NCLE Advanced Certification Exam Questions And
Answers Verified 100% Correct
The ANSWER is C.
To determine the parameters of a bitoric rigid lens, place the most plus (least
minus) power on the flattest meridian (-2.00 Don the 42.00 D meridian) and the
most minus (least plus) on the steepest meridian (-2.00 D plus an additional -5 .00
D, for a total of -7.00 Don the 45.25 D meridian). The -7.00 D must be vertexed,
which results in -6.50 D. Since we are fitting the lens "on K", the final lens
parameters are 42..25 -2.00/-6.50. - ANSWER -23. Given the following
information:
K's 42.00@180/45.25@90
Rx -2.00 -5.00 cx 180
Which of the following specifications, given in actual drum readings, would
represent a bitoric lens fit "on K"?
A. 42.00/45.25 -2.00 /-3.00
B. 42.00/45.25 -2.00 /-5.00
C. 42.00/45.25 -2.00 /-6.50
D. 42.00/45.25 -2.00 /-9.00
The ANSWER is A.
The only listed set of specifications that will give the patient a good visual result is
ANSWER A. In this case, the lens is fit 0.50 D flat in the horizontal meridian and
is 0.50 D flat in the vertical meridian. To determine the lens power, work with the
patient's refraction in minus cylinder and apply the principles of "SAM/FAP"
(Steep Add Minus, Flat Add Plus) to the sphere power only. In this case, the
flattest meridian was fit 0.50 D flatter, creating 0.50 D of minus power. To
compensate for this, 0.50 D of plus must be added to the -1.00D of sphere power in
the patient's Rx, resulting in -0.50D. The 3.000 of refractive cylinder is corrected
by the 2.00 D of cylinder on the posterior surface of the lens. Back surface toric
lenses will correct refractive cylinder that is 1 1/ 2 times the amount of cylinder on
its back surface. While all back surface toric lenses do not need to be fit 0.50 D flat
- ANSWER -24. Given the following patient information:
K's 41.25@.25@90
Rx -1.00 -3.00 cx 180
The best parameters for a back surface toric rigid gas permeable lens would be:
,A. 40.75/42.75 -0.50
B. 40.75/43.25 -1.00
C. 41.25/43.25 -4.00
D. 41.25/44.25 -1.00
25. The ANSWER is D.
A front surface toric lens will show clear mires in all meridians which indicates a
spherical posterior surface. Warped, bitoric and back surface toric lenses will all
show unclear mires in the radiuscope indicating that the posterior surface is not
spherical. In the lensometer, bitoric, back toric and front surface toric lenses will
all display sphero-cylindrical readings. Only the warped lens will show a spherical
lensometer reading. - ANSWER -25. When verifying the posterior curves of a rigid
gas permeable not all of the mires are clear
in all meridians. This can occur in all but a:
A. Warped lens
B. Bitoric lens
C. Back surface toric lens
D. Front surface toric lens
The ANSWER is D.
VLK, or Vascularized Limbal Keratitis, is a condition associated with rigid gas
permeable lenses, predominantly those lenses that are designed with low edge lifts
and large diameters. In its most advanced stage, a heaping of the corneal
epithelium in the area of irritation becomes evident. This area becomes
vascularized from the conjunctiva to the limbus leading to the elevated mass in the
area. Staining on the cornea and conjunctiva accompany patient symptoms which
may include reduced wearing time, redness, photophobia and in some instances,
pain. - ANSWER -26. Heaping of epithelium, vascularization, and staining of the
conjunctiva and cornea are characteristic of...
A. Corneal warpage
B. Gian papillary
C. Vascularized limbal keratitis
D. Dendritic keratitis
The ANSWER is D.
,When adding a spherical over-refraction to a bitoric lens, it must be added to both
meridians
Example:
-1.00 / -4.50
-1.00 / -1.00
-2.00 / -5.50 - ANSWER -27. Lens specifications in actual drum readings:
43.50/45.50 -1.00/-4.50 9.2 Over-refraction: -1.00 sphere
What is the new lens power?
A. plano/-3.50
B. -1.00/-5.50
C. -2.00/-4.50
D. -2.00/-5.50
The ANSWER is D.
Decreasing the height of the bifocal segment is the only option that will drop the
seg and alleviate the visual confusion caused by the segment bisecting the pupil.
All of the other options will move the bifocal segment further up into the line of
vision. - ANSWER -28. A translating bifocal wearer complains of blur at distance.
