Master Accommodation mcq & Presbyopia with this comprehensive set of Ophthalmology and Optometry MCQs (Q41–80), including answers and concise explanations. Covers AC/A ratio, Donder’s rule, near addition by age, presbyopia correction, bifocal and trifocal lenses, progressive addition lenses (PALs), and clinical optics of presbyopia. Ideal for Optometry students, AIIMS, RRB, and competitive exam preparation.
Measurement of Accommodation
41. Push-down test measures:
A. Range of accommodation
B. Near point of accommodation
C. AC/A ratio
D. Pupillary reflex
View Answer
B. Near point of accommodation ✅ Exp: Similar to push-up, but object moved away until clear.
42. Donder’s rule is applied in:
A. Presbyopia correction
B. Myopia correction
C. Astigmatism testing
D. Accommodation amplitude
View Answer
A. Presbyopia correction ✅ Exp: Based on keeping half the amplitude in reserve.
43. Near addition is calculated by:
A. Age chart
B. Trial lenses only
C. Retinoscopy only
D. Keratometry
View Answer
A. Age chart ✅ Exp: Standard charts give near add by age.
44. Near point decreases with:
A. Age
B. Myopia
C. Accommodation
D. Hypermetropia
View Answer
A. Age ✅ Exp: With age, near point recedes due to reduced amplitude.
45. Far point in emmetropic presbyope is:
A. Infinity
B. 25 cm
C. 50 cm
D. Behind retina
View Answer
A. Infinity ✅ Exp: Far point remains at infinity.
AC/A Ratio & Clinical Significance
46. Normal AC/A ratio is about:
A. 1:1B. 2–6:1
C. 8–10:1
D. No standard
View Answer
B. 2–6:1 ✅ Exp: Accommodative convergence per diopter of accommodation.
47. High AC/A ratio is associated with:
A. Convergence excess esotropia
B. Exophoria
C. Divergence paralysis
D. Myopia
View Answer
A. Convergence excess esotropia ✅ Exp: Excessive convergence for near.
48. Low AC/A ratio is associated with:
A. Exophoria / convergence insufficiency
B. Esotropia
C. Presbyopia
D. Hypermetropia
View Answer
A. Exophoria / convergence insufficiency ✅ Exp: Poor convergence response to accommodation.
49. Gradient method is used to measure:
A. Amplitude of accommodation
B. AC/A ratio
C. IOP
D. Retinal disparity
View Answer
B. AC/A ratio ✅ Exp: AC/A measured using plus/minus lens changes.
50. Stimulus AC/A ratio is measured using:
A. Phoropter lenses
B. Synoptophore
C. Keratometer
D. Retinoscope
View Answer
A. Phoropter lenses ✅ Exp: Lens-induced accommodation tests AC/A.
Presbyopia Correction – Special Cases
51. Early presbyopia correction is needed in:
A. Hypermetropia
B. Myopia
C. Astigmatism
D. Emmetropia
View Answer
A. Hypermetropia ✅ Exp: Hyperopes already using accommodation.
52. Delayed presbyopia correction is seen in:
A. Myopia
B. Hypermetropia
C. Aphakia
D. Glaucoma
View Answer
A. Myopia ✅ Exp: Myopes remove glasses for near.
53. Presbyopia appears earlier in:
A. Women
B. Men
C. Equal in both
D. Children only
View Answer
A. Women ✅ Exp: Slight earlier onset in women reported.
54. Presbyopia onset is earlier in:
A. Diabetes mellitus
B. Hypertension
C. Glaucoma
D. Cataract
View Answer
A. Diabetes mellitus ✅ Exp: DM accelerates lenticular sclerosis.
55. Presbyopia correction in uncorrected –2 D myope:
A. No addition needed for near
B. +1 D add
C. +2 D add
D. Always bifocals
View Answer
A. No addition needed for near ✅ Exp: –2 D myope can read at 50 cm unaided.
Special Lens Designs
56. Bifocal lenses have:
A. Two optical centers
B. Two focal lengths
C. One focal length
D. No optical center
View Answer
B. Two focal lengths ✅ Exp: One for distance, one for near.
57. Trifocal lenses add correction for:
A. Near only
B. Intermediate vision
C. Astigmatism
D. Presbyopia only
View Answer
B. Intermediate vision ✅ Exp: 3 zones: distance, intermediate, near.
58. PAL (progressive addition lenses) eliminate:
A. Visible segment line
B. Peripheral distortion
C. Image
D. Presbyopia
View Answer
A. Visible segment line ✅ Exp: Smooth power transition without visible line.
