DIS - Myopic Pathology - Week 8 Flashcards
What percentage of Australians are myopic?
20%
Does myopia prevalence vary with ethnicity?
Yes
Is myopia a leading cause of blindness and vision impairment?
Yes
What happens to the ocular globe with myopia?
Ocular elongation and stretch
What is considered a high myope and what percentage of them have pathological changes? Can retinal pathology be associated with mild myopia?
High myopes have >6.00D
77% of high myopes have pathology
Retinal pathology can be associated with mild myopia
What percentage of high myopes have macular pathology? Does incidence increase with axial length? What about age?
7%
-incidence increases with AL/age
What is the retinal at the macula and RNFL like in a myopic eye?
Thinned
What appearance does the retina of a myopic eye generally have? Are choroidal vessels more or less visible? Does this appearance increase or decrease with age?
Tesselated/tigroid appearance
-increased visibility of choroidal vessels
-decreases with age
How does early atrophy appear in myopic eyes (colour/border) and in what percentage of high myopes?
Patchy/diffuse atrophy
-greyish/white lesions with distinct borders
-widespread yellow lesions
20-40% of high myopes
What are lacquer cracks, how do they appear, what are their borders like and in what percentage of high myopes do they appear?
Irregular pale yellow/white thin lesions branching and crisscrossing the retina
May have pigmented borders
7% of high myopes
Does choroidal vasculature tend to be visible if lacquer cracks are present?
Yes
What are lacquer cracks suggested to be (4)?
Healed mechanical breaks in the RPE, bruchs membrane, and choriocapillaris
What percentage of lacquer cracks progress?
20%
What 7 things are associated with lacquer cracks?
CRA
Age
Axial length
Vision loss
Fuchs spot
CNVM
Haemorrhage
What is usually seen at the ONH/macula with staphyloma?
Posterior ectasia
How does staphyloma appear (colour/margins)?
Pallor, atrophyc retina, distinct margins
Are choroidal vasculature prominent with staphyloma?
Yes
What six things is staphyloma associated with?
Progressive RD
Macular holes
CNVM
Macular retinoschisis
Lacquer cracks
Vitreous abnormalities
What percentage od high myopes have staphyloma?
12-25%
List four common ONH pathologies associated with myopia.
PPA/myopic crescents
Peripapillary retinal detachment
Tilted disc
What does a tilted disc predispose you to?
Glaucoma damage
What percentage of normal eyes and high myopes have PPA/myopic crescents?
23-38% in high myopes
14% in normal eyes
What happens to the area of PPA with age and axial length?
Increases with age and axial length
What is meant by zone β and zone α in terms of location for PPA?
Zone β - clostest, complete CRA/crescent/ring
Zone α - outer, hypo and hyper
How does peripapillary retinal detachments appear (colour and location)? What is it due to and what could be used to detect this?
Tellow/orange lesions localised near the ONH
Cystoid spaces in the choroid
-OCT
What kind of traction is often seen in a tilted disc?
Supra-traction
What is the association between PVD, myopia, and axial length? Explain what ocular enlargement entails for the vitreous (2).
Develop PVD earlier with increasing myopia and axial length
Ocular enlargement associated with peripheral changes, but no significant associations with peripheral degenerations
Compare the incidence of lattice degeneration in normal eyes vs myopes.
General <10%
Myopic 25%
When does lattice degeneration develop and is it age-related?
2nd/3rd decades, not age related
Describe what lattice degeneration looks like.
Sharp bordered, white arborising/branching lines
Irregular pigment
Spiral shaped
Where are lattice degenerations often seen? Is it often bilateral?
Temporal
Often bilateral
What do the white branching lines of lattice degeneration indicate?
Sclerosed retinal vessels
What is the vitreous overlying lattice degeneration often like (2)?
Liquefied
Abnrmal vitreoretinal adhesions
What is meant by an atypical lattce degeneration? What is it possibly?
No white lines, local accumuation of snowflakes (muller remnants?)
Possibly RPE clumping only
What is the most significant peripheral retinal change in myopic pathology?
Lattice degeneration
What does lattice degeneration have a significant association with?
RD
What is a retina with lattice degeneration prone to and from what? Along what edge and when does it frequently develop?
Prone to retinal tears from vitreous traction
-typically along posterior edge
-frequently develop at onset of acute PVD
What is a snail trail thought to be?
Probably a precursor or variant of lattice degeneration
Do snail trails have similar size, shape, and distribution to lattice degeneration?
Yes
Describe what snail trails look like.
Bands of tightly packed snowflakes on the inner retinal surface, glistening or frost-like surface
What is the risk of vitreous changes, tears, and detachment like in snail trails vs lattice degeneration?
Less risk
Are snail trails often uni- or bilateral? What part of pathological myopic eyes often has them?
Often bilateral and temporal