Explore 40 unique Pediatric Clinical Refraction MCQ of Optometry (Q391–430) topic Optometry & Ophthalmology. Includes verified answers and short explanations covering pediatric refraction, pseudophakia, LASIK, IOL power, anisometropia, and presbyopia. Perfect for optometry students, AIIMS, and NBEO exam preparation. MCQ of optometry
391. In a 6-year-old child with accommodative esotropia, the initial management should include:
A. Prism therapy
B. Full cycloplegic correction of hypermetropia
C. Under-correction of hypermetropia
D. Immediate strabismus surgery
View Answer
B. Full cycloplegic correction of hypermetropia ✅ Exp: Full cycloplegic plus corrects accommodation and often reduces the esotropia.
392. For infants, the preferred method to estimate refractive error without full cycloplegia is:
A. Subjective refraction
B. Mohindra retinoscopy
C. Autorefraction only
D. JCC testing
View Answer
B. Mohindra retinoscopy ✅ Exp: Mohindra retinoscopy in dark room is used for infants/toddlers as a near retinoscopy method.
393. In pediatric refraction, atropine cycloplegia is preferred over tropicamide when:
A. Short duration cycloplegia is desired
B. Latent hypermetropia is suspected and strong cycloplegia is needed
C. The child is over 40 years
D. Myopia is the concern
View Answer
B. Latent hypermetropia is suspected and strong cycloplegia is needed ✅ Exp: Atropine gives maximal, long-acting cycloplegia useful to uncover latent hyperopia.
394. When prescribing full hypermetropic correction to a child, the main goals are:
A. Cosmetic appearance only
B. Prevent accommodative esotropia and amblyopia
C. Increase myopia risk
D. Reduce corneal curvature
View Answer
B. Prevent accommodative esotropia and amblyopia ✅ Exp: Full correction reduces accommodation/convergence effort, preventing squint and amblyopia.
395. In a case of unilateral high hypermetropia in a child, best immediate step is:
A. Under-correct to encourage fusion
B. Full cycloplegic correction and amblyopia therapy if needed
C. Observation only
D. Contact lens fitting only in adults
View Answer
B. Full cycloplegic correction and amblyopia therapy if needed ✅ Exp: Full Rx and amblyopia treatment (patching) are indicated to optimize vision.
MCQ of optometry
396. In post-cataract pseudophakic refraction, the manifest refraction often shows:
A. Large accommodative amplitude
B. A need for near add due to loss of accommodation
C. Severe myopic shift always
D. No need for spectacles ever
View Answer
B. A need for near add due to loss of accommodation ✅ Exp: After IOL implantation, accommodation is lost and near add is usually required.
397. After uncomplicated cataract surgery with monofocal IOL aiming for emmetropia, the patient typically needs:
A. Distance glasses only
B. Reading glasses for near tasks
C. No glasses at all for distance or near
D. High plus spectacles
View Answer
B. Reading glasses for near tasks ✅ Exp: Monofocal IOL corrects distance; patients require near add for close work.
398. The effective IOL power calculation post-keratorefractive surgery is challenging because:
A. Axial length changes drastically after LASIK
B. Anterior corneal radius no longer reflects true corneal power
C. Pupil size changes permanently
D. Retina curvature alters
View Answer
B. Anterior corneal radius no longer reflects true corneal power ✅ Exp: LASIK/PRK alter anterior corneal curvature so keratometry often underestimates true corneal power.
399. In a patient with previous LASIK, the surgeon’s planned IOL power should be calculated using:
A. Standard SRK-II only
B. Special post-LASIK formulas (e.g., Barrett True-K)
C. No formula necessary
D. Retinoscopy only
View Answer
B. Special post-LASIK formulas (e.g., Barrett True-K) ✅ Exp: Special formulas account for altered corneal power and give more accurate IOL power.
400. Aphakic spectacles cause aniseikonia because:
A. They reduce axial length
B. High plus spectacle lenses significantly magnify retinal image size
C. They are lightweight
D. They correct astigmatism poorly
View Answer
B. High plus spectacle lenses significantly magnify retinal image size ✅ Exp: High plus lenses are far from eye, producing large retinal image magnification.