59. Executive bifocals disadvantage:
A. Heavy, thick lens
B. Narrow near zone
C. Poor cosmetics only
D. Peripheral distortion
View Answer
A. Heavy, thick lens ✅ Exp: Large near segment adds weight.
60. Cemented bifocals disadvantage:
A. Fragile junction
B. Too heavy
C. No near correction
D. Poor vision
View Answer
A. Fragile junction ✅ Exp: Junction prone to breakage.
Clinical Optics of Presbyopia
61. Presbyopia reduces:
A. Far point
B. Amplitude of accommodation
C. Axial length
D. Corneal power
View Answer
B. Amplitude of accommodation ✅ Exp: Amplitude declines with age → near blur.
62. Presbyopia is a:
A. Refractive error
B. Age-related physiological condition
C. Pathological error
D. Muscle weakness
View Answer
B. Age-related physiological condition ✅ Exp: Physiological age-related decline.
63. Absolute presbyopia means:
A. Fully corrected
B. No accommodation left
C. Early presbyopia
D. Excessive presbyopia
View Answer
B. No accommodation left ✅ Exp: Zero accommodation amplitude.
64. Incipient presbyopia means:
A. Onset stage
B. Fully developed
C. No correction needed
D. Pathological only
View Answer
A. Onset stage ✅ Exp: Initial symptoms, early stage.
65. Amplitude of accommodation in incipient presbyopia:
A. >5 D
B. 3–4 D
C. 0 D
D. 8–10 D
View Answer
B. 3–4 D ✅ Exp: Still some amplitude present.
Practical Additions & Tests
66. Near add for 40-year-old:
A. +0.50 D
B. +1.00 D
C. +2.00 D
D. +3.00 D
View Answer
B. +1.00 D ✅ Exp: Standard guideline.
67. Near add for 45-year-old:
A. +0.50 D
B. +1.50 D
C. +2.50 D
D. +3.00 D
View Answer
B. +1.50 D ✅ Exp: Gradual increase per age.
68. Near add for 55-year-old:
A. +1.50 D
B. +2.50 D
C. +1.00 D
D. +3.50 D
View Answer
B. +2.50 D ✅ Exp: At 55, ~+2.50 D add.
69. Near add for 60-year-old:
A. +2.50 D
B. +3.00 D
C. +3.50 D
D. +4.00 D
View Answer
B. +3.00 D ✅ Exp: Complete presbyopia → +3.00 D.
70. Presbyopia correction in hypermetropic 40-year-old may require:
A. +1.00 D
B. +2.00 D
C. 0 D
D. –1.00 D
View Answer
B. +2.00 D ✅ Exp: Hyperopes need more plus than emmetropes.
71. Accommodation reflex is lost in:
A. Argyll Robertson pupil
B. Holmes-Adie pupil
C. Horner’s syndrome
D. RAPD
View Answer
A. Argyll Robertson pupil ✅ Exp: AR pupil → light-near dissociation.
72. Light reflex absent, near reflex present in:
A. Argyll Robertson pupil
B. Horner’s syndrome
C. Optic neuritis
D. RAPD
View Answer
A. Argyll Robertson pupil ✅ Exp: Classic light-near dissociation.
73. Presbyopia correction with contact lenses:
A. Monovision technique
B. Always bifocal CLs only
C. Not possible
D. Requires IOLs
View Answer
A. Monovision technique ✅ Exp: One eye distance, other near.
74. Multifocal contact lenses are designed for:
A. Myopia only
B. Presbyopia correction
C. Astigmatism
D. Aphakia
View Answer
B. Presbyopia correction ✅ Exp: Provide distance + near correction.
75. Presbyopia correction in unilateral aphakia:
A. Spectacles
B. Contact lenses
C. No correction
D. Prism lenses
View Answer
B. Contact lenses ✅ Exp: CLs prevent aniseikonia in one eye.
76. Accommodation decreases steadily from:
A. Birth
B. 10 years
C. 20 years
D. 40 years
View Answer
A. Birth ✅ Exp: Decline begins early, symptomatic at 40.
77. Presbyopia is essentially:
A. Lens sclerosis
B. Ciliary weakness
C. Vitreous liquefaction
D. Corneal flattening
View Answer
A. Lens sclerosis ✅ Exp: Lens loses elasticity with age.
78. Near point in presbyopia lies:
A. Farther away
B. At 25 cm
C. At infinity
D. At 1 m always
View Answer
A. Farther away ✅ Exp: Near point recedes as amplitude falls.
79. Dynamic retinoscopy in presbyopes shows:
A. Lag of accommodation
B. Lead of accommodation
C. Normal response
D. None
View Answer
A. Lag of accommodation ✅ Exp: Reduced accommodative response.
80. Presbyopia is corrected for near work at:
A. 25 cm working distance
B. 50 cm
C. Infinity
D. 1 m
View Answer
A. 25 cm working distance ✅ Exp: Standard reading distance used for correction.
