Presbyopia

PRESBYOPIA

Q. 1

All of the following are causes of premature presbyopia, EXCEPT:

 A

Hypermetropia

 B

Primary open angle glaucoma

 C

Premature sclerosis of the lens

 D

Uncorrected myopia

Q. 1

All of the following are causes of premature presbyopia, EXCEPT:

 A

Hypermetropia

 B

Primary open angle glaucoma

 C

Premature sclerosis of the lens

 D

Uncorrected myopia

Ans. D

Explanation:

Causes of premature Presbyopia:

  • Hypermetropia
  • Primary open angle glaucoma
  • General debility, causing presenile weakness of ciliary muscle
  • Premature sclerosis of the crystalline lens
Ref: Review of Ophthalmology A.K. Khurana, 5th Edition, Page 41.

Q. 2

Which of the following refractive problems most closely resembles presbyopia?

 A

Hyperopia

 B

Myopia

 C

Astigmatism

 D

Cataract

Q. 2

Which of the following refractive problems most closely resembles presbyopia?

 A

Hyperopia

 B

Myopia

 C

Astigmatism

 D

Cataract

Ans. A

Explanation:

Presbyopia is the loss of accommodative power that occurs as a person ages. Because accommodation cannot occur, the near point moves way from the eye and images must be held at some distance from the eye to be clearly seen. This is similar to the situation in hyperopia where the converging power is too weak for the axial length of the eye. Hyperopes must accommodate to see distant objects clearly and thus have less accommodation available for near vision. Thus hyperopes, like presbyopes, must hold objects at a distance to see them clearly (hence the term “farsighted”). 
 
Ref: Riordan-Eva P. (2011). Chapter 21. Optics & Refraction. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury’s General Ophthalmology, 18e. 

Q. 3

All are true about presbyopia except:

 A

Common in young age group 

 B

Common in eye sight of old age

 C

Spectacles having unifocal or bifocal lens should be used

 D

Correction of refractive error should be done

Q. 3

All are true about presbyopia except:

 A

Common in young age group 

 B

Common in eye sight of old age

 C

Spectacles having unifocal or bifocal lens should be used

 D

Correction of refractive error should be done

Ans. A

Explanation:

A i.e. Common in young age group

Presbyopia (eye sight of old age) is physiological insufficiency of accommodation (not refraction) seen in advanced (not young) ageQ and resulting in blurred near visionQ. To manage it always find out and correct refractive error for distance firstQ. And then find out and add presbyopic correction to it. In general the weakest convex (plus) lensesQ for near work either in a bifocal, multifocal progressive or variable focus lenses (in patients with refractive errors for distance) or unifocal (reading glasses)Q which will allow adequate vision should be used.

Quiz In Between


Q. 4

A 14 year old boy complains of pain during reading. On examination, his both eyes are normal and vision with Snellen’s reading is 6/5. He still complains of pain on occluding one eye. The diagnosis is :

 A

Myopia

 B

Pseudomyopia

 C

Hyperopia

 D

Emmetropia

Q. 4

A 14 year old boy complains of pain during reading. On examination, his both eyes are normal and vision with Snellen’s reading is 6/5. He still complains of pain on occluding one eye. The diagnosis is :

 A

Myopia

 B

Pseudomyopia

 C

Hyperopia

 D

Emmetropia

Ans. B

Explanation:

B i.e. Pseudomyopia

This boy is having symptom of ocular strain (pain during reading) but vision with snellen’s reading (without cycloplegia) is normal (6/5 or 6/6) because he is compensating for his refractory error by hyperaccomodation. So the diagnosis is Pseudomyopia/ Accommodative spasm.


