Free Laser and Surgical Procedures Examination (LSPE) — Laser Section Practice Questions

Sample Practice Questions

Try these 10 sample questions from the Laser and Surgical Procedures Examination (LSPE) — Laser Section practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1A 62-year-old patient has an intraocular pressure of 26 mmHg, glaucomatous optic disc cupping with a matching arcuate field defect, and an angle open to the ciliary body band for 360 degrees on gonioscopy. Under the indications for use FDA has cleared for slit-lamp laser systems operating in trabeculoplasty mode, which condition is selective laser trabeculoplasty intended to treat?

   1. A. Chronic open-angle glaucoma in an eye with an open angle
   2. B. Acute angle-closure glaucoma in an eye with pupillary block
   3. C. Neovascular glaucoma in an eye with new vessels on the iris
   4. D. Congenital glaucoma in an infant with an immature angle

   Answer: A

   Explanation: The FDA-cleared principle of operation for combined slit-lamp YAG/SLT systems states that the SLT mode is used for "Selective Laser Trabeculoplasty (SLT mode) for the treatment of chronic open angle glaucoma." This patient's angle is open on gonioscopy and the diagnosis is chronic open-angle glaucoma, so the eye falls within the cleared trabeculoplasty indication. Pupillary block angle closure is addressed by the photodisruption mode, whose cleared indications are iridotomy and iridectomy, not trabeculoplasty.

   Reference: FDA K 212630 Ellex — 510(k) K212630 Summary, section V Device Technological characteristics and section VII Indications for Use

2. 2A patient presents with severe eye pain, nausea, a red eye and blurred vision, and the pressure is 52 mmHg with a very shallow anterior chamber. What is the anatomical event that defines this type of glaucoma and makes an iris opening the logical treatment?

   1. A. The outer edge of the iris blocks fluid from draining out of the front of the eye
   2. B. Pigment shed from the back of the iris settles on and clogs the drainage tissue
   3. C. New blood vessels grow across the face of the drainage tissue and seal it shut
   4. D. Extra fibrillar material is deposited on ocular structures and blocks the drainage

   Answer: A

   Explanation: The National Eye Institute describes this presentation and states that "In this type of glaucoma, the outer edge of the iris (the colored part of your eye) blocks fluid from draining out of the front of the eye. The fluid builds up quickly, causing a sudden increase in eye pressure." Because the obstruction is the iris itself, an opening made through the peripheral iris addresses it. Pigment shedding, new vessel growth and exfoliative deposits are the mechanisms of three other named glaucomas in which the iris is not the obstructing structure.

   Reference: Types of Glaucoma | National Eye Institute — Types of Glaucoma, 'Angle-closure glaucoma' entry

3. 3A pseudophakic patient whose vision was excellent after cataract surgery two years ago now reports gradually blurred, hazy vision with glare, and the view of the fundus is misty behind the implant. What has developed?

   1. A. A secondary cataract, that is posterior capsule opacification
   2. B. A recurrent nuclear cataract within the residual lens material
   3. C. A corneal endothelial decompensation with stromal oedema
   4. D. A pigment deposit on the front surface of the implanted lens

   Answer: A

   Explanation: The National Eye Institute states that "After cataract surgery, some people may develop a condition known as a secondary cataract, or posterior capsule opacification" and lists "Secondary cataracts (posterior capsule opacity)" among the complications that can follow cataract surgery. The natural lens has already been removed, so a new nuclear cataract cannot form, and neither endothelial decompensation nor a deposit on the implant surface is the entity described.

   Reference: Cataract Surgery | National Eye Institute — Cataract Surgery, 'What are the risks of cataract surgery?' and the secondary cataract passage

4. 4A patient referred for possible laser trabeculoplasty has white flaky material on the anterior lens capsule and pupil margin, heavy trabecular pigment, and an intraocular pressure of 28 mmHg with an open angle. The referral letter calls the diagnosis exfoliation glaucoma. How is exfoliation glaucoma classified?

   1. A. A type of open-angle glaucoma that often causes higher eye pressure
   2. B. A type of angle-closure glaucoma that causes a sudden painful attack
   3. C. A type of childhood glaucoma that is present at birth or in infancy
   4. D. A type of secondary glaucoma caused by new vessels over the angle

   Answer: A

   Explanation: The National Eye Institute states that "Exfoliation glaucoma (sometimes called pseudoexfoliation) is a type of open-angle glaucoma that happens in some people with exfoliation syndrome, a condition that causes extra material to deposit on parts of the eye and block fluid from draining" and that "This type of glaucoma can progress faster than primary open-angle glaucoma, and often causes higher eye pressure." Because the classification is open-angle, the eye falls inside the condition that trabeculoplasty mode is cleared to treat.

   Reference: Types of Glaucoma | National Eye Institute — Types of Glaucoma, 'Exfoliation glaucoma' entry

5. 5A patient has had an acute angle-closure attack in the left eye only. The right eye is asymptomatic but has an equally narrow angle. What is the accepted approach to the asymptomatic fellow eye?

