1- A retinoscopy performed at 66cm produces this result.

Which ONE of the

following is the correct starting prescription for a subjective refraction?
Select one:
a. -4.25 / +1.25 @ 15.
b. -2.75 / +4.00 @ 105.
c. +1.25 /-4.00 @ 105.
d. -0.25 / -4.00 @ 105.

A working distance of 66com is equivalent to 1.5 dioptres which should be removed

from the spherical component of the power cross when prescribing spectacles. If the
sphere is negative this results in more minus, if positive the plus sphere is reduced.

The cylindrical component of this refraction is the difference between the powers in
the 2 meridia. The difference between+1.25 and -2.75 is 4 dioptres. The sign will
depend on what you choose to use as the sphere. If you choose -0.25 ( having
removed 1.5 dioptres) the cylinder will be
-4.00 dioptres if you choose -4.25 it will be +4 dioptres.
The correct answer is: -0.25 / -4.00 @ 105.

2-
Regarding a convex mirror, which ONE of the following statements is MOST
likely to be TRUE?
Select one:
a. Incident light rays parallel to the principal plane are reflected towards the
principle focus.
b. Magnification is the distance of the object from the mirror divided by the
distance of the image from the mirror.
c. The image is always smaller than the object.
d. The image is inverted if the object is between the centre of the curvature and
the principles focus.

Rays incident to a convex mirror are reflected away from the principal focus so any
image is virtual. A convex mirror produces an image that is virtual, upright and
diminished no matter the distance of the object from the mirror.

The image produced by a CONCAVE mirror varies according to the position of the
object.

Magnification is a ratio of image size (i) to object size (o) and equals minus image
distance (v) over object distance (u) i.e. :

            i/v = - v/u
The correct answer is: The image is always smaller than the object.

3- Regarding aphakic glasses, which ONE of the following statements is MOST

likely to be TRUE?
Select one:
a. A 'Jack in the box' effect is due to the prismatic effect of viewing through the
lens periphery.
b. Image magnification is less than 10%.
c. Objects appear closer than they really are.
d. The field of view is increased relative to contact lens correction.

The correct answer is: A 'Jack in the box' effect is due to the prismatic effect of
viewing through the lens periphery.

4- Regarding a Wollaston prism, which ONE of the following statements is

MOST likely to be TRUE?
Select one:
a. A polarized beam of light is split into two at the second refracting surface.
b. Dispersion of light is neutralised.
c. It consists of two right angle prisms with parallel optic axes.
d. It is used for image doubling in a focimeter.
A Wollaston prism consists of two right angle prisms cemented together with their
optical axes at right angles to each other. At the first refracting surface (within the
body of the prism and the plane at which the two prisms are joined) polarized and non
polarized light is split into two polarized beams of light both of which are further
refracted at the second interface where the light leaves the prism.

Dispersion occurs at both interfaces but that produced at the first is neutralized by the
second.

A Wollaston prism is used for image doubling in a keratometer

The correct answer is: Dispersion of light is neutralised.

5- Regarding dispersion of light, which ONE of the following statements is

MOST likely to be TRUE?
Select one:
a. At any refractive interface, longer wavelength light deviates more than shorter
wavelength light.
b. Dispersion of light is integral to the use of Maddox rod.
c. The dispersive power is half the angle between the refracted red wavelength
and refracted blue wavelength lights.
 d. The refractive index of a medium varies with the wavelength of incident light.
The refractive index of a medium varies slightly with the wavelength of light.

Shorter wavelength light (blue) light is deviated more than longer wavelength (red)
light.

The dispersive power is the angle between the red wavelengths light and blue
wavelength after refraction

A Maddox rod is a series of high powered cylindrical lens which makes the image of
a point focus of light as seen by the eye to appear as a line. It happens to be coloured
red.
The correct answer is: The refractive index of a medium varies with the wavelength of
incident light.

6- Regarding low vision aids, which ONE of the following statements is MOST
likely to be TRUE?
Select one:
a. A concave lens used as a loupe held at 33cm has a magnification of x8.
b. A Galilean telescope increases the angle subtended by the object at the eye.
c. As the object viewed through a convex lens moves closer to the principal focus
the magnification reduces.
d. The Galilean telescope includes two convex lenses separated by the difference
in their focal lengths.

