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ABO Ophthalmology study materials
ABO Ophthalmology study resources

ABO Ophthalmology practice questions

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Question 1Cornea and External Disease

Which layer of the cornea is primarily responsible for maintaining corneal deturgescence and transparency?

  1. Descemet's membrane
  2. Corneal epithelium
  3. Bowman's layer
  4. Corneal endothelium Correct answer.

Explanation

The endothelium actively pumps fluid out of the stroma via Na+/K+-ATPase, keeping the cornea relatively dehydrated and clear. Loss of endothelial cells leads to stromal edema and haze.

Question 2Cornea and External Disease

A patient has a dendritic corneal epithelial lesion with terminal bulbs that stains with fluorescein. What is the most appropriate initial treatment?

  1. Topical acyclovir or oral antiviral therapy Correct answer.
  2. Observation without treatment
  3. Topical corticosteroid alone
  4. Topical antibiotic monotherapy

Explanation

A branching dendritic ulcer with terminal bulbs is characteristic of herpes simplex epithelial keratitis, which is treated with antiviral therapy. Topical steroids alone can worsen epithelial HSV disease.

Question 3Cornea and External Disease

Which of the following is the most common cause of bacterial corneal ulcer in contact lens wearers?

  1. Streptococcus pneumoniae
  2. Moraxella catarrhalis
  3. Staphylococcus epidermidis
  4. Pseudomonas aeruginosa Correct answer.

Explanation

Pseudomonas aeruginosa is the classic and most frequent cause of contact lens-associated bacterial keratitis, favored by its affinity for damaged epithelium and biofilm formation on lenses.

Question 4Cornea and External Disease

In a patient with keratoconus, which finding is most characteristic on slit-lamp examination?

  1. Diffuse stromal thickening with Descemet folds
  2. Central epithelial hypertrophy with iron lines at the limbus
  3. Superior corneal flattening with pachymetry increase
  4. Inferior corneal steepening with apical thinning Correct answer.

Explanation

Keratoconus produces localized inferior corneal steepening and apical thinning, often with Vogt striae and a Fleischer ring. Corneal topography confirms the asymmetric steepening.

Question 5Cornea and External Disease

Which systemic medication is most strongly associated with corneal verticillata (whorl-like epithelial deposits)?

  1. Amiodarone Correct answer.
  2. Lisinopril
  3. Atorvastatin
  4. Metformin

Explanation

Amiodarone, chloroquine, hydroxychloroquine, and some other cationic drugs produce intracellular lipid deposits forming corneal verticillata. They are usually visually insignificant and reversible.

Question 6Cornea and External Disease

Which of the following best describes the Schirmer I test?

  1. Corneal sensitivity measured with a Cochet-Bonnet esthesiometer
  2. Tear film breakup time measured after fluorescein instillation
  3. Tear production measured with filter paper over 5 minutes without anesthesia Correct answer.
  4. Tear osmolarity measured with a laboratory assay

Explanation

The Schirmer I test measures total tear secretion using filter paper placed in the lower fornix for 5 minutes, typically without topical anesthesia. Wetting under 5 mm suggests aqueous deficiency.

Question 7Cornea and External Disease

A 65-year-old presents with a painful, unilateral vesicular rash in the V1 dermatome and corneal hypesthesia. Which ocular structure is most at risk of subsequent neurotrophic complications?

  1. Corneal epithelium due to loss of sensory innervation Correct answer.
  2. Crystalline lens due to osmotic stress
  3. Optic nerve due to demyelination
  4. Trabecular meshwork due to pigment dispersion

Explanation

Herpes zoster ophthalmicus can damage the nasociliary branch, reducing corneal sensation and predisposing to neurotrophic epithelial breakdown and persistent defects. Prompt antiviral therapy reduces this risk.

Question 8Cornea and External Disease

A patient with advanced keratoconus develops sudden severe pain, decreased vision, and corneal edema with a break in Descemet's membrane. What is the diagnosis?

  1. Terrien marginal degeneration
  2. Acute hydrops Correct answer.
  3. Corneal abrasion
  4. Mooren ulcer

Explanation

Acute hydrops results from a rupture of Descemet's membrane in ectatic corneas, allowing aqueous to enter the stroma and causing sudden edema and pain. It usually resolves with scarring over weeks to months.

Question 9Cornea and External Disease

Which feature best distinguishes fungal from bacterial corneal ulcer on clinical examination?

