Comp 6.1.1

Question 1

What are the risk factors of AMD? Give me 9

Answer 1

1. Age; the eyes lose the ability to remove toxins.
2. Race: Caucasians, as their eyes have the reduced ability to remove toxin due to lack of pigmentation, therefore, resulting in a buildup of debris in the RPE and Bruchs membrane
3. Gender; women tend to live longer so they’re more likely to develop it.
4. FH of AMD; increases chance by three times
   5.smoking; increases risk by 2.5 more times as retina has a high rate of oxygen consumption and smoking causes oxidative damage which reduces the ability to remove toxins

5.sunlight; blue wavelength causes damage to the macular, therefore, leading to formation of Drusen.

6. Diet; diet high in Fats, cholesterol, and have a high glycaemic index, promote AMD, and as does a lack of antioxidant consumption.
7. AMD, in one eye; patient have 50% chance developing AMD in the following eye
8. Lack of exercise.
9. Hypertension

Question 2

What are the symptoms of dry AMD? Give 5

Answer 2

Reduced colour vision

difficulty reading

gradual reduction in visual acuity

reduced contrast sensitivity

and difficulty, recognising faces

Question 3

What are the symptoms of wet AMD? Give me five

Answer 3

Sudden reduction in visual acuity

decreased intensity of colours

well-defined blurry spot in field of vision

distortion of straight lines and edges

and objects seeming smaller than usual also known as micropsia

Question 4

What are some expected clinical findings for someone with dry AMD?

Answer 4

Early AMD; harden, focal hyperpigmentation of RPE, areas of sharply, defined, RPE, atrophy

Intermediate AMD: RPE degeneration with sub retinal fluid without neovascularisation and pigment, epithelial detachment without neovascularisation

Late dry AMD: geographic, atrophy, significant visual loss (<6/18)

Question 5

What are some expected clinical findings for somebody with wet AMD?

Answer 5

Normal: drusen

Intermediate: RPE degeneration with subretinal fluid without neovascularisation and pigment, epithelial detachment without neovascularisation

Late active : choroidal neovascularisation

Late inactive: fibre, scar, atrophy, and cystic degeneration

Question 6

What test would you use for central visual fields and what are some expected results and how would you conduct this test?

Answer 6

You would use an amsler grid

you would do this test by asking the patient to wear their near correction and test them monocular at 30 cm

Some abnormal results you could expect are holes or spots within the grid, blurring of lines, or curvy lines.

Question 7

Explain the difference between a scotomae and metamorphopsia

Answer 7

Scotoma is when there is blurry or missing areas on the grid, and may correspond to areas of RPE atrophy

Metamorphopsia is areas of wobbly or wavy lines. Distorted lines may indicate oedema or subretinal fluid.

Question 8

What is the management of dry AMD?

Answer 8

Self monitoring, which includes routine exams that entail; Amsler, indirect ophthalmoscopy, and OCT

Knowledge of vision changes which might indicate what AMD, blur or grey patch in their vision, straight lines, appearing to distorted, or objects, appearing smaller than normal

How the patient minimise their risk factors which include smoking (refer patient to smoking cessation clinic at Boots pharmacy, as they are 3 to 4 times more likely to develop MD. If you’re a smoker), UV protection, sunglasses, transitions, Iceland, and diet nutrition

Question 9

What is the management for Wet AMD?

Answer 9

Refer a patient for what AMD for certification of site impairment.
You would also do an urgent referral for a person with suspected, late AMD (wet active) to immaculate service, whether or not they report any visual impairment.
The referral should be made in one working day but does not need to be emergency

Question 10

What is the treatment and the criteria for wet active AMD?

Answer 10

So the visual acuity needs to be between 6/12, and 6/96, there should be no permanent structural damage to the central fovea, the lesion size needs to be less than equal to 12 disc areas in the greatest linear dimension and the treatment would be anti-vegf injections, for example, ranibizumab

Question 11

How do anti-injections work

Answer 11

Anti vegf injections were by binding to an inhibit actions of the vascular endothelial growth factor,

it reduces new blood vessel growth.

There will be less subretinal fluid/haemorrhages.

It is injected into the vitreous spine, ophthalmologist/trained nurse/optometrist.

Question 12

What is the treatment regime for anti-vegf injections?

Answer 12

It starts from monthly to 3 monthly injections, the regime depends on progression and response to treatment, it could be injections for life potentially

Question 13

Give me some anti-Vegf drug options

Answer 13

Lucentis, macugen, Eyelea

Question 14

Given an alternative treatment for wet AMD

Answer 14

PDT is photo dynamic therapy; it’s rarely used due to the injections, patients receive a dye in their eye, and that dye accumulates in Choroidal new vessels, selective absorption of low intensity, laser lines on thermal causes the leaky vessels to close, and it is most effective in classic subfoveal AMD

Question 15

What are some common risk factors for primary open glaucoma?

Answer 15

An IOP higher than 24, Afro Caribbean race, due to their thinner corneas, makes some five times more likely to get open angle, age, the prevalence increases, somebody with myopia higher than three dioptres causes them to be five times more likely due to the stretching of the disk, and the lack of blood supply, family, ocular, history of glaucoma, optic nerve structure (large discs are more vulnerable to damage), and people with vascular diseases such as hypertension

Question 16

What are some common risk factors for normal tension glaucoma?

Answer 16

Age, these patients tends to be older than those with primary open and Goma, race, as it occurs more frequently in people of Japanese origin, family, history, glaucoma, CCT patients are lower with normal tension, glaucoma than primary glucoma, abnormal vasa regulation, touches, migraines, and raynaud phenomenon

Question 17

What are the risk factors of angle-closure glaucoma?

Answer 17

Age the average age of relative pupillary block is about 60 years at presentation, race, Eskimos and Asians are more likely to develop ACG, positive family, history of glucoma, hyper ropes, due to their shallower, angles, and AC, people with vascular diseases, can cause secondary ACG as a result of neovascularisation. The new blood vessels can block the iris which impedes the flow of the acre with humour into the tubercular, meshwork, leading to increased IOP, medications, which can cause the iris and cornea to come together.

Question 18

What are some risk factors of developing cataracts?

Answer 18

Age , gender – women are more likely to live longer, so they’re more likely to develop cataracts, positive family, history of cataracts, UVB, exposure, medication, such as steroids used for PSC, diabetes is the increased sugar levels, caused the lens to swell, smoking due to the oxidation, traumatic cataract as a result of penetrating, injuries, concussions, or electric, shock, et cetera

Question 19

What are some risk factors of developing diabetic retinopathy?

Answer 19

The duration of diabetes, the longer a patient suffers from diabetes agreed to the risk of developing DR no matter how well it’s controlled. For example, a patient who has developed diabetes for over five years is 5% likely, over 10 years is 30% likely, over 30 years is 90% likely, glycaemic control, if it’s well control will progress at a slow rate, race, South, Asians, Africans, and non-Americans are predisposed to developing diabetes due to biological and electrical factors, hypertension as it is detrimental to retinal blood vessels, and can cause hypertensive retinopathy, thus increasing the risk of DPR, hyper lipidemic, smoking, other factors, including pregnancy, and renal disease

Question 20

What are some risk factors of a retinal attachment?

Answer 20

Age, previous retinal detachment, in one eye, family, history of retinal, detachment, extreme myopia, previous eye surgery, such as cataract removals, previous severe eye, injury, previous other eye, disease, or disorders, including UV -itis, or thinning of the peripheral retina, also known as lattice degeneration