1. Twintech Semester 8
SAMPLE ANSWER FOR ESSAY QUESTIONS ON CLINICAL CASE
CONFERENCE (BMA 3421)
QUESTION 1
CASE OF MONOCULAR APHAKIC
ADVANTAGES OF CL OVER SPECS DISADVANTAGES OF CL OVER SPECS
1. IMPROVE VISUAL FIELD 1. RISK OF INFECTION
2. ELIMINATE ANISEIKONIA 2. COSTLY
3. COSMETICALLY BETTER 3. COMPLEX PROCEDURE
FACTORS TO BE CONSIDERED WHEN CHOOSING MATERIAL, DESIGN &
POWER
1. MATERIAL = HIGH OXYGEN PERMEABILITY OR HIGH DK VALUE
2. DESIGN = MULTIFOCAL CL, ASPHERIC
3. POWER = VERTEX DISTANCE & EFFECTIVITY
QUESTION 2
GLAUCOMA SUSPECT
SUITABLE TEST SUITABLE ADVICE
1. MEASURE/ESTIMATE THE 1. MUST BE SEEN BY EYE
ANTERIOR CHAMBER ANGLE SPECIALIST
2. MEASURE IOP 2. MUST NEVER FAILS TO
3. ESTIMATE THE CD/RATIO ATTEND FUTURE
4. PERIMETRY USING APPOINTMENT
HUMPHREY VISUAL FIELD 3. IF MEDICATION PRESCRIBED,
ANALYSER MUST USE PROPER CARE
4. MUST INFORM OF ANY NEW
SYMPTOMS
Effendy Hashim 21 August 2010

2. Twintech Semester 8
QUESTION 3
CHARACTERISTICS OF LOOSE FITTING SOFT CL
CENTRATION 1. DO NOT COVER THE WHOLE LIMBUS
2. LARGE SAG (DOWNWARD DECENTRATION)
MORE THAN 1 MM
RELOCATION 1. DECENTRED INFERIORLY (LOW RIDING)
(AFTER BLINK) 2. LARGE LAG (LATERAL MOVEMENT) MORE
THAN 2 MM
MOVEMENT ON 1. MOVES FAST & FREELY
UPGAZE BLINK 2. DO NOT COVER THE SUPERIOR LIMBUS
PUSH-UP TEST 1. FREELY MOVING
2. RAPID RECOVERY
COMFORT 1. UNCOMFORTABLE, EDGE IS WRINKLING
AND INTERACTING MORE WITH THE LIDS
2. UNSTABLE VISION, CLEAR ONLY AFTER
BLINK
QUESTION 4
LATENT HYPEROPIA & INTERMITTENT ESOTROPIA
PLAN & REMEDIAL
1. PRESCRIBE GLASSES OF FULL CYCLOPLEGICS REFRACTION
2. LEFT EYE OCCLUSION THERAPY
Effendy Hashim 21 August 2010

3. Twintech Semester 8
QUESTION 5
ADVANCE OPEN-ANGLE GLAUCOMA NEED LOW VISION CARE
(A)
MAGNIFICATION REQUIRED = REQUIRED DISTANCE VA
__________________
PRESENT DISTANCE VA
MAGNIFICATION = OLD OBJECT DISTANCE
______________________
NEW OBJECT DISTANCE
(B)
EITHER BASED ON THE LOGARITHMIC PROGRESSION TABLE USING
THE JUMP METHOD TO GET THE MAGNIFICATION REQUIRED FOR
NEAR
OR
USING THE FORMULA TO CALCULATE
MAGNIFICATION = PRESENT NEAR VA
____________________
REQUIRED NEAR VA
QUESTION 6
COMMON DRY EYE SYNDROME
PHYSIOLOGICAL BASES POSSIBLE CAUSES
1. TEAR FILM PROPERTIES 1. LESS PRODUCTION OF
(AQUEOS, LIPID, MUCIN) AQUEOS – SCHIMER TEST
2. TEARS PRODUCTION 2. MUCIN CONTAMINATED
WITH LIPID– TBUT
Effendy Hashim 21 August 2010