Upon slit lamp exam, you notice that the bifocal segment bisects the pupil. In order
to improve this situation, you should:
A. Increase the seg height
B. Decrease truncation
C. Decrease prism ballast
D. Decrease seg height
The ANSWER is B.
Dimple veil staining may occur when there is either a steeper or flatter than
recommended lens to cornea relationship. Air bubbles become trapped in the
excessive space and create dimples on the corneal surface. Antibiotics will not
affect dimple veil staining, nor will lenticulating the edges. Re-evaluating the lens
to cornea relationship will identify the problem and allow the fitter to change the
base curve and/ or peripheral curves to eliminate the dimples. - ANSWER -29.
Dimple veil staining is resolved by:
1. Antibiotics
2. Steepening the lens to cornea relationship
, 3. Flattening the lens to cornea relationship
4. Lenticulation
A. 1 and 2 are correct
B. 2 and 3 are correct
C. 1, 2 and 4 are correct
D. None of the above will resolve dimple veil staining
The ANSWER is B.
The Rose K, McGuire and Soper lenses are all designs specifically created for the
keratoconus eye, with steeper, smaller optical zone diameters and customized
peripheral curve systems to improve the fit on the unique corneal topography of a
keratoconic eye. - ANSWER -30. Rose K, McGuire and Soper are all different
types of which lens design?
A. Post-refractive surgery
B. Keratoconus
C. Torie
D. Aspheric
The term-28ANSWER is A.
An uncut rigid gas permeable lens has both the posterior and anterior surface cut
and polished. It does not have a peripheral curve system, or a final diameter. The
subsequent steps in lens fabrication would be to reduce the lens to within a 1/ 10 of
a millimeter of its projected finished diameter, apply the posterior peripheral
curves, bevel the front edge and round and taper the edges. - ANSWER -31. An
uncut rigid gas permeable contact lens will have the following:
A. Both sides surfaced
B. One side surfaced
C. Semi-finished blank
D. One side molded
The ANSWER is C.
VascularizedUmbal Keratitis (VLK)is believed to be caused mainly by large
diameter rigid gas permeable lenses with low edge lifts. These lenses chafe the
epithelium in the limbal area in the three and nine o' dock areas, The tear film in
Answers Verified 100% Correct
The ANSWER is C.
To determine the parameters of a bitoric rigid lens, place the most plus (least
minus) power on the flattest meridian (-2.00 Don the 42.00 D meridian) and the
most minus (least plus) on the steepest meridian (-2.00 D plus an additional -5 .00
D, for a total of -7.00 Don the 45.25 D meridian). The -7.00 D must be vertexed,
which results in -6.50 D. Since we are fitting the lens "on K", the final lens
parameters are 42..25 -2.00/-6.50. - ANSWER -23. Given the following
information:
K's 42.00@180/45.25@90
Rx -2.00 -5.00 cx 180
Which of the following specifications, given in actual drum readings, would
represent a bitoric lens fit "on K"?
A. 42.00/45.25 -2.00 /-3.00
B. 42.00/45.25 -2.00 /-5.00
C. 42.00/45.25 -2.00 /-6.50
D. 42.00/45.25 -2.00 /-9.00
The ANSWER is A.
The only listed set of specifications that will give the patient a good visual result is
ANSWER A. In this case, the lens is fit 0.50 D flat in the horizontal meridian and
is 0.50 D flat in the vertical meridian. To determine the lens power, work with the
patient's refraction in minus cylinder and apply the principles of "SAM/FAP"
(Steep Add Minus, Flat Add Plus) to the sphere power only. In this case, the
flattest meridian was fit 0.50 D flatter, creating 0.50 D of minus power. To
compensate for this, 0.50 D of plus must be added to the -1.00D of sphere power in
the patient's Rx, resulting in -0.50D. The 3.000 of refractive cylinder is corrected
by the 2.00 D of cylinder on the posterior surface of the lens. Back surface toric
lenses will correct refractive cylinder that is 1 1/ 2 times the amount of cylinder on
its back surface. While all back surface toric lenses do not need to be fit 0.50 D flat
- ANSWER -24. Given the following patient information:
K's 41.25@.25@90
Rx -1.00 -3.00 cx 180
The best parameters for a back surface toric rigid gas permeable lens would be:
