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Question 1Ocular Anatomy, Physiology, and Pathology

Which sequence lists the layers of the cornea in correct order from anterior to posterior?

  1. Epithelium, stroma, Bowman layer, Descemet membrane, endothelium
  2. Epithelium, Bowman layer, stroma, Descemet membrane, endothelium Correct answer.
  3. Epithelium, Descemet membrane, stroma, Bowman layer, endothelium
  4. Bowman layer, epithelium, stroma, endothelium, Descemet membrane

Explanation

The cornea has five layers arranged anterior to posterior: epithelium, Bowman layer, stroma, Descemet membrane, and endothelium. The epithelium and endothelium are cellular barriers, while the stroma makes up most of the corneal thickness and provides tensile strength.

Question 2Ocular Anatomy, Physiology, and Pathology

Which tissue secretes aqueous humor into the posterior chamber?

  1. Corneal endothelium
  2. Lens epithelium
  3. Trabecular meshwork
  4. Ciliary epithelium Correct answer.

Explanation

Aqueous humor is actively secreted by the nonpigmented epithelium covering the ciliary processes into the posterior chamber. From there it passes through the pupil into the anterior chamber and leaves via the conventional outflow pathway.

Question 3Ocular Anatomy, Physiology, and Pathology

Which photoreceptors mediate vision in dim illumination but do not support color discrimination?

  1. Ganglion cells
  2. Rods Correct answer.
  3. Bipolar cells
  4. Cones

Explanation

Rods contain rhodopsin, are extremely sensitive to low light levels, and lack the cone photopigments needed for color vision. Cones require brighter illumination but provide high acuity and color discrimination.

Question 4Ocular Anatomy, Physiology, and Pathology

The physiologic blind spot of the visual field corresponds to which structure?

  1. Ora serrata
  2. Fovea centralis
  3. Macula lutea
  4. Optic disc Correct answer.

Explanation

The optic disc is the point where ganglion cell axons exit the eye and retinal vessels enter. Because it contains no photoreceptors, light falling on it is not perceived, creating a physiologic scotoma.

Question 5Ocular Anatomy, Physiology, and Pathology

The main lacrimal gland is located in which region of the orbit?

  1. Inferotemporal orbit
  2. Superonasal orbit
  3. Superotemporal orbit Correct answer.
  4. Inferonasal orbit

Explanation

The main lacrimal gland lies in the lacrimal fossa of the frontal bone in the superotemporal orbit. Its ducts open into the superior conjunctival fornix to deliver the aqueous component of the tear film.

Question 6Ocular Anatomy, Physiology, and Pathology

Which extraocular muscle intorts the globe and is innervated by the trochlear nerve?

  1. Inferior rectus
  2. Superior oblique Correct answer.
  3. Superior rectus
  4. Inferior oblique

Explanation

The superior oblique is the only muscle supplied by the trochlear nerve and acts primarily as an intorter, adding depression and abduction depending on the position of the eye.

Question 7Ocular Anatomy, Physiology, and Pathology

Which conjunctival cells secrete the mucin that makes the corneal surface wettable?

  1. Goblet cells Correct answer.
  2. Glands of Zeis
  3. Glands of Krause
  4. Meibomian glands

Explanation

Goblet cells of the conjunctival epithelium secrete mucins, chiefly MUC5AC, which coat the hydrophobic corneal epithelium and allow the aqueous tear layer to spread evenly. Loss of goblet cells produces mucus deficiency and tear film instability.

Question 8Ocular Anatomy, Physiology, and Pathology

The dilator pupillae muscle receives its innervation from which source?

  1. Sympathetic fibers from the superior cervical ganglion Correct answer.
  2. Somatomotor fibers of the oculomotor nerve
  3. Sensory fibers of the trigeminal nerve
  4. Parasympathetic fibers from the ciliary ganglion

Explanation

The dilator pupillae is a radially oriented smooth muscle derived from the anterior iris pigment epithelium. It is supplied by sympathetic fibers that travel from the superior cervical ganglion through the long ciliary nerves.

Question 9Ocular Anatomy, Physiology, and Pathology

What keeps the corneal stroma relatively dehydrated and the cornea transparent?

  1. Surface evaporation
  2. Stromal imbibition pressure
  3. Epithelial tight junctions
  4. Endothelial fluid pump Correct answer.

