Mixed Deck — All NBEO Topics Flashcards

A flame-shaped hemorrhage in the nerve fiber layer is most commonly associated with which condition?

Answer: Hypertensive retinopathy

Hypertensive retinopathy produces flame-shaped (splinter) hemorrhages because elevated blood pressure ruptures nerve fiber layer vessels that spread along axonal bundles.

What is the treatment for herpes simplex keratitis?

Answer: Topical antiviral medication (trifluridine or ganciclovir gel) and possibly oral antiviral therapy; corticosteroids require careful management

HSV keratitis requires antiviral therapy. Topical antivirals treat epithelial disease. Stromal disease may require steroids (carefully, with antiviral cover) to reduce inflammation and prevent scarring.

Internuclear ophthalmoplegia (INO) is caused by a lesion in which structure?

Answer: Medial longitudinal fasciculus (MLF)

INO results from disruption of the MLF, which connects the contralateral abducens nucleus to the ipsilateral medial rectus subnucleus, impairing adduction.

A +7.00 D lens has a real object located 20 cm from the lens. The conjugate image is:

Answer: real and located 50 cm from the lens

Explanation: With a +7.00 D lens and a real object 20 cm from the lens, the image is real and located 50 cm from the lens. This is because the lens equation yields this result.

What is the hallmark OCT finding in central serous chorioretinopathy (CSCR)?

Answer: Subretinal fluid beneath the neurosensory retina

CSCR is characterized by a serous detachment of the neurosensory retina overlying a focal RPE leak, appearing as subretinal fluid on OCT.

According to the Amblyopia Treatment Studies (ATS), which of the following is an effective initial treatment for a 5-year-old child with moderate amblyopia (20/80) due to strabismus?

Answer: Daily patching of the sound eye for 2 hours

The Pediatric Eye Disease Investigator Group (PEDIG) Amblyopia Treatment Studies (ATS) demonstrated that for moderate amblyopia (20/40 to 20/100) in children aged 3 to <7 years, patching the sound eye for 2 hours daily is as effective as patching for 6 hours daily. [16, 17, 18] This minimal effective dose is often preferred to enhance compliance.

What is age-related macular degeneration (AMD)?

Answer: A progressive disease affecting the macula causing central vision loss, existing in dry (atrophic) and wet (neovascular) forms

Dry AMD (85-90% of cases) involves drusen deposits and atrophy. Wet AMD involves abnormal blood vessel growth under the retina that leaks fluid and blood, causing rapid central vision loss. Anti-VEGF injections treat wet AMD.

What are artificial tears and when are they prescribed?

Answer: Lubricating eye drops that supplement the natural tear film, prescribed for dry eye disease, post-surgical care, and contact lens discomfort

Artificial tears come in various formulations (preserved, preservative-free, lipid-based, gel) to supplement deficient tear film, reduce symptoms of dryness, and protect the ocular surface.

Toxoplasma retinochoroiditis typically presents with which characteristic fundus finding?

Answer: Active white lesion adjacent to an old pigmented chorioretinal scar ('headlight in fog')

Toxoplasma retinochoroiditis classically shows a fluffy white active satellite lesion adjacent to a hyperpigmented old scar, described as a headlight in the fog.

What is the cornea and what are its functions?

Answer: The transparent front surface of the eye that provides about two-thirds of the eye's refractive power and protects internal structures

The cornea is the eye's primary refractive surface, bending light as it enters the eye. Its transparency is maintained by precise arrangement of collagen fibers and controlled hydration through the endothelial pump mechanism.

Contact lens-induced acute red eye (CLARE) is most commonly associated with colonization by which category of organism?

Answer: Gram-negative bacteria

CLARE is most commonly associated with Gram-negative bacterial colonization of extended wear contact lenses, with endotoxins triggering the inflammatory response.

Which parameter describes the radius of curvature of the posterior surface of a contact lens?

Answer: Base curve radius

The base curve radius defines the curvature of the posterior surface of the contact lens that interfaces with the tear film and cornea.

The near point of accommodation (NPA) of a patient wearing a +1.25 D Add over his best distance correction is 19 cm. If the Add is removed, the NPA would then be at approximately:

Answer: 25 cm

Explanation: The near point of accommodation (NPA) is the closest point to the eyes at which clear vision is maintained through accommodation. When a patient wears a reading addition (Add), the NPA is brought closer. Removing the Add will push the NPA farther away. Since the patient's NPA with the Add is 19 cm, removing the Add would approximate the NPA to be at a greater distance, around 25 cm.

A patient with sickle cell disease is at highest risk for which posterior segment complication?

Answer: Proliferative sickle cell retinopathy

Sickle cell retinopathy progresses to a proliferative stage with sea-fan neovascularization, vitreous hemorrhage, and traction retinal detachment.

Which peripheral retinal degeneration is considered a significant risk factor for rhegmatogenous retinal detachment?

Answer: Lattice degeneration

Lattice degeneration causes thinning of the peripheral retina with overlying vitreous liquefaction and strong vitreoretinal adhesions at its edges, predisposing to tears and detachment.

Which visual field defect is produced by a lesion at the optic chiasm?

Answer: Bitemporal hemianopia

A chiasmal lesion (commonly a pituitary adenoma) damages crossing nasal fibers, resulting in loss of both temporal fields — bitemporal hemianopia.

What is vertex distance and why does it matter?

Answer: The distance from the back surface of a spectacle lens to the front of the cornea, which affects the effective power of the lens

Vertex distance (typically 12-14mm) affects effective lens power. For prescriptions over ±4.00D, changes in vertex distance require power adjustment. Contact lens prescriptions must be adjusted from spectacle prescriptions for this reason.

A 6-year-old child with intermittent exotropia (X(T)) is asymptomatic, but the deviation is manifest more than 50% of the time. Which of the following is a common non-surgical management option used to improve control of the deviation and potentially delay surgery?

Answer: Over-minus lens therapy

Over-minus lens therapy (e.g., prescribing an additional -2.00 D to -3.00 D over the cycloplegic refraction) is a non-surgical option used in intermittent exotropia. The additional minus power stimulates accommodative convergence, which in turn helps to control the exodeviation. This is often used for younger children to improve fusion and delay the need for surgery. [2, 3, 21]

A 9-year-old complains of headaches, intermittent blurred vision, and losing her place while reading. Clinical testing reveals a receded near point of convergence (NPC) to 15 cm break / 20 cm recovery, reduced positive fusional vergence (PFV) at near, and an exophoria of 10 prism diopters at near. What is the MOST appropriate initial management?

Answer: Office-based vision therapy

The patient's symptoms (asthenopia, blurred vision, difficulty with reading) and clinical signs (receded NPC, reduced PFV, near exophoria) are classic for convergence insufficiency (CI). [5, 6, 8, 10] Office-based vision therapy is the most effective and evidence-based treatment for improving convergence ability and alleviating symptoms in children with CI. [5, 8]

What is glaucoma and how is it detected?

Answer: A group of diseases that damage the optic nerve, often associated with elevated IOP, detected through tonometry, optic nerve evaluation, and visual field testing

Glaucoma causes progressive, irreversible optic nerve damage and visual field loss. Detection requires IOP measurement, optic disc evaluation (cupping), OCT nerve fiber analysis, and perimetry (visual field testing).