Gradual Loss of Vision Flashcards
What are important conditions to think about in gradual loss of vision?
- Age-related degeneration, diabetic retinopathy
- Glaucoma, cataract, corneal disease
- Refractive errors
- Compressive lesions of optic pathway
What are important questions in the history of age-related macular degeneration?
- Any pain or redness?
- Are both eyes affected?
- Have they noticed a change in field of vision or just central sight?
- Do they have an up-to-date pair of reading glasses?
- Any previous eye problems or surgery e.g. cataracts
- Any FH of visual problems or poor sight
What are investigations for age related macular degeneration?
- Visual acuity - Snellen Chart
- Visual fields - Goldmann visual field charts
- Amsler grid to test central vision (macular function) - distortion of line perception
- Fundoscopy - drusen (white-yellow deposits) may be present in macula
- Slit lamp microscopy
- Fluorescein angiography
What is dry age-related macular degeneration (ARMD)?
- Common cause of vision loss in elderly
- Results in gradual loss of central vision (macular region responsible for this) - peripheral vision is spared
What are the symptoms of DARMD?
- Patients describe difficulty with reading/seeing fine detail (visual acuity)
- Often can’t see people’s faces clearly
- Straight lines look wavy or distorted
- Difficulties in dark adaptation, overall deterioration in vision at night
- Fluctuations in visual disturbances that may vary day to day
- Photopsia (perception of flickering or flashing lights) and glare around objects
What are the risk factors for DARMD?
- Female
- Smoking
- HTN, DM, IHD
- Previous cataract surgery
- FH
- Advancing age
What is the treatment for DARMD?
- Stop smoking
- Diet of fruit and vegetables help
- Some evidence that high doses Vit C + E, minerals, micronutrients etc can help slow progression
- Sometimes anti-VEGF therapies
What is wet macular degeneration?
Can develop rapidly, causing serious changes to central vision in a short period of time, over days or weeks. It occurs when macula cells stop working and body starts growing new blood vessels to fix problem (neovascularisation). It causes macula damage and leads to scarring.
How do you treat wet macular degeneration?
Need to stop new blood vessels from growing so use anti-VEGF (vascular endothelial growth factor), intravitreal injection).
What are the symptoms of wet macular degeneration?
Sudden central vision loss (dry AMD tends to be gradual) due to significant blood and fluid overlying macula area.
Who should the patient inform if they are diagnosed with glaucoma?
- DVLA - arrange their own specific tests to see if eye sight meets current driving standards
- Inform family as glaucoma has a genetic component
What are the risk factors of glaucoma?
- Short sighted (myopia)
- Old age
- Diabetes
- FH
- Wearing a tight collar/tie
- Race
- Thin cornea
What are the symptoms of glaucoma?
- Severe eye pain
- Blurred vision (visual loss)
- Haloes around lights (due to raised IOP causing fluid to enter cornea so light not refracted properly)
- N+V
What would you find in an examination for glaucoma?
- Ciliary flush: red injection around periphery of cornea (around iris) with non-reactive/minimally reactive pupil
- Eyeball would feel hard like a golf ball (due to increased pressure)
- Visual field defect
What medications lower intra-ocular pressure?
- Beta blockers
- Carbonic anhydrase inhibitors
- Prostaglandin analogues
- Pilocarpine
