NCLE Practice Test

Inadequate movement of a soft lens can be corrected by using a lens that

a) has a steeper base curve

b) has a smaller diameter

c) has a larger diameter

d) has a higher water content

b)has a smaller diameter

Which of the following changes would improve a rigid contact lens fit that shows sluggish movement after 1 hour of wear?

a) Add hyperflange edge treatment

b) Reduce overall diameter

c) Decrease center thickness

d) Increase overall diameter

b) Reduce overall diameter

Upon initial insertion of a GP lens, the patient complains about flare. To correct this problem, the fitter should choose a lens with a/an:

a) increased base curve

b) increased optical zone

c) decreased optical zone

d) flattened base curve

b) increased optical zone

For a patient with 1.25D of with-the-rule astigmatism, who is active outdoors and who operates heavy construction equipment, the most appropriate type of contact lens would be:

a) soft toric lenses

b) spherical gas permeable lenses

c) spherical soft lenses

d) toric gas permeable lenses

a) soft toric lenses

The most frequently used corneal contact lenses for patients with keratoconus are:

a) specially designed cone lenses

b) bandage contact lenses

c) scleral lenses

d) soft contact lenses

a) specially designed cone lenses

In order to check the front vertex power of a contact lens, the lens should be placed in which of the following positions relative to the aperture of the lensometer

a) concave side to the aperture

b) 5 mm in front of the aperture

c) peripheral curve opposite the aperture

d) convex side to the aperture

d) convex side to the aperture

Reducing the diameter of a minus lens results in:

a) increased center thickness

b) a reduction in weight

c) a steeper base curve

d) decreased center thickness

b) a reduction in weight

Which of the following is best detected by observing the cornea without the microscope when the beam of the slit lamp is focused directly on the limbus?

a) Epithelial erosion

b) The lens/cornea relationship

c) Central cornea clouding

d) limbal vascularization

c) Central cornea clouding

A patient wearing a -2.00 diagnostic soft lens has the best vision with an over-refraction of -0.25 -0.50 x090. Which of the following should be ordered?

a) -2.00 sph

b) -2.25 sph

c) -2.50 sph

d) -2.25 -0.50 x090

b) -2.25 sph

When working with rigid contact lenses, fitters often use a fluorescene to evaluate the:

a) lens surface integrity

b) lens/lid relationship

c) blink rate

d) lens/cornea relationship

d) lens/cornea relationship

Patients with high riding rigid lenses often have:

a) high myopia

b) against-the-rule astigmatism

c) aphakia

d) steep-fitting lenses

c) aphakia

A patient wearing a toric soft lens with the parameters -1.50 -1.50 x180 has an over-refraction of -0.75 +0.50 x090. A new lens should be ordered with which parameters?

a) -1.75 -0.75 x180

b) -1.75 -1.75 x180

c) -2.25 -0.75 x090

d) -2.25 -0.75 x180

a) -1.75 -0.75 x180

A fitter is evaluating the visual acuity of a patient who is currently wearing multifocal soft lenses. For this patient, over-refraction is best done using:

a) an autorefractor

b) a pinhole

c) a phoroptor

d) hand-held lenses

b) a pinhole

During slit-lamp evaluation, on upward gaze, a patient's soft contact lenses move 0.5 to 1mm when the patient blinks. These lenses are:

a) a good fit

b) too loose

c) too tight

d) too large

a) a good fit

Which of the following is the mode of slit-lamp illumination used to view the early stages of microcystic edema?

a) Retroillumination

b) Direct illumination

c) Parrallelpiped

d) Oscillation

a) Retroillumination

A fluorescein pattern that has a black area over the corneal apex and a diffuse green area in the periphery normally indicates:

a) flat fit

b) steep fit

c) normal fit

d) tight fit

a) flat fit

Which curve would a fitter modify to allow more tear flow under the edge of a rigid lens?

