Common Medical Retina Diseases Flashcards
What is age related macular degeneration?
AMD is a disease of people over 50, it results in progressive central visual loss, is usually bilateral
What are the two types of AMD?
Dry AMD (the most common form of AMD)Wet AMD (most aggressive form)
Describe dry AMD and the vision loss it causes
most common form of AMDcauses gradual death of the macula slow and gradual loss of central vision - difficulty reading and recognising facesno treatment possible visual rehabilitation
Describe wet AMD and the vision loss it causes
results in 90% of all AMD vision lossvisual loss is characterised by distortion in vision and sudden loss of central vision immediate referral to an ophthalmologist
What causes wet AMD
formation of abnormal new blood vessels from the inner choroid blood vessels leak, bleed and scar
What are the risk factors for AMD (wet and dry)
smoking CV disease - HTN and hyperlipidaemia Low antioxidant levels in the blood
What disabilities/difficulties are associated with AMD?How does it affect the pt’s life
increased risk of fallingdifficulty with shopping difficulty with managing money difficulty preparing meals difficulty using the telephone difficulty with housework suffering emotional distress and depression can lead to dependence and isolation high users of health care services and community services
What investigations are carried out if AMD is suspected?
Fundus photos Fundus fluorescein angiography Indocyanine green angiography Optical coherent tomography Ultrasonography
How does wet AMD develop?
Depends on the type50% develop classic CNV (choroidal neovascularization) within 1 year otherwise visual loss slow
What is choroidal neovascularization (CNV)?
wet AMD - abnormal blood vessels that grow under retina/macula
What is the treatment of CNV/wet AMD?
focal laser photocoagulation photodynamic therapy (PDT) with visudyne pharmacological agents (anti-VEGF agents are FIRST LINE) surgery - excision of CNV combination treatments
How can rehabilitation be used in AMD?
Blind registration may lead to help from social services LVA - initial visit and continuing dialogueSupport groups and societies - macular disease society, RNIB
How common is diabetic retinopathy?
commonest cause of visual impairment and blindness in working age peoplemost blindness associated with DM is preventable
What are the RFs for developing diabetic retinopathy?
Duration of DM Age Smoking HypertensionPoor DM control Hyperlipidaemia Renal impairment Pregnancy
What are the two types of DR?
Non-proliferative DR (NPDR) Proliferative (PDR)
What is diabetic maculopathy?
a special retinopathy that may occur with either NPDR or PDRmore common in type 2leads to visual loss if not treated
How/when does NPDR present in patients?
usually asymptomatic usually occurs after >8-10 yrs dm may be mild/mod/severe
How does NPDR manifest clinically?
microaneurysms exudatesretinal haemorrhage cotton wool spotsvascular dilations calibre variations intraretinal microvascular abnormalities LOOK AT FUNDOSCOPY IMAGES on PP
How common is PDR?
occurs in ~5% of DM more common in type 1 than type 2 DM
Describe PDR
characterised by the development of new vessels on the optic disc or the retina occurs as a response to significant retinal ischemia
How does the neovascularisation in PDR develop?
New vessel appear as small tufts of irregularly ramifying vasculature arising from veinsThey move forward into vitreous and are fragile and likely to bleed with slight traction resulting in pre-retinal and/or vitreous haemorrhage
What are the late changes in PDR?
retinal fibrosis traction retinal detachment iris neovascularisation and neovascular glaucoma
What are the 3 types of diabetic maculopathy?
focal diffuseischaemia may occur in different combinations
What are the management options in diabetic retinopathy?
control of diabetes and other risk factors laser photocoagulation - to stop focal leaks that occur with focal maculopathy pharmacologic treatments (anti VEGF and anti permeability agents)vitrectomy
What are the other eye problems which can occur in diabetics?diabetic eye disease
increased incidence of eyelid infections, cataracts cranial nerve palsies: III, IV, VIdelayed healing of corneal abrasions; corneal ulcersmore severe post op intraocular inflammation - e.g. after cataract surgery abnormal wound healing
