NCLE EXAM, PRACTICE EXAM AND STUDY

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600 QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) |ALREADY GRADED A+

The advantages aphakia have over spectacle lenses - ANSWER Less peripheral
aberration
Less magnification
Increase visual field

not having a lens inside your eye - ANSWER Aphakia

Which of the following can aphakia cause, myopia or hypermetropia? - ANSWER

Hypermetropia

Causes of aphakia - ANSWER *Congenital absence of lens

*Surgical Aphakia
*Absorption of lens matter
*Traumatic extrusion (push or forced out)
*Posterior dislocation- in vitreous, causes optical aphakia

The cornea thins and bulges outward into a cone shape - ANSWER Keratoconus

Symptoms of Keratoconus - ANSWER *distorted, blurred, double vision

*inability to see dim light
*sensitivity to light

Signs of keratoconus - ANSWER CORNEAL THINNING AT THE APEX

CHANGES OF ASTIGMATISM
DECREASING VISION IN ONE EYE

cause of keratoconus - ANSWER Cause is unknown, but it is believed to be

present at birth or the loss of collagen in the cornea

How can be keratoconus be treated? - ANSWER *Surgical treatment

*Vision correction
*specialty contact
*Corneal cross link

Slows down and stop the progression of keratoconus but doesn't improve vision -
ANSWER Cornea Cross Linking
A conical shaped cornea can best be fit with contact lenses through the use of:
A.trial lenses
B. keratometer readings
C. eye impressions
D. topogometer readings - ANSWER A. Trial lenses

Prism ballast lenses can be useful for: - ANSWER For cylindrical lenses and some
bifocals
Helping to reduce lens rotation

What type of contacts needs prism ballast? - ANSWER Front surface toric GP and
bifocal/multifocal GP

What type of contacts does not need prism ballast - ANSWER Back surface toric,
Bitoric, and Spherical lenses

Base down prism from 0.75-1.5 diopters weighs the lens down and keeps it stable so
it doesn't rotate - ANSWER Prism ballast

Bitoric lenses are prescribed:

A. Only when there is a small amount of corneal
B. Astigmatism and no residual when there 1s no corneal
C. Astigmatism only for bifocal contact lenses
D. When there is at least 2.00D of corneal astigmatism accompanied by a significant
amount of residual astigmatism - ANSWER D. When there is at least 2.00D of
corneal astigmatism accompanied by a significant amount of residual astigmatism

In which of the following cases would a front toric lens most likely be prescribed?
A. K: 41.00@180/41.25@090
Rx: -1.25 - 0.25 x 090
B. K: 41.25@175/42.50@085
Rx: -2.75 -1.00 x 005
C. K: 43.25@165/43.37@075
Rx: -4.00 -0.75 x 165
D. K: 42.00@180/42.000@090
Rx: -1.25 -3.75 x 180 - ANSWER D. K: 42.00@180/42.000@090
Rx: -1.25 -3.75 x 180

K: 41.50@090/42.75@180 This K reading indicates:

A. With the rule astigmatism
B. Against the rule astigmatism
C. Oblique astigmatism
D. Residual astigmatism - ANSWER B. Against the rule astigmatism

Rx: -4.50 + 2.50 x 095

Transposed - 2.00 - 2.50 x005
K: 44.75@090/45.00@180
What type of lens would best fit this patient?
A. Spherical contact lens
b. bitoric contact lens
C. front toric contact lens
D. Monovision - ANSWER C. Front toric contact lens

Early stages of keratoconus may be detected through the use of :

A. Slit lamp
B. Radiuscope
C. Keratometer
D. Retinoscope - ANSWER C. Keratometer

The hyperflange lens design is useful in fitting which of the following?

A. High minus lenses
B. Low minus lenses
C. High plus lenses
D. Low plus lenses - ANSWER A. High minus lenses

A wide beam of light is directed obliquely at the cornea with no attempt to focus the
light. Used for the cornea, sclera and lids - ANSWER Diffuse illumination

uses for diffuse illumination are: - ANSWER • lens position and movement
• surface wettability of the cornea or contact lens
• tear break-up time
•gross corneal staining
• blink reflex

The microscope and the beam of light are focused on the same area. - ANSWER
Direct Illumination

What are the 3 types of direct illumination? - ANSWER Optic section, parallelpiped,
and conical beam

also known as Pinpoint illumination the width and the height go down to about a
1.0mm cone shape - ANSWER Conical beam

Uses for Conical Beam - ANSWER To observe debris floating in the anterior
chamber.

