Download VSII Final 2010-Smith section

1. Recent epidemiologic studies of the US population indicate that over the last 30-40 years
_____.
a. the prevalence of myopia has been stable at about 25-30% of the population.
b. the prevalence of myopia has increased due exclusively to the higher proportion of
citizens of Asian descend.
c. the prevalence of myopia has decreased in individuals of Asian descend.
d. the prevalence of myopia has increased by about 50%, with all ethnic groups showing
increases in myopia prevalence
e. the prevalence of myopia has increased only in those individuals younger than 30
years of age.
2. Which of the following statements concerning the influence of outdoor activities on the
likelihood that a child will develop myopia is correct?
a. Children who spend at least 4 hours a day outdoors never develop myopia.
b. The amount of outdoor activities only reduces the odds of myopia in children who
spend low or moderate amounts of time involved in nearwork.
c. High amounts of outdoor activities appear to reduce the odds of myopia in children
regardless of how much time they spend doing nearwork.
d. The time spent outdoors only reduces the odds of myopia in children who actively
participate in sporting activities.
e. The amount of time spent performing nearwork has a much larger effect on the odds
of myopia than the amount of time a child is involved in outdoor activities.
3. With respect to the axis of astigmatism in a young adult population, which of the following
statements is correct?
a. The proportion of oblique astigmatism is approximately two times higher in myopic
individuals than in emmetropes or hyperopes.
b. The prevalence of against-the-rule astigmatism is greatest in eyes with more that
-3.00 D of myopia.
c. For any given amount of spherical ametropia, more eyes exhibit with-the-rule
astigmatism than against-the-rule astigmatism.
d. The proportion of eyes with with-the-rule astigmatism is not influenced by the
magnitude of the spherical refractive error.
e. For eyes with low to moderate degrees of myopia (e.g., -1.0 to -2.0 D), against-therule astigmatism is more prevalent than with-the-rule astigmatism.
4. With respect to the effects of traditional spectacle lenses on the pattern of peripheral
refractive errors, which of the following statements is correct?
a. Negative-powered spectacle lenses increase the effective amount of relative
peripheral hyperopia in myopic eyes corrected for distance.
b. Negative-powered spectacle lenses have little influence on the pattern of peripheral
refractions in young adults.
c. Undercorrecting myopic eyes for distance with spectacle lenses reduces the amount
of relative peripheral hyperopia at all viewing distances.
d. Spectacle lenses can not be used to manipulate the pattern of peripheral refractive
errors without altering central vision.
e. None of the above is correct
5. In terms of reducing the rate of myopia progression, recent clinical trials have shown that
undercorrecting young myopes for distance by about 0.75 D __________.
a. is as effective in reducing myopia progression as progressive addition lenses.
b. is only effective in reducing myopia progression in children with exophoria at near.
c. is only effective in reducing myopia progression in children who exhibit a significant
lag of accommodation at near.
d. actually increases the rate of myopia progression relative to traditional distance
correction strategies.
e. reduces myopia progression by reducing the amount of accommodation that a child
must exert during nearwork.
6. Which of the following statements concerning the refractive errors in newborn infants is NOT
correct?
a. The distribution of refractive errors is similar in shape to a random Gaussian
distribution.
b. In comparison to children 3-5 years of age, newborns exhibit a higher prevalence of
larger refractive errors.
c. Premature infant are generally more hyperopic than full-term infants.
d. The average refractive error is about +2.5 D of hyperopia.
e. The shape of the distribution of refractive errors is symmetric about the mean.
7. In comparison to infants whose parents are both myopic, infants of emmetropic parents
_______.
a. are just as likely to become myopic if they start school at the same age.
b. are at least 5 times less likely to develop myopia during the school years.
c. are not affected, at least in terms of the odds of becoming myopic, by the amount of
time spent in outdoor activities.
d. are twice as likely to develop myopia after age 20 years.
e. usually exhibit faster annual rates of myopia progression during the early school
years.
