2023 Edition

Contact Lens Practice Test

Take this free practice test to see how prepared you are for an Contact Lens Registry Exam, taken by opticians.

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Ocular Anatomy, Physiology, and Pathology

1.	Which anatomical part of the eye can have up to 33 diopters of optical power?
		a. Cornea
		b. Iris
		c. Vitreous humour
		d. Crystalline lens
As the eye is accommodating, the crystalline lens makes up to 33 diopters (D) of its optical power. In a relaxed state, the lens usually has 20 D of power while the other majority of the eye's 60 D of total optical power is from the cornea. The iris and vitreous humour do not refract light. Incorrect answer. Please choose another answer.

2.	______ is inflammation of the upper tarsal conjunctiva resulting in large papillae and is associated with contact lens wear.
		a. Atopic keratoconjunctivitis
		b. Giant papillary conjunctivitis
		c. Pterygium
		d. Subconjunctival hemorrhage
Giant papillary conjunctivitis is commonly associated with poor cleaning of contact lenses. This causes irritation of the palpebrae conjunctiva of the upper lid. The resulting inflammation leads to very large papillae (or bumps). Pterygium is a growth in the conjunctiva and a subconjunctival hemorrhage is when a blood vessel in the conjunctiva breaks. Atopic keratoconjunctivitis is characterized by chronic inflammation of the conjunctiva. Incorrect answer. Please choose another answer.

Refractive Errors

3.	A ________ eye focuses light ____ the retina.
		a. myopic; in front of.
		b. myopic; behind.
		c. hyperopic; on.
		d. hyperopic; in front of.
In myopia (nearsightedness) light focuses in front of the retina, whereas with hyperopia (farsightedness) light focuses behind the retina. An emmetropic eye requires no correction because light already focuses on the retina. Incorrect answer. Please choose another answer.

4.	Which term describes the property of a lens that is thickest in the middle?
		a. Convex
		b. Cylindrical
		c. Minus
		d. Concave
A convex (plus) lens is used to correct hyperopia. A concave (minus) lens is used to correct myopia. A cylindrical lens corrects astigmatism. Incorrect answer. Please choose another answer.

Instrumentation for Measurement and Observation

5.	All of the following can be used in establishing a patient's contact lens prescription except:
		a. Keratometer
		b. Phoropter
		c. Pupilometer
		d. Corneal topography
A pupilometer is used for fitting a patient for glasses. A phoropter is a machine which assists the prescriber in refracting the eye while a keratometer measures the patient's cornea. Corneal topography can also be used when a patient requires rigid gas permeable or hybrid lens. Incorrect answer. Please choose another answer.

6.	Which test can be used to measure if a patient's dry eye symptoms are too severe for contact lens wear?
		a. Tear Break-Up Time
		b. Eye Dominance
		c. Visual Acuity
		d. Refraction
Tear Break-Up Time (BUT) is a test where fluorescein dye is used to track how long it takes dry spots to form after a patient blinks. Visual acuity (or the patient's ability to see) and refraction (the process of determining a patient's refractive error) are normal parts of an eye exam. Knowing which eye is dominant is essential for fitting monovision and some multifocal lenses. Incorrect answer. Please choose another answer.

7.	If a patient has a glasses prescription of -3.00 -2.00 x 130 and corneal measurements of 45.00/43.00 x 130, which type of astigmatism is present?
		a. Corneal astigmatism
		b. Against-the-rule astigmatism
		c. Lenticular astigmatism
		d. With-the-rule astigmatism
Since there is a 2 diopter (D) difference between the corneal measurements of the eye and also the amount of cylindrical power listed in the refraction, the patient has corneal astigmatism. The patient's astigmatism is not caused by the difference in curvature of the crystalline lens (lenticular astigmatism). The astigmatism at 130 degrees is also known as oblique astigmatism. Against-the-rule astigmatism is described as an axis located approximately between 0 degrees to 30 degrees or 150 degrees to 180 degrees. With-the-rule astigmatism is described as an axis located approximately between 60 degrees to 120 degrees. Incorrect answer. Please choose another answer.

