B7.034 Ophthalmologic Diseases Overview

Question 1

etiologies of cataracts

Answer 1

process of aging
-70% of people > 75
congenital
-rubella infection
genetic anomaly
-Lowe syndrome, Wilsons
secondary to various diseases, trauma, inflammation, radiation, meds (etc)
-steroids and diabetes

Question 2

basics of an eye exam

Answer 2

visual acuity
pupillary response
ocular motility
slit lamp exam
fundus exam

Question 3

glare vision testing

Answer 3

shine light in eyes

in case of cataracts, this can worsen vision

Question 4

types of cataracts

Answer 4

nuclear
cortical
posterior subcapsular
posterior

Question 5

treatment of cataracts

Answer 5

cataract removal with/without intraocular lens implantation

phacoemulsification

Question 6

posterior capsular opacification

Answer 6

most common “complication” of cataract surgery
-leftover cataract cells proliferate on back of lens
about 40% of patients require YAG laser capsulotomy to resolve

Question 7

most common cause of acute glaucoma

Answer 7

angle closure

Question 8

symptoms of angle closure glaucoma

Answer 8

pain
blurred vision
halos
nausea/vomiting
headache

Question 9

signs of angle closure glaucoma

Answer 9

conjunctival injection
fixed mid-dilated pupil
"steamy" or edematous cornea
elevated intraocular pressure
history of hyperopia
Asian race

Question 10

why can hyperopia lead to angle closure glaucoma

Answer 10

smaller eye than average
structures more likely to be compressed
far sighted

Question 11

treatment for angle closure glaucoma

Answer 11

IV Diamox
topical glaucoma meds
laser iridotomy (hole in iris to bypass usual channel that is closed off)

Question 12

epidemiology of macular degeneration

Answer 12

leading cause of irreversible central vision loss among people 52 and up

Question 13

symptoms of macular degeneration

Answer 13

metamorphopsia and decreased central vision (opposite of glaucoma, which tends to cause loss of peripheral vision first)

Question 14

where is the macula

Answer 14

darkish spot 2 disc diameters from the optic nerve

high proportion of cones here

Question 15

what is metamorphopsia

Answer 15

distortion of vision in addition to blurring

tested with grid to determine if it looks wavy

Question 16

exam for macular degeneration

Answer 16

visual acuity
ophthalmoscopy
optical coherence tomography
fluorescein angiography

Question 17

changes seen in macular degeneration

Answer 17

drusen
retinal pigment epithelium (RPE) changes
neovascular membrane

Question 18

drusen

Answer 18

hyaline nodules in Bruch’s membrane, which separates RPE from inner choroidal vessels

Question 19

RPE changes in macular degeneration

Answer 19

hyper and hypopigmentation
can occur with or without drusen
variable effect on vision

Question 20

progression of macular degeneration

Answer 20

10-20% of eyes with AMD develop a neovascular membrane, which means a defect in Bruch’s membrane, leading to wet macular degeneration

Question 21

worse prognostic factors in macular degeneration

Answer 21

larger membrane

closer to center of fovea

Question 22

treatment of dry macular degeneration

Answer 22

ocular AREDS vitamins to slow progression

Amsler Grid testing to monitor progression to wet form

Question 23

treatment of wet macular degeneration

Answer 23

intravitreal injections of anti-VEGF

-decreased swelling and abnormal blood vessels to get rid of fluid

Question 24

diabetic eye changes

Answer 24

changes in refraction
-myopic shift (near sighted)
posterior subcapsular cataracts
retinopathy

Question 25

epidemiology of retinopathy

Answer 25

patients with IDDM for 5 yrs have 23% probability after 15 years, 80% probability NIDDM have lower probability

Question 26

importance of annual dilated diabetic eye exam

Answer 26

patients can have retinopathy without visual complaints

Question 27

exam for diabetic eye changes

Answer 27

visual acuity ophthalmoscopy optical coherence tomography fluorescein angiography

Question 28

mild-moderate findings in diabetic retinopathy

Answer 28

dot and blot hemorrhages hard exudate macular edema

Question 29

severe findings in diabetic retinopathy

Answer 29

cotton wool spots (ischemic retina) venous bleeding intraretinal microvascular abnormalities (IRMA)

Question 30

proliferative diabetic retinopathy

Answer 30

when leakage occurs, the eye thinks it isn't getting oxygen, and it increased VEGF to build new blood vessels to the periphery there new blood vessels are crappy

Question 31

sequalae of proliferative diabetic retinopathy

Answer 31

vitreous hemorrhage retinal hemorrhage retinal detachment

Question 32

treatment of macular edema in diabetics

Answer 32

eye drops focal laser treatment intravitreal injections with anti-VEGF and steroids

Question 33

why do laser treatments help in diabetic retinopathy

Answer 33

kills peripheral retina, so eye no longer thinks its deprived of O2, bc that area no longer exists

Question 34

treatment of diabetic retinopathy

Answer 34

``` panretinal photocoagulation (PRP) intravitreal injections with anti-VEGF and steroids surgery ```

Question 35

what is a cherry red spot on the macula

Answer 35

central retinal artery occlusion (CRAO)

Question 36

when might you see a cherry red spot

Answer 36

diabetes, HTN, increase cholesterol -emboli from carotid can cause stroke in the eye metabolic storage diseases -tay sachs, neimann pick, sandhoff

Question 37

laser vision correction options

Answer 37

surface ablation | ablation under a flap

Question 38

good candidate for LASIK

Answer 38

``` 18 and up contact lens wearer or failure willingness to tolerate healing phase consistent prescription for 1 year desire ```

Question 39

who should avoid LASIK

Answer 39

``` unrealistic expectations pregnant and nursing women unstable prescriptions history of uncontrolled autoimmune disease history of certain infections/diseases ```