A concave lens makes an image appear smaller. All magnifying hand held loupes are
convex lenses and a standard loupe of +32DS has a magnification of x8.

A simple convex lens used as a magnifying loupe if moved so the object is closer to
the principal focus increases the size of the virtual image and moves it further from
the eye. In this way a patient can move the loupe to get the optimal size and viewing
distance to suit them.

A Galilean telescope has a convex objective lens and concave eyepiece lens separated
by the difference in their focal lengths
The correct answer is: A Galilean telescope increases the angle subtended by the
object at the eye.

7- Regarding polarisation of light, which ONE of the following statements is

MOST likely to be TRUE?
Select one:
a. A polarizing substance makes all light vibrate in the same plane.
b. Light is polarized on reflection from a plane surface if the angle of incidence
equals the critical angle.
 c. The human eye can distinguish polarized from non polarized light.
d. The process by which some substances produce two separate beams of
polarized light is birefringence.

A polarizing substance such as calcite crystals. only allows the passage of light
vibrating in a particular plane, the rest being blocked

Light is polarized on reflection from a plane surface e.g. water if the angle of
incidence equals the polarizing angle for the substance. it is otherwise only partially
polarized.

The critical angle is used in relation to total internal reflection.

The human eye is unable to distinguish when light has been polarized.

Substances such as quartz which cause birefringence have two refractive indices
The correct answer is: The process by which some substances produce two separate
beams of polarized light is birefringence.

8- Regarding Purkinje-Sanson (catoptric) images, which ONE of the following

statements is MOST likely to be TRUE?
Select one:
a. Image 1 is erect and just posterior to the anterior lens capsule.
b. Image 11 is formed from the anterior lens surface.
c. Image 111 is an inverted virtual image.
d. Image iV is a virtual image as it is formed from a concave surface.

Images 1,11 and 111 are formed from convex reflecting surfaces (anterior cornea,
posterior cornea and anterior lens surface respectively) and as such are erect virtual
images.

Image 1V is the only one formed by a concave reflecting surface (posterior lens
surface) and the only inverted real image.

The images seen by an observer are more anterior in the eye than is actually the case
so whilst image 1 is seen in the anterior part of the anterior chamber, the actual image
is further back just behind the anterior lens capsule.
The correct answer is: Image 1 is erect and just posterior to the anterior lens capsule.

9- Regarding sperical aberration, which ONE of the following statements is

MOST likely to be TRUE?
Select one:
a. It is reduced in spectacles by ensuring the central lens curvature is less than the
peripheral curvature.
b. It is reduced in the human eye as the lens nucleus has a lower refractive index
than the cortex.
 c. It is the cause of reduced visual acuity when the pupil is dilated.
d. The Stiles-Crawford effect limits the sensitivity of the rods in the retinal
periphery.

Spectacle lenses can be ground with an aplanatic surface in other words the peripheral
curvature is less than the central.

The axial zone of the lens has a higher refractive power than the periphery because of
its higher refractive index.

Spherical aberration occurs because the prismatic effect of a spherical lens increases
towards the periphery of the lens. Obstructing these paraxial rays therefore has the
effect of reducing this effect. This is achieved with a pinhole and with a small pupil.
Spherical aberration is a large contributor to the reduced vision experienced when a
pupil is dilated.

The Stiles-Crawford effect is the increased sensitivity of retinal cones to paraxial light
rather than light which stimulates them obliquely ie through the peripheral cornea.
This is another mechanism by which the eye limits the impact of spherical aberration.
The correct answer is: It is the cause of reduced visual acuity when the pupil is
dilated.

10- Regarding the accommodative convergence/accommodation ratio, which ONE of

the following statements is MOST likely to be TRUE?
Select one:
a. A ratio of 4:1 is considered normal.
b. It is measured without correcting for any refractive error.
c. When measuring using the gradient method, the value is usually greater than
using the heterophoria method.
d. When measuring using the herophoria method a minus lens stimulates
accommodation.

The AC/A ratio is measured with the patient wearing their full spectacle correction.

The gradient method uses a minus lens to stimulate accommodation and the
heterophoria method a near target.

The gradient method usually gives a slightly lower ratio and is sometimes considered
to be more accurate.

The normal range is 3:1 to 5:1

The correct answer is: A ratio of 4:1 is considered normal.

