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OD3 - Clinical Optometry Practice > DIS - Macular Diseases II: AMD - Week 1 > Flashcards

DIS - Macular Diseases II: AMD - Week 1 Flashcards

1
Q

List the 6 components of an AMD work-up.

A 
Measure visual function
Fundus view with mydriasis
Colour fundus photopgraphy
OCT
FAF
Can also do OCTa for CNVM
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2
Q

What two things should you look for when doing fundus to assess AMD?

A

Foveal/macular swelling and CNVM (as well as drusen)

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3
Q

What OCT setting should be used to assess AMD?

A

Macula cube or single line through fovea (just do both)

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4
Q

What central retinal thickness on OCT should you refer?

A

> 350 microns

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5
Q

Is early CNVM generally visible on colour fundus photography, BIO, or fundus?

A

Often noot

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6
Q

How should visual function be measured when assessing AMD?

A

HC + LC VA, and macular VF

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7
Q

What is better, macular cube scan or line scan at the macula?

A

Macula cube

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8
Q

What should check on an OCT when assessing AMD?

A

Check ISe integrity

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9
Q

Is identification of CNVM easy or challenging?

A

challenging

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10
Q

How does CNVM appear on colour fundus photography?

A

Grey/pinkish yellow lesiond

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11
Q

What can CNVM lead to? How can this appear on FAF?

A 
RPE detachment (pigment epithelial detachment)
-hypo-fluorescent donut
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12
Q

List 5 OCT signs of CNVM. Describe how each appears on the OCT.

A 
Disruption of the ISe
-self-explanatory
Presence of sub-retinal fluid
-dark bands
Cystic formation within inner retinal layers
-dark bubbles
Pigment epithelial detachment
-clear internal cf drusen (milky)
Increased foveal thickness
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13
Q

What foveal thickness on OCT is an indication of CNVM?

A

> 100 microns between the eyes or >350 microns

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14
Q

List 5 OCT signs of nascent geographic atrophy. Describe how each appears on the OCT.

A 
Disruption of the ISe
-self-explanatory
Drusen regression
Subsidence of OPL and INL
-drops down
Hyporeflective wedge outer retina
Increased signal below bruchs membrane
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15
Q

What does ISe disruption on OCT indicate?

A

Advanced disease

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16
Q

Nascent geographic atrophy is visible by OCT by up to how many months before CFP/FA?

A

12 months

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17
Q

When does geographic atrophy tend to form?

A

After drusen regression

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18
Q

Describe the order of geographic atrophy development on OCT (6).

A 
Disruption of the ISe
Drusen regression
Subsidence of OPL and INL
Hyporeflective wedge outer retina
Increased signal below bruchs membrane
Complete loss of OS/RPE
-geographic atrophy
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19
Q

What should you do when assessing VA for an AMd work-up?

A

Pinhole

20
Q

List 3 tests that stress the retina to look for early disfunction.

A

Low luminance low contrast (LLLC)
Low luminance EDTRS
-with +2ND welding goggles and logMAR
High frequence filtered chart

21
Q

Compare LLLC with HC in terms of line loss.

A

Normal 1-2 line loss

22
Q

What can abnormal LLLC acuity predict of HC acuity?

A

HC vision loss by 4 years

23
Q

Describe LLLC acuity in high risk AMD.

A

Its worse

24
Q

List 5 components of functionally assessing unilateral vision loss when doing an AMD work-up.

A 
Visual acuity
RAPD
Colour vision (R/B)
Flicker sensitivity
Amsler grid
25
Q

What visual field setting should you use to assess AMD?

A

10-2

26
Q

List 3 additional functional assessment tests for AMD.

A

Dark adaptation/photostress recovery time test
Maddox rod
mfERG

27
Q

Describe how maddox rod can be used for AMD assessment. What is this called?

A

Watzke sign - distortion, gap, or change in line of light when looking at its middle
-slit lamp + maddox rod

28
Q

What happens to mfERG with AMD>

A

Implicit time delayed with retinal disease

29
Q

Is amsler reliable for AMD?

A

No, consider doing other tests as well

-in a study, it only found 30%

30
Q

Is looking for all vision changes reliable for AMD?

A

No, consider doing other tests as well

-in a study, it only found 67%

31
Q

Is OCT reliable for AMD?

A

Yes, but consider doing other tests as well

-in a study, it found all 100%

32
Q

Is dark adaptation reliable for AMD?

A

Yes, but consider doing other tests as well

-in a study, it found 95%

33
Q

Does home monitoring have high or low predictive performance? Describe its role.

A

Low but allows early detection and early treatment

-advise patients to do this with phone/tablet apps

34
Q

At what risk score should OCT be routinely used to assess AMD?

A

≥1

35
Q

When should AMD be monitored and when is a referral needed (2)?

A

Monitor until nascent or pre-wet AMD occurs

-refer when functional loss or OCT change is established

36
Q

What dietary modification is a therapeutic intervention for what stage of AMD?

A

Antioxidants for early stages

37
Q

What surgical option s available for AMD? Describe how it affects progression for early AMD and if reticular drusen is present.

A

Nanosecond laser (like SLT)

  • gives drusen regression and reduced progression for early AMD
  • gives progression of AMD if reticular drusen is present
38
Q

What drug is used to treat dry AMD?

A

None available, being developed

39
Q

What is the intervention for dry AMD?

A

Low vision aids

40
Q

What are the two interventions for wet AMD? Are both used?

A

Photodynamic therapy - not used anymore
-inject verteporfin, damages local blood vessels when laser activated, seals CNVM
aVEGF

41
Q

What happens if CNVM breaks through the RPE?

A

Sub-retinal fluid accumulation

42
Q

What is retinal angiomatous proliferation? What does it show with early OCT?

A

Neovascular growth beginning at the inner retina

Shows cystic formation early with OCT

43
Q

Where does retinal angiomatous proliferation grow towards and in what stage? What does it look like?

A

Towards the choroid - looks like CNVM

44
Q

True or false

All advanced wet-AMD has retinal angiomatous proliferation.

A

True

45
Q

Are CNVM and retinal angiomatous proliferation treated the same way?

A

Yesd

46
Q

Consider an AMD patient being treated with aVEGF who doesnt improve or regress. What now?

A

Place on another drug

47
Q

Is it likely for vision with AMD to improve with treatment?

A

Unlikely

OD3 - Clinical Optometry Practice (114 decks)

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