Chronic Vision Loss

Question 1

What eye diseases cause chronic visual loss

Answer 1

• cataract
• primary open angle glaucoma (POAG)
• age related macular degeneration (AMD)
• diabetic maculopathy

Question 2

Common etiology of cataract

Answer 2

• ageing (the most common)
• metabolic disorder (DM)
• trauma
• intrauterine infection: rubella

Question 3

Symptoms of cataract

Answer 3

• blurring of vision months to years
  -bilateral (aging/metabolic)
  -unilateral (trauma/ocular surgery)
• no pain
• no redness (until late)

Question 4

Physical examination of cataract

Answer 4

• red reflex reduced
• no RAPD
• normal anterior segment (except for cataract)
• normal posterior segment

Question 5

Cataract types

Answer 5

• nuclear sclerosis cataract
• morgagnian cataract
• posterior subcapsular cataract

Question 6

How do we treat cataract

Answer 6

• extracapsular cataract extraction (ECCE)
• phacoemulsification aspiration
• intraocular lens implant

Question 7

Complications of cataract surgery

Answer 7

Preop
- retrobulbar haemorrhage

Intraop
- suprachoroidal haemorrhage

Post op
- endolphthalmitis
- retinal detachment

Question 8

What is it called if blurred vision come back after cataract surgery and what is the treatment

Answer 8

• posterior capsular opacification
• tx with yag laser capsulotomy

Question 9

history between open angle vs closed angle

Answer 9

Open angle (80%)
- present late
- no pain
- no redness
- mild headache

Closed angle (20%)
- present acutely (ocular emergency)
- painful
- red eye
- haloes
- severe headache

Question 10

Rf of poag

Answer 10

• old age
• family history
• myopia
• ocular hypertension
• diabetes mellitus

Question 11

Physical examination for glaucoma

Answer 11

• goldman aplanation tonometer: IOP
  normal iop (10-21mmHg)
• gonioscopy
• fundoscopy >0.7

Question 12

Investigation for glaucoma

Answer 12

• humphrey visuql field: to diagnose and monitor glaucoma

Question 13

Mx for primary oag

Answer 13

Topical
- timolol: beta blocker
- prostaglandin analogue
- alpha agonist
- carbonic anhydrase inhibitor

Systemic: acetazolamide

Laser: laser trabeculoplasty
Surgery: trabeculectomy

Question 14

AMD
Types
Pe
Ix
Tx

Answer 14

Types
- dry: drusens
- wet: subretinal haemorrhage

Pe
- red reflex normal or slightly reduced
- no RAPD
- macula abnormal

Ix
- OCT
- FFA
- ICGA

Tx
Dry amd
- vitamin supplementation
- diet high in antioxidants, lutein, betacarotene
- stop smoking
Wet amd
- antivegf
- same lifestyle