Gradual Vision Loss

Question 1

pneumonic for causes of gradual vision loss

Answer 1

CARDIGAN

Cataracts

Age related macular degeneration (dry)

Refractive Error

Diabetic Retinopathy

Inherited Disease

Glaucoma (Open angle)

Access to eye clinic (non-urgent)

Question 2

what is cataracts

Answer 2

gradual clouding of the lens

Question 3

what can cause cataracts

Answer 3

age related - denaturing of lens protein as part of ageing

congenital - screened for with red reflex during neonatal exam

diabetes

steroids

trauma

Question 4

key sign in cataracts

Answer 4

diminished/ loss of red reflex

Question 5

symptoms of cataracts

Answer 5

gradual painless decrease in visual acuity

faded colour vision

glare - lights seem brighter

haloes around lights, particularly at night

Question 6

treatment of cataracts

Answer 6

cataract surgery - removal of lens and replacing with artificial one

• endopthalmitis is a rare but serious complication

Question 7

pathological hallmark of dry age related macular degeneration

Answer 7

drusen - yellow deposits of lipids / proteins

Question 8

symptoms of dry age related macular degeneration

Answer 8

gradual painless loss of central vision

distortion of straight lines

Question 9

management of dry age related macular degeneration

Answer 9

irreversible damage - treatment based on supporting the remaining vision the patient has left

Question 10

what is a refractive error

Answer 10

eye’s inability to clearly focus on an image

e.g. hypermetropia, myopia, astigmatisms

Question 11

what is astigmatism? what are the symptoms?

Answer 11

abnormal curvature of the cornea

• causes two focal points of light on the retina instead of one

blurry vision, headaches, eye strain

Question 13

how is a refractive error corrected

Answer 13

glasses

contact lenses

laser eye surgery for permanent correction of vision

Question 14

pathophysiology of diabetic retinopathy

Answer 14

hypercalcaemia causes:

• epithelial dysfunction: increased vascular permeability – haemorrhages + exudate formation
• pericyte dysfunction: microaneurysms

Question 15

classifications of diabetic retinopathy

Answer 15

non-proliferative (mild, moderate, severe)

proliferative

Question 16

what is seen in mild diabetic retinopathy

Answer 16

microanuerysms

Question 17

what is seen in moderate diabetic retinopathy

Answer 17

microanuerysms

blot haemorrhages

hard exudates

cotton wool spots

Question 18

what is seen in severe diabetic retinopathy

Answer 18

blot haemorrhages

microaneurysms in 4 quardrants

venous bleeding in 2 quadrants

intraretinal microvascular abnormality (IRMA) in any quadrant

Question 19

features of proliferative diabetic retinopathy

Answer 19

neovascularisation

vitreous haemorrhage

Question 20

complications of diabetic retinopathy

Answer 20

retinal detachment

vitreous haemorrhage

optic neuropathy

cataracts

Question 21

treatment of diabetic retinopathy

Answer 21

laser photocoagulation

anti-VEGF

Vitreoretinal surgery in very severe disease

Question 22

what is diabetic maculopathy

Answer 22

macula oedema + ischaemic changes

tx: laser surgery

Question 23

what causes an open angle glaucoma

Answer 23

gradual rise in IOP due to resistance in the trabecular meshwork

Question 24

risk factors for open angle glaucoma

Answer 24

increased age

myopia

black ethnicity

family history

Question 25

symptoms of open angle glaucoma

Answer 25

gradual decrease in **peripheral** vision -- tunnel vision gradual onset of fluctuating headaches, pain, blurred vision, haloes around lights

Question 26

how is intra occular pressure measured? what is normal range?

Answer 26

tonometry 10-21mmHg

Question 27

signs of raised IOP on fundoscopy

Answer 27

optic disc **cupping -** indent in the middle of optic disc, should be less than half the size of the disc. Cup - disc ratio \>0.7 = abnormal optic disc **colour-** pale = optic atrophy

Question 28

1st line treatment of open angle glaucoma

Answer 28

latanoprost (prostaglandin analogue)

Question 29

how does latanoprost work

Answer 29

increaeses uveoscleral outflow

Question 30

side effects of latanoprost

Answer 30

eyelash growth eye lid pigmentation browning of iris

Question 31

2nd line treatment options of open angle glaucoma

Answer 31

beta blockers (timolol) - decrease aqueous humour production carbonic anydrase inhibitors (dorzolamide) - decrease aqueous humour production miotics (pilocarpine)- increase uveoscleral outflow

Question 32

treatment of open angle glaucoma if topical therapy ineffective

Answer 32

trabelectomy surgery

Question 33

what is retinitis pigmentosa

Answer 33

inherited condition where there is degeneration of rods + cones in the retina

Question 34

symptoms of retinitis pigmentosa

Answer 34

_night blindness-_ often first symptom _peripheral vision lost first_, before central vision - tunnel vision

Question 35

signs of retinitis pigmentosa on fundoscopy

Answer 35

**black bone spiculae** pigmentation on peripheral retina

Question 36

what is Usher's syndrome

Answer 36

retinitis pigmentosa + hearing loss