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Ophthalmology > 3: Macular and Retinal Disease > Flashcards

3: Macular and Retinal Disease Flashcards

1
Q

What is the most common cause of blindness

A

ARMD

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2
Q

In which population does age-related macular degeneration occur

A

Elderly

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3
Q

What are the 2 types of ARMD

A

Wet and Dry

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4
Q

What is the most common type of ARMD

A

Dry (90%)

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5
Q

What is dry ARMD

A

Macular degeneration caused by accumulation of drusen

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6
Q

What is wet ARMD

A

Macular degeneration caused by choroidal neovascularisation - leading to leakage of serous fluid and blood loss

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7
Q

What are 4 risk factors for ARMD

A

FH
Smoking
Age
CVD - DM, HTN, dyslipidaemia

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8
Q

Is ARMD unilateral or bilateral

A

Bilateral

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9
Q

Explain presentation of ARMD

A
  • Good visual acuity
  • Difficultly making-out images due to failing contrast
  • Difficultly recognising faces
  • Difficultly with night vision and changing conditions
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10
Q

What is a never event in ARMD

A

Peripheral fields will never be affected

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11
Q

What is a feature of wet ARMD

A

Metamorphosia

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12
Q

What is metamorphosia

A

Distortion of straight lines

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13
Q

What causes metamorphopsia

A

Due to disruption of retinal layers by fluid

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14
Q

What is a classic presentation in wet ARMD

A

Window frames will appear wonky

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15
Q

How is wet ARMD tested for

A

Amsler grid testing

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16
Q

How will fundoscopy present in dry ARMD

A

drusen

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17
Q

How will fundoscopy present in wet ARMD

A

red patches - sub retinal or intra-retinal haemorrhages

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18
Q

what does drusen indicate

A

degeneration of the axonal head

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19
Q

over what time period does wet ARMD develop

A

months

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20
Q

over what time period does dry ARMD develop

A

years

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21
Q

what investigations are ordered for ARMD

A

Slit lamp microscopy

Fluorescein angiography

Ocular coherence tomography

22
Q

when is fluorescin angiography indicated

A

If suspect wet-ARMD

23
Q

what accompanies fluorescin angiography

A

indocyanine green angiography - to look for changes in choroidal circulation

24
Q

What is the problem with dry ARMD

A

Little treatment can be offered

25
Q

What is given for dry ARMD

A

Vitamins

26
Q

What 4 vitamins are given in dry-ARMD

A

Zinc
Vitamin A
Vitamin E
Lutein

(ZEAL)

27
Q

What investigations are ordered in wet-ARMD

A

Fluorescein angiography. Results are reviewed in 4-6W with optical coherence tomography.

28
Q

What is given for wet ARMD

A

anti-VEGF

29
Q

Name an anti-VEGF

A

bevacizumab

30
Q

How often is bevacizumab or ranibizumab given

A

monthly

31
Q

When is laser photocoagulation indicated

A

proliferation

32
Q

Why is screening indicated

A

to identify proliferation

33
Q

How is screening for wet-ARMD performed

A

Amsler grid testing

34
Q

What are 2 methods to prevent wet-ARMD

A

Smoking cessation

Green vegetables

35
Q

Does wet or dry ARMD have a worse prognosis

A

Wet ARMD

36
Q

What visual field defect will be present in ARMD and why

A

central scotoma

37
Q

What time frame does dry ARMD present

A

gradual progressive visual field loss

38
Q

What time frame does wet ARMD present

A

insidious over weeks-months

39
Q

What is a vitreous haemorrhage

A

collection of blood in vitreous body

40
Q

What are the two ‘groups’ of causes of vitreous haemorrhage

A
  • due to rupture of neovascularisation vessels secondary to ischaemia
  • rupture physiological vessels
41
Q

What are two causes of vitreous haemorrhage due to rupture of ‘neovascularisation’

A

diabetic retinopathy

central retinal vein occlusion

42
Q

What is the most common cause of vitreous haemorrhage

A

diabetic retinopathy

43
Q

What are two causes of vitreous haemorrhage due to rupture of physiological vessels

A

PVD

Retinal tear

44
Q

Describe symptoms of vitreous haemorrhage

A
  • Sudden monocular vision loss
  • Some report ‘red’ colour before this
  • visual loss or floaters may be worse after sleep
45
Q

Why are floaters or visual worse following sleep

A

as when lying down blood collects at the back of the eye covering the macula

46
Q

What are two signs vitreous haemorrhage

A

No RAPID

No red reflex

47
Q

What 2 investigations are ordered for suspected vitreous haemorrhage

A

Slit lamp microscopy

US Scan

48
Q

What is slit lamp microscopy used for

A

Detect blood

49
Q

What is US used for

A

Look for retinal tear

50
Q

How does vitreous haemorrhage usually repair

A

Often blood reabsorbs - cause of watching and waiting

51
Q

If a large vitreous haemorrhage what may be required

A

Vitrectomy

Ophthalmology (12 decks)

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