8. Which of the following ocular changes results in the largest changes in total refracting
power during the first 3 years of life?
a. an increase in the anterior and posterior lens radii.
b. an increase in anterior chamber depth.
c. a decrease in the posterior corneal radius of curvature
d. an increase in anterior corneal radius of curvature.
e. a decrease in the refractive index gradient in the crystalline lens
9. Myopia is almost always associated with an increase in axial length. However, at which of the
following ages is the incidence of myopia or relative myopic shifts in refractive error
likely to be due to factors other than axial length?
a. full-term neonates and children 14-18 years old
b. full-term neonates and individuals 40-60 years of age
c. full-term neonates and individuals 65-80 years of age
d. premature infants and individuals 14-18 years of age.
e. premature infants and individuals 65-80 years of age
10. Which of the following predictive statements is correct?
a. At 6 years of age, refractive error can not be used to predict who will become myopic.
b. More than half of the children who have myopic errors larger than -1.0 D at age 6
years will come clinically emmetropic over the next 5-6 years.
c. Children who have hyperopic errors between +0.5 and +1.5 D at age 6 years will
typically remain clinically emmetropic over the next 5-6 years.
d. Only children who show against-the-rule astigmatism at age 6 years will become
myopic in the next 5-6 years.
e. None of the above. All the statements are correct.
11. After 40 years of age, the eye develops more ______________.
a. against-the-rule/less with-the-rule astigmatism because the horizontal meridian
of the cornea gets steeper with age at a faster rate than the vertical meridian.
b. with-the-rule/less against-the-rule astigmatism because the vertical meridian of
the cornea flattens with age at a faster rate than the horizontal meridian.
c. against-the-rule/less with-the-rule astigmatism because the vertical meridian of
the cornea flattens with age at a faster rate than the horizontal meridian.
d. with-the-rule/less against-the-rule astigmatism because the horizontal meridian
of the cornea flattens with age at a faster rate than the vertical meridian.
e. none of the above are correct
12. Which of the following changes does NOT take place in the mammalian sclera during the
development of form-deprivation myopia?
a. The sclera gets thinner.
b. Gelatinolytic enzymes increase the amount catabolic activity in the scleral
extracellular matrix.
c. The extensibility or creep rate of the sclera increases
d. There is an increase in proteoglycan synthesis.
e. None of the above. All the statements are correct.
13. Which of the following substances has been implicated as a possible choroidal signal
messenger in the biochemical cascade that regulates eye growth?
a. muscarinc acetylcholine receptors
b. retinoic acid
c. dopamine
d. vasoactive intestinal peptide
e. matrix metalloproteinase
14. Which of the following statements concerning the mechanisms that mediate visiondependent eye growth are NOT correct?
a. Form deprivation myopia is a graded phenomenon; the degree of axial myopia is
dependent of the degree of image degradation.
b. Very brief exposures to visual signals that normally increase axial growth have a
greater effect on eye growth than very long exposures to visual signals that normally
reduce or stop axial growth.
c. Because the mechanisms that mediate vision dependent growth integrate visual
experience over time in a non-linear way, the use of “diopters-hours” to quantify the
amount of near work is probably not the optimal measure.
c. The performance properties of the emmetropization process are qualitatively similar
across many species.
e. None of the above. All the statements are correct.
15. Which of the following statements concerning the operational properties of the visiondependent mechanisms that regulate refractive development is NOT correct?
a. Vision-dependent mechanisms are probably active well into early adult life.
b. The potential for a clear retinal image is essential for normal emmetropization.
c. The vision-dependent mechanisms in the two eyes are strongly linked to ensure that
factors that influence images in one eye affect growth in both eyes equally.
d. The emmetropization process does not operate in a predictable manner in the dark.
e. None of the above. All the statements are correct.
16. Which of the following is least likely to be a risk associated with axial myopia?
a. posterior subcapsular cataract
b. open-angle glaucoma
c. chorioretinal degeneration
d. idiopathic retinal detachment
e. diabetic retinopathy
17. Which of the following statements concerning the prevalence of anisometropia during early
infancy (0-3 years) is correct?
a. The prevalence of significant anisometropia (e.g., >1,0 D) is higher at 3 years of age
than at birth.
b. Approximately 50% of normal full-term infants will exhibit a detectable anisometropia
(1 D or greater) at 1 year of age.
c. If an infant is isometropic (i.e., no anisometropia) at 1 year of age, there is only about
a 1 out of 100 chance that the infant will ever develop a significant anisometropia
(e.g., >1.0 D).
d. Anisometropias of about 1-2 D are frequently transient during early development and
not very predictive of the balance of refractive errors later in life.
e. None of the above.
