MOC PQA Optometrist cheat sheet

Visual acuity is recorded with the smallest line read, plus the number of errors; pinhole improvement indicates uncorrected refractive error rather than pathology.

Amsler grid testing uses a 10 cm viewing distance with near correction; new metamorphopsia or scotoma warrants dilated fundus examination within days.

Intraocular pressure by Goldmann applanation is calibrated so 1 g of force on a 3.06 mm diameter area equals 1 mmHg; average central corneal thickness is about 540 micrometers.

Pupil testing sequence: size in light and dark, direct and consensual response, near response, and swinging flashlight for relative afferent pupillary defect.

Confrontation visual field testing compares the patient's field with the examiner's at roughly 1 meter; a temporal defect respecting the vertical midline suggests a chiasmal lesion.

Cover test interpretation: a refixation movement when the cover is removed indicates a phoria; movement while the cover is in place indicates a tropia.

Stereopsis thresholds: 40 arc seconds is normal on the Titmus fly/animals circle test; 400 arc seconds or worse suggests reduced binocularity.

Red eye danger signs requiring urgent referral include decreased acuity, ciliary flush, corneal opacity, fixed pupil, and severe pain with photophobia.

Retinoscopy working distance of 50 cm adds 2.00 D of with-motion; subtract 2.00 D from the gross finding to obtain the net refraction.

Schiascopy neutrality is judged by the reversal point; with-motion means add plus, against-motion means add minus, until reversal is achieved.

Keratometry converts to corneal power using the 1.3375 refractive index; average corneal power is about 43.00 D with 0.5 D of with-the-rule toricity.

Autorefraction is a starting point only; it tends to over-minus in young patients due to accommodative tone, so fogging before subjective refinement is standard.

Slit lamp illumination types: diffuse for general inspection, direct focal for corneal sections, sclerotic scatter for edema, and optic section for depth estimation.

OCT retinal nerve fiber layer thickness averages roughly 100 micrometers; a difference of 10 micrometers or more between eyes warrants glaucoma investigation.

Humphrey visual field 24-2 uses a 6-degree test grid; glaucoma hemifield test outside normal limits plus pattern deviation defect supports a diagnosis.

Gonioscopy with a four-mirror lens: the angle is graded by the deepest visible structure, from Schwalbe line to ciliary body band.

Age-related macular degeneration: dry form shows drusen and geographic atrophy; wet form shows choroidal neovascular membrane with subretinal fluid, hemorrhage, or pigment epithelial detachment.

Diabetic retinopathy grading: mild nonproliferative shows microaneurysms only; moderate adds dot hemorrhages and hard exudates; severe shows venous beading or intraretinal microvascular abnormalities in multiple quadrants.

Primary open-angle glaucoma is defined by characteristic optic disc cupping with corresponding field loss in an open angle; intraocular pressure may be normal in up to one third of cases.

Anterior uveitis presents with ciliary flush, cells and flare in the anterior chamber, and photophobia; HLA-B27 and sarcoidosis are common associations.

Retinal detachment: flashes and floaters plus a curtain-like field defect; a visible tear with subretinal fluid requires same-day referral.

Giant cell arteritis warning signs include age over 50, new headache, jaw claudication, and elevated ESR; treat as an emergency because vision loss can be permanent.

Keratoconus shows inferior steepening, scissoring on retinoscopy, and Fleischer ring; corneal cross-linking slows progression in younger patients.

Systemic associations: diabetes with cataract and retinopathy, hypertension with arteriolar narrowing and AV nicking, and rheumatoid arthritis with dry eye and scleritis.

Tropicamide 1% dilates for 4 to 6 hours; cyclopentolate 1% lasts about 24 hours; atropine 1% lasts up to 2 weeks and is used for cycloplegic refraction in children.

Phenylephrine 2.5% is a mydriatic without cycloplegia; it can cause systemic hypertension and should be used cautiously in older patients.

Prostaglandin analogs such as latanoprost lower intraocular pressure by increasing uveoscleral outflow and commonly cause iris darkening and eyelash growth.

Timolol, a beta blocker, is contraindicated in asthma and heart block; it can cause bradycardia and bronchospasm.

Topical anesthetic use is diagnostic only; chronic use causes corneal toxicity and masks infection.

Preservative-free artificial tears are preferred in patients using more than four drops daily or with known benzalkonium chloride sensitivity.

Fluorescein angiography requires a documented allergy history; adverse reactions range from nausea to anaphylaxis, and emergency equipment must be available.

The Plan-Do-Study-Act cycle is the standard quality improvement framework: plan a change, test it, analyze results, and act on findings.

A root cause analysis is triggered by a sentinel event, such as wrong-site procedures or medication errors resulting in harm.

Hand hygiene before and after every patient contact is the single most effective infection control measure in an optometric practice.

Instrument disinfection: tonometer prisms and contact lenses require approved disinfection between patients; alcohol alone is insufficient for some pathogens.

Medication reconciliation at each visit reduces prescribing errors, especially in patients using multiple topical and systemic agents.

Audit metrics for optometry include dilated exam rates for diabetic patients, glaucoma follow-up intervals, and referral completion rates.

Incident reporting should be nonpunitive to encourage disclosure; near misses are reported alongside actual harm events.

Informed consent requires disclosure of diagnosis, proposed treatment, alternatives, risks, and the patient's right to refuse.

Patient confidentiality is protected by law; disclosure without consent is permitted only for legal reporting, imminent harm, or court order.

Optometrists must practice within their scope; referral is required when a condition exceeds competence or licensure.

Conflict of interest disclosure is required when recommending products in which the practitioner has a financial interest.

Record documentation should be contemporaneous, legible, and include findings, advice given, and follow-up plan.

Communication with patients should use plain language and confirm understanding; interpreters are required for patients with limited English proficiency.

Advertising must be truthful and not misleading; claims of superiority require objective evidence.

Screening guidelines: children should have vision screening by age 3 to 5; adults without risk factors every 2 years from age 40.

Diabetic retinopathy screening should begin at diagnosis for type 2 diabetes and 5 years after diagnosis for type 1.

Glaucoma screening is recommended for adults over 40 with risk factors including African ancestry, family history, and elevated intraocular pressure.

Ultraviolet protection reduces risk of cataract, pterygium, and eyelid malignancy; wrap-around sunglasses with UV400 rating are recommended.

Smoking cessation reduces risk of age-related macular degeneration and cataract progression.

Nutrition: the AREDS2 formulation with lutein and zeaxanthin slows progression of intermediate age-related macular degeneration.

Amblyopia screening in children is time-sensitive; treatment effectiveness declines after age 7.