  1. Purulent discharge with hypopyon
  2. Rapid onset within 12 hours
  3. Diffuse superficial punctate staining
  4. Feathery margins with satellite lesions Correct answer.

Explanation

Fungal ulcers often show feathery or irregular borders, satellite lesions, and a dry-looking infiltrate, reflecting hyphal spread. Bacterial ulcers tend to progress more rapidly with purulent discharge.

Question 10Cornea and External Disease

A patient using topical timolol develops punctate epithelial erosions and reduced corneal sensation. Which mechanism best explains these findings?

  1. Beta-blocker-induced reduction of epithelial proliferation and corneal sensitivity Correct answer.
  2. Direct infection of the epithelium by the preservative
  3. Immune complex deposition in Bowman's layer
  4. Increased aqueous production causing stromal edema

Explanation

Topical beta-blockers can reduce corneal epithelial proliferation and sensitivity, contributing to ocular surface toxicity, especially with preserved formulations. Switching to a preservative-free or alternative agent often improves symptoms.

Question 11Cornea and External Disease

Which of the following is a hallmark of ocular cicatricial pemphigoid on conjunctival biopsy?

  1. Linear deposition of IgG and C3 along the basement membrane Correct answer.
  2. Granulomatous inflammation with giant cells
  3. Subepithelial amyloid deposition
  4. Fungal hyphae within the epithelium

Explanation

Ocular cicatricial pemphigoid is a mucous membrane pemphigoid showing linear IgG and C3 along the epithelial basement membrane on direct immunofluorescence. This distinguishes it from other cicatrizing conjunctivitides.

Question 12Cornea and External Disease

A patient with rheumatoid arthritis presents with severe peripheral corneal thinning and an overhanging edge without significant inflammation. What is the most likely diagnosis?

  1. Band keratopathy
  2. Peripheral ulcerative keratitis Correct answer.
  3. Salzmann nodular degeneration
  4. Pellucid marginal degeneration

Explanation

Peripheral ulcerative keratitis is associated with systemic autoimmune disease such as rheumatoid arthritis and presents with peripheral thinning, often with an overhanging epithelial edge. It requires systemic workup and immunosuppression.

Question 13Cornea and External Disease

Which finding is most consistent with a diagnosis of dry eye disease on tear film evaluation?

  1. Absent corneal staining with normal tear meniscus
  2. Increased Schirmer I values above 15 mm
  3. Elevated tear film lipid layer thickness
  4. Reduced tear breakup time and increased osmolarity Correct answer.

Explanation

Dry eye disease is characterized by tear film instability (short breakup time) and hyperosmolarity, often with ocular surface staining. These findings reflect loss of tear homeostasis.

Question 14Cornea and External Disease

A patient with a history of radial keratotomy presents with fluctuating vision and hyperopic shift years after surgery. Which mechanism best explains this change?

  1. Acute bacterial infection of the incisions
  2. Progressive flattening from continued wound remodeling and corneal instability Correct answer.
  3. Development of a Salzmann nodule over the incision
  4. Postoperative steroid-induced glaucoma

Explanation

Radial keratotomy incisions can continue to remodel over decades, causing progressive corneal flattening and hyperopic shift. This is a recognized long-term complication of RK.

Question 15Cornea and External Disease

Which of the following is the most appropriate first-line treatment for mild-to-moderate meibomian gland dysfunction?

  1. Punctal occlusion as initial therapy
  2. Oral doxycycline for all patients
  3. Topical corticosteroids indefinitely
  4. Lid hygiene with warm compresses Correct answer.

Explanation

Meibomian gland dysfunction is initially managed with lid hygiene and warm compresses to liquefy and express meibum. Adjunctive therapies are added based on severity and response.

Question 16Cornea and External Disease

A patient develops a corneal infiltrate after sleeping in hydrogel lenses. Which organism should be empirically covered while cultures are pending?

  1. Herpes simplex virus
  2. Pseudomonas aeruginosa Correct answer.
  3. Candida albicans
  4. Acanthamoeba species

Explanation

Overnight contact lens wear is a major risk factor for Pseudomonas keratitis, so empiric therapy should cover gram-negative organisms including Pseudomonas. Fortified antibiotics are typically used for sight-threatening ulcers.

Question 17Cornea and External Disease

A patient with a corneal transplant develops a graft rejection line composed of keratic precipitates limited to the donor endothelium. What is the most appropriate initial management?