Prefitting

8.	After transposing the following glasses prescription, what is the next step in determining the contact lens prescription? OD +3.50 +2.50 x 075
		a. Finalize the patient's contact lens prescription.
		b. Select lenses in the patient's prescription.
		c. Add the cylinder power to the sphere, change the sign and adjust the axis.
		d. Adjust for vertex effect.
A spectacle prescription is transposed by adding the cylinder power to the sphere, switching the cylinder's sign and changing the axis by 90 degrees. The transposed prescription will read +6.00 -2.50 x 165. Since the sphere is higher than +4.00, the next step is to adjust for the vertex effect. The corresponding contact lens prescription will then be +6.50 -2.50 x 165. Incorrect answer. Please choose another answer.

9.	Which of the following base curves will fit the eye best if the patient has a corneal measurement of 41.00/41.25 x 90?
		a. 8.2
		b. 8.4
		c. 8.7
		d. 8.9
The corneal measurement (K) of 41.00/41.25 x 90 is considerably steep and matches up best with the 8.2 base curve (BC). Usually the higher the BC, the flatter the contact lens will appear. Incorrect answer. Please choose another answer.

10.	Which eye condition would benefit the most from a hybrid contact lens?
		a. Keratoconus
		b. Astigmatism
		c. Presbyopia
		d. Cataracts
Keratoconus is a thinning of the cornea which leads to a steep coning of the front of the eye. Hybrid lenses (Rigid Gas Permeable lenses with a soft lens skirt) therapy can be used to improve vision. When either the front surface of the eye, the cornea, or the lens inside the eye have mismatched or misshapen curves, astigmatism occurs causing blurred vision at all distances. Presbyopic patients require additional plus power in certain zones of the contact lens in order to help accommodate for lost near vision. A cataract is a clouding of the crystalline lens. Incorrect answer. Please choose another answer.

11.	A contact lens that contains an additional plus power in certain zones to assist presbyopic patients is also called a:
		a. Cylindrical lens
		b. Toric lens
		c. Multifocal lens
		d. Monovision lens
Presbyopic patients require additional plus power in certain zones of the contact lens in order to help accommodate for lost near vision. Another option is monovision where one eye is corrected for far vision and the other eye is corrected for near vision. A toric (or cylindrical) lens corrects astigmatism. Incorrect answer. Please choose another answer.

Diagnostic Fitting

12.	What factors should be considered when selecting a lens for a patient?
		a. Contact lens parameters
		b. Patient's age
		c. Patient's employment and hobbies
		d. All of the above
The patient's daily activities and age range are important factors to consider for a successful contact lens fitting (including what modality of lenses should be chosen). Unless a contact lens is custom made, a fitter will have to select a brand with parameters that match the patient's contact lens prescription. Incorrect answer. Please choose another answer.

13.	Which one of the following statements is true about insertion and removal of soft contact lenses?
		a. During insertion, an RGP lens can be placed anywhere on the sclera.
		b. During insertion, soft lenses can be placed anywhere on the sclera.
		c. During removal, a patient can typically blink a soft lens out of the eye or use a plunger.
		d. During removal, a patient will need to pinch out the RGP lens with their fingers.
Soft lenses can be inserted by placing them anywhere on the sclera. Unlike soft lenses, Rigid Gas Permeable (RGP) lenses must be placed on the cornea for proper insertion. RGP lenses can also be removed by blinking while your hand is placed in the outer corner of the eye or with use of a contact lens plunger. Incorrect answer. Please choose another answer.

14.	What is not one of the characteristics of an optimal RGP lens fit?
		a. A bullseye fit
		b. A flat fit
		c. An apical fit
		d. A dynamic fit
A flat fit is not an ideal RGP fit. A fluorescein pattern resembling a bullseye with apical clearance is optimal. The fitter also will check that the lens is not too tight allowing for slight dynamic movement. Incorrect answer. Please choose another answer.

