Gradual Vision Loss: Cataracts, Macular Degeneration ☺️

Question 1

Macular degeneration

• presentation, pathophysiology
• risk factors
• investigations
• management

Answer 1

Bilateral degeneration of macula => subacute vision loss

• poor night vision
• fluctuations in visual acuity
• photopsia, glare

Risk factors

• AGE
• smoking, FHx, IHD

Dry - MOST COMMON
-drusen
-VitACE, Zn
Wet - worse prognosis
-choroidal neovascularisation
-antiVEGF

GOLD STANDARD - slit lamp
Amsler grid - straight lines look wavy
Fundoscopy - drusen
OCT - retinal visualisation
Fluroscein angiography - if neovascular disease suspected

Question 2

Types of macular degeneration

-management

Answer 2

Dry - MOST COMMON
-drusen
Zinc + VitACE

Wet
-neovascularisation => high risk of bleeding
-worse prognosis
AntiVEGF drugs

Question 3

Cataracts

• pathophysiology
• risk factors
• presentation
• investigations

Answer 3

Lens opacifies

Age
Smoking, alcohol
DM
Long term CS

Reduced vision
Faded colour vision
Glares
Reduced red reflex

Opthalmoscopy - normal fundus, optic nerve
Slit lamp - visible cataract

Change prescription, avoid driving at night
Definitive - surgery

Question 4

Cataracts

• management
• complications

Answer 4

Supportive - does not change disease progression

• stronger glasses/contacts
• brighter lighting

Definitive - surgery
-replace lens

Post capusle opacification/rupture
Retinal detachment
Endophthalmitis - inflammation of aqueous/vitreous