  1. Topical antibiotics alone
  2. Immediate repeat penetrating keratoplasty
  3. Intensive topical corticosteroids Correct answer.
  4. Observation without treatment

Explanation

Endothelial rejection is treated promptly with intensive topical corticosteroids, often supplemented with systemic steroids in severe cases. Early treatment can reverse rejection and preserve the graft.

Question 18Cornea and External Disease

Which of the following best explains why the cornea remains transparent despite lacking blood vessels?

  1. Uniform collagen fibril spacing and relative stromal dehydration Correct answer.
  2. Continuous epithelial mitosis replacing stromal collagen
  3. High lipid content of the stroma
  4. Presence of a dense lymphatic network

Explanation

Corneal transparency depends on the regular lattice arrangement of collagen fibrils and on endothelial pump function maintaining relative dehydration. Disruption of either causes light scatter.

Question 19Cornea and External Disease

A patient with Stevens-Johnson syndrome develops severe dry eye, symblepharon, and corneal neovascularization. Which management strategy is most appropriate?

  1. Topical antibiotic prophylaxis alone
  2. Elective photorefractive keratectomy
  3. Aggressive ocular surface lubrication with early amniotic membrane and systemic immunosuppression Correct answer.
  4. Topical proparacaine for comfort

Explanation

Severe ocular surface disease after SJS requires aggressive lubrication, amniotic membrane grafting to promote healing, and systemic immunomodulation to limit inflammation and scarring. Topical anesthetics are contraindicated.

Question 20Cornea and External Disease

Which of the following is the most common cause of infectious keratitis in the developing world and a leading cause of preventable corneal blindness?

  1. Acanthamoeba keratitis
  2. Fungal keratitis after agricultural trauma
  3. Trachoma-associated corneal disease Correct answer.
  4. Herpes simplex keratitis

Explanation

Trachoma, caused by Chlamydia trachomatis, produces chronic conjunctival inflammation, entropion, trichiasis, and corneal scarring, making it a leading infectious cause of blindness worldwide.

Question 21Glaucoma

Which structure is the principal route of aqueous humor outflow in the normal human eye?

  1. Trabecular meshwork into Schlemm canal Correct answer.
  2. Ciliary body into the suprachoroidal space
  3. Optic nerve sheath into the subarachnoid space
  4. Iris root into the anterior chamber angle recess

Explanation

Aqueous humor exits mainly through the trabecular meshwork into Schlemm canal and then into episcleral veins, accounting for the majority of outflow. The uveoscleral route is a minor alternative pathway.

Question 22Glaucoma

A 62-year-old has intraocular pressure of 26 mmHg in both eyes, open angles on gonioscopy, and a normal-appearing optic disc with no visual field defect. Which diagnosis best fits?

  1. Ocular hypertension Correct answer.
  2. Primary open-angle glaucoma
  3. Normal-tension glaucoma
  4. Acute angle-closure glaucoma

Explanation

Ocular hypertension requires elevated intraocular pressure with open angles and no detectable glaucomatous optic neuropathy or field loss. Glaucoma is defined by structural or functional damage, not pressure alone.

Question 23Glaucoma

Which finding on gonioscopy is characteristic of a normal open anterior chamber angle?

  1. Peripheral anterior synechiae bridging the angle recess
  2. Anterior insertion of the iris root onto the trabecular meshwork
  3. Complete apposition of the peripheral iris to the cornea
  4. Visibility of the scleral spur and pigmented trabecular band Correct answer.

Explanation

In an open angle the scleral spur and the pigmented trabecular meshwork are visible because the iris root lies posterior to the meshwork. Iris insertion onto the meshwork or synechiae indicate narrowing or closure.

Question 24Glaucoma

Which optic disc feature is most suggestive of glaucomatous damage?

  1. Diffuse pallor with preserved neuroretinal rim
  2. Increased cup size with stable rim thickness over years
  3. Focal thinning of the neuroretinal rim at the inferior pole Correct answer.
  4. Peripapillary atrophy without rim change

Explanation

Glaucomatous cupping preferentially thins the neuroretinal rim, often first inferiorly and superiorly, producing focal notching. Pallor disproportionate to cupping suggests a nonglaucomatous optic neuropathy.

Question 25Glaucoma

Which class of topical medication lowers intraocular pressure primarily by increasing uveoscleral outflow?