15.	While fitting a patient with a toric soft lens in the prescription below, it is observed the lens is over-rotated by 10 degrees to the left. How should the prescription be adjusted?
		a. The prescription should not be changed.
		b. The new axis should be 080 degrees.
		c. The new axis should be 100 degrees.
		d. The new axis should be 085 degrees.
The over-rotation of the toric lens is causing the effective contact lens prescription to be 1.75 -1.25 x 080. In order to get the desired effective contact lens prescription, 10 degrees must be added to the original prescription. If the over-rotation had been to the right, 10 degrees would need to be subtracted instead. Incorrect answer. Please choose another answer.

16.	A patient returns for a toric contact lens fitting follow-up and complains of temporary blurriness after blinking. The patient states this is a concern since their job performance relies heavily on their vision. How can this be resolved?
		a. Refitting the patient in a different brand of toric contact lenses.
		b. Masking the astigmatism with spherical lenses.
		c. Have the patient use rewetting eye drops.
		d. Make no changes to the contact lens prescription.
Temporary blurriness after blinking is caused by excessive contact lens movement. The patient should be refitted in toric lenses with either a different ballast system or decreased base curve to decrease unwanted movement. If the blurriness was resolved by blinking, this is an indication of dry eyes, dictating the use of rewetting drops. Masking of the astigmatism with spherical lenses will provide less movement but will not improve visual acuity. Incorrect answer. Please choose another answer.

Dispensing

17.	If a contact lens is monthly wear, which one of the following statements is true?
		a. The contact lens can be worn 30 days before removal.
		b. The contact lens can be worn for 30 nonconsecutive days.
		c. Unless the contact lens is torn or warped, it can be worn past 30 days.
		d. The contact lens should only be worn during a 30-day period.
A monthly contact lens should only be used for a 30-day period, regardless of how many days the contact lens is worn during the 30 days. Patients should not sleep in contact lenses. Incorrect answer. Please choose another answer.

18.	For a new fit, which type of contact lens requires the longest period for building up wear time?
		a. Soft
		b. RGP
		c. Silicone hydrogel
		d. Hydrogel
In fitting RGPs, also known as hard lenses, it is recommended that the patient builds up wear time by adding an hour each day. Soft lenses are made from silicone hydrogel or hydrogel material. Incorrect answer. Please choose another answer.

19.	Which type of contact lens solution requires a process of 6 to 8 hours for the lenses to be safe for wear?
		a. Saline solution
		b. Hydrogen peroxide solution
		c. Multipurpose contact lens solution
		d. Wetting solution
All of these solutions can be used with contact lenses however, since the hydrogen peroxide solution contains hydrogen peroxide to disinfect the lenses, the patient must use the provided case which includes a neutralizing disc. The active ingredient will be completely neutralized by the time listed in the instructions, usually 6 to 8 hours (or overnight). This type of solution may be recommended for patients with allergies to preservatives found in other types of contact lens solution. Incorrect answer. Please choose another answer.

20.	Which one of the following statements is true?
		a. Saline solution does not disinfect the contact lens.
		b. Saline solution contains preservatives.
		c. Multipurpose contact lens solution is a disinfectant.
		d. Multipurpose contact lens solution and saline solution are the same.
Saline solution does not disinfect contact lenses. It is only a combination of sodium chloride and sterilized water. Multipurpose contact lens solution is a disinfectant used to clean lenses and usually contains preservatives. Incorrect answer. Please choose another answer.

21.	Which of the following does not increase a patient's risk of eye infection?
		a. Topping off contact lens solution.
		b. Removing contact lenses before bed.
		c. Swimming with contact lenses in.
		d. Wearing contact lenses.
Topping off old contact lens solution and swimming in contact lenses increases a patient's risk of eye infection. In fact, any normal use of contact lenses can increase risk of infection. This is why it is important to wash hands before/after handling, not sleep in the lenses and clean them properly. Incorrect answer. Please choose another answer.

22.	This should not be used to clean soft contact lenses:
		a. Sterile saline solution
		b. Contact lens solution
		c. Distilled water
		d. Hydrogen peroxide solution
Using any type of water to clean contact lenses will increase the risk of eye infection. One corneal infection associated with distilled or tap water is Acanthamoeba Keratitis. Incorrect answer. Please choose another answer.