Explanation

The corneal endothelium actively transports bicarbonate and fluid from the stroma into the anterior chamber. This pump offsets the tendency of the glycosaminoglycan-rich stroma to swell and is essential for corneal clarity.

Question 10Ocular Anatomy, Physiology, and Pathology

Aqueous humor passes through the trabecular meshwork into which structure before reaching the episcleral veins?

  1. Canal of Schlemm Correct answer.
  2. Canal of Cloquet
  3. Nasolacrimal canal
  4. Central retinal vein

Explanation

After crossing the trabecular meshwork, aqueous enters Schlemm canal, a circumferential endothelial-lined channel. From there it exits through collector channels into the aqueous and episcleral veins.

Question 11Ocular Anatomy, Physiology, and Pathology

Which sequence describes the events of accommodation for near vision?

  1. Ciliary muscle relaxes and zonules tighten
  2. Ciliary muscle contracts and zonules tighten
  3. Ciliary muscle contracts and zonules relax Correct answer.
  4. Ciliary muscle relaxes and zonules relax

Explanation

During near accommodation the ciliary muscle contracts, the ciliary ring narrows, and tension on the zonules decreases. The lens then assumes a more convex shape with increased refractive power.

Question 12Ocular Anatomy, Physiology, and Pathology

The optic nerve is formed by the axons of which retinal cells?

  1. Photoreceptors
  2. Bipolar cells
  3. Horizontal cells
  4. Ganglion cells Correct answer.

Explanation

Retinal ganglion cells are the output neurons of the retina, and their unmyelinated axons converge at the optic disc to form the optic nerve. They acquire myelin after passing through the lamina cribrosa.

Question 13Ocular Anatomy, Physiology, and Pathology

Which nerve supplies the superior rectus muscle?

  1. Trochlear division of CN IV
  2. Abducens division of CN VI
  3. Oculomotor division of CN III Correct answer.
  4. Ophthalmic division of CN V

Explanation

The superior rectus is innervated by the superior division of the oculomotor nerve. The same division also supplies the levator palpebrae superioris and the medial rectus.

Question 14Ocular Anatomy, Physiology, and Pathology

The vitreous is most firmly attached to the retina at which location?

  1. The fovea
  2. The ora serrata Correct answer.
  3. The optic disc
  4. The posterior pole

Explanation

The vitreous base straddles the ora serrata, where vitreous collagen fibrils are densely interwoven with the internal limiting membrane and pars plana epithelium. This makes it the strongest vitreoretinal adhesion and the site where retinal tears commonly occur.

Question 15Ocular Anatomy, Physiology, and Pathology

Tight junctions between which cells form the outer blood-retinal barrier?

  1. Muller cells
  2. Retinal capillary endothelial cells
  3. Retinal pigment epithelial cells Correct answer.
  4. Photoreceptor inner segments

Explanation

The retinal pigment epithelium forms the outer blood-retinal barrier through zonulae occludentes between adjacent cells. These junctions regulate movement of fluid and solutes between the choroid and the subretinal space.

Question 16Ocular Anatomy, Physiology, and Pathology

The lipid layer of the tear film is produced by which structures?

  1. Meibomian glands Correct answer.
  2. Glands of Krause
  3. Lacrimal gland
  4. Goblet cells

Explanation

Meibomian glands are holocrine sebaceous glands embedded in the tarsal plates. Their lipid secretion forms the superficial tear film layer and slows evaporation of the underlying aqueous layer.

Question 17Ocular Anatomy, Physiology, and Pathology

Corneal sensation is carried by which nerve?

  1. Oculomotor nerve CN III
  2. Ophthalmic division of CN V Correct answer.
  3. Facial nerve CN VII
  4. Maxillary division of CN V

Explanation

Corneal sensation is mediated by the ophthalmic division of the trigeminal nerve through the long ciliary nerves. These fibers form a dense subepithelial plexus, making the cornea one of the most sensitive tissues in the body.

Question 18Ocular Anatomy, Physiology, and Pathology

A sustained rise in episcleral venous pressure would have which effect on intraocular pressure?

  1. A decrease in intraocular pressure
  2. No change in intraocular pressure
  3. A decrease in aqueous production
  4. An increase in intraocular pressure Correct answer.