a) Posterior peripheral curve

b) Optical curve

c) Anterior peripheral curve

d) Anterior central curve

a) Posterior peripheral curve

When using a lid manipulation to assist in "popping" a rigid lens off the eye, the wearer should first make sure that the:

a) lower lid meets the lower part of the cornea

b) lens is resting on the cornea, where the fissure is widest

c) edge of the lens has been located with a penlight

d) lens is resting on the sclera, where the tissue is widest

b) lens is resting on the cornea, where the fissure is widest

Soft lenses should be considered when the patient:

a) wants the best possible vision at all times

b) is concered with cost

c) desires intermittent wear

d) has a small palpebral fissure

c) desires intermittent wear

Upon completion of a contact lens fitting, the best way to provide additional information to the patient on fees, care systems, and wearing schedules is by:

a) directing the patient to consult online reference material

b) discussing such matters with the patient by telephone, as the need arises

c) supplying the patient with pamphlets and office handouts

d) asking the patient to bring up any questions at the next regular visit

c) supplying the patient with pamphlets and office handouts

The Fairness to Contact Lens Consumers Act covers:

a) GP lenses only

b) specialty lenses only

c) disposable lenses only

d) all types of lenses

c) disposable lenses only

Which of the following instruments can be used to measure both corneal curvature and the base curve of a rigid contact lens?

a) lensometer

b) biomicroscope

c) keratometer

d) radiuscope

c) keratometer

The optical zone width of a GP lens can be assessed with a:

a) magnifier with a millimeter grid

b) radiuscope

c) topogometer

d) diameter v-gauge

a) magnifier with a millimeter grid

It is recommended that after successful initial follow-up visits, the continuous/extended wear contact lens patient should be seen:

a) monthly, late in the day after a full week of wear

b) semiannually, as soon as possible after awakening

c) annually, when the lenses are ready to be replaced

d) every 18 months, even if no problems are obvious

b) semiannually, as soon as possible after awakening

Bedewing of the cornea occurs on which of the following corneal layers?

a) Bowman's membrane

b) Epithelium

c) Endothelium

d) Descemet's membrane

c) Endothelium

A silicone hydrogel soft lens wearer presents with a superior arculate lesion. This indicates:

a) corneal dystrophy

b) microcysts

c) corneal edema

d) epithelial splitting

d) epithelial splitting

With-the-rule corneal astigmatism with a GP lens in place will show which of the following fluorescein patterns?

a) Central pooling

b) Dark narrow band horizontally

c) Dark narrow band vertically

d) Central touch

b) Dark narrow band horizontally

The base curve of a rigid lens is usually verified with a:

a) topogometer

b) radiuscope

c) keratoscope

d) profile analyzer

b) radiuscope

A daily wear soft lens patient should be scheduled to return for the first follow-up visit in:

a) 24 hours

b) 48 hours

c) 1 week

d) 1 month

c) 1 week

The most important procedure for preventing the spread of infections in healthcare offices is:

a) handwashing

b) use of rubber gloves

c) wiping instruments with alcohol between uses

d) use of face masks

c) wiping instruments with alcohol between uses

The primary advantage to the practice of direct delivery of contact lenses from manufacturer to patient is that it:

a) encourages buying from third-party distributors

b) saves the office time and money

c) discourages excessive office visits

d) encourages patient compliance

b) saves the office time and money

Rose bengal stains areas of:

a) neovascularization

b) microcysts

c) devitalized tissue

d) Fleisher's ring

c) devitalized tissue

A soft lens patient has a spectacle correction of +8.50D at a vertex of 12mm. What would be the most appropriate sphere power?

a) +7.50D

b) +8.00D

c) +8.50D

d) +9.50D

d) +9.50D

A patient has the RX Plano -1.25 x170 and "K" readings of 42.50/42.50. To achieve the best visual acuity in fluorosilicone acrylate material, the lens design should be:

a) front toric

b) spherical

c) panafocal

d) bitoric

a) front toric

The evaluation of a rigid lens detects centrally, minimal lens movement, and poor tear exchange. Which of the following lens changes would be most appropriate?

