Comp 6.1.1 Flashcards
What are the risk factors of AMD? Give me 9
- Age; the eyes lose the ability to remove toxins.
- 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
- Gender; women tend to live longer so they’re more likely to develop it.
- 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.
- Diet; diet high in Fats, cholesterol, and have a high glycaemic index, promote AMD, and as does a lack of antioxidant consumption.
- AMD, in one eye; patient have 50% chance developing AMD in the following eye
- Lack of exercise.
- Hypertension
What are the symptoms of dry AMD? Give 5
Reduced colour vision
difficulty reading
gradual reduction in visual acuity
reduced contrast sensitivity
and difficulty, recognising faces
What are the symptoms of wet AMD? Give me five
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
What are some expected clinical findings for someone with dry AMD?
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)
What are some expected clinical findings for somebody with wet AMD?
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
What test would you use for central visual fields and what are some expected results and how would you conduct this test?
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.
Explain the difference between a scotomae and metamorphopsia
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.
What is the management of dry AMD?
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
What is the management for Wet AMD?
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
What is the treatment and the criteria for wet active AMD?
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
How do anti-injections work
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.
What is the treatment regime for anti-vegf injections?
It starts from monthly to 3 monthly injections, the regime depends on progression and response to treatment, it could be injections for life potentially
Give me some anti-Vegf drug options
Lucentis, macugen, Eyelea
Given an alternative treatment for wet AMD
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
What are some common risk factors for primary open glaucoma?
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
What are some common risk factors for normal tension glaucoma?
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
What are the risk factors of angle-closure glaucoma?
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.
What are some risk factors of developing cataracts?
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
What are some risk factors of developing diabetic retinopathy?
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
What are some risk factors of a retinal attachment?
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