  1. Carbonic anhydrase inhibitors
  2. Beta-adrenergic antagonists
  3. Alpha-2 adrenergic agonists
  4. Prostaglandin analogs Correct answer.

Explanation

Prostaglandin analogs such as latanoprost increase uveoscleral outflow and are first-line for open-angle glaucoma. Beta-blockers and carbonic anhydrase inhibitors reduce aqueous production.

Question 26Glaucoma

Which risk factor is most strongly associated with primary open-angle glaucoma?

  1. Elevated intraocular pressure Correct answer.
  2. Hyperopia with a shallow anterior chamber
  3. Asian ancestry
  4. Young age

Explanation

Elevated intraocular pressure is the most important modifiable risk factor for primary open-angle glaucoma. Age, African ancestry, family history, and thin central corneas also contribute.

Question 27Glaucoma

A patient on topical timolol reports wheezing and increased shortness of breath. What is the most likely explanation?

  1. Alpha-1 stimulation causing mydriasis
  2. Beta-2 blockade causing bronchoconstriction Correct answer.
  3. Prostaglandin-induced iris pigmentation
  4. Carbonic anhydrase inhibition causing acidosis

Explanation

Timolol is a nonselective beta-blocker, and beta-2 blockade in the airways can precipitate bronchospasm, particularly in patients with asthma or COPD. It is relatively contraindicated in reactive airway disease.

Question 28Glaucoma

A 70-year-old presents with severe eye pain, headache, nausea, blurred vision, and a hazy cornea. Intraocular pressure is 58 mmHg and the anterior chamber is shallow. What is the most appropriate immediate management?

  1. Oral antibiotics and warm compresses
  2. Topical steroid alone with observation
  3. Intravenous acetazolamide plus topical pressure-lowering agents and urgent ophthalmology referral Correct answer.
  4. Topical prostaglandin alone and outpatient review

Explanation

This is acute angle-closure glaucoma, an ocular emergency requiring rapid lowering of pressure with systemic carbonic anhydrase inhibitors, topical agents, and often hyperosmotic therapy before definitive laser iridotomy. Prompt referral is essential to prevent permanent vision loss.

Question 29Glaucoma

Which corneal measurement is important when interpreting applanation tonometry because it affects the reading?

  1. Central corneal thickness Correct answer.
  2. Corneal diameter
  3. Anterior chamber depth
  4. Tear film osmolarity

Explanation

Central corneal thickness influences applanation tonometry: thick corneas tend to overestimate and thin corneas underestimate true intraocular pressure. Thin central corneas are also an independent risk factor for glaucoma progression.

Question 30Glaucoma

Which visual field defect pattern is typical of early glaucomatous damage?

  1. Homonymous hemianopia
  2. Arcuate scotoma Correct answer.
  3. Central scotoma
  4. Bitemporal hemianopia

Explanation

Glaucomatous field loss follows retinal nerve fiber bundle damage and typically begins as paracentral defects that enlarge into arcuate scotomas respecting the horizontal meridian. Central and chiasmal or retrochiasmal patterns suggest other pathology.

Question 31Glaucoma

Laser trabeculoplasty lowers intraocular pressure by which mechanism?

  1. Increasing trabecular outflow facility Correct answer.
  2. Reducing aqueous production by the ciliary body
  3. Creating a full-thickness scleral fistula
  4. Ablating the ciliary processes

Explanation

Selective or argon laser trabeculoplasty improves aqueous outflow through the trabecular meshwork, likely by remodeling the meshwork and stimulating cellular responses. It is used as adjunctive or primary therapy in open-angle glaucoma.

Question 32Glaucoma

Which agent is a topical carbonic anhydrase inhibitor used to lower intraocular pressure?

  1. Dorzolamide Correct answer.
  2. Brimonidine
  3. Pilocarpine
  4. Latanoprost

Explanation

Dorzolamide and brinzolamide are topical carbonic anhydrase inhibitors that reduce aqueous humor secretion. Brimonidine is an alpha-2 agonist, latanoprost a prostaglandin analog, and pilocarpine a cholinergic agonist.

Question 33Glaucoma

A patient with narrow angles is scheduled for cataract surgery. Which consideration is most relevant to glaucoma management?