Q. 5

Preferably presbyopia should be:

 A

Fully corrected

 B

Under corrected

 C

Over corrected

 D

None of the above

Q. 5

Preferably presbyopia should be:

 A

Fully corrected

 B

Under corrected

 C

Over corrected

 D

None of the above

Ans. B

Explanation:

Ans. Under corrected


Q. 6

Excessive accommodation causes:

 A

Hypermetropia

 B

Myopia

 C

Pseudomyopia

 D

Pseudohypermetropia

Q. 6

Excessive accommodation causes:

 A

Hypermetropia

 B

Myopia

 C

Pseudomyopia

 D

Pseudohypermetropia

Ans. C

Explanation:

Ans. C: Pseudomyopia

Pseudomyopia

  • It refers to an intermittent and temporary shift in refraction of the eye towards myopia, in which the focusing of light in front of the retina is due to a transient spasm of the ciliary muscle causing an increase in the refractive power of the eye.
  • It may be either organic, through stimulation of the parasympathetic nervous system, or functional in origin, through eye strain or fatigue of ocular systems.
  • It is common in young adults who have active accommodation, and classically occurs after a change in visual requirements, such as students preparing for an exam, or a change in occupation.
  • The major symptom is intermittent blurring of distance vision particularly noticeable after prolonged periods of near work, and symptoms of asthenopia.
  • The vision may clear temporarily using concave (minus) lenses.
  • The diagnosis is done by cycloplegic refraction using a strong cycloplegic like atropine or homatropine eye drops.
  • Accommodative amplitude and facility may be reduced as a result of the ciliary muscle spasm.
  • Treatment is dependent on the underlying aetiology.
  • Organic causes may include systemic or ocular medications, brain stem injury, or active ocular inflammation such as uveitis.
  • Functional pseudomyopia is managed though modification of working conditions, an updated refraction, or through appropriate ocular exercises

Quiz In Between


Q. 7

Presbyopia is due to

 A

Loss of elasticity of lens capsule

 B

Weakness of ciliary muscle

 C

Weakness of suspensory ligament

 D

All of the above

Q. 7

Presbyopia is due to

 A

Loss of elasticity of lens capsule

 B

Weakness of ciliary muscle

 C

Weakness of suspensory ligament

 D

All of the above

Ans. D

Explanation:

Ans. All of the above


Q. 8

Treatment of presbyopia is by use of which lens?

 A

Convex

 B

Concave

 C

Biconcave

 D

Concavoconvex

Q. 8

Treatment of presbyopia is by use of which lens?

 A

Convex

 B

Concave

 C

Biconcave

 D

Concavoconvex

Ans. A

Explanation:

Ans. is ‘a’ i.e., Convex

Presbvopia

  • Presbyopia is a vision condition in which the crystalline lens of eye loses its flexibility, which make it difficult to focus on the objects closer to the eye. Presbyopia is not an error of refraction but a condition of physiological insufficiency of accommodation leading to a progressive fall in near vision. Presbyopia is an age related problem, therefore also called eye sight of old age.
  • Symptoms are usually seen after 40 years of age.
  • Presbyopia is not a disease, rather a natural part of the aging process of the eye.
  • The treatment of presbyopia is the prescription of appropriate convex glasses for near work.

Q. 9

Antigaucomatous drug causing spasm of accommodation

 A

Timolol

 B

Pilocarpine

 C

Dorazolamide

 D

Latanoprost

Q. 9

Antigaucomatous drug causing spasm of accommodation

 A

Timolol

 B

Pilocarpine

 C

Dorazolamide

 D

Latanoprost

Ans. B

Explanation:

Ans. is ‘b’ i.e., Pilocarpine

  • Ocular side effects of topical agents for POAG
  • 13-blocker: Allergic blepheroconjunctivitis, corneal hyposthesia, blurred vision, dry eye, superficial punctate keratitis.
  • Cholinomietics (pilocarpine): Blurred vision, miosis, accommodative spasm, browache.
  • Sympathomimetics
  • Non-selective (Dipivefrine): Follicular conjunctivities, rebound congestion, macular edema in aphakic
  • Apraclonidine: Allergies, lid retraction, follicular conjunctivitis, fluctuation in visual acuity
  • Brimonidine: Ocular allergy, conjuntival blanching.
  • Carbonic anhydrase inhibitors (Dorzolamide, brinaolamide): Punctate keratitis, ocular allergies.
  • Prostaglandin analogues (Latanoprost): Punctate keratitis, iris pigmentation.

Quiz In Between



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