a) Increase the diameter

b) Reduce the diameter

c) Steepen the base curve

d) Increase the optical zone diameter

b) Reduce the diameter

A rigid lens of 45.00D/-4.00, provides 20/20 vision. What power would be needed if the central posterior curve(base curve) is changed to 45.50D?

a) -3.50

b) -4.25

c) -4.50

d) -5.00

c) -4.50

The appearance of transient bubbles near the periphery of a contact lens is indicative of:

a) a steep base curve

b) flat posterior peripheral curves

c) a large optical zone

d) narrow posterior peripheral curves

b) flat posterior peripheral curves

One way to eliminate silicone hydrogel edge fluting is to use a material with a:

a) lower water content

b) plasma- treated surface

c) lower modulus

d) highter Dk/t value

a) lower water content

The most common technique for a patient to insert a rigid lens is to:

a) evert the lids

b) place the lens directly on the cornea

c) place the lens on the sclera, then move it to the cornea

d) insert the lens with a suction cup

b) place the lens directly on the cornea

During long periods between uses, rigid lenses should be stored in a:

a) dry state

b) cleaning solution

c) hydrogen peroxide solution

d) wetting solution

a) dry state

Which of the following disinfectant chemicals is safe to use with soft contact lenses?

a) Thimerosal

b) Benzalkonium chloride

c) Benzyl alcohol

d) Polyquarternium 1

d) Polyquarternium 1

A lens that was ordered as 45.00 (7.50) -4.00 8.7 has been received as 45.50 (7.42) -4.25 8.7. In regard to this lens, which of the following statements is correct under ANSI standards?

a) the power only is acceptable

b) the base curve only is acceptable

c) Neither the power nor base curve is acceptable

d) Both the power and base curve are acceptable

c) Neither the power nor base curve is acceptable

Which of the following compounds would be best to use for adjusting or polishing GP lenses?

a) Ammonia-based polish

b) Sodium bicarbonate polish

c) Solvent- based polish

d) Water- soluble polish

d) Water- soluble polish

A Correct Statement regarding epithelial cells is that they:

a)Comprise the posterior layer of the cornea

b)Are unable to regenerate

c)Comprise the thickest layer of the cornea

d) Have the ability to reproduce

d) have the ability to reproduce

Which of the following prescriptions indicates against-the-rule astigmatism?

a)-4.50 +1.00 x75

b)-4.50 +1.00 x 180

c)-4.50 -1.00 x 165

d)4.50 -1.00 x 180

a)-4.50 +1.00 x75

When a keratometer is being calibrated, which of the following targets will provide the most reliable result?

a)the single-cut anterior surface of a high-plus lens

b)a perfectly flat highly polished mirror

c) a set of steell balls of known radii

d)the unfinished posterior surface of a low-minus lens

c) a set of steel balls of known radii

A long-term, successful, hydrogel contact lens wearer suddenly develops dry eyes. Which of the following is most likely to cause this problem?

a) Use of oxidative solution

b) use of rewetting drops

c) use of anti-histamines

d) Wearing of lenses in the wrong eyes

c) use of anti-histamines

A new daily wearer of soft lenses returns for the first follow up visit with itching, burning, injected eyes. The most likely cause of these problems is:

a) solution reaction

b) giant-cell papillary conjunctivitis

c) a lens fit that is too loose

d) inability to wear soft lenses

a) solution reaction

Which of the following changes is best able to improve oxygen transmissibility to a patient's cornea?

a) Increasing tear exchange

b) Increasing Dk

c) Increasing optical zone diameter

d) Increasing CN bevel

b) Increasing Dk

In using fluorescein to evaluate the fit of a rigid lens of 9.0mm diameter on a typical eye, a correct statement is that:

a) apical touch with pooling in the PPC curve area is preferred

b) apical toxicity may not be obvious

c) apical pooling with edge touch is recommended

d) apical area, mid-peripheral area, and the lens edges should be assessed

d) apical area, mid-peripheral area, and the lens edges should be assessed

Moving a +7.50 RX from the spectacle plane to the corneal plane will require:

a) no change in power

b) more minus power

c) more plus power

d) less plus power

c) more plus power

IPC's are used to:

a) provide a transition between the peripheral and base curves

b) reduce edge thickness and lens mass

c) increase the optical zone

d) smooth the lens edge

a) provide a transition between the peripheral and base curves

A toric soft lens with an RX of -2.00 -1.25 x 120 has the axis resting at the 5 o' clock position. What should the new axis be when the lens is ordered?

