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Ophthalmology RIA > Gradual loss of vision including cataracts, POAG + ARMD > Flashcards

Gradual loss of vision including cataracts, POAG + ARMD Flashcards

1
Q

name an inherited cause of gradual loss of vision

A

Retinitis pigmentosa

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2
Q

vitamin that can slow the progression of retinitis pigmentosa?

A

vitamin A

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3
Q

vision affected in retinitis pigmentosa? (3)

A
  • peripheral vision
  • decreased visual acuity
  • night blindness
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4
Q

name 6 causes of gradual loss of vision

A
  1. Cataracts
  2. Diabetic maculopathy
  3. Retinitis pigmentosa
  4. Age related macular degeneration
  5. Primary open angle glaucoma
  6. Refractive errors
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5
Q

opacity of the lens

A

cataracts

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6
Q

most common cause of blindness worldwide

A

cataracts

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7
Q

risk factors for cataracts

A
  • age
  • smoking
  • DM
  • long term ocular corticosteroids
  • drugs
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8
Q

3 drugs that are risk factors for developing cataracts

A
  • steroids
  • amiodarone
  • phenothiazines
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9
Q

describe the typical presentation of a patient with cataracts

A
  • Gradual reduced vision, difficulty recognising faces, reading and watching TV
  • Glare: lights seem brighter than they are
  • Halos around lights
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10
Q

what is the surgical and non surgical management of cataracts

A

surgical: removal and replacement with artificial lens

non surgical: stronger glasses, encourage use of brighter lights

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11
Q

Glaucoma is

A

a multifocal optic neuropathy, associated with raised intraocular pressure

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12
Q

what is the most common type of glaucoma

A

primary open angle glaucoma

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13
Q

pathophysiology of primary open angle glaucoma

A

the angle between the iris + cornea is open and the obstruction to the outflow of aqueous humor leading to blockage of the drainage system –> raising IOP –> pressure on optic nerve –> atrophy of the outer rim

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14
Q

risk factors for primary open angle glaucoma

A
  • Africo-caribbean
  • Fhx
  • Myopia
  • Hypertension
  • DM
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15
Q

presentation of primary open angle glaucoma

A

progressive peripheral visual loss, progressing to affect the central vision

decreasing visual acuity

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16
Q

Fundoscopy findings in POAG? and why does this occur?

A

optic disc cupping + optic disc pallor

because the raised intraocular pressure causes compression on the optic nerve leading to loss of optic nerve fibres leading to enlargement of the optic disc (widening and deepening)

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17
Q

normal optic cup to disc ratio?

A

0.4 - 0.7

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18
Q

cup to disc ratio in POAG?

A

> 0.7

19
Q

how is POAG diagnosed?

A
  • referral to ophthalmologist
  • applanation tonometry Golmann-Type (to measure IOP)
  • goinoscopy
  • corneal thickness measurement
20
Q

1st line management of POAG?

A
  • prostaglandin analogue
21
Q

2nd line management of POAG?

A
  • BB
  • CAI
    or
  • sympathomimetic
22
Q

Management of more advanced POAG?

A
  • surgery

- laser treatment

23
Q
  • name a prostaglandin analogue
  • mechanism
  • adverse effect
A
  • LATANOPROST
  • increases uveoscleral outflow
  • brown pigmentation of iris
24
Q
  • name a BB used to treat POAG
  • mechanism
  • avoided in ___
A
  • TIMOLOL
  • reduced aqueous production
  • asthmatics + patients with heart block
25
Q
  • name a CAI

- mechanism

A
  • DORZALOMIDE

- decreases aqueous production

26
Q
  • name a sympathomimetic
  • mechanism
  • avoid if taking which other meds
A
  • BRIMOMIDINE
  • reduces aqueous production + increases outflow
  • MAOI or TCA
27
Q

what is the surgical management for more advanced POAG?

A

Trabeculoectomy

28
Q

what is the most common cause of blindness in the UK

A

Age related macular degeneration

29
Q

what is ARMD characterised by

A
  • degeneration of retinal photoreceptors

- presence of drusen formation seen on fundoscopy

30
Q

which form is 85% of all ARMD (dry or wet)

A

dry

31
Q

risk factors for ARMD (7)

A
  • female
  • smoking history
  • family history
  • hypermetropia
  • hypercholesterolaemia
  • hypertension
  • diabetes mellitus
32
Q

describe the presentation of ARMD (what the patient may describe)

A
  • difficulty reading near field content
  • difficulties adjusting to darkness
  • fluctuation in visual disturbance which may vary from day to day
  • reading and lines may appear distorted
  • flickering/flashing of lights
  • glare around objects
33
Q

how can distortion of line perception be tested for

A

amsler grid testing

34
Q

fundoscopy findings in ARMD

A
  • drusen, yellow areas of pigment deposition in the macular
35
Q

Management of Wet ARMD?

A

anti-VEGF injections

36
Q

name 2 anti-VEGF injections

A
  • Ranibizumab

- Aflibercept

37
Q

how does anti-VEGF work?

A

closing off the areas of choiroidal neovascularisation

38
Q

what is the frequency of anti-VEGF injections?

A

following diagnosis: loading dose of 3 injections across 3 months initially, and then given variably depending on the response

39
Q

what is VEGF and what does it do?

A

vascular endothelial growth factor

it drives increased vascular permeability in patients with wet AMRD

40
Q

side effects of anti-VEGF injections?

A
  • bleeding

- irritation and redness of eye

41
Q

what therapy can be offered if a patient does not respond to anti-VEGF injections

A
  • laser photocoagulation
  • photodynamic therapy
  • macular translocation
42
Q

management of dry ARMD?

A

nutritional supplementation in the form of AERDS

includes: zinc, vitamin A, C + E

43
Q

when must you inform the DVLA about your macular degeneration?

A

when the macular degeneration affects both your eyes

Ophthalmology RIA (13 decks)

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