  1. Lens removal has no effect on intraocular pressure
  2. Cataract extraction may deepen the anterior chamber and relieve angle crowding Correct answer.
  3. Cataract surgery is contraindicated in narrow angles
  4. Phacoemulsification reliably worsens angle closure

Explanation

Removing the crystalline lens with phacoemulsification deepens the anterior chamber and can open a crowded angle, lowering intraocular pressure in angle-closure disease. It is often combined with goniosynechialysis or performed before laser iridotomy in selected cases.

Question 34Glaucoma

Which finding on optical coherence tomography suggests progressive glaucomatous damage?

  1. Stable rim area across serial scans
  2. Progressive thinning of the peripapillary retinal nerve fiber layer Correct answer.
  3. Increased macular ganglion cell layer thickness
  4. Thickening of the retinal nerve fiber layer over time

Explanation

Glaucoma causes loss of retinal ganglion cells and their axons, producing progressive thinning of the peripapillary nerve fiber layer and macular ganglion cell complex on OCT. Serial change analysis is key for detecting progression.

Question 35Glaucoma

Which medication should be avoided in a patient with a history of angle closure because it may precipitate an attack?

  1. Preservative-free artificial tears
  2. Topical latanoprost
  3. Topical dorzolamide
  4. Oral topiramate Correct answer.

Explanation

Topiramate can cause idiosyncratic ciliary body swelling and anterior displacement of the lens-iris diaphragm, precipitating secondary angle closure. Other drugs such as sulfonamides and anticholinergics can also trigger closure in susceptible eyes.

Question 36Glaucoma

Which form of glaucoma is characterized by elevated intraocular pressure with a normal-appearing open angle but occurs secondary to another ocular or systemic condition?

  1. Primary open-angle glaucoma
  2. Secondary open-angle glaucoma Correct answer.
  3. Congenital glaucoma
  4. Primary angle-closure glaucoma

Explanation

Secondary open-angle glaucoma arises from identifiable causes such as pigment dispersion, pseudoexfoliation, steroid use, or trauma that obstruct the trabecular outflow pathway. Primary open-angle glaucoma has no identifiable secondary cause.

Question 37Glaucoma

A patient using topical prostaglandin analog reports increased iris pigmentation and longer eyelashes. What is the best explanation for these findings?

  1. Allergic contact dermatitis to the preservative
  2. Ciliary muscle spasm causing miosis
  3. Corneal endothelial toxicity
  4. Melanogenesis stimulation in iris melanocytes and hair follicle effects Correct answer.

Explanation

Prostaglandin analogs stimulate melanin production in iris stromal melanocytes and prolong the anagen phase of eyelash follicles, causing iris darkening and lash lengthening. These effects are typically cosmetic and often irreversible.

Question 38Glaucoma

Which tonometric method is most affected by corneal biomechanics and may overestimate pressure in thick corneas?

  1. Goldmann applanation tonometry Correct answer.
  2. Pneumotonometry
  3. Rebound tonometry
  4. Dynamic contour tonometry

Explanation

Goldmann applanation tonometry assumes a fixed corneal thickness and rigidity, so thick or steep corneas tend to yield higher readings. Dynamic contour tonometry was designed to be less dependent on corneal properties.

Question 39Glaucoma

A 55-year-old with pseudoexfoliation syndrome presents with asymmetric intraocular pressure and a heavily pigmented trabecular meshwork. Which mechanism best explains the glaucoma?

  1. Steroid-induced remodeling of the meshwork
  2. Neovascularization of the iris
  3. Closure of the angle by a swollen lens
  4. Trabecular obstruction by exfoliative material and pigment Correct answer.

Explanation

Pseudoexfoliation deposits and released pigment obstruct the trabecular meshwork, raising outflow resistance and causing secondary open-angle glaucoma. It is often asymmetric and associated with rapid progression.

Question 40Glaucoma

A patient with advanced glaucoma has intraocular pressure of 14 mmHg on three medications but continues to show progressive visual field loss. Which approach is most appropriate?

  1. Discontinue one medication to reduce side effects
  2. Reassure because pressure is within the normal range
  3. Consider surgical intervention such as trabeculectomy or a drainage device Correct answer.
  4. Repeat visual field testing in one year without change

Explanation

Progression despite apparently normal pressure indicates that the target pressure is not low enough for this optic nerve, and surgical lowering of pressure should be considered. Functional goals in advanced disease often require pressures well below the population mean.

Question 41Retina and Vitreous

Which retinal layer contains the photoreceptor cell bodies?