a) 90 degrees

b) 105 degrees

c) 135 degrees

d) 150 degrees

a) 90 degrees

If a well fitted diagnostic lens has a -3.00 power and the over-refraction at 12mm is -2.00, the correct lens power to order is:

a) -4.50

b) -4.75

c) -5.00

d) -5.25

c) -5.00

Which of the following instruments is most commonly used to measure the diameter of the optical zone of a contact lens?

a) contactometer

b) radiuscope

c) measuring magnifyer

d) lensometer

c) measuring magnifyer

According to the US Food and Drug Administration, the maximum time allowable for continuous wearing of silicone hydrogel lenses is:

a) 7 days

b) 14 days

c) 21 days

d) 30 days

d) 30 days

When ridig lenses are received from the manufacturer, which of the following instuments is not needed for inspection and verification?

a) biomicroscope

b) radiuscope

c) lensometer

d) measuring magnifyer

a) biomicroscope

The most effective way to remove a soft contact lens that has adhered to the cornea is to:

a) firmly press the lids against the sclera with fingertips, release, then blink the lid closed firmly

b) gently pinch the lens directly off the cornea with clean fingertips

c) affix a suction cup to the center of the lens and pull it straight away, using steady pressure

d) irrigate the eye with lubricant until the lens moves freely, then remove as usual

d) irrigate the eye with lubricant until the lens moves freely, then remove as usual

Following the fitting and dispensing of any continuous wear contact lenses, it is advisable to see the patient:

a) the following morning

b) in 2 weeks

c) within 2 days

d) in 1 week

a) the following morning

The fitter can differientiate between a back toric lens and bitoric lens by utilizing a:

a) radiuscope

b) keratometer

c) profile analyzer

d) lensometer

a) radiuscope

The instrument designed primarily to measure the base curve of a contact lens is the:

a) keratometer

b) radiuscope

c) lensometer

d) ophthalmascope

b) radiuscope

The majority of continuous wear hydrophillic soft lenses are composed of:

a) plymethyl-methacrylate

b) fluorosilicone acrylate

c) silicone acrylate

d) silicone hydrogel

d) silicone hydrogel

A drooping of the upper lid is called:

a) entropion

b) strabismus

c) ptosis

d) nystagmus

c) ptosis

A spherical rigid contact lens has:

a) a ballast system to accommodate rotational effects

b) one continuous curve throughout the optical zone

c) correction for approximately 1.5D of presbyopia

d) a back surface curve that flattens progressively

b) one continuous curve throughout the optical zone

Which layer of the tear film helps to prevent evaporation?

a) vitreous layer

b) lipid layer

c) mucin layer

d) aqueous layer

b) lipid layer

Which of the following characteristics is most likely to be exhibited by a diabetic contact lens patient?

a) exophthalmos

b) blepharitis

c) fluctuating vision

d) poor blink habits

c) fluctuating vision

A rigid contact lens used to enhance color vision in patients who have color deficiencies is:

a) light green

b) dark red

c) medium yellow

d) dark blue

b) dark red

A patient complains of pain upon lens insertion, with excessive tearing and blurry vision. Fluorescein evaluation reveals zigzag linear corneal staining. These signs and symptoms are most likely due to a:

a) tight-fitting lens

b) solution sensitivity reaction

c) loose-fitting lens

d) foreign body under the lens

d) foreign body under the lens

When a soft diagnostic lens is too flat, it may demostrate:

a) limited movement

b) impingement on the limbus

c) scleral indentation

d) edge standoff

d) edge standoff

Given the following "K" readings: 41.87@055/43.62@145 What optical condition does the patient have?