A 1-2mm slit that separates the anterior and posterior cornea - ANSWER
Parallelpiped section

Parallelpiped is good for getting a detailed look at: - ANSWER • corneal staining
• corneal opacities and infiltrates
• endothelial deposits
• deposits and scratches on the lens surface

A 1.0mm wide illumination that is used to see all layers of the corneal - ANSWER
Optical section

Optical section is used to: - ANSWER • determine which layer of the cornea is
involved
• detect irregular topography
• view the lens/cornea relationship

The illuminating arm and the microscope are positioned such that the beam of light,
when reflected from the corneal surfaces, will pass through one of the oculars of the
microscope. - ANSWER Specular reflection

Specular reflection is especially useful for detecting: - ANSWER • hazy lenses

• fine epithelial edema
• endothelial cells
• surfaces of the crystalline lens

Beam of light is focused next to the area being examined. The viewer looks to the
side of the slit instead of directly into it. - ANSWER Indirect Illumination

Indirect is very effective for inspecting opaque structures, such as: - ANSWER •
lids and lashes
• sclera and conjunctiva

Uses reflected light from the iris or retina to backlight something opaque or
translucent in the cornea. - ANSWER Retro illumination

Used in contact lens examination to assess surface deposits on lenses - ANSWER

Retroillumination

A halo effect is produced when a bright beam is directed toward the limbus at a wide
angle - ANSWER Sclerotic Scatter

Sclerotic scatter is used for - ANSWER • Opacities

• Central Corneal Clouding or patch edema

Used with fluorescein to observe areas of roughened or absent epithelium

Used to evaluate fit of RGP lens; causes fluorescein to appear yellowish green to
observer - ANSWER Blue cobalt

Screen out excess blue light and makes fluorescein appear more vibrant green -
ANSWER Wratten #12 yellow filter

Increases contrast of red areas making them appear black - ANSWER Green (red-
free) filter

Triangular opaque tissue on the nasal side of the conjunctiva that grows toward the
center of the cornea - ANSWER Pterygium

What causes pterygium? - ANSWER Long term exposure to UV light

____IS A TURNING OUTWARD OF THE EYELID AS A RESULT OF AGING -

ANSWER Ectropian

_____ IS A TURNING INWARD OF THE EYELID AS A RESULT OF AGING -

ANSWER Entropian
Eyelashes grow inwards toward the eye. - ANSWER Trichiasis

What causes Trichiasis - ANSWER eye infection

inflammation of the eyelid
autoimmune conditions
trauma

Drooling eyelid - ANSWER Ptosis

A YELLOWISH TRIANGULAR THICKENING OF THE BULBAR CONJUNCTIVA IS

A: - ANSWER Pinguecula

What causes pinguecula? - ANSWER heavy exposure to UV light

Abnormal formation of new blood vessels. - ANSWER Neovascularization

What causes Neovascularization? - ANSWER A bacterial or viral infection

Chemical burn
Contact lens wear that causes hypoxia, or lack of oxygen to the eye
Ocular herpes
Trauma to the eye

It is richly vascular, extremely thin and strongly bounded to the tarsal plate -
ANSWER Palpebral conjuctiva

LID EVERSION IS NECESSARY TO OBSERVE WHICH OF THE FOLLOWING

CONDITIONS? - ANSWER GIANT PAPILLARY CONJUNTIVITIS

Tiny oil glands of the inner eyelid become inflamed and affects the eyelashes or tear
production. - ANSWER Blepharitis

Inflammation of the eyelid and conjunctiva. - ANSWER Blepharoconjunctivitis

Plastic surgery of the eyelid. - ANSWER Blepharoplasty

Drooping of the upper eyelid. - ANSWER Blepharoptisis

What causes Blepharitis? - ANSWER Too much bacteria on your eyelids at the
base of your eyelashes or clogged eyelids

The pool of tears in the lower conjunctival cul-de-sac of the eye, which drains into
the opening of the tear drainage system. - ANSWER Lacrimal lake

What drains the lacrimal lake? - ANSWER lacrimal punctum and canaliculi

When the glands become blocked, the oily part of the tears cannot be released -
ANSWER Meibomian glands

What causes Plugged Meibomian Glands - ANSWER Environmental stress

Hormonal influence
Contact lenses
Some medications

a tender red bump on the edge of your eyelid. - ANSWER stye (hordeolum)

What causes a stye (hordeolum)? - ANSWER a gland on the edge of your eyelid
gets infected and is most often caused by a bacteria or germ called starch

A small, usually painless, lump or swelling that appears on your eyelid. It can
develop on the upper or lower eyelid. - ANSWER Chalazion (cyst)

What causes chalazion? - ANSWER By a blockage in one of the tiny meibomian

glands of the upper and lower eyelids. Inflammation or viruses affecting the
meibomian glands are the underlying causes of chalazia.

occurs when a tiny blood vessel breaks just underneath the clear surface of your eye
(conjunctiva). - ANSWER Subconjunctival hemorrhage

What causes a Subconjunctival hemorrhage? - ANSWER sudden or severe

sneeze or cough, heavy lifting, straining, vomiting, or even rubbing one's eyes too
roughly. It can also occur as a side effect of eye surgery or blood thinners.

an irritation or inflammation of the conjunctiva, which covers the white part of the
eyeball - ANSWER Conjunctivitis (pink eye?

