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Ophthamology > Aeromedical Impact of Selected Ophthamologic Conditions > Flashcards

Aeromedical Impact of Selected Ophthamologic Conditions Flashcards

1
Q

Name the 7 conditions discussed.

A
  1. Keratoconus
  2. Topographical pattern suggestive of keratoconus
  3. Cataract
  4. Glaucoma
  5. Ocular HTN
  6. Lattice retinal degeneration
  7. Central serous retinopathy
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2
Q

Describe what is occurring in keratoconus.

A

The cornea is abnormally shaped (like a cone) and thin, causing irregular astigmatism.Large astigmatism.
Image distortion.
Fail depth perception
Problems with contrast.
Is progressive– initially correctable with rigid gas permeable (RGP) contacts, but later cannot be corrected to 20/20. May require transplant.

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3
Q

What is the aeromedical concern in keratoconus?

A

Poor contact lens fit
Contact lens failure in flight (does not sit properly secondary to abnormal shape of corneal; at risk of movement with G-force)
Corneal hydrops (acute, painful corneal separation with 20/400 vision instantly)
Decreased vision
Progression to need for corneal transplant

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4
Q

At what point is someone who is a trained asset DQ’s with keratoconus?

A

With loss of depth perception

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5
Q

What % of pts with topographical pattern suggestive of keratinous progress to keratoconus? Over what time frame? Why does this matter

A

30% in 10 years. Is DQ for IFC 1 physical.

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6
Q

What is cataracts?

A

Clouding of the lens

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7
Q

Name 6 causes of cataracts.

A
  1. Natural aging
  2. Medications (i.e. steroids)
  3. Ocular trauma
  4. Radiation (i.e. UV)
  5. Metabolic dz (i.e. DM, Wilson’s)
  6. Congenital/genetic
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8
Q

Define mild cataracts. What is the areomedical implication?

A

Correctable to 20/20, may continue to fly.

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9
Q

Define moderate cataracts. What are the aeromedical considerations?

A

Continued refractive shift with inability to correct to 20/20. Glare. Need increased light to read.

FCII will require surgery (which is earlier than in standard population)

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10
Q

What are the 4 lens characteristics that are approved aeromedically?

A

Acrylic
Monofocal
1 or 3 piece
Clear (NOT blue-blocking yellow)

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11
Q

What risk is increased following cataract surgery?

A

3x increased risk of retinal detachment

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12
Q

What is the required follow-up after cataract surgery?

A

1 month, then annually

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13
Q

Define aeromedical glaucoma.

A

IOP >30 mmHg (regardless of whether optic neuropathy is present)

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14
Q

What occurs pathologically in glaucoma?

A

progressive optic neuropathy

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15
Q

What 4 findings are seen on exam in glaucoma?

A
  1. Enlarged cup/disc ratio (>0.4) or asymmetric (>0.2 difference)
  2. Thinning of retinal nerve fiber layer on OCT
  3. VF defects
  4. Increased IOP
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16
Q

Name 4 mechanisms of action of secondary glaucoma?

A
  1. Medications (steroids, TPM)
  2. Trauma (damage to drainage system)
  3. Mechanical (particulate blockage)
  4. Anatomic (blockage)
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17
Q

Name 3 aeromedical hazards of glaucoma.

A
  1. Progressive occult loss of peripheral or central VF loss
  2. Acquired color/contrast deficit
  3. Eventual incisional surgery or visual loss leads to DQ
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18
Q

What is the preferred way for IOP measurement?

A

Goldmann applanation tonometry (GAT)

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19
Q

What are the 3 aeromedical approved treatments for glaucoma?

A
  1. Timilol
  2. Latanaprost
  3. Laser surgery
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20
Q

Define ocular hypertension

A

Evidence of elevated intraocular pressures (measured by applanation tonometry, without “correction” for central corneal thickness; two or more IOPs over 21 mmHg on two separate occasions) without evidence of optic neuropathy (retinal nerve fiber loss and disc based visual field defect).

