Common Medical Retina Diseases

Question 1

What is age related macular degeneration?

Answer 1

AMD is a disease of people over 50, it results in progressive central visual loss, is usually bilateral

Question 2

What are the two types of AMD?

Answer 2

Dry AMD (the most common form of AMD)Wet AMD (most aggressive form)

Question 3

Describe dry AMD and the vision loss it causes

Answer 3

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

Question 4

Describe wet AMD and the vision loss it causes

Answer 4

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

Question 5

What causes wet AMD

Answer 5

formation of abnormal new blood vessels from the inner choroid blood vessels leak, bleed and scar

Question 6

What are the risk factors for AMD (wet and dry)

Answer 6

smoking CV disease - HTN and hyperlipidaemia Low antioxidant levels in the blood

Question 7

What disabilities/difficulties are associated with AMD?How does it affect the pt’s life

Answer 7

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

Question 8

What investigations are carried out if AMD is suspected?

Answer 8

Fundus photos Fundus fluorescein angiography Indocyanine green angiography Optical coherent tomography Ultrasonography

Question 9

How does wet AMD develop?

Answer 9

Depends on the type50% develop classic CNV (choroidal neovascularization) within 1 year otherwise visual loss slow

Question 10

What is choroidal neovascularization (CNV)?

Answer 10

wet AMD - abnormal blood vessels that grow under retina/macula

Question 11

What is the treatment of CNV/wet AMD?

Answer 11

focal laser photocoagulation photodynamic therapy (PDT) with visudyne pharmacological agents (anti-VEGF agents are FIRST LINE) surgery - excision of CNV combination treatments

Question 12

How can rehabilitation be used in AMD?

Answer 12

Blind registration may lead to help from social services LVA - initial visit and continuing dialogueSupport groups and societies - macular disease society, RNIB

Question 13

How common is diabetic retinopathy?

Answer 13

commonest cause of visual impairment and blindness in working age peoplemost blindness associated with DM is preventable

Question 14

What are the RFs for developing diabetic retinopathy?

Answer 14

Duration of DM Age Smoking HypertensionPoor DM control Hyperlipidaemia Renal impairment Pregnancy

Question 15

What are the two types of DR?

Answer 15

Non-proliferative DR (NPDR) Proliferative (PDR)

Question 16

What is diabetic maculopathy?

Answer 16

a special retinopathy that may occur with either NPDR or PDRmore common in type 2leads to visual loss if not treated

Question 17

How/when does NPDR present in patients?

Answer 17

usually asymptomatic usually occurs after >8-10 yrs dm may be mild/mod/severe

Question 18

How does NPDR manifest clinically?

Answer 18

microaneurysms exudatesretinal haemorrhage cotton wool spotsvascular dilations calibre variations intraretinal microvascular abnormalities LOOK AT FUNDOSCOPY IMAGES on PP

Question 19

How common is PDR?

Answer 19

occurs in ~5% of DM more common in type 1 than type 2 DM

Question 20

Describe PDR

Answer 20

characterised by the development of new vessels on the optic disc or the retina occurs as a response to significant retinal ischemia

Question 21

How does the neovascularisation in PDR develop?

Answer 21

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

Question 22

What are the late changes in PDR?

Answer 22

retinal fibrosis traction retinal detachment iris neovascularisation and neovascular glaucoma

Question 23

What are the 3 types of diabetic maculopathy?

Answer 23

focal diffuseischaemia may occur in different combinations

Question 24

What are the management options in diabetic retinopathy?

Answer 24

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

Question 25

What are the other eye problems which can occur in diabetics?diabetic eye disease

Answer 25

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