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OD3 - Clinical Optometry Practice > AED - Cataracts I - PAP Week 1 > Flashcards

AED - Cataracts I - PAP Week 1 Flashcards

1
Q

Describe the SOAP acronym.

A

Subjective - symptoms
Objective - signs
Assessment - detecting signs and symptoms
Plan - optometric and medical management

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2
Q

Is the lens vascular or avascular?

A

Avascular

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3
Q

Is the lens innervated or non-innervated?

A

Non-innervated

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4
Q

List the three components of the lens.

A

Capsule
Cortex with endothelium
Nucleus

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5
Q

List the two cell types of the lens.

A

Cuboidal

Bow

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6
Q

What connects the lens to the ciliary bodies?

A

Zonules

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7
Q

Which of the three crystallin proteins form foetally? How do the others form (2)?

A

γ forms foetally. Others form over life or due to the effects of light oxidation.

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8
Q

What is the main means of metabolism in the lens epithelium? Where does this energy go (3)?

A

Anaerobic glycolysis

Energy needed for ion pumps, protein synthesis, and provide antioxidants

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9
Q

What molecule is used as an antioxidant by the lens?

A

Glutathione

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10
Q

Describe the fluid flux within the lens, where it enters and exits. Name the protein responsible for pumping water out.

A

Enters via the thin posterior capsule

Pumped out of the anterior epithelium by Na/K-ATPase

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11
Q

Describe how bow cells contribute to lens growth. Where do lens fibres meet?

A

Bow cells elongate to form fibres

Lens fibres elongate and meet at suture lines

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12
Q

Describe the shape of suture lines anteriorly and posteriorly

A

Anterior - Y

Posterior - ⅄

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13
Q

What happens to the number of lens fibres over time and what does this lead to? What is the consequence of this (3)?

A

Lens fibre numbers increases over time due to continuous addition to outer coats, leading to increased protein density with age

  • increased refractive index with age
  • compression promotes cataract formation
  • chromophores accumulate
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14
Q

What causes the lens to yellow with age?

A

Accumulation of chromophores

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15
Q

What happens to the capsule (which region specifically) with expansion and ageing of the lens? What is a consequence of this (2)?

A

Posterior capsule thinning

  • increased fluid uptake
  • cataract formation
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16
Q

List the four types of cataracts. Note the most common type.

A

Artefacts
Congenital
Aquired
Senile - most common

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17
Q

List the two types of congenital cataracts. Note which is more common.

A

Sight debilitating - not common

Non-debilitating - common

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18
Q

List the three types of acquired cataracts.

A

Induced/toxic
Secondary/metabolic
Trauma/radiation

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19
Q

List the three types of senile cataracts.

A

Posterior sub-capsular
Cortical
Nuclear

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20
Q

List three anterior cataractous artefacts.

A

Epicapsular stars
Persistent pupillary membrane
Lenticonus

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21
Q

Describe what lenticonus looks like.

A

Cone-like bulging of the lens cortex and thinning in the anterior, posterior, or both poles of the lens

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22
Q

With what two conditions is lenticonus associated with?

A

High myopia

Alports syndrome

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23
Q

Is it possible to have lenticonus concurrently with cataracts?

A

Yes

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24
Q

List two posterior cataractous artefacts.

A

Mittendorf dots

Nets/whorls (vitreous condensations)

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25
Q

What may sight debilitating congenital cataract be associated with?

A

Neural underdevelopment

Tropia

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26
Q

What condition can occur with sight debilitating congenital cataracts? Is it urgent to manage?

A

Isolated vision threat needs urgent management to prevent amblyopia

27
Q

Consider non-debilitating congenital cataracts. Is management typically radical or conservative?

A

Conservative

28
Q

What may individuals with non-debilitating congenital cataracts complain of? What is a possible solution?

A

May complain of glare

Dark sunglasses

29
Q

Are congenital cataracts (both types) progressive?

A

Yes usually

30
Q

With what two systemic conditions are congenital cataracts (both types) associated with? What is additionally required as a result?

A

Galactosaemia
Rubella
Need GP/paediatrician for blood work-up

31
Q

What posterior polar structure may be seen with sight debilitating congenital cataracts?

A

Remnant of mesodermal vascular tissue (Mittendorf’s dot)

32
Q

What may be seen in the lens in individuals with sight debilitating congenital cataracts secondary to galactosaemia? What would a blood test reveal?

A

Produces oil droplet cataract

Blood test shows decreased GL-1 kinase

33
Q

How does the lens appear in individuals with sight debilitating congenital cataracts secondary to rubella? What other problems may be seen?

