Ocular Disease and Clinical Optometry
What this domain tests
Clinical optometry questions present signs, symptoms and test results and ask for the most likely diagnosis, urgency and referral pathway. Red-flag recognition carries heavy marks.
Core patterns
- Sudden painless loss: retinal artery occlusion, retinal detachment, vitreous haemorrhage, CRVO.
- Painful red eye: acute angle closure, uveitis, microbial keratitis, endophthalmitis.
- Gradual loss: cataract, glaucoma, AMD, diabetic maculopathy.
- Diabetic retinopathy: mild NPDR = microaneurysms only; severe NPDR uses the 4-2-1 rule; PDR = neovascularisation, refer urgently.
- Glaucoma: optic disc cupping, RNFL loss and field defect; angle closure needs immediate IOP lowering and referral.
Worked example
A 72-year-old with hypertension reports sudden painless loss of vision in one eye; fundoscopy shows a pale retina with a cherry-red spot and boxcarring. Reasoning: central retinal artery occlusion. Ask about jaw claudication, scalp tenderness and polymyalgia rheumatica; if giant cell arteritis is possible, urgent ESR/CRP and same-day referral are required. Ocular massage and IOP reduction may be attempted only within the local emergency protocol.
Traps
Missing giant cell arteritis in an older patient with visual loss; not checking for a relative afferent pupillary defect; labelling floaters as benign vitreous without fundus examination; failing to refer suspected endophthalmitis the same day.