common and chronic conditions

Question 1

leading causes of vision loss

Answer 1

ARMD, refractive error, cataract, diabetic retinopathy

Question 2

what is refractive error

Answer 2

light is focussed inaccurately onto the retina, due to the size and shape of the eye

Question 4

myopia is when

Answer 4

eye ball is too long / high corneal curvature
focus is in front of the retina
short sightedness, more common

Question 5

hypermetropia is when

Answer 5

long sightedness
eyeball is too short or the corneal curvative is less
focus is behind the retina

Question 6

how do you correct myopia

Answer 6

correct with a concave lens to unbend the light and correct for high corneal curvature or long eye

Question 7

presbyopia

Answer 7

> 40yo
gradual loss of accomodation reflex
often at work using screens
discomfort, headache, blurriness, eye strain at work

Question 8

how do you correct hypermetropia

Answer 8

convex lens

Question 9

refractive error Hx

Answer 9

blurred vision at a distance (driving, TV), near (reading, screens) or both.
presbyopia: ~40yo, discomfort, headache, blurriness at work (eye strain)

Question 10

aetiology or refractive error

Answer 10

myopia and hypermetropia: axial length and/or corneal curvature
presbyopia: loss of accomodation

Question 11

astigmatism

Answer 11

irregular corneal curvature

Question 12

examination of refractive error

Answer 12

improvement in VA with pin-hole occlusion (difficult in some patients)
get them to keep distance glasses on

Question 13

management of refractive error

Answer 13

glasses/contacts (optometry), refractive surgery (ophthalmology)
drivers advice
presbyopes: 20-20-20 rule. lubricating drops
children: 20-20-2 rule, low dose atropine (ophthalmology)

Question 14

presbyopia 20-20-20 rule

Answer 14

every 20 minutes, look 20 metres in the distance for 20 seconds
plus lubricating drops

Question 15

kids 20-20-2 rule

Answer 15

2 hours spent outdoor every day to prevent myopia
plus low dose atropine (for a paediatric opthalmologist to consider in kids developing myopia)

Question 16

a cataract is

Answer 16

an opacity of the natural lens
the lens should be transparent

Question 17

symptoms of cataract

Answer 17

blur
diminish in brightness
glare in some subtypes of cataract

Question 18

cataracts can be brought on my

Answer 18

systemic steroid use
diabetes
aging

Question 19

cataract surgery

Answer 19

removal of the natural lens under anaesthetised eye
under local anaesthetic
ultrasonic probe used
laser can be used but often isn’t - primarily an ultrasound based surgery
artificial lens tailored to the patients eye replaces the natural lens

Question 20

Hx of cataract

Answer 20

> 60 year olds
gradual blurring of distance vision
‘glasses seem smudged’
‘second sight’ = myopic shift causes people to be able to read better than before
glare, monocular diplopia

Question 21

second sight

Answer 21

happens in cataract
caused by myopic shift
patient can paradoxically read/see close up better than they could before

Question 22

aetiology of cataracts

Answer 22

age- related opacification of the natural lens fibres (protein denaturation)
others: congenital, traumatic, iatrogenic (steroids), diabetes, UV radiation

Question 23

examination of cataract

Answer 23

progression of clear lens to yellow, brown, or white
slit lamp: nuclear, cortical or posterior sub capsular

Question 24

management of cataract

Answer 24

address refractive error and dry eye first, this can often defer surgery
cataract surgery: day surgery, LAS (local anaesthetic sedation), painless, sequential; >90% success, recovery in days, dry eye symptoms post-op, may still need glasses

Question 25

will you need glasses after cateract surgery

Answer 25

maybe - advise patients they may still need it

Question 26

glaucoma is

Answer 26

a group of conditions characterised by progressive optic neuropathy, often linked to increased intraoccqular pressure (but not all glaucoma has increased intraoccqular pressure)

Question 27

ow does glaucoma present

Answer 27

peripheral field vision loss
eventually leading to tunnel vision

Question 28

Hx of primary open angle glaucoma

Answer 28

usually asymptomatic, may present late with field constriction or blurred vision
risk factors: +/- family history, age >40yo, obstructive sleep apnea, myopia, diabetes

Question 29

risk factors of primary open angle glaucoma

Answer 29

risk factors: +/- family history, age >40yo, obstructive sleep apnea, myopia, diabetes

Question 30

aetiology of primary open angle glaucoma

Answer 30

reduced aqueous outflow and raised IOP -> altered optic nerve head perfusion and progressive loss of retinal ganglion cells

Question 31

examination of primary open angle glaucoma

Answer 31

raised IOP (>21 mmHg)
visual field loss
optic disc cupping or asymmetry worsening over time over serial measurements
normal anterior chamber depth and appearance

Question 32

management of glaucoma

Answer 32

screening: 1-2 yearly with ophthalmology or optometry (at risk patients)
medical: b-blockers (e.g. timoptol), prostaglandin analogues, (Xalatan), alpha-agonsits (e.g. alphagan), carbonic anyhydrase inhibitors (e.g. Azopt)
surgical: SLT laser, trabeculectomy, glaucoma drainage devices

Question 33

drusen looks like

Answer 33

kinda looks like hard exudate but its not
this is age related macula degeneration
drusen - deposits of protein and fat at the back of the eye that are waste products not being adequately pumped out of the retina because the ability to pump waste product out of the retina reduces with age

Question 34

what is age related macula degeneration

Answer 34

progressive degeneration (wear and tear) of the macula, affecting central vision

Question 35

pathophysiology of ARMD

Answer 35

degeneration of outer retina leading to drusen formation and photoreceptor loss

Question 36

Hx of age related macula degernation

Answer 36

gradual central blurring, distortion (over months/years), prolonged dark adaptation
+/- smoking
family history, metabolic/cardiovascular disease
60-70+ yo

Question 37

what is prolonged dark adaptation

Answer 37

eyes take too long to acclimate to the dark

Question 38

examination of age related macula degeneration

Answer 38

macular drusen (yellow), pigment (black)
if you see red this is blood and this may be indicative of neo vascular age related macula degeneration which has a more subacute onset than ARMD

Question 39

management of ARMD

Answer 39

routine ophthalmology referral
conservative management to slow progression
diet rich in green leafy vegetables, antioxidants, Mediterranean diet
supplimentation
stop smoking
self monitoring with amsler grid

Question 40

how to monitor ARMD

Answer 40

use amsler grid chart at home
monitor for new distortion of new scotoma which is dry ARMD changing to wet
sooner wet is caught the better