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P3 > DISEASE (Hypertensive Retinopathy) > Flashcards

DISEASE (Hypertensive Retinopathy) Flashcards

1
Q

Complications of Diabetic Retinopathy (VRGB)

A

-Vitreous hemorrhage
-Retinal detachment
-Glaucoma
-Blindness

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2
Q

Treatment for early diabetic retinopathy

A

-Good blood sugar control to slow progression
-Collaboration with an endocrinologist to improve diabetes management

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3
Q

Treatment for Proliferative DR (w macular edema)

A

-Photocoagulation/Focal laser
-Grid laser photocoagulation
-Panretinal photocoagulation (PRP)
-Vitrectomy

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4
Q

also known as focal laser treatment, can stop/slow leakage of blood & fluid in the eye

A

Photocoagulation/focal laser

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5
Q

usually done in outpatient department or in eye single session clinic

A

Photocoagulation/focal laser

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6
Q

Surgical procedure for diffuse clinically significant diabetic macula edema

A

Grid laser photocoagulation

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7
Q

treatment of choice for cases not responding to anti-VEGF & steroids

A

Grid laser photocoagulation

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8
Q

for “recalcitrant” (stubborn) cases DM Ret

A

Grid laser photocoagulation

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9
Q

also known as “scatter laser treatment” can shrink abnormal blood vessels

A

Panretinal photocoagulation (PRP)

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10
Q

some loss of peripheral vision or night vision after the procedure

A

Panretinal photocoagulation (PRP)

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11
Q

areas of retina away from macula are treated with scattered laser burns

A

Panretinal photocoagulation (PRP)

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12
Q

uses tiny incision in your eye to remove blood in the vitreous as well as scar tissue thats tugging on retina that can cause tractional retinal detachment

A

Vitrectomy

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13
Q

done in a surgical center/hospital using local/general anesthesia

A

Vitrectomy

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14
Q

Pharmacologic therapy for DR

A

-Anti-VEGF
-Triamicinolone

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15
Q

help stop growth of new blood vessels by blocking effects of growth signals the body send to generate new blood vessels

A

Anti-VEGF (Ranibizumab, Bevacizumab)

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16
Q

administered intravitreally; corticosteroid used in treatment of diabetic macular edema

A

Triamicinolone

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17
Q

Diabetes Control & Complications tral found that intensive __________ in px with type 1 diabetes decreased the incidence of progression of DR

A

Glucose control

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18
Q

Optometric Management for DR

A

-close monitoring for px suspected for DM Ret
-dilated retinal examination
- refer if:
1. macular edema
2. severe NDR
3. PDR

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19
Q

Prevention for DR

A
  1. Regular eye exams
  2. Reduce risk of getting DR by
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20
Q

Reduce risk of getting DR by the following:

A

-Manage diabetes
-Healthy diet
-Physical activity part of daily routine
-Moderate aerobic activity (walking)
-Oral diabetes meds or insulin as directed
-Monitor blood sugar level
-Keep bp & cholesterol under control
-Avoid smoking
-Pay attention to vision changes (changes in prescription, sudden vision loss)
-Lifestyle modification

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21
Q

complication of high blood pressure (hypertension)

A

Hypertensive Retinopathy

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22
Q

due to persistent, untreated high bp can cause damage to the retina

A

Hypertensive retinopathy

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23
Q

occurs when force of blood against artery walls is too high, causing: DAN

A

-Damaged over time
-Arteries to stretch
-Narrow

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24
Q

Damage to retina increase with: SL

A

-Severity of high bp
-Length of time

25
Q

at risk:

A

older people

26
Q

caused by chronically elevated blood pressure

A

Arteriosclerosis changes of hypertensive retinopathy

27
Q

elevated blood pressure systolic & diastolic

A

systolic: 120-129mmHg
diastolic: <80mmHg

28
Q

Stage 1 hypertension systolic & diastolic

A

systolic: 130-139mmHg
diastolic: 80-89mmHg

29
Q

Stage 2 hypertension systolic & diastolic

A

systolic: equal or less than 140 mmHg
diastolic: >90 mmHg

30
Q

stage of retinopathy: narrowing of arteries is mild

A

Grade 1

31
Q

stage of retinopathy: AV nicking

A

Grade 2

32
Q

stage of retinopathy: retinal hemorrhage, cotton-wool spots

A

Grade 3

33
Q

stage of retinopathy: combines first two categories into one

A

Grade 4

34
Q

stage of retinopathy: severe G3 swelling of optic disc (papilledema)