MCQ of optometry
401. Best optical correction for unilateral aphakia in a cooperative adult is:
A. Spectacles only
B. Contact lens or secondary IOL (to minimize aniseikonia)
C. Small add spectacles
D. Prism spectacle
View Answer
B. Contact lens or secondary IOL (to minimize aniseikonia) ✅ Exp: Contact lens or IOL minimizes image size difference (aniseikonia) vs high plus spectacles.
402. When converting spectacle Rx to contact lens power (for high astigmatism), which is TRUE:
A. The same power is always used
B. Vertex distance and back-vertex formulas must be considered
C. Cylinder sign is inverted automatically
D. Axis is irrelevant
View Answer
B. Vertex distance and back-vertex formulas must be considered ✅ Exp: Vertex effects change effective power; formula conversion needed especially for high powers.
403. For a −8.00 D spectacle wearer switching to contact lens, the contact lens power will be:
A. More negative than −8.00 D
B. Less negative in absolute value (closer to zero) than −8.00 D
C. Exactly −8.00 D
D. Plus power instead
View Answer
B. Less negative in absolute value (closer to zero) than −8.00 D ✅ Exp: Contact lens sits at corneal plane; spectacle to corneal plane conversion reduces required minus power magnitude.
404. In pseudophakia with toric IOL, residual astigmatism after rotation is best corrected by:
A. Increasing plus sphere
B. Rotating the IOL to proper axis or corneal refractive surgery
C. Adding prism base-in
D. Contact lens only
View Answer
B. Rotating the IOL to proper axis or corneal refractive surgery ✅ Exp: Toric IOL alignment is critical; rotation correction or corneal procedure addresses residual cylinder.
405. An example of index myopia is seen in:
A. Keratoconus
B. Nuclear sclerosis cataract
C. Axial elongation in youth
D. Presbyopia
View Answer
B. Nuclear sclerosis cataract ✅ Exp: Nuclear sclerosis increases lens refractive index causing myopic shift (index myopia).
MCQ of optometry
406. In early nuclear sclerosis, patients often experience improved near vision due to:
A. Increased axial length
B. Index myopia (myopic shift)
C. Pupil constriction
D. Corneal flattening
View Answer
B. Index myopia (myopic shift) ✅ Exp: Lens nucleus hardening increases refractive index and adds myopic power, improving near VA.
407. Pseudomyopia due to ciliary spasm is best differentiated from true myopia by:
A. Subjective history only
B. Cycloplegic refraction showing reduction of myopia
C. Keratometry reading
D. Fundus exam
View Answer
B. Cycloplegic refraction showing reduction of myopia ✅ Exp: Cycloplegia removes accommodative spasm; refractive error reduces in pseudomyopia.
408. Persistent residual refractive error after cataract surgery may be due to:
A. Incorrect axial length measurement, wrong keratometry, or IOL constant error
B. Myopia only
C. Lens subluxation only
D. Corneal infection
View Answer
A. Incorrect axial length measurement, wrong keratometry, or IOL constant error ✅ Exp: Preop biometry/keratometry inaccuracies or IOL constants lead to refractive surprises.
409. When prescribing near add for pseudophakic patient, the add is calculated based on:
A. Desired working distance and residual distance Rx
B. Corneal curvature only
C. Axial length only
D. Pupil diameter
View Answer
A. Desired working distance and residual distance Rx ✅ Exp: Near add = required near power considering residual distance Rx and working distance.
410. In high myopia (e.g., −12 D), spectacle correction causes which optical issue most likely:
A. Image magnification
B. Ring scotoma and peripheral field restriction
C. Better night vision
D. Reduced distortion
View Answer
B. Ring scotoma and peripheral field restriction ✅ Exp: High minus spectacles cause ring scotoma and narrow field due to edge effects and minification.
