Cataracts and Age Related macular degeneration Flashcards
What is cataracts?
A clouding of the lens in the eye which leads to a decrease in vision
What should you always check in someone who presents with opacity in the lens?
Fasting plasma glucose - DM related cataracts
What are the 4 major causes of blindness in the world?
- Cataract
- Vit A deficiency
- Trachoma
- Onchocerciasis
What are common causes of cataract?
- Senility
- Smoking
- Ocular Trauma
- Previous intraocular surgery
- Congenital
- Diabees
- Steroid use
What are features of cataracts?
- Blurred/hazy vision - frequent spectacle use
- Glare - esp in sunlight
- Myopic shift
- Monocular diplopia
- Halos
- Decreased night vision
What would you see on slit lamp examination of the eye in cataracts?
- Clouded lens
- If dense - No red reflex, No visible fundus
What are the different types of cataracts?
- Nuclear cataracts
- Anterior and posterior polar cataracts
- Subcapsular cataracts
What is subcapsular cataracts most commonly associated with?
Steroid use
What is the management for cataracts?
- Myadriatic eye drops
- Sunshades/sunglasses
- Surgery - most common treatment
What are compications of cataracts surgery?
- Infective endopthalmitis
- Suprachoroidal haemorrhage
- Ocular perforation
- Retinal detachment - esp in myopics
- Post-op refractive error - astigmatism
- Posterior capsular rupture/thickening
- Anertior Uveitis
- Glaucoma
What method is used to remove the affected lens in cataracts surgery?
Phacoemulsion - ultrasound breaks it up, then fragments aspirated by cannula
What post-op care is needed with cataracts surgery?
- Antibiotic and anti-inflammatory eye drops for 3-6 weeks
- Change specs after 3-6 weeks to get maximum effect
What is age related macular degeneration?
A medical condition which may result in blurred or no vision in the center of the visual field. Early on there are often no symptoms. Over time, however, some people experience a gradual worsening of vision that may affect one or both eyes.
What is the cause of age-related muclar degeneration?
Unknown
What are risk factors for age-related macular degeneration?
- Age
- Smoking
- Hypertension
- Hypercholesterolaemia
- Ultraviolet exposure
What are the two types of macular degeneration?
- Non-exudative (dry) macular degeneration .
- Exudative (wet) AMD
What is dry macular degeneration?
THIS IS NON-NEOVASCULAR AMD
Describes a painless and progressive loss of central vision. With age, lipofuscin deposits (drusen) are found between the retinal pigment epithelium (RPE) and Bruch’s membrane.
Drusen may be hard or soft and there may be focal RPE detachment. Not all people with these changes will be affected visually but some develop distortion and blurring of their central vision. Extensive atrophy of RPE can occur (geographic atrophy).
What is wet macular degeneration?
Aberrent vessels grow from the choroid into the neurosensory retina and leak. This causes severe central visual loss. It is usually, but not always, preceded by the dry form of AMD.
What is the following?
Druesen - tiny yellow or white accumulations of extracellular material that build up between Bruch’s membrane and the retinal pigment epithelium of the eye
What are symptoms of dry age-related macular degeneration?
Gradual reduction in central vision - both eyes
- Affects ability to read, recognise faces, and see clearly in the distance.
Metamorphopsia - Mild distortion of their central vision
What are signs of dry AMD?
- Drusen in macular region
- Macular changes - diffuse pale, mottled appearance due to atrophy of the RPE and choroid
What specific visual changes that occur with Wet AMD?
Sudden change - central vision
- Rapid visual deterioration
- Marked central distortion - “straight lines have a bend in the middle”
What are features of Wet AMD on opthalmoscopy?
- Drusen
- Macular changes - atrophic changes
-
Choroidal neovascularisation - small, focal, pale pink-yellow or grey-green elevation at the macula
- May be associated exudation of serous fluid or blood
What are risk factors for AMD?
- Age
- Smoking
- Cardiovascular disease
- Family history
- Cataract surgery
What investigations would you want to do if you suspected age-related macular degeneration?
- Flourescein angiogram
- OCT - 4-6weekly reviews
How would you manage someone with Wet AMD?
- VEGF inhibitors
- Laser photocoagulation
- Intravitreal steroid adjunct
What are the benefits of VEGF treatment when used to treat AMD?
- Increased acuity
- Decreased cell proliferation
- Decreased neovascularisation
- Decreased vascular leaks
What is endopthalmitis?
An inflammation of the interior of the eye. It is a possible complication of all intraocular surgeries, particularly cataract surgery, with possible loss of vision and the eye itself. Infectious cause is the most common and various bacteria and fungi have been isolated as the cause of the endophthalmitis
What can be a complication of congenital cataracts?
Deprivation amblyopia
When is the latent period of visual development?
First 6 weeks of life
What are features of endopthalmitis?
High index of suspicion in post-op
- Pain
- Loss of vision
- Redness
- Discharge
How would you manage endopthalmitis?
- Intravitreal antibiotics
- Vitrectomy