a) hyperopia

b) with-the-rule astigmatism

c) against-the-rule astigmatism

d) oblique astigmatism

d) oblique astigmatism

Recentering of a rigid contact lens should always be performed by manipulation of the lens:

a) through the upper or lower lids

b) with a sterile cotton-tipped swab

c) directly with the index fingers

d) with a suction cup

a) through the upper or lower lids

Fluorescein that has been instilled into the eye is best illuminated by using:

a) sclerotic scatter

b) a green filter

c) cobalt blue filter

d) a pen light

c) cobalt blue filter

A patient complains of reduced vision after a well-fitted rigid lens has been polished by the fitter. The fitter should:

a) check the quality of all lens parameters

b) repolish the lens

c) re-edge the lens

d) reduce the lens diameter

a) check the quality of all lens parameters

When an office visit is documented in a patients records, the final notation on the chart should be the:

a) patients "K" readings

b) patients overall satisfaction with the contact lenses

c) recommended time until the patients next office visit

d) results of the patients visual acuity assesment

c) recommended time until the patients next office visit

To ensure follow-up recall appointments, it is important to:

a) give an appointment a year in advance

b) rely on the patient to schedule the follow up appointments

c) send a note saying that it is not possible to replace a lens unless an appointment is scheduled in advance

d) reinforce the need for follow up care beginning with the initial contact lens fitting appointment

d) reinforce the need for follow up care beginning with the initial contact lens fitting appointment

On a follow up visit, a 20 year old myopic patient reports difficulty with near vision, although distance vision is excellent. This patient is most likely:

a) astigmatic

b) amblyopic

c) undercorrected

d) overcorrected

d) overcorrected

A patient returns for a recheck, reporting a sudden sharp pain this morning upon insertion of a soft daily wear lens. The fitting should suspect:

a) a damaged lens

b) improper blinking

c) a tight lens

d) edema

a) a damaged lens

What would be the most appropriate soft lens diameter for a patient whose HVID is 12mm?

a) 14mm

b) 13 mm

c) 15 mm

d)12 mm

a) 14 mm

With regard to a contact lens examination, the acronym SOAP stands for

a) Symptomatology, Over-refraciton, Anatomy, Physiolofy

b) Systemic disease, ocular disease, astigmatism, presbyopia

c) Sensitivity, Ophthalmometry, Acuity, Pathology

d) Subjective, Objective, Assessment, Plan

d) Subjective, Objective, Assesment, Plan

Which part of the eye is most sensitive to a rigid corneal contact lens during the adaption period?

a) Lid

b) Sclera

c) Limbus

d) Conjunctiva

a) Lid

A GP lens wearer reports a scratchy feeling upon lens insertion; the discomfort increases with wearing time. The most likely correction would be:

a) changing the care regimen

b) removing the CN bevel

c) blending the junction zone

d) decreasing the total lens diameter

c) blending the junction zone

If a soft lens wearer complains of awareness of the lens in the right eye only, and the right and left parameters are identical, which of the following would be best for the fitter to do first?

a) Put the lens in the right eye to see if the feeling subsides or alternates

b) Switch to a steeper lens on the right eye only

c) Order new lenses to see if the feeling subsides

d) Discontinue use of the lenses for 24 hours and order a new right lens only

a) Put the lens in the right eye to see if the feeling subsides or alternates

The goal of Occupational Safety Health and Administration(OSHA) is to:

a) eliminate work hazards through training in safety and the use of personal protective equipment

b) develop and enforce environmental regulations

c) develop and carry out eyewear safety tests and to certify eyewear for use in specific situations

d) ensures that foods, drugs, and medical devices are safe and effective

a) eliminate work hazards through training in safety and the use of personal protective equipment

A patient who is wearing a GP lens complains of a "scratching sensation" The lens specifications are found to be accurate. Which of the following instruments would be most valuable in determining the cause of the discomfort?

