AOA Low Vision and Geriatric Optometry 1 — Questions and Answers
Question 1: Legal blindness in the United States is defined as best-corrected visual acuity of:
- 20/200 or worse in the better eye, or visual field ≤20° (Correct answer)
- 20/400 or worse in both eyes
- Less than 20/100 in the worse eye
- 20/200 in one eye regardless of the fellow eye
Correct answer: 20/200 or worse in the better eye, or visual field ≤20°
US legal blindness is BCVA ≤20/200 in the better-seeing eye OR a remaining visual field of ≤20° diameter (central island or tunnel vision).
Question 2: The most common cause of irreversible vision loss in Americans over age 65 is:
- Age-related macular degeneration (Correct answer)
- Glaucoma
- Diabetic retinopathy
- Cataracts
Correct answer: Age-related macular degeneration
AMD is the leading cause of irreversible (non-correctable) vision loss in adults over 65 in the United States, primarily affecting central vision.
Question 3: When prescribing reading glasses for a presbyopic patient in their 70s, the optometrist should expect the full near add to be approximately:
- +2.50 to +3.00 D for a 40 cm working distance (Correct answer)
- +1.00 D for any working distance
- +4.00 D for computer distance only
- +1.50 D regardless of working distance
Correct answer: +2.50 to +3.00 D for a 40 cm working distance
By the mid-60s most patients have lost all functional accommodation; a +2.50 D add is needed for the standard 40 cm reading distance, potentially adjusted for the patient's preferred working distance.
Question 4: Contrast sensitivity testing is important in geriatric optometry because:
- It detects functional vision loss not captured by Snellen acuity (Correct answer)
- It measures the amplitude of accommodation accurately
- It screens for color blindness in elderly patients
- It determines the need for anti-reflective coatings only
Correct answer: It detects functional vision loss not captured by Snellen acuity
Contrast sensitivity (CS) decline is common in aging and early cataracts/AMD and can significantly impair functional vision even when Snellen acuity is near-normal.
Question 5: Which optical low vision device provides the highest magnification but requires the shortest working distance?
- High-plus microscopic spectacles (Correct answer)
- Telemicroscope
- Handheld magnifier
- Bar magnifier
Correct answer: High-plus microscopic spectacles
High-plus microscopic spectacle lenses (e.g., +20D) provide high magnification but require very short working distances (5 cm for +20D), limiting their practical use.
Question 6: Driving cessation recommendations for visually impaired elderly patients should include which statement?
- Patients with BCVA worse than 20/40 in the better eye typically do not meet US driving standards (Correct answer)
- All patients over age 75 should stop driving regardless of visual acuity
- Night driving is acceptable as long as daytime acuity is 20/20
- Monocular patients with 20/20 in one eye have no driving restrictions
Correct answer: Patients with BCVA worse than 20/40 in the better eye typically do not meet US driving standards
Most US state driving standards require minimum acuity of 20/40 in the better eye; patients below this threshold should be counseled about driving cessation and alternative transportation.
AOA Low Vision and Geriatric Optometry 1
Legal blindness in the United States is defined as best-corrected visual acuity of: