Geriatrics Potpourri 3 Flashcards
What is the leading cause of adult blindness in the developing world?
Age-Related Macular Degeneration (AMD)
Impacts of Age-Related Macular Degeneration (AMD) on the elderly?
- Ability to drive
- Increased rates of falls
- Ability to live independently
- What is AMD?
- Early AMD usually presents how?
- Results in the loss of what?
- Degenerative disease of the central portion of the retina (macula)
- Early AMD is often asymptomatic
- Results in loss of central vision primarily
Classifications of AMD? 2
- Dry (atrophic)*
2. Wet (neovascular or exudative)
Describe the following types of AMD:
1. Dry (atrophic)*? 2
- Wet (neovascular or exudative)?
2
- Dry (atrophic)*
- Ischemia
-Retinal epithial cell apoptosis/activating inflammation
- Wet (neovascular or exudative)
- Balance between substances that promote or inhibit blood vessel development
-Vascular endothelial growth factor (VEGF)
AMD Risk factors?
7
- Age
- Smoking
- Genetics
- CVD
- Diet?
- Cataract surgery?
- Possibly alcohol
AMD Hx questions? 4
Vision loss occurring over days or weeks requires what?
- Rate of vision loss
- Whether one or both eyes involved
- Loss near or far vision or both
- Acute distortion of loss of central vision—may be wet AMD
urgent ophthalmic referral
Ophthalmologic Evaluation
for Dry? 3
For wet? 3
Dry:
- Drusen appears as bright yellow spots
- Atrophy appears as areas of depigmentation
- There may be increased pigmentation
Wet:
- Subretinal fluid/and or hemorrhage
- Neovascularization—appears as grayish-green discoloration
- Often require fluorescein angiogram
Treatment for dry? 1
-To slow progression? 3
Wet? 3
Tool for detecting AMD?
Dry:
- None
- For slowing the progression:
- Antioxidants with Vitamin C, E;
- beta carotene,
- zinc & copper (in smokers NO beta carotene)
Wet:
- VEGF inhibitors
- Photocoagulation
- Surgery
Tool for detecting disease progression: Amsler Grid
What are the types of glaucoma?
4
Most common?
- Acute angle glaucoma
- Secondary glaucoma
- Congenital glaucoma
- Primary open-angle glaucoma: most common
Subtypes of secondary glaucoma?
3
: many subtypes
- Uveitis
- Old trauma
- Steroid therapy
Characteristics of POAG?
3
Disease must be screened for
- Optic neuropathy—optic disc described as “cupping”
- Peripheral visual field loss followed by central field loss—cannot be recovered
- No symptoms initially
Disease must be screened for
POAG—Risk Factors
4
- Elevated IOP:
- Increasing age w/ increased risk of blindness
- African Americans have 4-5 times greater risk
- Family history
What is a normal IOP?
Normal range 8-22 mg Hg
Exact relationship between elevated IOP & cupping not well understood
- POAG screening?
- Done by who?
- How? - Tx? 3
- Screening:
- Generally done by specialist with specialized equipment
- Can examine optic disc for cupping—cup > then 50% of the vertical disc diameter is suspicious - Treatment:
- Topical and systemic medications
- Laser therapy
- Surgery
Angle-Closure Glaucoma
What is the difference between primary and secondary?
- Primary:
- patients anatomically predisposed
- No identifiable secondary cause - Secondary:
- Secondary process responsible for closure of the anterior chamber angle
Examples of secondary angle closure glaucoma? 2
- A fibrovascular membrane grows over the angle
2. A mass or hemorrhage in the posterior segment pushes the angle closed
ACG—Risk Factors
6
- Family history
- Age older then 40-50 years
- Female
- Hyperopia (farsightedness)
- Pseudoexfoliation
- Race:
What races are most at risk for ACG? 2
Least? 2
- Highest in Inuit and Asian populations
2. Lower in African and European origins
ACG—Presentation
1. Pressure rising acutely: symptoms? 5
- Signs? 4
- Decreased vision
- Halos around lights
- Headache
- Severe eye pain
- N/V
- Signs:
- Conjunctival redness
- Corneal edema or cloudiness
- Shallow anterior chamber
- Mid-dilated pupil (4-6mm); reacts poorly to light