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21
Q

What are the etiologies of ocular HTN?

A

Same as glaucoma

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22
Q

What differentiates ocular HTN from glaucoma?

A

No evidence of optic neuropathy on retinal nerve fiber layer analysis, visual field testing, or structural changes or asymmetry of optic nerve cupping

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23
Q

What is the goal of treatment?

A

Risk stratification (those with risk factors should be treated)

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24
Q

Name 7 risk factors for glaucoma.

A
  1. High IOP
  2. Family history – primary relative
  3. Race (African American)
  4. Age (higher)
  5. Myopia (high myopia)
  6. Central corneal thickness (< 540 um)
  7. Low diastolic arterial perfusion pressure
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25
Q

Name 4 parts to the ocular HTN/glaucoma work-up?

A
  1. Humphrey Visual Field 30-2
  2. Diurnal GAT IOP (At least three measurements two hours apart)
  3. Dilated fundus and optic nerve evaluation
  4. Retinal nerve fiber layer analysis by OCT
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26
Q

Define central chorioretinopathy (CSR).

A

A serous/exudative neurosensory retinal detachment secondary to a breakdown of the retinal pigmented epithelial (RPE) retinal blood barrier; also known as a pigmented epithelial detachment (PED)

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27
Q

What is the clinical presentation?

A

smoky, smudge in or near central fixation

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28
Q

List 3 risk factors for CSR?

A
  1. Heavy stress exposure (Pilots, engineers, physicians)
  2. Type A personality
  3. Exogenous steroid exposure
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29
Q

What is the treatment for CSR? What does the FS need to be wary of?

A

Observation x 3 mo. Stress reduction. Off-base ophtho will want to treat with laser. This should not be done until later in the course in aeromedical patients.

30
Q

What is the prognosis for CSR?

A

May fully resolve or have retinal damage.

31
Q

What is the risk of recurrence of CSR?

A

50% first year, 40% lifetime after first year (either eye)

32
Q

List 4 aeromedical hazards of CSR.

A
  1. Acquired color and contrast deficit
  2. Retinal scarring / pigment mottling
  3. Visual field defects
  4. Metamorphopsia (abn Amsler grid)
33
Q

List 3 types or retinal changes.

A
  1. Lattice retinal degeneration
  2. Retinal breaks/tears
  3. Retinal detachment
34
Q

How does lattice retinal degeneration present?

A

Usually found on annual eye exam

35
Q

What patients are high risk for lattice retinal degeneration?

A

High myopia (>5.00)

36
Q

What is the prognosis of lattice retinal degeneration?

A

Rarely progressive but at higher risk for retinal detachment (30%)

37
Q

What is the treatment for lattice retinal degeneration?

A

Low risk– observation

High risk– laser retinopexy

38
Q

What are two types of retinal detachment?

A

Macula on or off

39
Q

How does macula-on retinal detachment present?

A

Flashing lights
Floaters
Veils
No sig vision acuity change

40
Q

How does macula-off retinal detachment present?

A

Marked decreased visual acuity

h/o macula-on sx (i.e. flashes/floaters)

41
Q

What is the management priority of the two types of retinal detachment?

A

Macula-on: Emergent

Macula-off: Urgent (couple days)

42
Q

What is the prognosis of macula-off retinal detachment?

A

Macula-off: low likelihood of full recovery

43
Q

Name 3 aeromedical hazards of glaucoma.

A
  1. Progressive occult loss of peripheral or central VF loss
  2. Acquired color/contrast deficit
  3. Eventual incisional surgery or visual loss leads to DQ
44
Q

What is the preferred way for IOP measurement?

A

Goldmann applanation tonometry (GAT)

45
Q

What are the 3 aeromedical approved treatments for glaucoma?

