellipsoid zone without vitreous attachment
Correct answer: Posterior hyaloid attached to macula causing inner retinal distortion
VMT is characterized by the posterior hyaloid remaining attached to the macula and exerting tractional force, distorting inner retinal contour on OCT.
Question 2: Specular microscopy of the corneal endothelium measures which parameter most directly?
- Corneal thickness (pachymetry)
- Endothelial cell density (cells/mm²) (Correct answer)
- Anterior curvature radius
- Tear film break-up time
Correct answer: Endothelial cell density (cells/mm²)
Specular microscopy images and counts corneal endothelial cells, providing cell density (cells/mm²), morphology, and coefficient of variation.
Question 3: A 'staining' pattern on late-phase fluorescein angiography is best described as:
- Persistent hyperfluorescence without increasing size or intensity (Correct answer)
- Expanding bright spot with leakage obscuring lesion borders
- Dark area due to RPE atrophy
- Intermittent fluorescence with arterial pulsation
Correct answer: Persistent hyperfluorescence without increasing size or intensity
Staining refers to dye pooling in fibrous or scar tissue producing persistent late hyperfluorescence that does not expand, distinguishing it from active leakage.
Question 4: In optic nerve head imaging with the Heidelberg Retina Tomograph (HRT), the reference plane is set at:
- The inner limiting membrane
- 350 µm posterior to the temporal retinal surface at the disc margin (Correct answer)
- The lamina cribrosa
- The anterior surface of the optic nerve head
Correct answer: 350 µm posterior to the temporal retinal surface at the disc margin
The HRT reference plane is positioned 350 µm below the mean retinal surface height at the temporal disc margin to separate the optic cup from the rim.
Question 5: When a patient has poor fixation during automated perimetry, which reliability index will be most directly elevated?
- False positive rate
- False negative rate
- Fixation loss rate (Correct answer)
- Short-term fluctuation
Correct answer: Fixation loss rate
Fixation loss rate is measured by presenting stimuli to the blind spot; if the patient responds to these stimuli, it indicates the eye has moved off fixation.
Question 6: Multicolor imaging using the Spectralis SLO captures three reflectance images using which laser wavelengths simultaneously?
- 488 nm, 515 nm, and 820 nm (Correct answer)
- 514 nm, 635 nm, and 785 nm
- 450 nm, 550 nm, and 650 nm
- 532 nm, 660 nm, and 790 nm
Correct answer: 488 nm, 515 nm, and 820 nm
Spectralis multicolor uses three simultaneous lasers (488 nm blue, 515 nm green, 820 nm infrared) to produce a composite color image highlighting different retinal layers.
Question 7: On fluorescein angiography, a retinal artery macroaneurysm typically appears as:
- A focal saccular dilation of a retinal arteriole with early filling and late staining (Correct answer)
- A leaking microaneurysm at the capillary level
- A blocked fluorescence area surrounded by leakage
- An area of choroidal neovascularization
Correct answer: A focal saccular dilation of a retinal arteriole with early filling and late staining
RAM appears as a focal outpouching of a retinal artery that fills early with fluorescein and may show late staining, often with surrounding exudates and hemorrhage.
JCAHPO Imaging 5
Which finding on OCT is most associated with vitreomacular traction syndrome?