Explanation

Aqueous outflow depends on the pressure difference between the anterior chamber and the episcleral veins. When venous pressure rises, that gradient narrows, outflow falls, and intraocular pressure increases.

Question 19Ocular Anatomy, Physiology, and Pathology

The cell bodies of the photoreceptors are located in which retinal layer?

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

Explanation

Photoreceptor nuclei occupy the outer nuclear layer, while their inner and outer segments extend into the subretinal space toward the retinal pigment epithelium. The layer's thickness varies with rod and cone density across the retina.

Question 20Ocular Anatomy, Physiology, and Pathology

Which retinal cell type provides structural and metabolic support by spanning the full thickness of the retina?

  1. Photoreceptors
  2. Retinal pigment epithelium
  3. Muller cells Correct answer.
  4. Ciliary epithelium

Explanation

Muller cells are the principal glia of the retina and extend from the inner to the outer limiting membrane. They ensheath neurons, regulate the extracellular ionic environment, and recycle visual pigment intermediates.

Question 21Ocular Anatomy, Physiology, and Pathology

Before projecting to the Edinger-Westphal nucleus, the afferent limb of the pupillary light reflex relays through which structure?

  1. Superior colliculus
  2. Ciliary ganglion
  3. Lateral geniculate nucleus
  4. Pretectal nucleus Correct answer.

Explanation

Light-driven ganglion cell axons synapse in the pretectal nucleus, which projects bilaterally to both Edinger-Westphal nuclei. This bilateral projection explains the consensual pupillary response.

Question 22Ocular Anatomy, Physiology, and Pathology

Compression of the optic chiasm typically produces which visual field defect?

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

Explanation

Axons from the nasal half of each retina cross in the chiasm and carry the temporal field. A chiasmal lesion interrupts these crossing fibers, producing a bitemporal hemianopia, classically from a pituitary mass expanding upward from below.

Question 23Ocular Anatomy, Physiology, and Pathology

After a penetrating stromal injury, which cells transform into myofibroblasts and generate the corneal scar?

  1. Endothelial cells
  2. Keratocytes Correct answer.
  3. Basal epithelial cells
  4. Langerhans cells

Explanation

Stromal injury triggers apoptosis of keratocytes near the wound, and surviving keratocytes proliferate and differentiate into fibroblasts and myofibroblasts. These cells deposit disorganized collagen that forms the clinically visible scar.

Question 24Ocular Anatomy, Physiology, and Pathology

A cherry-red fovea is seen after central retinal artery occlusion. Which vessels normally supply the outer retina at the fovea and account for this appearance?

  1. Vortex veins
  2. Anterior ciliary arteries
  3. Pial vessels
  4. Choroidal capillaries Correct answer.

Explanation

The central retinal artery supplies the inner retina, while the outer retina, including the fovea, is sustained by the choriocapillaris. Because the fovea lacks inner retinal layers, the intact choroidal circulation shows through as a cherry-red spot against the surrounding pale retina.

Question 25Ocular Anatomy, Physiology, and Pathology

Which substance is present in aqueous humor at a concentration many times higher than in plasma?

  1. Albumin
  2. Glucose
  3. Ascorbate Correct answer.
  4. Total protein

Explanation

The ciliary epithelium actively secretes ascorbate, producing aqueous concentrations far above plasma levels and contributing to the eye's antioxidant defense. Most other solutes are either similar to or lower than their plasma concentrations.

Question 26Ocular Anatomy, Physiology, and Pathology

Aqueous humor is secreted into the posterior chamber by cells of which structure?

  1. Iris pigment epithelium
  2. Trabecular meshwork
  3. Corneal endothelium
  4. Ciliary epithelium Correct answer.

Explanation

Aqueous humor is actively secreted by the double-layered epithelium covering the ciliary processes of the pars plicata. Secretion depends on carbonic anhydrase and Na+/K+-ATPase activity in these cells, which is why carbonic anhydrase inhibitors reduce aqueous formation.

Question 27Ocular Anatomy, Physiology, and Pathology

The physiologic blind spot in the visual field corresponds to which ocular structure?