4. Twintech Semester 8
QUESTION 7
INTERMITTENT BLUR @ DISTANCE & NEAR
POSSIBLE CAUSES CONFIRMATION TEST
1. REFRACTIVE ERROR OF 1. REFRACTION/CYCLO
HYPERMETROPIA REFRACTION
2. ACCOMMODATION 2. NPA/FACILITY/
ANOMALY AMPLITUDE / NRA/PRA
3. DECOMPENSATED 3. COVER TEST /MADDOX /
HETEROPHORIA NFV /PFV
QUESTION 8
KERATOCONUS
RGP CL FITTING TECHNIQUE
1. ELIMINATE CENTRAL BEARING BY FITTING APICAL CLEARANCE
2. MID-PERIPHERAL BEARING BY THREE-POINT TOUCH
3. SMALL OPTIC ZONE DIAMETER 5-6 MM WITH NORMAL OVERALL
DIAMETER
4. BASE CURVE WILL BE FLATTER THAN CORNEAL APEX WITH MORE
FLATTENING IN THE PERIPHERAL
ADVANTAGES OF RGP DISADVANTAGES OF RGP
1. IMPROVE VA 1. RISK OF INFECTION OR
2. GOOD TEARS EXCHANGE ABRASION
2. DISCOMFORT
3. INSTABILITY-EASILY POP OUT
Effendy Hashim 21 August 2010

5. Twintech Semester 8
QUESTION 9
ADVICE FOR MYOPE & EARLY PRESBYOPE ON LASIK COMPARE TO CL
LASIK CL
1. SURGICAL – IRREVERSIBLE 1. NON-SURGICAL –
2. HANDLING FREE REVERSIBLE
3. RISK OF SURGICAL 2. NEEDS HANDLING
OMPLICATION 3. RISK OF INFECTION
4. SHORT-TERM EXPENSIVE 4. LONG-TERM COSTLY
5. POST-LASIK VISUAL 5. POSSIBILITY OF
DISTURBANCE DURING MONOVISION
NIGHT
QUESTION 10
CYCLOPENTOLATE VS ATROPINE
PROPERTIES CYCLOPENTOLATE ATROPINE
OPTOMETRIC USAGE 1. O.5% % 1.0 % 1. 1% SOLUTION &
SOLUTION 0.5 % OINTMENT
2. 3 DROPS IN 10 2. 1 DROP b.i.d. FOR 3
MINUTES DAYS PRIOR TO
INTERVAL EXAM
MECHANISM OF 1. BLOCKS THE 1. BLOCK THE
ACTION ACTION OF ACTION OF
ACETYLCHOLIN ACETYLCHOLINE
E TO RELAX IRIS 2. NON-SPECIFIC
SPHINCTER BINDING TO THE
Effendy Hashim 21 August 2010

6. Twintech Semester 8
MUSCLE VARIOUS
2. BLOCK MUSCARINIC
CHOLINERGIC RECEPTORS
STIMULATION
OF CILIARY
MUSCLE
1. RAPID ONSET OF 1. LONGER ONSET
PHARMACOKINETICS ACTION OF ACTION
PRODUCING AFTER 30 MINS
MAX TO 1-3 HOURS
MYDRIATICS 2. DURATION OF
AND CYCLOPLEGIA IS
CYCLOPLEGIA 6-12 DAYS
IN 15-60 MINS
2. DURATION OF
CYCLOPLEGIA
24 HOURS
SAFETY PROFILE CNS EFFECTS ; 1. CAUTION WITH
CONFUSION, ATAXIA, DOWN’S
PERSONALITY SYNDROME & PT
CHANGES & ON ANTI-
DISORIENTATION CHOLINERGIC
DRUG
2. CNS EFFECTS OF
DRYNESS OF
MOUTH,
TACHYCARDIA,
FEVER, SEIZURE &
DEATH
Effendy Hashim 21 August 2010