a) Measuring magnifier

b) Topogometer

c) Thickness gauge

d) Radiuscope

a) Measuring magnifier

A contact lens wearer presents with acute red eyes. The fitter would most likely ask the patient:

a) Do you always wash your hand before inserting your lenses

b) What lens care products have you been using

c) Do you have a history of blepharitis

d) Have you injured your eye recently

b) What lens care products have you been using

Which of the following should be noted on the patients health history record as a temporary contraindication to the use of contact lenses?

a) Amblyopia

b) Acute conjunctivitis

c) Glaucoma

d) Aniridia

b) Acute conjunctivitis

Which of the following base curves would loosen the fit of a 8.70 soft lens if the diameter is kept constant?

a) 8.30

b) 8.40

c) 8.60

d) 8.90

d) 8.90

A new corneal transplant patient who is wearing GP's presents with injection, edema, and neovascularization at the graft juncture. The fitter should:

a) remove the lens and call the referring practitioner

b) have the patient discontinue wearing the lenses until the eye is quiet

c) refit the patient with flatter GP lenses

d) conclude that the patient is not a candidate for contact lenses

a) remove the lens and call the referring practitioner

Most multifocal lens designs will;

a) permit light from both near and far fields to enter the pupil simultaneously

b) depend on the lower lid to move the lenses downward when the patient looks down to read

c) lack an intermediate zone to provide good visual acuity for computer users

d) resemble traditional bifocal spectacle lenses

a) permit light from both near and far fields to enter the pupil simultaneously

Which of the following can be employed to limit rotation in soft toric lenses?

a) Friction of front surface markings

b) Peripheral curve design

c) Double slab-off thin zones

d) Anterior toricity

c) Double slab-off thin zones

To verify rigid contact lens power, most laboratories use:

a) a radiuscope

b) the back vertex method

c) the front vertex method

d) an ophthalmoscope

a) a radiuscope

If the base curve of a rigid contact lens was ordered as 7.80mm and the lens received measures 7.85mm the lens is:

a) 0.25 D flatter than ordered

b) 0.25 D steeper than ordered

c) 0.50 D flatter than ordered

d) 0.50 D steeper than ordered

a) 0.25 D flatter than ordered

Upon insertion, a well-fitting hydrogel lens is repeatedly ejected from the eye. The most likely cause of this problem is:

a) lens eversion

b) too-low Dk value

c) too-high water content

d) a thin lens edge

a) lens eversion

Diagnostic soft lenses in blister packs should be:

a) safe to use for 2 weeks beyond the expiration date

b) cleaned and placed in vials

c) heated if they are going to be reused

d) dispensed to the patient or discarded after use

d) dispensed to the patient or discarded after use

Evaluation instruments that touch patient's skin, lashes, or lenses should be wiped after each use with:

a) multipurpose solution

b) contact lens surfactant cleaner

c) contact lens disinfecting solution

d) isopropyl alcohol

d) isopropyl alcohol

Under the Fairness to Contact Lens Consumer Act, fee bundling of contact lenses, solutions, and fitting:

a) is no longer acceptable under any circumstance

b) is no longer acceptable; only lenses and solutions may be bundled

c) is no longer acceptable; only solutions and fittings may be bundled

d) is acceptable if the patient receives the prescription and has the option to purchase elsewhere

d) is acceptable if the patient receives the prescription and has the option to purchase elsewhere

When a practice dispenses the older solutions before the newer solutions, it is called:

a) first in, first out inventory

b) fixed asset inventory

c) economic order quantity inventory

d) safety stock inventory

a) first in, first out inventory

Which of the following is the primary function of ANSI?

a) Establishment of protective standards for safe and healthy working conditions

b) Development and publication of standards for many industries

c) Provision of technical assistance to employers and employees

d) Provision of guidelines for disposing of manufacturing wastes

b) Development and publication of standards for many industries

The Age Discrimination in Employment Act of 1967 prohibits the employment discrimination of persons over the age of:

a) 40

b) 55

c) 62

d) 67

a) 40

A patient has the following RX +14.50 Sph This RX is typical of which of the following conditions?

a) Hypertropia

b) Keratoconus

c) Emmetropia

d) Aphakia

d) Aphakia