Accommodation and Presbyopia — MCQs
Following are the changes during accommodation, except:
Scleral Expansion Bands are used in the management of:
A 50-year-old patient has difficulty reading close objects. Likely diagnosis?
A patient presented with gradual loss in night vision and peripheral vision. Based on the fundoscopic image provided, what is the most likely diagnosis?
The zonules suspending the lens are attached to the?
Treatment of presbyopia is by use of which type of lens?
The following spectacle is used in? (AIIMS Nov 2018)
Silk retina is seen in ?
Esotropia is common in
Primary objective of the use of atropine in anterior uveitis
Accommodation and Presbyopia Indian Medical PG Practice Questions and MCQs
Question 1: Following are the changes during accommodation, except:
- A. Constriction of pupil
- B. Dilatation of pupil (Correct Answer)
- C. Convergence of eyeball
- D. Increase in the anterior curvature of lens
Explanation: ***Dilatation of pupil*** - During **accommodation**, the pupils constrict (miosis) to increase the **depth of field** and sharpen the image on the retina. - Dilatation of the pupil (mydriasis) would lead to a larger circle of confusion and a **blurred image** for near vision. *Constriction of pupil* - This is a normal part of the **accommodation reflex**, driven by **parasympathetic activation**, which helps to improve the focus of near objects. - Pupillary constriction **increases the depth of field**, reducing spherical aberration and improving image clarity. *Convergence of eye ball* - As part of the **near reflex triad**, both eyes turn inward (converge) to ensure that the image of the near object falls on the **fovea** of each eye. - This movement helps maintain **binocular single vision** and prevents double vision (diplopia). *Increase in the anterior curvature of lens* - The **ciliary muscles contract**, relaxing the zonular fibers, allowing the **elastic lens** to become more convex, specifically increasing its anterior curvature. - This increased convexity **enhances the refractive power** of the lens, bringing the focal point of near objects onto the retina.
Question 2: Scleral Expansion Bands are used in the management of:
- A. Astigmatism
- B. Keratoconus
- C. Presbyopia (Correct Answer)
- D. Myopia
Explanation: ***Presbyopia*** - **Scleral expansion bands** are a surgical treatment strategy designed to restore the eye's ability to accommodate by altering the biomechanics of the sclera and ciliary body. - They aim to improve the range of motion of the ciliary body, thereby allowing the **lens to change shape** more effectively for near vision in **presbyopic** patients. *Astigmatism* - **Astigmatism** is primarily caused by an **irregularly shaped cornea** or lens, leading to blurred vision at all distances. - It is typically managed with corrective lenses (glasses or contact lenses) or refractive surgeries like **LASIK** or **PRK**, which reshape the cornea. *Keratoconus* - **Keratoconus** is a progressive eye disease where the **cornea thins** and bulges into a cone-like shape, causing distorted vision. - Treatments include rigid gas permeable contact lenses, **corneal collagen cross-linking** to halt progression, and in severe cases, corneal transplant. *Myopia* - **Myopia**, or nearsightedness, occurs when the eye focuses images in front of the retina, often due to an **elongated eyeball** or excessive corneal curvature. - It is commonly corrected with concave lenses, contact lenses, or refractive surgeries such as **LASIK** or **PRK** to flatten the cornea.
Question 3: A 50-year-old patient has difficulty reading close objects. Likely diagnosis?
- A. Hypermetropia
- B. Astigmatism
- C. Myopia
- D. Presbyopia (Correct Answer)
Explanation: ***Presbyopia*** - This condition is characterized by the **loss of elasticity** in the lens of the eye, which occurs naturally with age, making it difficult to focus on **near objects**. - Its typical presentation, as seen in this 50-year-old patient, is **difficulty reading close objects** or performing other tasks requiring near vision. *Hypermetropia* - Often causes **farsightedness**, meaning distant objects are seen clearly, but near objects appear blurry due to the eye attempting to constantly accommodate. - While it can make near vision difficult, it is not primarily an age-related loss of accommodation and can affect individuals of various ages. *Astigmatism* - Results from an **irregular curvature of the cornea or lens**, causing blurred or distorted vision at all distances, rather than specifically difficulty with close objects. - This condition makes it difficult for the eye to focus light uniformly on the retina, leading to multiple focal points or streaks. *Myopia* - This is commonly known as **nearsightedness**, where distant objects appear blurry while near objects are seen clearly. - It occurs when the eyeball is too long or the cornea is too steeply curved, causing light to focus in front of the retina.
Question 4: A patient presented with gradual loss in night vision and peripheral vision. Based on the fundoscopic image provided, what is the most likely diagnosis?
