Gradual Vision Loss

Question 1

What is cataracts?

Answer 1

any opacity on or within the lens incidence increases with age by the age of 100, 100% incidence major cause of blindness in the world Look at diagram of the lens

Question 2

What are the causes of cataracts?

Answer 2

age-relatedtraumatic metabolictoxicsecondary maternal infection maternal drug ingestionhereditary

Question 3

What are the different types of senile cataract?

Answer 3

subcapsular - anterior suncapsular- posterior subcapsular - patients will be particularly troubled with bright sunlight/oncoming headlightsnuclear sclerotic cataract - exaggeration of normal ageing leads to myopic shift cortical cataract - opacification of lens cortex

Question 4

What does a cortical cataract look like?

Answer 4

opacities assume a radial spoke-like configuration

Question 5

What are the metabolic causes of cataracts?

Answer 5

DiabetesAge-Related cataractTrue Diabetic Cataract

Question 6

What are the 3 stages of cataract development?

Answer 6

Immature cataractMature cataractHypermature - mature cataract, lens material has become smaller and wrinkled lens capsule due to leakage of water out of lens

Question 7

How are cataracts managed?Describe the assessment of the patient - 7 steps

Answer 7

1 - Degree of disability - reading, driving, occupation, impact on household2 - Patients opinion3 - Best corrected visual acuity - is after a recent refraction 4 - coexisting ocular pathology - macular degeneration, advanced glaucoma 5 - general health, serious cardiac or resp disease 6 - age of patient is not a contraindication7 - no need to wait until cataract matures

Question 8

How is biometry used in cataract management?

Answer 8

implant surgery can be used to correct refractive error at the same time as cataracts operation(most pts are made slightly myopic to enable some reading vision)

Question 9

What is the standard operation used in the UK?

Answer 9

lens extraction by PHACO (80%)

Question 10

What are the advantages of PHACO cataract surgery?

Answer 10

small incision fast recovery good refractive results v little astigmatism quick operation

Question 11

What are the potential complications of cataract surgery?

Answer 11

posterior capsule opacification vitreous loss retinal detachment endophthalmitis (acute bacterial infection)

Question 12

What is Age Related Macular Degeneration (AMD)?

Answer 12

Common cause for gradual visual loss in the western world typically affects patients over the age of 70 but can occur at a younger age Dry and wet types

Question 13

Describe dry type of macular degeneration?

Answer 13

patients have a gradual reduction of central vision difficulties recognising faces and reading presence of druden, retinal pigmentary atrophy, generally less visually disabling

Question 14

How is AMD (dry type) treated?

Answer 14

no form of treatment to restore vision, patients require to make use of low visual aids to cope with their disability

Question 15

Describe the progression of AMD (dry)?LOOK AT PHOTOS OF FUNDUS

Answer 15

Drusen –> geographic atrophy –> RPE & sensory detachment –> RPE & sensory haemorrhagic detachment –> fibrous disciform scar

Question 16

What is AMD - wet type?

Answer 16

repaid loss of central vision, may start with distortion of central vision progresses to a central scotoma patient usable to use central vision can lead to a severe handicap

Question 17

How is AMD (wet) treated?

Answer 17

largely unsatisfactory but laser photocoagulation may help recent treatment with photodynamic therapy is emerging

Question 18

What is seen in late stage ARMD on fundoscopy?

Answer 18

disciform scarring of the macula is seen

Question 19

How does wet AMD progress?

Answer 19

1 - normal view 2 - distortion of lines seen in early macular degeneration 3 - blurred central vision in subsequent stages of macular degeneration 4 - complete loss of central vision in late stage macular degeneration