Objective structured practical question (ospe)

Objective Structured Practical
Question (OSPE)
Topic: Cataract
According to the course curriculum of
Bangladesh College of Physician &
Surgeon (BCPS)
7/14/2014 1anjumk38dmc@gmail.com

AUTHOR:
Dr Md Anisur Rahman Anjum.
MBBS (Dhaka Medical College). DO (Dhaka
University) FCPS (EYE)
Associate Professor
National Institute of Ophthalmology
Dhaka, Bangladesh.
Chamber: Mojibunnessa Eye Hospital
House: 18 Road: 6. Dhanmondi, Dhaka, 1205.
Bangladesh.
Email: anjumk38dmc@gmail.com
Cell: 01711-832397

OSPE:1

Question
• A 56-year-old woman complains of increasing
difficulty reading the newspaper in the
morning, especially in bright sunlight.
1) What may be the cause?
2) What will be the treatment of choice?
3) Before doing the treatment proper, what
investigation you have to do? Mention one
general and two ocular investigation.

Answer
1) Posterior subcapsular cataracts
• (Posterior subcapsular cataracts create more difficulty with
glare and near vision. Nuclear and cortical cataracts affect
distance vision more than near vision. Progressive loss of
vision from oil droplet or anterior polar cataracts is not often
seen in this age group)
2) Phacoemulsification with posterior chamber
intra ocular lens implantation.
3) General: Blood Sugar
Ocular: a) Biometry, b) IOP or SPT

OSPE:2

Referring to the picture below
• What is the name of
this device?
• b. Name two
conditions which may
increase the use of this
device.

ANSWER
• ANS=1. Intra capsular tension ring. It is used to
expand capsule following significant
zonulolysis.
• ANS=2
Marfan’s syndrome.
Pseudo exfoliation syndrome

OSPE:3

Question
 A l -month -old baby is diagnosed with unilateral
anterior polar cataract that is approximately 1.5 mm
in diameter.
Q: 1. What is the most appropriate initial management?
Q: 2. What is the another name of this cataract?
Q: 3. How many bigger are they?
Q: 4. Are they usually required surgery?
Q: 5. Why the vision is usually affected?
Q: 6 What should you do to preserve the vision?

Answer
1) Close observation.
2) Pyramidal cataract.
3) They are < 3 mm.
4) No
5) there is an increased incidence of anisometropia in
patients with anterior polar cataracts;
6) Refraction.

Marks distribution
1) Close observation. ----------------------- 2
2) Pyramidal cataract. ---------------------- 2
3) They are < 3 mm ------------------------- 1
4) No ------------------------------------------ 1
5) there is an increased incidence of
anisometropia in patients with anterior polar
cataracts; ------------------------------------ 3
6) Refraction. --------------------------------- 1

• a. Anterior polar cataracts are typically small
«3 mm) white opacities located centrally in the
anterior lens capsule. They are not progressive
and are not large enough to interfere with
vision. However, there is an increased
incidence of anisometropia in patients with
anterior polar cataracts; refractions should
therefore be monitored in these patients.

• Anterior polar cataract may be flat or project as
a conical opacity into the anterior chamber
(pyramidal cataract) Flat anterior polar opacities
are central, less than 3 mm in diameter, bilateral
in one-third of cases and visually insignificant.
Pyramidal opacities are frequently surrounded by
an area of cortical opacity and may affect vision.
Occasional associations of anterior polar cataracts
include persistent pupillary membrane. Aniridia,
Peters anomaly and anterior lenticonus

OSPE:4

• The following patients are seen in the pre-
assessment clinic for cataract surgery. Which of the
following patients are candidates for astigmatic
keratotomy during cataract surgery with intraocular
implant.
• Patient 1 44.50/48.25@90, refraction -1.75/-3.00X175
Patient 2 45.25/45.55@160 ,refraction -0.75/+2.25X170
Patient 3 42.00/45.00@5 , refraction +1.75/-2.25X100
Patient 4 44.28/44.75@30 , refraction -2.00/+1.75X35

• Patient 1 & 3.
• It is important for the surgeon to recognize
the contribution of lenticular astigmatism to
the refraction. Astigmatic keratotomy should
only be performed on patient with mainly
corneal astigmatism.

OSPE:5

• The above is the A-scan of a patient's eye
taken at the pre-operative assessment for
cataract surgery.
• a. Which formulae is best for this eye?
• b. Is peribulbar or retrobulbar anaesthesia the
anaesthesia of choice in this patient? Give your
reason(s)

• The eye has a high axial length, hence high
myopia. The best formula to use is SRK/T.
• No, a large eye increases the risk of accidental
globe perforation. Other technique may be
preferable such as topical anesthesia,
intracameral anesthesia or sub-tenon
anesthesia,

Formulae for biometry
 Axial length (mm) Formula
 <22mm Hoffer Q
 22-24.5mm Average of Hoffer Q, Holladay and SRK/T
 24.6-26mm Holladay
 >26mm SRK/T

OSPE:6

This 70 year-old woman is due to have a cataract
extraction. Her A-scan taken in the pre-assessment
clinic is shown above.
1 ) Which eye is this A-scan taken from? = 1
2) What are the three peaks (A, B & C) shown here? = 3
3) What is the required lens power for emmetropia
assuming the A constant is 118 and her average
keratometry is 44.0D? =4
4) If the axial length were overestimated by 1mm would
the resultant lens implant (which you aim for
emmetropia) give rise to hypermetropia or
myopia?=2

1) OS and therefore left eye.
(OD = right eye)
2) A = anterior lens echo
B = posterior lens echo
C = retinal echo
3) Power of the intraocular lens needed for emmetropia
= 118 – {2.5x(22.3) - 0.9x(43)}
= 23.55D
The power needed would be 23.50D as the implant
comes in step of 0.5D
4) The resultant refraction would be hypermetropic if the
axial length is overestimated.

Objective structured practical question (ospe)

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