  1. Outer nuclear layer Correct answer.
  2. Ganglion cell layer
  3. Inner nuclear layer
  4. Nerve fiber layer

Explanation

Photoreceptor nuclei reside in the outer nuclear layer, which lies between the external limiting membrane and the outer plexiform layer. The inner nuclear layer holds bipolar, horizontal, and amacrine cells.

Question 42Retina and Vitreous

Blood supply to the inner retinal layers is derived primarily from which vascular system?

  1. Long posterior ciliary arteries
  2. Choroidal capillaries
  3. Anterior ciliary arteries
  4. Central retinal artery branches Correct answer.

Explanation

The central retinal artery supplies the inner retina, while the outer retina depends on the choroid. This dual arrangement explains the different patterns of ischemic damage.

Question 43Retina and Vitreous

Which structure forms the boundary between the neurosensory retina and the vitreous?

  1. Bruch membrane
  2. Internal limiting membrane Correct answer.
  3. External limiting membrane
  4. Retinal pigment epithelium

Explanation

The internal limiting membrane is the innermost retinal boundary, formed by Müller cell endfeet and basement membrane. It is the surgical plane targeted in macular hole surgery.

Question 44Retina and Vitreous

What is the normal vitreous attachment site at the posterior pole in a healthy adult eye?

  1. Fovea and optic disc center
  2. Along all retinal veins
  3. Optic disc margin and vitreous base Correct answer.
  4. Macular center only

Explanation

The vitreous is firmly attached at the vitreous base and at the optic disc margin (Weiss ring on separation). The macula has only loose attachment, which is why posterior vitreous detachment can cause traction there.

Question 45Retina and Vitreous

Which type of retinal detachment is caused by a full-thickness break in the neurosensory retina?

  1. Rhegmatogenous Correct answer.
  2. Exudative
  3. Serous
  4. Tractional

Explanation

Rhegmatogenous detachment results from a retinal break allowing fluid into the subretinal space. Exudative and tractional detachments occur without a break.

Question 46Retina and Vitreous

Which finding on fundoscopy is characteristic of a retinal tear with an associated operculum?

  1. A free-floating flap of retinal tissue near a break Correct answer.
  2. Bilateral optic disc swelling
  3. Subretinal lipid exudation in a circinate pattern
  4. Diffuse retinal whitening with a cherry-red spot

Explanation

An operculated tear occurs when a retinal flap is completely avulsed and floats in the vitreous near the break. It is a common finding after an acute posterior vitreous detachment.

Question 47Retina and Vitreous

Which layer of the retina is primarily affected in central retinal artery occlusion?

  1. Outer nuclear layer
  2. Inner retinal layers Correct answer.
  3. Retinal pigment epithelium
  4. Choroid

Explanation

The central retinal artery supplies the inner retina, so occlusion causes ischemic whitening of the inner layers. The outer retina is spared because it is supplied by the choroid.

Question 48Retina and Vitreous

A patient with sudden painless visual loss has a cherry-red spot at the fovea and diffuse retinal pallor. Which diagnosis is most likely?

  1. Retinal detachment
  2. Central retinal artery occlusion Correct answer.
  3. Central retinal vein occlusion
  4. Vitreous hemorrhage

Explanation

Retinal pallor from inner retinal ischemia contrasts with the choroidally supplied fovea, producing the cherry-red spot. The presentation is sudden and painless.

Question 49Retina and Vitreous

Which feature distinguishes central retinal vein occlusion from central retinal artery occlusion on examination?

  1. Retinal pallor
  2. Cherry-red spot
  3. Boxcarring of vessels
  4. Widespread flame-shaped hemorrhages Correct answer.

Explanation

Venous occlusion produces engorged veins with diffuse flame hemorrhages in all quadrants, while arterial occlusion produces pallor and a cherry-red spot.

Question 50Retina and Vitreous

What is the recommended treatment window for intravitreal anti-VEGF therapy in a patient with neovascular age-related macular degeneration presenting with new metamorphopsia?

  1. As soon as possible after diagnosis Correct answer.
  2. Only if vision drops below 20/200
  3. Only after laser photocoagulation fails
  4. Only after 6 months of observation

Explanation

Anti-VEGF therapy should be initiated promptly in active neovascular AMD to limit irreversible photoreceptor loss. Delay is associated with worse visual outcomes.