11- Regarding the identification of an unknown lens, which ONE of the following
statements is MOST likely to be TRUE?
Select one:
a. Green light is used in a focimeter to make the numbers easier to read.
 b. To neutralize a lens by hand the test lens must be held against the front surface
of the unknown lens with no gap.
c. The collimating lens in a focimeter renders light waves parallel.
d. When a line of writing is viewed through a convace spherical lens which is
moved upwards the writing will appear to move downwards.

Green light is used in a focimeter to eliminate chromatic aberration

Spectacle lenses are identified by their back vertex power therefore when using the
neutralization technique the test lens should be held flat against the posterior surface
of the unknown lens although if this is very curved inaccuracies will occur and the
front surface may need to be used.

A concave lens moved over writing will make the writing appear to move in the same
direction. With a convex lens the movement is in the opposite direction.
The correct answer is: The collimating lens in a focimeter renders light waves
parallel.

12- Regarding the indirect ophthalmoscope, which ONE of the following statements
is MOST likely to be TRUE?
Select one:
a. An emmetropic observer viewing a hypermetropic subject must use a
correcting concave lens for a clear image.
b. The field of view in a myopic eye increases by reducing the distance between
the observer and the eye.
c. The magnification is approximately x12 for an emmetropic eye.
d. The retina seen in an aphakic eye appears magnified relative to an emmetropic
eye.

A hypermetropic eye illuminated by a direct ophthalmoscope will have a diverging

beam of light leaving the eye and so a convex (plus) lens is needed for an emmetropic
observer to have a clear image. The opposite is true for a myopic eye.

A hypermetropic eye has a smaller retinal image size than a myopic eye. An aphakic
eye because of the high hypermetropia will appear smaller even than an emmetropic
eye.

The field of view using a direct ophthalmoscope increases the closer the observer is to
the eye whatever the refractive error of the subject.

The magnification of the direct ophthalmoscope for an emmetropic eye is

approximately x15
The correct answer is: The field of view in a myopic eye increases by reducing the
distance between the observer and the eye.

13- Regarding the use of a Jackson cross-cylinder, which ONE of the following
statements is MOST likely to be TRUE?
Select one:
a. If labelled with +0.5 and -0.5, it is a 1 dioptre cross cylinder.
b. It cannot be used to confirm the absence of a cylinder.
c. The patient should view a round letter on the smallest line they are able to see.
d. The power of the cylinder should be checked first.

The correct answer is: If labelled with +0.5 and -0.5, it is a 1 dioptre cross cylinder.

14- Regarding toric lenses, which ONE of the following statements is MOST likely to
be TRUE?
Select one:
a. A toric lens of power +2 D in one meridian and +4D in the other is written
+2DS/ +4DC.
b. The interval of Sturm is the difference in power between the two meridians of
the lens.
c. They are not suitable for use as a contact lens because of lens rotation.
d. They are sphero-cylindrical lenses.

A toric lens is documented as a fraction with the numerator being the spherical power
and the denominator the cylindrical power. In this example the cylindrical power is
2dioptres therefore it should be      +2DS / +2DC

The interval of Sturm is the distance between the two foci of a toric lens

Toric contact lenses in both soft and gas permeable form are used to correct moderate
to high degrees of astigmatism. A number of techniques are used to encourage the
lens to stay in the correct orientation
The correct answer is: They are sphero-cylindrical lenses.

15- Regarding total internal reflection, which ONE of the following statements is
MOST likely to be TRUE?
Select one:
a. It occurs when light passes from a less dense material to a denser material.
b. It occurs when the angle of incidence is less than the critical angle.
c. It prevents examination of the peripheral retina with a direct ophthalmoscope.
d. The critical angle is calculated using Sherrington's law.

The correct answer is: It prevents examination of the peripheral retina with a direct
ophthalmoscope.

16- Which ONE of the following is MOST likely to cause a patient to complain about
their new spectacles?
Select one:
a. Leaving a cylinder axis unchanged even though it appears to be 10 degrees
different on subjective testing.
b. Introducing a large cylinder to the spectacles of a pseudophakic patient who
has previously only needed spherical correction.
c. Overcorrecting a hypermetrope by 0.5 dioptres.
d. Under correcting myopes by 0.25 dioptres.