  1. Optic disc Correct answer.
  2. Ora serrata
  3. Fovea centralis
  4. Macula lutea

Explanation

The optic nerve head contains axons passing into the nerve but no photoreceptors, so light falling on it is not perceived, creating an absolute scotoma. The blind spot lies roughly 15 degrees temporal to fixation and is not noticed because of binocular overlap and cortical filling-in.

Question 28Ocular Anatomy, Physiology, and Pathology

Contraction of which muscle is chiefly responsible for raising the upper eyelid?

  1. Superior oblique muscle
  2. Frontalis muscle
  3. Orbicularis oculi muscle
  4. Levator palpebrae Correct answer.

Explanation

The levator palpebrae superioris, innervated by the superior division of the oculomotor nerve, is the principal elevator of the lid. The sympathetically innervated superior tarsal muscle provides only a small additional lift of about 2 mm.

Question 29Ocular Anatomy, Physiology, and Pathology

Which ocular structure contributes the largest share of the eye's total refractive power?

  1. Crystalline lens
  2. Cornea Correct answer.
  3. Vitreous body
  4. Aqueous humor

Explanation

The air-to-tear film-to-cornea interface accounts for roughly two thirds of the eye's refractive power, about 43 diopters of a total near 60 diopters. The crystalline lens supplies the remainder and provides the variable power used in accommodation.

Question 30Ocular Anatomy, Physiology, and Pathology

In a rod photoreceptor, absorption of light ultimately lowers intracellular cGMP because of which step in the phototransduction cascade?

  1. Transducin directly hydrolyzes cGMP to GMP
  2. Arrestin opens cation channels in the outer segment
  3. Guanylate cyclase is inhibited by rhodopsin kinase
  4. Activated phosphodiesterase converts cGMP to GMP Correct answer.

Explanation

Photoactivated rhodopsin activates the G protein transducin, which in turn activates phosphodiesterase-6 to hydrolyze cGMP. The falling cGMP level closes cGMP-gated cation channels, hyperpolarizing the cell and reducing glutamate release.

Question 31Ocular Anatomy, Physiology, and Pathology

In thyroid eye disease, which extraocular muscle is most commonly enlarged and restricted first?

  1. Inferior rectus Correct answer.
  2. Superior oblique
  3. Medial rectus
  4. Lateral rectus

Explanation

The inferior rectus is involved most often, followed in frequency by the medial rectus, superior rectus, and lateral rectus. This pattern explains why patients frequently present with a hypotropia and limitation of elevation rather than an abduction deficit.

Question 32Ocular Anatomy, Physiology, and Pathology

A patient has severe ocular pain, blurred vision with colored halos, a mid-dilated nonreactive pupil, corneal haze, and a uniformly shallow anterior chamber. Which mechanism produces the elevated intraocular pressure?

  1. Iris apposition closing the trabecular meshwork Correct answer.
  2. Increased episcleral venous pressure from orbital congestion
  3. Obstruction of the pupil by a nuclear sclerotic lens
  4. Hypersecretion of aqueous humor by the ciliary epithelium

Explanation

Pupillary block drives the peripheral iris forward, closing the angle and blocking trabecular outflow. The mid-dilated pupil is characteristic, and the presenting picture is acute angle-closure glaucoma needing urgent pressure lowering.

Question 33Ocular Anatomy, Physiology, and Pathology

Which sequence correctly traces the path of tears from the ocular surface to the nasal cavity?

  1. Punctum, canaliculus, lacrimal sac, nasolacrimal duct Correct answer.
  2. Lacrimal sac, punctum, canaliculus, nasolacrimal duct
  3. Canaliculus, punctum, nasolacrimal duct, lacrimal sac
  4. Punctum, lacrimal sac, canaliculus, nasolacrimal duct

Explanation

Tears enter the superior and inferior puncta, pass into the canaliculi, drain into the lacrimal sac, and then travel down the nasolacrimal duct to open beneath the inferior turbinate. Obstruction anywhere along this route produces epiphora.

Question 34Ocular Anatomy, Physiology, and Pathology

Which statement describes the distinctive anatomy of the foveola?

  1. It contains a high density of rods and relatively few cones
  2. It contains only cones and lacks inner retinal layers Correct answer.
  3. It is nourished by branches of the central retinal artery
  4. It contains the highest concentration of ganglion cells

Explanation

At the foveola the inner retinal layers are displaced laterally, leaving cones lying close to the retinal pigment epithelium for maximum light capture. The foveal avascular zone lacks retinal capillaries, and the region is supplied by the underlying choriocapillaris.