- A. Retinitis pigmentosa (Correct Answer)
- B. Retinal hemorrhage
- C. Fundus albipunctatus
- D. Fundus flavimaculatus
Explanation: ***Retinitis pigmentosa*** - The fundoscopic image exhibits **bone spicule-like pigment deposits** in the periphery, **attenuation of retinal vessels**, and a **waxy pallor of the optic disc**, which are characteristic signs of retinitis pigmentosa. The clinical presentation of gradual loss in **night vision (nyctalopia)** and **peripheral vision** (tunnel vision) is classic for this inherited retinal dystrophy, as it primarily affects the **rod photoreceptors** first. *Retinal hemorrhage* - Retinal hemorrhages appear as **red blotches or streaks** on the fundus and are usually associated with conditions like **hypertension**, **diabetes**, or **retinal vein occlusion**. This image does not show acute red hemorrhages, but rather **dark, aggregated pigment**, and the symptoms do not align with sudden vision changes often seen in acute hemorrhages. *Fundus albipunctatus* - This condition is characterized by numerous **small, discrete, white or yellowish dots** scattered throughout the retina, usually sparing the macula. While it can cause night blindness, the fundoscopic image here shows **bone spicule pigmentation** and **vascular attenuation**, not the widespread white dots typical of fundus albipunctatus. *Fundus flavimaculatus* - This refers to Stargardt disease or fundus flavimaculatus, which presents with **yellowish flecks** (pisiform or fish-tail shaped) scattered in the posterior pole and mid-periphery, along with **macular degeneration**. The image does not show these distinct yellow flecks or evident macular changes, and the pigmentary changes are more consistent with retinitis pigmentosa.
Question 5: The zonules suspending the lens are attached to the?
- A. Root of iris
- B. Ciliary body (Correct Answer)
- C. Anterior vitreous
- D. Limbus
Explanation: ***Ciliary body*** - The **suspensory ligaments of the lens**, also known as zonules of Zinn, connect the **lens capsule** to the **ciliary body**. - These zonules play a crucial role in **accommodation** by transmitting forces from the ciliary muscle to alter the shape of the lens. *Root of iris* - The **root of the iris** attaches the iris to the ciliary body but does not directly connect to the lens zonules. - The iris primarily controls the **pupil size** and light entry, while the zonules are involved in lens suspension and focusing. *Anterior vitreous* - The **anterior vitreous** is the part of the vitreous humor located in front of the lens. - While it is in close proximity to the lens, the zonules do not directly attach to the vitreous but rather to the ciliary body. *Limbus* - The **limbus** is the transitional zone between the cornea and the sclera, the white outer layer of the eye. - It is an important anatomical landmark for eye surgery and drainage of aqueous humor, but it has no direct role in suspending the lens.
Question 6: Treatment of presbyopia is by use of which type of lens?
- A. Convex (Correct Answer)
- B. Concave
- C. Biconcave
- D. Concavoconvex
Explanation: **Convex** - **Presbyopia** is an age-related condition where the **lens stiffens**, impairing its ability to accommodate and focus on near objects. - **Convex lenses** add converging power to the eye, helping to bring near objects into focus on the retina. *Concave* - **Concave lenses** diverge light rays and are used to correct **myopia (nearsightedness)**, where the eye focuses images in front of the retina. - They spread light out before it enters the eye, pushing the focal point back onto the retina. *Biconcave* - **Biconcave lenses** are a type of concave lens with two concave surfaces, used for correcting severe **myopia (nearsightedness)**. - These lenses further diverge light rays and are not suitable for presbyopia, which requires converging power. *Concavoconvex* - A **concavoconvex lens** has one concave and one convex surface; its overall power depends on the relative curvatures of the two surfaces. - While some forms might be used in specialized optical systems, they are not the primary or standard correction for presbyopia, which typically requires a simple converging (convex) power.
Question 7: The following spectacle is used in? (AIIMS Nov 2018)
- A. Progressive glasses for presbyopia
- B. Bifocal glasses for presbyopia (Correct Answer)
- C. Bifocals for paediatric pseudo-phakia
- D. Bifocals for adult aphakia
Explanation: ***Bifocal glasses for presbyopia*** - The image clearly shows spectacle lenses with a visible **horizontal line separating two distinct optical powers**, which is characteristic of **bifocal lenses**. - **Presbyopia** is the condition where the eye's lens loses its ability to focus on near objects, requiring a different optical correction for near vision separate from distance vision, precisely what bifocals provide. *Progressive glasses for presbyopia* - **Progressive lenses** offer a gradual change in optical power from distance to near vision without a visible dividing line, unlike the spectacles shown. - They provide a continuous range of focus, but the absence of a visible segment in progressive lenses differentiates them from bifocals. *Bifocals for paediatric pseudo-phakia* - While pediatric pseudophakia (presence of an intraocular lens in a child) might require bifocals, the question asks for the primary use of the *pictured* bifocals, which commonly address **age-related presbyopia**. - Additionally, pseudophakia itself doesn't inherently imply a need for bifocals unless there's an accommodative issue, which is more typically associated with adult presbyopia. *Bifocals for adult aphakia* - **Aphakia** is the absence of the natural lens in the eye, which requires strong corrective lenses. While bifocals can be used in aphakia to provide both distance and near correction, the pictured bifocals are a standard design most commonly associated with correcting **presbyopia** in the general population. - Aphakic corrections generally involve much higher power lenses, which might appear thicker or have different characteristics than the standard bifocal shown.