A
  1. Timilol
  2. Latanaprost
  3. Laser surgery
46
Q

Define ocular hypertension

A

Evidence of elevated intraocular pressures (measured by applanation tonometry, without “correction” for central corneal thickness; two or more IOPs over 21 mmHg on two separate occasions) without evidence of optic neuropathy (retinal nerve fiber loss and disc based visual field defect).

47
Q

What are the etiologies of ocular HTN?

A

Same as glaucoma

48
Q

What differentiates ocular HTN from glaucoma?

A

No evidence of optic neuropathy on retinal nerve fiber layer analysis, visual field testing, or structural changes or asymmetry of optic nerve cupping

49
Q

What is the goal of treatment?

A

Risk stratification (those with risk factors should be treated)

50
Q

Name 7 risk factors for glaucoma.

A
  1. High IOP
  2. Family history – primary relative
  3. Race (African American)
  4. Age (higher)
  5. Myopia (high myopia)
  6. Central corneal thickness (< 540 um)
  7. Low diastolic arterial perfusion pressure
51
Q

Name 4 parts to the ocular HTN/glaucoma work-up?

A
  1. Humphrey Visual Field 30-2
  2. Diurnal GAT IOP (At least three measurements two hours apart)
  3. Dilated fundus and optic nerve evaluation
  4. Retinal nerve fiber layer analysis by OCT
52
Q

Define central chorioretinopathy (CSR).

A

A serous/exudative neurosensory retinal detachment secondary to a breakdown of the retinal pigmented epithelial (RPE) retinal blood barrier; also known as a pigmented epithelial detachment (PED)

53
Q

What is the clinical presentation?

A

smoky, smudge in or near central fixation

54
Q

List 3 risk factors for CSR?

A
  1. Heavy stress exposure (Pilots, engineers, physicians)
  2. Type A personality
  3. Exogenous steroid exposure
55
Q

What is the treatment for CSR? What does the FS need to be wary of?

A

Observation x 3 mo. Stress reduction. Off-base ophtho will want to treat with laser. This should not be done until later in the course in aeromedical patients.

56
Q

What is the prognosis for CSR?

A

May fully resolve or have retinal damage.

57
Q

What is the risk of recurrence of CSR?

A

50% first year, 40% lifetime after first year (either eye)

58
Q

List 4 aeromedical hazards of CSR.

A
  1. Acquired color and contrast deficit
  2. Retinal scarring / pigment mottling
  3. Visual field defects
  4. Metamorphopsia (abn Amsler grid)
59
Q

List 3 types or retinal changes.

A
  1. Lattice retinal degeneration
  2. Retinal breaks/tears
  3. Retinal detachment
60
Q

How does lattice retinal degeneration present?

A

Usually found on annual eye exam

61
Q

What patients are high risk for lattice retinal degeneration?

A

High myopia (>5.00)

62
Q

What is the prognosis of lattice retinal degeneration?

A

Rarely progressive but at higher risk for retinal detachment (30%)

63
Q

What is the treatment for lattice retinal degeneration?

A

Low risk– observation

High risk– laser retinopexy

64
Q

What are two types of retinal detachment?

A

Macula on or off

65
Q

How does macula-on retinal detachment present?

A

Flashing lights
Floaters
Veils
No sig vision acuity change

66
Q

How does macula-off retinal detachment present?

A

Marked decreased visual acuity

h/o macula-on sx (i.e. flashes/floaters)

67
Q

What is the management priority of the two types of retinal detachment?

A

Macula-on: Emergent

Macula-off: Urgent (couple days)

68
Q

What is the prognosis of the two types of retinal detachment?

A

Macula-on:

69
Q

List 4 aeromedical hazards of retinal detachment?

A

Macula-on: loss of best peripheral vision
Macula-off: Loss of best central vision –> color/contrast deficits
Cataract formation
Refractive error –> blindness

70
Q

List 4 items included in the work-up for waiver.

A
  1. DFE
  2. Review of signs/sx (i.e. floaters/flashes/veil)
  3. 5% precision visual acuity (low contrast)
  4. VFs

Ophthamology (9 decks)

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