,A. 40.75/42.75 -0.50
B. 40.75/43.25 -1.00
C. 41.25/43.25 -4.00
D. 41.25/44.25 -1.00
25. The ANSWER is D.
A front surface toric lens will show clear mires in all meridians which indicates a
spherical posterior surface. Warped, bitoric and back surface toric lenses will all
show unclear mires in the radiuscope indicating that the posterior surface is not
spherical. In the lensometer, bitoric, back toric and front surface toric lenses will
all display sphero-cylindrical readings. Only the warped lens will show a spherical
lensometer reading. - ANSWER -25. When verifying the posterior curves of a rigid
gas permeable not all of the mires are clear
in all meridians. This can occur in all but a:
A. Warped lens
B. Bitoric lens
C. Back surface toric lens
D. Front surface toric lens
The ANSWER is D.
VLK, or Vascularized Limbal Keratitis, is a condition associated with rigid gas
permeable lenses, predominantly those lenses that are designed with low edge lifts
and large diameters. In its most advanced stage, a heaping of the corneal
epithelium in the area of irritation becomes evident. This area becomes
vascularized from the conjunctiva to the limbus leading to the elevated mass in the
area. Staining on the cornea and conjunctiva accompany patient symptoms which
may include reduced wearing time, redness, photophobia and in some instances,
pain. - ANSWER -26. Heaping of epithelium, vascularization, and staining of the
conjunctiva and cornea are characteristic of...
A. Corneal warpage
B. Gian papillary
C. Vascularized limbal keratitis
D. Dendritic keratitis
The ANSWER is D.
,When adding a spherical over-refraction to a bitoric lens, it must be added to both
meridians
Example:
-1.00 / -4.50
-1.00 / -1.00
-2.00 / -5.50 - ANSWER -27. Lens specifications in actual drum readings:
43.50/45.50 -1.00/-4.50 9.2 Over-refraction: -1.00 sphere
What is the new lens power?
A. plano/-3.50
B. -1.00/-5.50
C. -2.00/-4.50
D. -2.00/-5.50
The ANSWER is D.
Decreasing the height of the bifocal segment is the only option that will drop the
seg and alleviate the visual confusion caused by the segment bisecting the pupil.
All of the other options will move the bifocal segment further up into the line of
vision. - ANSWER -28. A translating bifocal wearer complains of blur at distance.
Upon slit lamp exam, you notice that the bifocal segment bisects the pupil. In order
to improve this situation, you should:
A. Increase the seg height
B. Decrease truncation
C. Decrease prism ballast
D. Decrease seg height
The ANSWER is B.
Dimple veil staining may occur when there is either a steeper or flatter than
recommended lens to cornea relationship. Air bubbles become trapped in the
excessive space and create dimples on the corneal surface. Antibiotics will not
affect dimple veil staining, nor will lenticulating the edges. Re-evaluating the lens
to cornea relationship will identify the problem and allow the fitter to change the
base curve and/ or peripheral curves to eliminate the dimples. - ANSWER -29.
Dimple veil staining is resolved by:
1. Antibiotics
2. Steepening the lens to cornea relationship
, 3. Flattening the lens to cornea relationship
4. Lenticulation
A. 1 and 2 are correct
B. 2 and 3 are correct
C. 1, 2 and 4 are correct
D. None of the above will resolve dimple veil staining
The ANSWER is B.
The Rose K, McGuire and Soper lenses are all designs specifically created for the
keratoconus eye, with steeper, smaller optical zone diameters and customized
peripheral curve systems to improve the fit on the unique corneal topography of a
keratoconic eye. - ANSWER -30. Rose K, McGuire and Soper are all different
types of which lens design?
A. Post-refractive surgery
B. Keratoconus
C. Torie
D. Aspheric
The term-28ANSWER is A.
An uncut rigid gas permeable lens has both the posterior and anterior surface cut
and polished. It does not have a peripheral curve system, or a final diameter. The
subsequent steps in lens fabrication would be to reduce the lens to within a 1/ 10 of
a millimeter of its projected finished diameter, apply the posterior peripheral
curves, bevel the front edge and round and taper the edges. - ANSWER -31. An
uncut rigid gas permeable contact lens will have the following:
A. Both sides surfaced
B. One side surfaced
C. Semi-finished blank
D. One side molded
The ANSWER is C.
VascularizedUmbal Keratitis (VLK)is believed to be caused mainly by large
diameter rigid gas permeable lenses with low edge lifts. These lenses chafe the
epithelium in the limbal area in the three and nine o' dock areas, The tear film in
