Associated diseases

Question 1

What is hypertensive retinopathy?

Answer 1

HTN accelerates atherosclerosis in retinal vessels

Leads to chronic retinal changes

Question 2

What is the grading for fundoscopy findings of someone with hypertensive retinopathy?

Answer 2

1. Arteriole narrowing/ turtuosity AND ↑light reflex (Ag/Cu wiring)
2. AV nipping
3. Cotton wool exudates AND flame/blot haemorrhages
4. Papilloedema

Question 3

What do cotton wool spots represent?

Answer 3

Retinal infarction

Question 4

What serious optic conditions is hypertensive retinopathy a risk factor for?

Answer 4

Renal artery/vein occlusion

Ischaemic optic neuropathy

Question 5

What is diabetic retinopathy?

Answer 5

Chronic, progressive, potentially sight-threatening disease of retinal microvasculature

Question 6

How common is diabetic retinopathy?

Answer 6

MOST COMMON CAUSE OF BLINDNESS!

Question 7

How is most likely to get diabetic retinopathy?

Answer 7

Prolonged hyperglycaemia in DM (leads to retinal vessel damage)

Question 8

How is diabetic retinopathy graded?

Answer 8

MILD NPDR = 1 micro aneurysm
MOD NPDR = >1 micro aneurysm/dot/blot haemorrhage, hard exudate, cotton wool, venous bleeding
SEVERE NPDR = Flame + blot haemorrhages in ALL 4 quadrants, retinal bleeding in 2 quadrants, intraretinal microvasc abnormalities in 1 quadrant
PROLIFERATIVE DR = Neovasc, fibrous tissue forms
MACULOPATHY = Oedema, ↓VA

Question 9

What are the types of diabetic retinopathy?

Answer 9

Non-proliferative
Proliferative
Maculopathy

Question 10

How is non-proliferative DR characterised?

Answer 10

Depends on degree of ischaemia
Microaneurysm (DOTS)
Flame/blot haemorrhages
Hard exudate (YELLOW)
Severe = Soft exudate (COTTON WOOL)
Engorged tortuous vessels

Question 11

How is proliferative DR characterised?

Answer 11

Fine new vessels appear on optic disc, retina

Vitreous haemorrhage

Question 12

How is maculopathy characterised?

Answer 12

Leakage from vessels close to macula cause oedema

Question 13

How is diabetic retinopathy investigated?

Answer 13

Fundoscopy
Optical coherence tomography scanning: IF visual loss
Fluorescein angiography: Find leakage for laser Tx

Question 14

How is DR treated?

Answer 14

Mild: Observe 
Ongoing: Intravitreal steroids
NPDR: Intravitreal Anti-VEFG+/- laser Tx
PDR: Severe = Vitrectomy
Pan-retinal photocoagulation (laser Tx)

Question 15

What is optic neuritis?

Answer 15

Inflammation of the optic nerve which can be associated with MS

Question 16

What are the causes of optic neuritis?

Answer 16

Idiopathic
Primary: Associated w/MS exact same disease pathway
Infectious: EBV, Lyme disease, Syphilis
Autoimmune: SLE, Sarcoid

Question 17

What is the pathophysiology of ON in terms of an MS diagnosis?

Answer 17

Autoimmune disease triggered by an environmental factor (virus)
T helper cells activated and cross blood-brain-barrier
Leads to pathological inflammation, demyelination, axonal loss & gliosis

Question 18

What are the Sx of ON?

Answer 18

• Peri/retro-orbital pain
• Loss of visual acuity with scotoma: Clouding/fogging
• Colour desaturation
• Optic disc swelling

Question 19

What are the risk factors for ON?

Answer 19

Female
30-50yo
White
HLA DR(2)15 genetic mutation

Question 20

How is ON investigated?

Answer 20

MRI of optic nerves

Bloods: FBC, ESR, CRP, ANA

Question 21

How is ON treated?

Answer 21

Acute: Pulsed MethylPred + PPI
Ongoing: Immunosuppression