MCQ of optometry
411. To calculate spectacle magnification change when moving from spectacle to contact lens, you must consider:
A. Only spherical equivalent
B. Vertex distance and power (effective power change)
C. Only PD
D. Only cylinder power
View Answer
B. Vertex distance and power (effective power change) ✅ Exp: Magnification varies with lens power and distance from eye (vertex).
412. The term “Jack-in-the-box” phenomenon describes:
A. Sudden diplopia with prism
B. Ring scotoma in high plus aphakic spectacles
C. Myopic shift in dim light
D. Sudden IOP rise
View Answer
B. Ring scotoma in high plus aphakic spectacles ✅ Exp: High plus spectacles in aphakia create peripheral ring scotoma that can ‘pop’ into peripheral vision.
413. A patient with irregular corneal astigmatism and poor acuity despite best spectacles should be trialed with:
A. Soft toric lenses
B. Rigid gas-permeable (RGP) lenses
C. Progressive spectacles
D. High plus spectacles
View Answer
B. Rigid gas-permeable (RGP) lenses ✅ Exp: RGP lenses mask irregular corneal surface and restore a more regular refracting surface.
414. After PRK, a patient complains of fluctuating refraction during healing — the correct counsel is:
A. Immediate spectacle change is recommended
B. Wait for epithelial remodeling (several weeks to months) before permanent Rx
C. Switch to contact lenses immediately
D. Expect immediate stable refraction
View Answer
B. Wait for epithelial remodeling (several weeks to months) before permanent Rx ✅ Exp: Corneal healing causes variable refraction; wait until stable for final prescription.
415. For post-LASIK retreatment (enhancement), minimum recommended residual stromal bed is:
A. >100 µm
B. >250 µm
C. >50 µm
D. Any depth acceptable
View Answer
B. >250 µm ✅ Exp: To avoid ectasia, conservative residual stromal thickness (commonly >250 µm) is recommended.
MCQ of optometry
416. When measuring refraction immediately after corneal cross-linking (CXL) for keratoconus, one should:
A. Prescribe final glasses immediately
B. Prefer temporary correction and reassess after corneal stabilization
C. Assume no change in refraction
D. Remove all correction
View Answer
B. Prefer temporary correction and reassess after corneal stabilization ✅ Exp: Corneal remodeling occurs after CXL; wait for stability before final Rx.
417. The term “effective addition” for near in multifocal IOL patients means:
A. Total lens power only
B. The practical near addition experienced by patient depends on IOL design and pupil size
C. The lens constant only
D. The axial length only
View Answer
B. The practical near addition experienced by patient depends on IOL design and pupil size ✅ Exp: Multifocal IOL actual near effect varies with pupil and optical design — “effective add” is functional.
418. In a child with suspected refractive amblyopia, the minimum follow-up after full correction to assess response is:
A. 1 day
B. 4–6 weeks
C. 1 year
D. 2 years
View Answer
B. 4–6 weeks ✅ Exp: Allow several weeks of optical correction and possible occlusion therapy before assessing improvement.
419. The best modality to quantify small residual cylinder in a pseudophakic patient who cannot cooperate with subjective testing is:
A. Keratometry and topography combined with retinoscopy under cycloplegia
B. Subjective JCC only
C. Snellen chart only
D. Pinhole test
View Answer
A. Keratometry and topography combined with retinoscopy under cycloplegia ✅ Exp: Objective measurements plus retinoscopy provide reliable estimate when subjective testing not possible.
420. When prescribing for unstable refraction due to fluctuating tear film, ideal initial management is:
A. Immediate spectacle Rx change
B. Treat ocular surface disease (e.g., lubricants) and reassess refraction
C. Prescribe contact lenses immediately
D. Refer for surgery
View Answer
B. Treat ocular surface disease (e.g., lubricants) and reassess refraction ✅ Exp: Tear film instability produces variable refraction; treat surface first for stable measurements.
