Gradual visual loss

Question 1

Basically what are cataracts?

Answer 1

A clouding of the lens.

Question 2

What % of people will develop cataracts in their life time if they live to 100?

Answer 2

100%

Question 3

What can lead to cataracts?

Answer 3

Age
trauma
metabolic problems
toxic chemicals

Question 4

Describe the appearance of a long standing cateract and explain why.

Answer 4

Wrinkled appearance

deeply clouded due to liquefaction of the lens

Question 5

What are the features and associated features of patients with atopic dermatitis?

Answer 5

Total cateract and associated lack of eye lashes and swollen eyelids due to fibrotic change.

Question 6

In what portion of the lens do age-related cataracts develop?

Answer 6

anterior subcapsular (in front of nucleus)

Posterior subcapsular (behind nucleus)

Nuclear sclerotic cataract

Cortical Cataract (lens cortex which is between the capsule and the nucleus)

Question 7

What particular complaints do posterior subcapsular cataract patients complain of?

Answer 7

troubled by bright light

reading vision affected more than distance vision

Question 8

What causes are posterior subcapsular cataract associated with?

Answer 8

steroid use and diabetes

Question 9

Explain what visual problems a nuclear sclerotic cataract will cause?

Answer 9

Patient will experience a myopic shift of up to 3 dioptres.

Question 10

Explain the configuration of cortical cataracts and how the affect vision.

Answer 10

assume a radial spoke-like configuration

usually not in the visual axis so may produce no problems

Question 11

What are risk factors for cortical cataracts?

Answer 11

UV exposure
Diabetes
Drug ingestion

Question 12

How do blue dot cataracts affect patient vision?

Answer 12

They do not

Question 13

What are blue dot cataracts and what is the risk with them?

Answer 13

Small dots scattered throughout the lens

The risk is they can develop into vision blocking cataracts

Question 14

What are the two types of cataract associated with diabetes?

Answer 14

Earlier age-related cataract

True diabetic cataract

Question 15

What is the problem with earlier age-related cataracts in DM patients?

Answer 15

Removing the cataract may have a less good result due to some background retinopathy.

Question 16

Describe the pathology of a true diabetic cataract.

Answer 16

Osmotic overhydration of the lens

Causing the lens capsule to become leaky

This lets in fluid from the anterior chamber

This produces a posterior or anterior snowflake opacity

Question 17

Describe how cataracts can be classified based on their maturity.

Answer 17

They can be:
immature
mature (cortex completely opaque)
hyper mature (small and wrinkled lens material due to leaking out of material)

Question 18

Explain how traumatic cateracts can occur.

Answer 18

Due to electric shock, IR radiation, X-ray

The iris is torn away from its normal point of insertion (the angle)

This causes shrinkage and damage and can lead to cataract.

Question 19

Name 3 metabolic causes of cataracts.

Answer 19

1) DM
2) Steroid use
3) Wilson’s disease (copper accumulation) –> sunflower cataract

Question 20

Name 3 systemic causes of cataracts.

Answer 20

1) Myotonic dystrophy
2) Marfan’s syndrome
3) Atopic dermatitis

Question 21

What can be achieved with cataract surgery?

Answer 21

Changing of the lense will:

1) remove opacity of lens
2) can correct refractive errors.

Question 22

What determines the amount of refraction in an eye?

Answer 22

1) cornea
2) lens
3) axial length

Question 23

What are the two most common causes of gradual visual loss in the UK?

Answer 23

1) Cataracts

2) Macular degeneration

Question 24

What are the two types of macular degeneration and what are how common are they comparatively?

Answer 24

1) Dry type (age-related) 90%

2) Wet type 10%

Question 25

Explain the pathophysiology of dry macular degeneration?

Answer 25

SLOW age-related death of retinal pigment epithelial (RPE) cells (supporting cells of photoreceptors) thus death of photoreceptors.

Question 26

What would you see on fundoscopy in dry macular degeneration and why?

Answer 26

1) Confluent DRUSEN (accumulations of extracellular material that build up between Bruch’s membrane and the retinal pigment epithelium of the eye) YELLOW
2) Retinal pigment ATROPHY. Due to death of retinal pigmented epithelium. WHITE

Question 27

What are the symptoms of dry macular degeneration?

Answer 27

gradual reduction in central vision

with problems:
reading and
recognising faces

Question 28

What is the treatment for dry macular degeneration?

Answer 28

There is none.

Use low visual aids to aid their disability.

Question 29

Explain the pathophysiology of wet macular degeneration?

Answer 29

New vessels (as the Bruch’s membrane has a hole in it) grow from the choroid into the macula region of the retina causing:

retinal elevation which may be associated with:

retinal haemorrhage
and oedema.

Question 30

What are the symptoms of wet macular degeneration?

Answer 30

rapid loss of central vision and may start with distortion of central vision (metamorphopsia)

This progresses to a central scotoma and this can cause a profound handicap (due to heamorrhage)

Question 31

What is the treatment for wet macular degeneration?

Answer 31

Laser photocoagulation. (not really used anymore
Photodynamic therapy.
Anti-VEGF is a new development which has very promising recults

Question 32

What would you see on fundoscopy in wet macular degeneration?

Answer 32

Blood vessel clusters
Hemorrhages
Optic disk oedema