Question 8: Silk retina is seen in ?
- A. Retinal detachment (Correct Answer)
- B. Diabetic retinopathy
- C. Macular degeneration
- D. Hypertensive retinopathy
Explanation: ***Retinal detachment*** - **"Silk retina" or "silky sheen"** is a classic ophthalmoscopic finding in retinal detachment, describing the **smooth, glistening appearance** of the detached sensory retina. - The detached retina appears **elevated, gray, and translucent** with characteristic folds or undulations, exhibiting a **satiny or silky luster** when examined. - Patients typically present with **photopsias (flashes of light)**, **floaters**, and progressive **visual field defect** described as a "curtain" or "shadow." - This is a true **ophthalmic emergency** requiring urgent surgical intervention. *Diabetic retinopathy* - Characterized by **microaneurysms, dot-blot hemorrhages, hard exudates**, and **cotton-wool spots** in non-proliferative stages. - Proliferative diabetic retinopathy shows **neovascularization** and vitreous hemorrhage. - Does not produce the "silk retina" appearance. *Macular degeneration* - Age-related macular degeneration presents with **drusen, pigmentary changes**, and in advanced stages, **geographic atrophy** or **choroidal neovascularization**. - May show a **"beaten-bronze" appearance** in certain macular dystrophies (Best's disease), but not "silk retina." - Central vision loss is the predominant symptom. *Hypertensive retinopathy* - Features include **generalized arteriolar narrowing, AV nicking, flame-shaped hemorrhages**, and **cotton-wool spots**. - In severe cases (Grade IV), **optic disc edema** and macular star exudates may occur. - Vascular changes dominate the clinical picture, not a silky retinal appearance.
Question 9: Esotropia is common in
- A. Myopia
- B. Hypermetropia (Correct Answer)
- C. Emmetropia
- D. Astigmatism
Explanation: ***Hypermetropia*** - **Esotropia**, or inward turning of the eye, is common in **hypermetropia** (farsightedness) due to the accommodative effort required to focus. - In hypermetropia, **excessive accommodation** is needed to see clearly at all distances, especially for **near vision**. - This constant **accommodative effort** stimulates convergence through the **accommodation-convergence reflex**, predisposing to **accommodative esotropia**, particularly in children. *Myopia* - **Myopia** (nearsightedness) is typically associated with **exotropia** (outward turning of the eye). - This is because myopic individuals exert less accommodative effort for near vision, reducing the stimulus for convergence and potentially leading to divergence of the eyes. *Emmetropia* - **Emmetropia** describes an eye with **no refractive error**, where light focuses perfectly on the retina without accommodation for distance. - Individuals with emmetropia generally have **orthophoria** (proper alignment of the eyes) and are less prone to strabismus like esotropia unless an underlying muscle imbalance is present. *Astigmatism* - **Astigmatism** is an optical defect in which the eye does not focus light evenly onto the retina, causing blurred vision at any distance. - While it can be associated with other refractive errors, **astigmatism itself is not directly or commonly associated with esotropia**.
Question 10: Primary objective of the use of atropine in anterior uveitis
- A. Rest to the ciliary muscle (Correct Answer)
- B. Helps in preventing posterior synechia formation
- C. Increase blood flow
- D. Increase supply of antibody
Explanation: ***Rest to the ciliary muscle*** - Atropine is a **cycloplegic** agent that paralyzes the **ciliary muscle**, thereby alleviating pain caused by spasms and inflammation in anterior uveitis. - This **cycloplegia** is the primary therapeutic goal, as it reduces **ciliary spasm** and the associated pain. *Helps in preventing posterior synechia formation (secondary effect)* - While atropine's **mydriatic** action (pupil dilation) helps prevent the formation of **posterior synechiae**, this is a beneficial secondary effect and not its primary objective in alleviating symptoms or pain. - The dilation breaks existing synechiae or prevents new ones from forming by moving the iris away from the lens capsule. *Increase blood flow* - Atropine's primary action is anticholinergic, leading to **cycloplegia** and **mydriasis**, not a direct increase in ocular blood flow. - Increased blood flow is not a targeted therapeutic effect of atropine in acute anterior uveitis. *Increase supply of antibody* - Atropine does not directly influence the immune system or increase the supply of antibodies to the inflamed eye. - Its mechanism of action is limited to blocking muscarinic acetylcholine receptors.
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