A

Dense nuclear opacity

May be other CNS problems (ear)

34
Q

What is the chance of sight debilitating congenital cataracts if <1/12 gestation at the time of inoculation for rubella? what about <3/12?

A

60% chance for <1/12

20% chance for <3/12

35
Q

List the five types of non-debilitating congenital cataracts.

A 
Axial/sutural
Cerulean
Zonular
Coronary
Pulverulant
36
Q

Describe what axial/sutural non-debilitating congenital cataracts looks like (2), and where specifically.

A

Chalky white clusters on/near the suture lines anteriorly (Y)
May be polychromatic/sparkling

37
Q

Describe what cerulean non-debilitating congenital cataracts looks like and where specifically.

A

Blue dots in the deep cortex near the nucleus

38
Q

Describe what pulverulent non-debilitating congenital cataracts looks like and where specifically.

A

Dense cataract located in the embryonic nucleus

39
Q

Describe what zonular non-debilitating congenital cataracts looks like and where specifically.

A

A zone of cataract in the outer nucleus

40
Q

Describe what coronary non-debilitating congenital cataracts looks like and where specifically.

A

Like zonular cataracts but with riders into the cortex

Riders are ridges/lines

41
Q

List the 5 most common cataractogenic substances.

A 
Corticosteroids
Tranquilisers/antipsychotics
Some cholesterol reducing drugs
Miotics
Pesticides
(not limited to this list)
42
Q

List four of the most important causes of metabolic cataracts.

A

Diabetes
Galactosaemia
Myotonic dystrophy
Atopic dermatitis

43
Q

What is a diabetic metabolic cataract likely due to?

A

Most commonly due to advanced senile changes

44
Q

Are true diabetic cataracts common? What is it called?

A

Rare

Called snowflake cataract

45
Q

In what age group does galactosaemia most commonly manifest and how does it appear?

A

Children <1-2 years

Oil droplet

46
Q

What is myotonic dystrophy and what age group (and gender) does it most commonly affect?

A

Skeletal muscle atrophy affecting young (20-30 year old) males

47
Q

List three syndromes that can casue cataracts.

A

Down’s
Marfan’s
Alport’s

48
Q

List three eye diseases associated with cataracts.

A

Retinitis pigmentosa
Uveitis
Glaucoma

49
Q

List four common caused of traumatic/radiation cataracts.

A 
Blunt injury (sporting injury)
Explosive injury (crackers)
Penetrating injury (workplace)
Radiating heat/electric shock (glassblowers)
50
Q

What two forms can a traumatic cataract have?

A

Rosette or stellate form

51
Q

Do sutures conduct or resist shockwaves?

A

Conduct

52
Q

Can cataracts cause diplopia (including monocular diplopia)?

A

Yes to both

53
Q

What are four ways of detecting cataracts?

A

Red reflex
Direct illumination
Indirect illumination
Specular reflection

54
Q

What causes the red reflex?

A

Light reflected from the RPE/choroid

55
Q

Describe the technique for using the ophthalmoscope to detect cataract.

A

Find the reflex and the shadow
Move your body and look at the relative motion of the reflex to the shadow
If with - behind the nodal point in the vitreous
If against - in front of the nodal point in the lens or AC

56
Q

Describe the technique for using the slit lamp to detect cataract.

A

Introduce slit at the edge of the pupil in line with the viewing system
Have the patient look in the desired location to look around the pupil

57
Q

What is an advantage and disadvantage of using diffuse illumination to detect cataract?

A

Good general view

No depth information

58
Q

What technique to detect cataract is best for position/depth information?

A

Slit lamp

59
Q

What structure can be used to define the location of the lens nucleus using slit lamp?

A

Suture lines

60
Q

True or false
The lens naturally yellows with age (beginning posteriorly) and is only considered a cataract when it enters the nucleus.

A

True

61
Q

Describe the grading scheme for cataracts including the grade, depth (2) and location (2).

A 
Grade (colour):
0 clear - 4 dark brown
Depth:
Cortex (C) Nucleus (N)
Location:
Central (Cen) Peripheral (P)
62
Q

Describe the LOCS-3 grading system.

A

Uses comparative photos

63
Q

Describe the Wisconsin grading system.

A

Divide the lens into 8 pie sectors and record the number of segments with any cataracts

64
Q

In reality, how are cataracts graded (3)?

A

Photographs, high/low contrast VA, and symptoms

OD3 - Clinical Optometry Practice (114 decks)

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