A

Grade 4

35
Q

Patho of HR that differentiates them from other blood vessels: TAP

A

-The absence of sympathetic nerve supply
-Autoregulation of blood flow
-Presence of blood-retinal barrier

36
Q

Hypertensive retinopathy phases

A

a. Vasoconstrictive phase
b. Sclerotic phase
c. Exudative phase
d. Malignant hypertension

37
Q

phase where the local autoregulatory mechanisms come into play

A

Vasoconstrictive phase

38
Q

cause vasospasm & retinal arteriole narrowing, which is evident by decrease in arteriole venule ratio

A

Vasoconstrictive phase

39
Q

persistent in BP causes certain vessel wall

A

Sclerotic phase

40
Q

Sclerotic phase: persistent increased BP changed in vessel wall (IMA)

A

Intima layer: thickening
Media layer: hyperplasia
Arteriolar wall: hyaline degeneration

41
Q

Sclerotic phase changes in vessel wall lead to (SAW)

A
  1. Severe form of arteriolar narrowing
  2. Arteriovenous (AV) crossing changes
  3. Widening & accentuation of light reflex (silver & copper wiring)
42
Q

seen in px with severely increased BP

A

Exudative phase

43
Q

Exudative phase is characterized by (DL)

A
  1. Disruption of blood-brain barrier
  2. Leakage of blood & plasma into vessel wall
    - disrupting autoregulatory mechanisms
44
Q

Exudative phase: retinal signs (RHNR)

A
  1. Retinal hemorrhage (flame-shape & dot blot)
  2. Hard exudate formation
  3. Necrosis of smooth muscle cells
  4. Retinal ischemia (cotton-wool spots)
45
Q

severe intracranial hypertension leads to optic nerve ischemia & edema (papilledema)

A

Malignant hypertension

46
Q

other factors contributing to developing high bp:

A

-Obesity
-Sedentary lifestyle
- A diet high in salt
-Stress
-Family history of high bp
-Diabetes
-Moderate to high alcohol intake

47
Q

Signs & symptoms of HR

A

-Permanent arterial narrowing
-Arteriovenous crossing abnormalities (arteriovenous nicking)
-Arteriosclerosis w moderate vascular wall changes (copper wiring) to more severe vascular wall hyperplasia & thickening (silver wiring)

48
Q

retinal arterioles appear orange or yellow instead of red

A

Copper wiring

49
Q

retinal arterioles look white if they have become occluded

A

Silver wiring

50
Q

retinal arterioles look dull white if with severe occlusion

A

Ghost vessel

51
Q

___________is a major predisposing factor to development of a branch retinal vein occlusion

A

arteriovenous nicking

52
Q

for severe cases, these are the findings:

A

-superficial flame-shaped hemorrhage
-small, white superficial foci of retinal ischemia (cotton-wool spots)
-yellow hard exudates
-optic disc edema

53
Q

Treatment for HR (CARD- RGL)

A

-controlling hypertension
-anti-VEGF
-giving up smoking
-losing weight
-regular exercise
-dietary changes
-reduce alcohol intake

54
Q

Medications for HR

A

a. Angiotensin-converting enzyme (ACE inhibitors)
b. Angiotensin-2 receptor blockers (ARBs)
c. Thiazide diuretics
d. Calcium-channel blockers
e. Beta-blockers

55
Q

Prevention for HR

A
  1. careful management oh high bp & related condition like diabetes
  2. lifestyle changes (lose weight, give up smoking)
  3. regular monitoring of bp
  4. regular eye screening
56
Q

Complications for HR

A
  1. Retinal vein occlusion
  2. Retinal artery occlusion
  3. Ischemic optic neuropathy
  4. Malignant hypertension
  5. Stroke & heart attack
57
Q

Prognosis for HR

A

Mild hyper (G1 & G2) - relatively positive, as long as bp is controlled
Severe hyper - if not properly managed, condition can enter “malignant” stage

58
Q

Optometrist’s role

A
  1. Early detection & diagnosis of ocular manifestations associated with HTN
  2. Lead to timely referral and appropriate management
59
Q

Challenge to all new & old opto

A

“We can affirm role of optometrists as primary health care provider, by performing a comprehensive eye examination, including blood pressure evaluation”.

P3 (7 decks)

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