A small cylinder axis change is frequently noticed by patients who then complain of
intolerance

Aphakic patients tolerate the inclusion of a large cylindrical correction remarkably

well. It is much less tolerated in phakic patients for whom a new large cylinder should
be introduced gradually.

If a hypermetrope is overcorrected they are more likely to complain about not even
being able to see large print in the distance eg shopping aisles in a supermarket.

A small undercorrection of myopes is well tolerated. Overcorrection however will

result in their using their accommodative power to distance view.
The correct answer is: Overcorrecting a hypermetrope by 0.5 dioptres.

17- Which ONE of the following is the correct transposition of the prescription below
into negative cylinder format?

-2.50/+3.25 x 160
Select one:
a. +0.75 / -3.25 x 70.
b. +2.50 / -0.75 x 70.
c. +2.50 / -3.25 x 160.
d. +3.25 / -2.5 x 160.

If glasses include a cylindrical component the power of that cylinder is exerted fully
in one direction but not at all at 90 degrees to that. In the above example the power of
the cylinder is fully expressed at 70 degrees (because the power is exerted at right
angles to the axis of a cylinder). Therefore at that angle there is +0.75 dioptres (-2.50
plus +3.25) At 160 degrees the cylinder has no effect and the power is -2.50.

To first transpose a prescription, add the sphere and cylinder together. In this example
-2.5 plus + 3.25 = + 0.75. Note that the signs must be respected. Had it been +1/+1.25
x 160 the answer would have been +2.25 and similarly with minus lenses.

Having done that, the sign of the cylinder needs to be changed but the power is
unaltered. The axis of the cylinder must be changed by 90 degrees.
The correct answer is: +0.75 / -3.25 x 70.
18- With regards to the back vertex distance, which ONE of the following statements
is MOST likely to be TRUE?
Select one:
a. It can be measured using A scan ultrasound.
b. It is a measure from the back surface of the spectacle lens to the front surface
of the closed eyelids.
c. It is a vital measure for all prescriptions.
d. The effective power of a 10.00 dioptre lens is reduced if the BVD is increased.

The BVD is measured from the back surface of the lens to the front surface of the
cornea and is measured during retinoscopy from the side with a ruler. Many trial
frames have an inbuilt measure on the side arms.

Moving a concave lens further from the eye moves the image into the vitreous so the
effective power of the lens has reduced and the power of the lens needs to be
increased in order for the image to again fall on the retina. The opposite is true of
convex lenses.

Changing the BVD has an increasing impact the higher the power of the lenses so
when prescribing spectacles for anyone more than 5 dioptres, the back vertex distance
at which the refraction was done must be recorded.
The correct answer is: It is a vital measure for all prescriptions.

19 - With regard to the prismatic effect of spherical lens decentration, which ONE of
the following statements is MOST likely to be TRUE?
Select one:
a. It is calculated as the power of the lens x decentration in millimetres.
b. It is the same at every position away from the axial zone of the lens.
c. It is used in spectacles instead of incorporating a prism.
d. It is well tolerated in high myopes.

As the refracting angle between the lens surfaces increases towards the periphery, the
prismatic effect also increases. There is no prismatic effect when viewing through the
axial zone of the lens and the power of prism is measured by the dioptric power of the
lens multiplied by the decentration in centimetres.
i.e. P(prism diopters)=F(lens power in diopters) x D(decentration in cm)

This effect can be made practical use of in making a spectacle lens if there is a prism
to be incorporated. On the other hand the higher the power of the lens the more likely
this effect is to cause spectacle intolerance in both hypermetropes (eg aphakia)and
myopes.
The correct answer is: It is used in spectacles instead of incorporating a prism.
20- With regard to the testing of stereopsis, which ONE of the following statements is
MOST likely to be TRUE?
Select one:
a. Polarising glasses are worn for the Frisby test.
b. No special glasses are needed for the TNO test.
c. The LANG test can be used on children under 1 year of age.
d. The Titmus stereo test chart may be viewed at any distance.

No special glasses are required for the Frisby test

The Titmus test is done at 40cm and wearing polarized glasses

The LANG test was developed to assess young infants and babies who may reach out
to touch the images. It requires no special glasses but only measures gross stereopsis

Red-green glasses are used for the TNO test which is performed at 40cm and assesses
stereoacuity to 15 seconds of arc
The correct answer is: The LANG test can be used on children under 1 year of age.