18. Which of the following changes has NOT been implicated in the slow refractive error shift
that occurs between the ages 40 and 65 years?
a. an increase in the radius of curvature of the lens surface
b. a decrease in vitreous chamber depth
c. the onset of presbyopia
d. an increase in the refractive index of the lens cortex.
e. a decrease in posterior corneal radius of curvature
19. At which of the following ages is a myopic shift most likely due to changes in the crystalline
lens?
a. premature infants
b. infants 6 months of age
c. juveniles 12-18 years of age
d. individual 40 to 65 years of age
e. individuals 65-80 years of age
20. Which of the following statements concerning the anti-myopia effects of muscarinic
cholinergic blocking agents is correct?
a. Atropine can reduce the progression of juvenile-onset myopia even at concentrations
that do not produce complete cycloplegia.
b. Although the duration of treatment required to slow myopic progression is not known,
it is likely that to maintain therapeutic effects, anti-myopia agents like atropine will only
have to be administered near the onset of myopia.
c. Pirenzepine is much stronger than atropine and only has to be administered once a
week to prevent myopic progression in juveniles.
d. Pirenzepine reduces axial elongation rates by decreasing intraocular pressure.
e. The decrease in depth of field produced by atropine-induced pupil dilation increases
the accuracy of emmetropization.
21. Which of the following statements concerning the implications of lens-rearing experiments in
laboratory animals on the phenomenon of emmetropization is NOT correct?
a. The emmetropization process has a limited operating range and refractive errors that
fall outside this range produce unpredictable growth.
b. The eye uses visual feedback associated with the eye’s effective refractive status to
guide ocular growth toward emmetropia.
c. Early emmetropization comes about primarily as a result of vision-dependent control
over corneal power.
d. Visual feedback can produce hyperopic shifts in refractive errors in infant animals but
not in adult animals.
e. None of the above. All the statements are correct.
22. Which of the following statements concerning the operational properties of the visiondependent mechanisms that regulate refractive development is correct?
a. Early in life, a functioning fovea is essential for the phenomenon of form deprivation
myopia.
b. Peripheral vision, by itself, is not sufficient to mediate emmetropization.
c. Visual signals from the fovea are essential for the phenomenon of lens compensation.
d. Peripheral form deprivation can promote central axial myopia in young animals.
e. None of the above.
23. Which of the following statements concerning the pattern of peripheral refractive errors
along the horizontal meridian is NOT correct?
a. The degree of radial astigmatism increases with eccentricity.
b. Myopic eyes (i.e., foveal refractive error) typically exhibit less myopia / more
hyperopia in the near periphery (i.e., central 30 degrees).
c. Clinically emmetropic eyes (i.e., foveal refractive error) typically exhibit less hyperopia
/ more myopia in the near periphery (i.e., central 30 degrees).
d. Clinical studies have suggested that in young emmetropic adults relative peripheral
hyperopia is a risk factor for adult onset myopia.
e. None of the above. All the statements are correct.
24. Which of the following ocular changes is most responsible for the refractive changes in
individuals with early adult onset myopia?
a. a decrease in anterior chamber depth
b. a decrease in choroidal thickness
c. a decrease in corneal radius
d. an increase in vitreous chamber depth
e. an increase the refractive index of the lens core
25. Which of the following statements concerning the role of accommodation in emmetropization
and the development of refractive errors is correct?
a. Accommodation has an indirect effect on refractive development via its influence on
the eye’s retinal image quality.
b. Studies in monkeys have shown that prolonged accommodation during near work
produces axial myopia.
c. The fact that bifocals slow the progression of myopia demonstrates that
accommodation plays a key role in the genesis of myopia.
d. The fact that the bifocals are more effective in reducing myopic progression in
esophoric juveniles indicates that chronic over convergence promotes myopia.
e. A and D are correct.
26. Which of the following statements concerning the effects of visual experience on
emmetropization is NOT correct?
a. Although LAISK procedures can correct the optical errors associated with myopia,
these surgical procedures do not reduce the extra risk for retinal detachment
associated with high degrees of myopia.
b. Topically applied anti-glaucoma drugs that reduce intraocular pressure can
significantly decrease the degree myopia produced by form-deprivation.
c. Optically imposed myopic defocus produces an increase in the thickness of the
choroid in young animals.
d. Form deprivation myopia can be prevented by the topical application of the dopamine
agonist, apomorphine,
e. None of the above. All the statements are correct.
27. During the first 3 years of life the power of the cornea decreases by approximately
____________.
a. 2-4 D
b. 6-8 D
c. 12-15 D
d. 18-22 D
e. 25-30 D