Question 35Ocular Anatomy, Physiology, and Pathology

The ophthalmic artery, which supplies most orbital and ocular structures, arises as a branch of which vessel?

  1. Internal carotid artery Correct answer.
  2. Maxillary artery
  3. Middle cerebral artery
  4. External carotid artery

Explanation

The ophthalmic artery arises from the internal carotid artery just after it leaves the cavernous sinus. Its branches include the central retinal artery, the posterior ciliary arteries, and the muscular arteries to the extraocular muscles.

Question 36Ocular Anatomy, Physiology, and Pathology

Which finding marks the transition from nonproliferative to proliferative diabetic retinopathy?

  1. Microaneurysms and dot hemorrhages
  2. Neovascularization of the disc or elsewhere Correct answer.
  3. Cotton-wool spots along the arcades
  4. Hard exudates within the macula

Explanation

Proliferative disease is defined by the growth of new vessels on the disc or elsewhere, driven by VEGF released from ischemic retina. These fragile vessels can bleed into the vitreous or cause tractional detachment.

Question 37Ocular Anatomy, Physiology, and Pathology

Renewal of the corneal epithelium is normally maintained by stem cells located in which region?

  1. Limbal epithelium Correct answer.
  2. Conjunctival goblet cells
  3. Central corneal epithelium
  4. Corneal endothelium

Explanation

Stem cells reside in the palisades of Vogt at the limbus and give rise to transient amplifying cells that migrate centripetally and anteriorly to replace shed epithelial cells. Limbal deficiency leads to conjunctivalization of the corneal surface.

Question 38Ocular Anatomy, Physiology, and Pathology

A lesion confined to the left temporal lobe involving Meyer's loop would most likely produce which visual field defect?

  1. Right inferior homonymous quadrantanopia
  2. Left superior homonymous quadrantanopia
  3. Bitemporal hemianopia
  4. Right superior homonymous quadrantanopia Correct answer.

Explanation

Meyer's loop sweeps through the temporal lobe carrying fibers from the inferior contralateral retina, which subserve the superior visual field. A left-sided lesion therefore produces a right superior quadrantanopia; parietal lesions instead give an inferior quadrantanopia.

Question 39Ocular Anatomy, Physiology, and Pathology

A 74-year-old reports sudden painless loss of vision with a swollen, pale optic disc and also describes jaw pain while chewing. Which vessels are most likely ischemic?

  1. Central retinal artery
  2. Anterior ciliary arteries
  3. Muscular branches of the ophthalmic artery
  4. Short posterior ciliary arteries Correct answer.

Explanation

The presentation suggests arteritic anterior ischemic optic neuropathy from giant cell arteritis, in which inflammation occludes the short posterior ciliary arteries supplying the optic nerve head. The disc swelling and systemic symptoms distinguish it from nonarteritic disease, and treatment with high-dose corticosteroid is urgent.

Question 40Ocular Anatomy, Physiology, and Pathology

A patient with a posterior communicating artery aneurysm develops ptosis, a dilated pupil, and a globe that is deviated down and out. Why is the pupil involved?

  1. The ciliary ganglion is destroyed, removing dilator tone
  2. Superficial parasympathetic pupillomotor fibers are compressed first Correct answer.
  3. Loss of accommodation unmasks a light-near dissociation
  4. Sympathetic fibers travelling within the oculomotor nerve are interrupted

Explanation

The parasympathetic pupillomotor fibers run on the superficial dorsomedial surface of the oculomotor nerve, where a compressing aneurysm or mass affects them early. Ischemic microvascular third nerve palsy typically spares the pupil because the deep fibers are supplied by the nerve's own vasa nervorum.

Question 41Optics, Refractometry, and Contact Lenses

A converging lens is labeled +5.00 D. What is its secondary focal length?

  1. 200 cm
  2. 50 cm
  3. 5 cm
  4. 20 cm Correct answer.

Explanation

Focal length in meters is the reciprocal of the power in diopters (f = 1/F). For a +5.00 D lens, 1/5.00 = 0.20 m, or 20 cm.