What causes conjunctivitis? - ANSWER by allergies or a bacterial or viral infection;

can be extremely contagious

The inside of your eyelid gets red, swollen, and irritated. - ANSWER Giant papillary
Conjunctivitis (GPC)

What causes Giant Papillary conjunctivitis? - ANSWER An allergy, either to contact

lenses or the chemicals used to clean them.
Contact lens wearers with asthma, hay fever, or other allergies
A contact lens, artificial eye, or exposed stitches rubbing against the eyelid
Deposits of proteins or other substances on the contact lenses
Chronic eye allergies

A darkly pigmented lesion found in the back of the eye, similar to a mole -
ANSWER Nevus

What causes a nevus (mole)? - ANSWER when a group of melanocytes (pigment

cells) group together

A superficial scratch on the clear, protective "window" at the front of the eye
(cornea). - ANSWER Abrasion

What can cause an abrasion? - ANSWER Poke your eye

Foreign matter/particles in your eye
Chemicals in your eye
Rub it too hard
Wear poor-fitting or dirty contact lenses
Overwear your contact lenses

Layers of the cornea anterior to posterior - ANSWER Epithelium

Bowman's layer
Stroma
Descemet's membrane
Endothelium

Projects from the front of the sclera, covers remaining 1/6th of the globe. -
ANSWER Cornea

Transparent, principle refracting medium of the eye. - ANSWER Cornea

What is the diameter of the cornea? - ANSWER 11-12 mm

What is the thickness of the cornea? - ANSWER .5mm central and 1.0 mm edge

Lack of oxygen in the cornea - ANSWER Hypoxia

Result of hypoxia - ANSWER Edema or swelling to the cornea; Cornea will appear
cloudy

What keeps the cornea in a relatively dehydrated state, or a state of deturgescence?

- ANSWER Epithelium and endothelium

The back two thirds of the eye, including the vitreous humor, the retina, the choroid,
and the optic nerve - ANSWER Posterior segment

Front most region of the eye, and includes the cornea, iris, and lens - ANSWER
Anterior segment

Surface layer of cells; Provide barrier function and a smooth surface to absorb
oxygen and nutrients for the tear film. - ANSWER Epithelium

Contains collagen fibers that maintain the cornea's shape. - ANSWER Bowman's
membrane

Thickest layer of the cornea (90% of cornea) Composed of collagen fibers, water,
and supporting keratocytes; which are the cells for general repair and maintenance. -
ANSWER Stroma

An inner layer of basement membrane. Serves as a protective barrier against

infection and injuries. - ANSWER Descemet's membrane

Works as a barrier and pump any excess fluid out of the stroma. preventing any
swelling, resulting in a thick and opaque cornea. - ANSWER Endothelium
What are the 3 layers of the tear film? - ANSWER Lipid, aqueous, mucin

Outermost layer
Secreted by meibomian and Zeis gland
Prevents evaporation of aqueous layer - ANSWER Lipid

Middle layer
Most of the tear film
Secreted by lacrimal gland and accessory glands of Krause and wolfering -
ANSWER Aqueous

Innermost layer
Secreted by goblet cells
Reduces surface tension of cornea to make tears spread easily - ANSWER Mucin

Time it takes for tear film to disrupt due to evaporation - ANSWER Tear break up
test (TBUT)

Normal TBUT - ANSWER 15 seconds or more

Measure volume of tears in the aqeous - ANSWER Shirmer's test

No surface anaesthetic drops are used; measures basic and reflex secretion. 10-
30mm is normal after 5 minutes - ANSWER Shirmer test 1

Surface anaesthetic drops are used. Measures only basic secretion. Less than 5mm
is abnormal, 10mm is normal - ANSWER Shirmer test 2

Shirmer's test is done using - ANSWER Schirmer's strip or what man filter paper
NO. 41

Produced by lacrimal glands to wash out the cause of ocular irritation - ANSWER
Reflex tears

Basic functional tears produced by lacrimal glands to keep the ocular surface moist. -
ANSWER Basal tears

Highlights devitalized corneal and epithelial cells - ANSWER Rose bengal

Makes a lens softer and more flexible but the flexibility can decrease the optical
quality; Attract more deposits. Also provides more oxygen permeability - ANSWER
High water content

Need less tears to remain hydrated. More comfortable for patients with dry eye -
ANSWER Low water content

Higher water content and Thinner lens = - ANSWER better oxygen transmission

Addition of silicone = - ANSWER higher oxygen transmission

Oxygen's ability to passively diffuse through a contact lens - ANSWER DK
(Oxygen permeability)

How can DK increase? - ANSWER With water content

Oxygen's ability to move through the thickness of a contact lens - ANSWER

Oxygen transmissibility (Dk/t or DK/L)

A diamond knife is used to cut both surface of the lens - ANSWER Lathe cutting

Advantages of lathe cutting - ANSWER Thicker than spincast, hence relatively

easier to handle.
Better movement and centration.