   1. A. It may be treated as well, to prevent a future attack in that eye
   2. B. It is left untreated and simply reviewed each year by gonioscopy
   3. C. It is treated only after it has had its own first acute attack
   4. D. It is treated only if its pressure is also raised at presentation

   Answer: A

   Explanation: The National Eye Institute states that in angle-closure glaucoma "Your doctor might treat both eyes to prevent future problems, even if you only have angle-closure glaucoma in 1 eye." Because the fellow eye shares the same anatomy, prophylactic treatment is accepted rather than waiting for a symptomatic attack or for the pressure in that eye to rise, especially since untreated angle closure "can cause blindness in just a few days".

   Reference: Types of Glaucoma | National Eye Institute — Types of Glaucoma, 'Angle-closure glaucoma' entry

6. 6A patient who had uncomplicated cataract surgery asks how long after the operation a secondary cataract can appear. What answer does National Eye Institute patient information support?

   1. A. Weeks, months, or even years after cataract surgery
   2. B. Only within the first six weeks after cataract surgery
   3. C. Only after ten years have passed since the surgery
   4. D. Only in the first twenty four hours after the surgery

   Answer: A

   Explanation: The National Eye Institute states that "Secondary cataracts can appear weeks, months, or even years after cataract surgery." Because the window is open-ended, a pseudophakic patient with new blurring is assessed for capsule opacification whatever the interval since surgery, rather than only within an early or a late period.

   Reference: Cataract Surgery | National Eye Institute — Cataract Surgery, secondary cataract passage

7. 7A patient has glaucomatous optic nerve damage with reproducible visual field loss, an angle open to the ciliary body band, and intraocular pressures that have never been recorded above 20 mmHg on repeated measurement. How is this form of glaucoma classified?

   1. A. Normal-tension glaucoma, which is a type of open-angle glaucoma
   2. B. Chronic angle-closure glaucoma, a slow form of angle closure
   3. C. Uveitic glaucoma, which can follow intraocular inflammation
   4. D. Neovascular glaucoma, which is driven by new vessel growth

   Answer: A

   Explanation: The National Eye Institute states that "Normal-tension glaucoma is a type of open-angle glaucoma that happens in people with normal eye pressure" and that "research shows that treatments that lower eye pressure can help slow the disease and stop vision loss." The angle is open and the pressure is statistically normal, which is exactly the described entity; the other three named entities each have a different defining mechanism.

   Reference: Types of Glaucoma | National Eye Institute — Types of Glaucoma, 'Normal-tension glaucoma' entry

8. 8A slit-lamp laser console is to be used to make an opening in the peripheral iris. Which cleared indications cover that use?

   1. A. Iridotomy and iridectomy, in the photodisruption mode of the device
   2. B. Selective laser trabeculoplasty, in the trabeculoplasty mode of it
   3. C. Retinal photocoagulation, in the continuous wave mode of the device
   4. D. Transscleral cyclophotocoagulation, in the contact probe mode of it

   Answer: A

   Explanation: The FDA Indications for Use statement for these consoles lists, for the photodisruption mode, "Iridotomy and iridectomy." together with posterior capsulotomy and posterior membranectomy, while the trabeculoplasty mode is cleared only for Selective Laser Trabeculoplasty. Retinal photocoagulation and transscleral cyclophotocoagulation are the cleared indications of other ophthalmic laser device types, not of this mode.

   Reference: FDA K 212630 Ellex — 510(k) K212630, Indications for Use form

9. 9Under the FDA-cleared indications for use of a photodisruption laser, which patients may undergo discission of the posterior capsule of the eye with the device?

   1. A. Aphakic and pseudophakic patients
   2. B. Phakic and pseudophakic patients
   3. C. Aphakic and phakic patients only
   4. D. Pseudophakic patients only

   Answer: A

   Explanation: The FDA-cleared Indications for Use state that the device is "indicated for photodisruption of ocular tissue using light energy emitted by a Nd:YAG laser, including discission of the posterior capsule of the eye (posterior capsulotomy), and discission of pupillary membranes (pupillary membranectomy) in aphakic and pseudophakic patients, and iridotomy." A phakic eye still has its natural crystalline lens in the capsular bag, so it is outside this indication.

   Reference: FDA K 220430 Quantel — 510(k) K220430 Summary, Indications for Use

10. 10An eye presents with an intraocular pressure of 34 mmHg, a shallow anterior chamber, and gonioscopy showing the angle appositionally closed for 360 degrees from pupillary block. Which statement explains why selective laser trabeculoplasty is not the indicated laser procedure for this eye?

    1. A. The trabeculoplasty mode is cleared only for chronic open-angle glaucoma
    2. B. The trabeculoplasty mode is cleared only for eyes that are pseudophakic
    3. C. The trabeculoplasty mode is cleared only for pressures above 30 mmHg
    4. D. The trabeculoplasty mode is cleared only after all drops have failed

    Answer: A

    Explanation: The cleared indications separate the two modes of a combined system: the photodisruption mode is cleared for "Iridotomy and iridectomy." while the trabeculoplasty mode is cleared for Selective Laser Trabeculoplasty, described as being "for the treatment of chronic open angle glaucoma." An appositionally closed angle from pupillary block is therefore outside the trabeculoplasty indication, and the meshwork cannot be targeted through a closed angle. Pseudophakia, a pressure threshold and prior medical failure are not part of the cleared indication statement.

    Reference: FDA K 212630 Ellex — 510(k) K212630, Indications for Use form and section V Device Technological characteristics