Follow-up

23.	Which of the following would be considered a subjective follow-up finding?
		a. An over-refraction of +0.50
		b. Visual acuity is 25/20
		c. Lens feels comfortable
		d. Lens over-rotates 15 degrees to the right
The comfort level of the contact lens is a subjective finding given by the patient. Over-refraction, visual acuity and over-rotation are measured objective findings. Incorrect answer. Please choose another answer.

24.	Which of the following would be considered an objective follow-up finding?
		a. Visual Acuity is 20/20
		b. Feeling like the lens is moving around too much in the eye
		c. Eyes feeling gritty
		d. Contact lens is too difficult to remove from the eye
The measured visual acuity of the contact lens is an objective finding. Subjective findings include the patient's feelings and opinions about the contact lenses. Incorrect answer. Please choose another answer.

25.	What is typically not included in the contact lens follow-up?
		a. Visual Acuity test
		b. Over-refraction
		c. Refitting
		d. Refraction
Visual acuity test, over-refractions and refitting are common parts of a contact lens follow-up to fine-tune the prescription, while refraction usually occurs at the initial exam. For this reason sometimes the prescriber will not provide a finalized contact lens prescription until the patient returns for the follow-up. Incorrect answer. Please choose another answer.

26.	After the contact lens prescription is finalized, when should the patient contact the prescriber?
		a. When they have to schedule another contact lens exam before their current prescription expires.
		b. If they are having insertion and removal issues.
		c. If they can no longer see well in the contact lenses.
		d. All of the above.
A patient should contact the prescriber in any of the above situations. Sudden changes in vision or trouble handling the lenses should be addressed as soon as possible. Once a contact lens prescription expires, a patient will be unable to receive any lenses until they have a new exam. Incorrect answer. Please choose another answer.

Regulatory and Administrative

27.	Under FDA regulations:
		a. Contact lens prescriptions need not include a brand.
		b. Contact lenses can be purchased without a prescription.
		c. Contact lenses are considered a medical device.
		d. Contact lenses are not regulated by the FDA.
The Food and Drug Administration regulates contact lenses because they are a medical device. Contact lenses require a valid prescription which includes the contact lens brand for purchase. Incorrect answer. Please choose another answer.

28.	All of the following are exemptions to a prescriber being legally obligated to provide a copy of a patient's contact lenses prescription at the end of evaluation except:
		a. The patient has yet to pay upfront costs of exam, fitting and evaluation.
		b. The prescriber has deemed the patient unfit for contact lens wear.
		c. The patient did not request a copy of the contact lenses prescription.
		d. The patient must return for follow-up before the prescription is finalized.
As long as a patient has paid their eye exam/contact lens fitting fees and the prescriber has finalized their contact lens prescription, a copy of this prescription must be given to the patient as mandated by the Fairness to Contact Lens Consumers Act. Incorrect answer. Please choose another answer.

29.	Under HIPAA, which of the following scenarios is prohibited:
		a. Confirming a contact lens prescription of a 17 year-old with the patient's parent since the patient is away at college.
		b. Verifying a patient's contact lens prescription with a contact lens retailer after the patient has ordered contact lenses through their website.
		c. Calling the prescribing doctor's office to verify a patient's previous contact lens prescription while they are being refitted at your clinic.
		d. Emailing a non-encrypted copy of a patient's prescription to them since they have lost their original copy.
According to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), for patients 18 years and older, patient consent is needed to share medical information. However, this medical information must be shared through secure methods. Sending the contact lens prescription through the person's patient portal which is encrypted, is a more secure option then using non-encrypted e-mail. Incorrect answer. Please choose another answer.

30.	The Fairness to Contact Lens Consumers Act states that it is ________ for a patient to purchase contact lenses from a seller other than the prescriber if the contact lens prescription is ____________.
		a. Legal; verified and unexpired.
		b. Legal; verified and expired.
		c. Illegal; verified and unexpired.
		d. Legal; unverified and unexpired.
According to the Federal Trade Commission's Fairness to Contact Lens Consumers Act, a contact lens prescription must be verified and unexpired in order for the patient to legally purchase contact lenses from a seller other than the prescriber. Incorrect answer. Please choose another answer.