Disadvantages of lathe cutting - ANSWER Time consuming and labor intensive

compared to spin casting; takes approx 30 minutes to complete

Difficult to reproduce, because each lens is individually made.

Process in which soft contact material is heated until it's in a liquid state, then it's
injected into precise, pressurized molds. - ANSWER Injection molding

Advantages of molding - ANSWER No need to polish the finished lens

Produce a high quality lens at a lower cost.
It has a very consistent edge and smooth surface.
Excellent t visual acuity and comfort.
Highest reproducabilty

Disadvantages of molding - ANSWER * All materials are not suitable for molding
due to there chemical composition or undesired dimensional changes to
polymerisation.
* New mold are required for each lens series
* Startup cost is very big

Liquid polymer is introduce in spinning mold. Front surface is formed by the suface
tension of mold and polymer. The shape of the back surface is governed by force
and the of effect gravity. Greater the speed of rotation will result in shifting of polymer
to the lens periphery. - ANSWER Spin casting

Advantages of spin casting - ANSWER - Smooth surface and tapered edge profile
- Back aspherical surface matches with aspheric cornea
- has only one base curve.

Disadvantages of spin casting - ANSWER - may decenter slightly.

- They are more difficult to handle especially in low power.

Lens touches center of the cornea and at the two opposite edges on the sclera -
ANSWER Three point touch
Substances that are added to solutions to protect them from spoilage after being
opened - ANSWER Preservatives

This preservatives can bind to proteins on contact lens - ANSWER Benzalkonium

chloride (BAK)

This preservatives can bind to proteins on contact lens and become concentrated
enough in a soft lens to cause corneal sensitivity - ANSWER Chlorhexidine

This preservative reacts slowly in killing bacteria and fungus; only used together with
BAK - ANSWER Chlorobutanol

Low concentration preservatives that are used as disinfecting agents in multipurpose

solutions - ANSWER Polyquad, DYMED, PHMB

Used primarily for thimerosal; limited antimicrobial effect and can cause discoloration
of contact lens material - ANSWER Potassium sorbate and Sorbic Acid

Mercury compound (toxic reaction) - ANSWER Thimerosal

Agents that kill, neutralize, or inhibit the growth of these microorganism - ANSWER
Disinfectants

Eliminates harmful bacteria and microorganisms from lens material - ANSWER

Chemical disinfection

Highly purified 3% used to disinfect the lens Preservative free

Effective on wide range of bacteria
Must be neutralized before lens can be placed in eye - ANSWER Hydrogen
peroxide disinfection

Uses ultraviolet light to destroy bacteria, viruses, fungi, molds, algae - ANSWER
UVC- Disnfection

Removes protein deposits from rigid and soft lenses - ANSWER Enzymatic
cleaning

Derived from papaya; attacks large enzyme molecules and breaks them down into
water soluble peptides - ANSWER Papain enzyme cleaner

From the pancreas of pigs - ANSWER Pancreatin enzyme cleaner

Can be used with heat, chemical, or hydrogen peroxide systems - ANSWER

Subtillisin enzyme cleaner

Keep pH levels stable - ANSWER Buffer

Used to rinse lenses off after cleaning and before insertion; does not disinfect lenses
- ANSWER Saline solution
Used to rewet both soft and rigid lenses while they are on the eye - ANSWER
Lubricating and rewetting drops

A refractive error that prevents the light rays from coming to a single focus on the
retina because of different degrees of refraction in the various meridians of the eye. -
ANSWER Astigmatism

Condition in which the steepest corneal meridian is in the horizontal plane. 0-30
degrees or 150-180 degrees - ANSWER Against the rule Astigmatism

Condition in which the steepest corneal meridian is in the vertical plane. 60-120
degrees - ANSWER With the rule Astigmatism

Regular astigmatism in which the principal meridians are other

than 90 and 180. 30-60 degrees or 120-150 degrees - ANSWER Oblique
astigmatism

Astigmatism remaining after the corneal astigmatism has been neutralized. -

ANSWER Residual astigmatism