Question 42Optics, Refractometry, and Contact Lenses

A patient's right eye acuity is recorded as 20/60. This notation means the patient:

  1. needs a +6.00 D add to read at 20 feet
  2. identifies at 60 feet a letter size that a standard eye identifies at 20 feet
  3. sees at 60 feet what a standard eye sees at 20 feet
  4. sees at 20 feet what a standard eye sees at 60 feet Correct answer.

Explanation

Snellen notation is testing distance over the distance at which a standard observer could identify that letter size. A 20/60 letter subtends 5 minutes of arc at 60 feet, so the patient needs to be twice as close as normal.

Question 43Optics, Refractometry, and Contact Lenses

A keratometer is designed to measure the curvature of which structure?

  1. The anterior lens capsule
  2. The posterior corneal surface
  3. The foveal pit
  4. The anterior corneal surface Correct answer.

Explanation

The keratometer analyzes the size of the reflected mire image from the precorneal tear film, which is governed by the radius of curvature of the anterior cornea. From this radius it derives corneal power in diopters.

Question 44Optics, Refractometry, and Contact Lenses

A spectacle prescription reads -3.00 +1.50 x 090. What is the spherical equivalent?

  1. -1.50 D
  2. -2.25 D Correct answer.
  3. -4.50 D
  4. -3.75 D

Explanation

The spherical equivalent adds half of the cylinder power to the sphere. Here -3.00 + (1.50 / 2) = -2.25 D.

Question 45Optics, Refractometry, and Contact Lenses

One prism diopter is defined as a deviation of:

  1. 1 cm at a distance of 1 cm
  2. 1 cm at a distance of 1 m Correct answer.
  3. 1 degree of arc at 1 m
  4. 1 mm at a distance of 1 m

Explanation

A prism diopter is the tangent-based deviation that displaces an image 1 cm at 1 m. It is not an angular unit, although 1 prism diopter is roughly 0.57 degrees.

Question 46Optics, Refractometry, and Contact Lenses

Vertex distance is the distance between:

  1. the back of the spectacle lens and the corneal apex Correct answer.
  2. the spectacle plane and the center of rotation of the globe
  3. the center of the cornea and the center of the pupil
  4. the front lens surface and the eyelid margin

Explanation

Vertex distance is measured along the optical axis from the posterior surface of the spectacle lens to the apex of the cornea. It becomes clinically important for corrections beyond roughly plus or minus 4 diopters.

Question 47Optics, Refractometry, and Contact Lenses

Which value expresses how much oxygen passes through a contact lens of a stated thickness?

  1. Water content
  2. Dk/t Correct answer.
  3. Base curve
  4. Refractive index

Explanation

Dk is the oxygen permeability of the material and t is the lens thickness. Dividing permeability by thickness gives transmissibility, Dk/t, which predicts the oxygen reaching the cornea.

Question 48Optics, Refractometry, and Contact Lenses

Against-the-rule astigmatism is present when the:

  1. cornea is flat centrally and steep peripherally
  2. horizontal meridian is steeper Correct answer.
  3. two principal meridians are equal in power
  4. vertical meridian is steeper

Explanation

With-the-rule astigmatism has the vertical meridian steeper, while against-the-rule astigmatism has the horizontal meridian steeper, so a plus cylinder correction lies near 180 degrees.

Question 49Optics, Refractometry, and Contact Lenses

Retinoscopy at a working distance of 50 cm reaches neutrality with +3.00 D in the trial frame. What is the net refractive error?

  1. -1.00 D
  2. +2.00 D
  3. +1.00 D Correct answer.
  4. +5.00 D

Explanation

The working distance lens must be subtracted from the gross finding. A 50 cm distance corresponds to 1/0.50 = 2.00 D, so +3.00 - 2.00 = +1.00 D.

Question 50Optics, Refractometry, and Contact Lenses

Transpose +2.00 +1.00 x 045 into minus cylinder form.

  1. +3.00 -1.00 x 045
  2. +2.00 -1.00 x 135
  3. +1.00 +1.00 x 135
  4. +3.00 -1.00 x 135 Correct answer.

Explanation

Transposition adds the cylinder to the sphere, changes the cylinder sign while keeping its power, and rotates the axis by 90 degrees. Adding +1.00 to +2.00 gives +3.00, and 45 plus 90 equals 135.