MCQ of optometry
421. The spectacle change rule “reduce plus by 0.50 D if patient complains of distance blur after new Rx” is based on:
A. Immediate acceptance only
B. Principle of “maximum plus for best VA” and patient tolerance
C. Retinoscopy only
D. Keratometry
View Answer
B. Principle of “maximum plus for best VA” and patient tolerance ✅ Exp: Small reductions in plus can alleviate over-plussing symptoms while maintaining adequate acuity.
422. In severe anisometropia causing symptomatic aniseikonia, surgical options include:
A. Corneal refractive surgery on one eye to balance image sizes
B. Prescribe plus lenses only
C. Use single pair of spectacles always
D. Reduce PD only
View Answer
A. Corneal refractive surgery on one eye to balance image sizes ✅ Exp: Surgical refractive correction (e.g., LASIK, IOL exchange) can help equalize spectacle magnification.
423. For near addition in presbyopes who habitually read at 40 cm, the needed add approximates:
A. +1.00 D
B. +2.50 D
C. +0.50 D
D. +4.00 D
View Answer
B. +2.50 D ✅ Exp: Near demand = 1 / 0.4 m = +2.50 D; add adjusted for residual accommodation.
424. A 45-year-old hypermetrope with +3.00 D residual hyperopia will likely need near add of approximately:
A. +0.50 D
B. +1.50 to +2.00 D depending on residual accommodation
C. +4.00 D
D. −1.00 D
View Answer
B. +1.50 to +2.00 D depending on residual accommodation ✅ Exp: Hypermetrope uses accommodation; required add depends on how much accommodation remains.
425. In clinical practice, when prescribing for occupational tasks (microsurgery), consider:
A. Only distance vision
B. Specific working distance, binocular comfort, and depth of focus
C. Cosmetic appearance only
D. Ignore PD
View Answer
B. Specific working distance, binocular comfort, and depth of focus ✅ Exp: Task-specific Rx tailored to working distance optimizes performance and comfort.
MCQ of optometry
426. When converting from plus cylinder to minus cylinder notation, the sphere:
A. Remains unchanged
B. Sphere is changed by adding the cylinder power to the sphere
C. Cylinder sign stays same
D. Axis reduced by 45°
View Answer
B. Sphere is changed by adding the cylinder power to the sphere ✅ Exp: Transposition: New sphere = old sphere + cylinder; new cylinder = −old cylinder; axis + 90°.
427. In presbyopic patients, monovision contact lens fitting aims to:
A. Give both eyes same power
B. Correct one eye for distance and the other for near (trade-off between binocular stereopsis)
C. Eliminate need for near add always
D. Increase accommodation
View Answer
B. Correct one eye for distance and the other for near (trade-off between binocular stereopsis) ✅ Exp: Monovision sacrifices some stereopsis for spectacle independence.
428. For a patient with residual anisometropic amblyopia, best long-term visual rehabilitation includes:
A. Only spectacle correction
B. Full optical correction + occlusion therapy + vision therapy
C. Immediate refractive surgery in children
D. Ignore amblyopic eye
View Answer
B. Full optical correction + occlusion therapy + vision therapy ✅ Exp: Multimodal approach yields best outcomes; surgery considered later in select cases.
429. A patient with residual refractive error after corneal transplant commonly has:
A. Regular astigmatism only
B. Irregular and high astigmatism often requiring RGP or further surgery
C. No visual symptoms
D. Simple myopia easily corrected with spectacles
View Answer
B. Irregular and high astigmatism often requiring RGP or further surgery ✅ Exp: Post-keratoplasty irregular astigmatism is common; RGP or suture adjustment may help.
430. In clinical refraction, the principal benefit of trial contact lens over spectacles for high refractive errors is:
A. Increased weight of correction
B. Elimination of vertex distance effects leading to better visual acuity and less aniseikonia
C. Always cheaper solution
D. Immediate permanent correction
View Answer
B. Elimination of vertex distance effects leading to better visual acuity and less aniseikonia ✅ Exp: Contact lens at corneal plane reduces minification/magnification and prismatic effects, improving optics.
MCQ of optometry
