NBEO NBEO Neuro-Optometry & Visual Fields 2 — Questions and Answers
Question 1: Which condition causes disc edema, vision loss, and pain on eye movement, most often in young women?
- Optic neuritis (Correct answer)
- Non-arteritic ischemic optic neuropathy
- Papilledema
- Leber hereditary optic neuropathy
Correct answer: Optic neuritis
Optic neuritis classically presents in young women with subacute monocular vision loss, periorbital pain worsened by eye movement, and a central scotoma; it is strongly associated with multiple sclerosis.
Question 2: Non-arteritic anterior ischemic optic neuropathy (NAION) most commonly produces which visual field defect?
- Altitudinal field defect (inferior) (Correct answer)
- Central scotoma
- Bitemporal hemianopia
- Arcuate scotoma
Correct answer: Altitudinal field defect (inferior)
NAION infarcts the superior or inferior pole of the optic disc, causing an altitudinal (most often inferior) visual field defect that respects the horizontal meridian.
Question 3: Papilledema from raised intracranial pressure typically causes which early visual field defect?
- Enlarged blind spot (Correct answer)
- Central scotoma
- Superior altitudinal defect
- Constricted peripheral field
Correct answer: Enlarged blind spot
The earliest visual field defect in papilledema is enlargement of the physiologic blind spot due to peripapillary edema displacing photoreceptors around the disc.
Question 4: Which hereditary optic neuropathy causes bilateral, painless, central vision loss in young males and is associated with mitochondrial DNA mutations?
- Leber hereditary optic neuropathy (LHON) (Correct answer)
- Dominant optic atrophy (Kjer disease)
- Wolfram syndrome
- Friedrich ataxia optic neuropathy
Correct answer: Leber hereditary optic neuropathy (LHON)
LHON is caused by mitochondrial DNA point mutations and causes sequential bilateral central vision loss in young men due to retinal ganglion cell death.
Question 5: In a patient with a trochlear nerve (CN IV) palsy, which head position reliably worsens vertical diplopia?
- Ipsilateral head tilt (Correct answer)
- Contralateral head tilt
- Head tilt toward the shoulder of the affected eye
- Upgaze
Correct answer: Ipsilateral head tilt
The Bielschowsky head tilt test: tilting toward the side of the palsy worsens hypertropia because the affected superior oblique cannot intort, forcing the eye upward.
Question 6: Which test is used to distinguish a functional (non-organic) visual field loss from a true organic field defect?
- Confrontation testing with varying distances showing a tubular (non-expanding) field (Correct answer)
- Pattern visual evoked potentials (VEP)
- Optical coherence tomography
- Color vision testing with Farnsworth-Munsell
Correct answer: Confrontation testing with varying distances showing a tubular (non-expanding) field
In functional vision loss the visual field does not expand appropriately with distance (tubular field), whereas a true scotoma subtends a consistent visual angle at any test distance.
NBEO NBEO Neuro-Optometry & Visual Fields 2
Which condition causes disc edema, vision loss, and pain on eye movement, most often in young women?