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Opthalmology > Gradual Visual Loss > Flashcards

Gradual Visual Loss Flashcards

1
Q

What are cataracts

A

opacification of the lens causing decreased visual acuity

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2
Q

what is the leading cause of blindness in the UK

A

cataracts

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3
Q

by 100 years old, how many people get cataracts

A

basically 100%

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4
Q

How are cataracts characterised

A

by the anatomical location

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5
Q

what are the anatomical classifications of cataracts

A

posterior subcapsular cataracts
cortical cataracts
nuclear

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6
Q

what are some risk factors of posterior subcapsular cataracts

A

Diabetes

Steroids

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7
Q

What do posterior subcapsular cataracts do to vision

A

reduce acuity
reading distance affected the most
cause issues with direct bright light (as it gets refracted in the cloudy lens)

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8
Q

what are some risk factors of cortical cataracts

A

UV exposure
Diabetes
Drugs - corticosteroids, aspirin, K+ sparing diuretics

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9
Q

what do nuclear cataracts look like

A

yellowing nuclear sclerosis in the center of the lens

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10
Q

what are some risk factors for nuclear catarcts

A

milk intake
calcitonin
smoking

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11
Q

What is the aetiology of cataracts

A 
Age-related 
Congenital
Traumatic 
Metabolic 
Toxic (drugs) 
primary eye conditions 
systemic disease
connective tissue disease 
CNS issues (sjorens, neurofibromatosis) 
Trisomy 21
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12
Q

what are risk factors for age related cataracts (apart from age)

A 
allergy 
hyper/hypoension 
low IQ
UV light
infrared radiation
Diabetes
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13
Q

how much of a genetic component do congenital cataracts have

A

about 1/3 are inherited

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14
Q

what are the types+ subtypes of congenital cataracts

A

total

partial - partial may be polar (ant or post), zonular (lamellar, stellate ,sutural, nuclear) or membranous

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15
Q

what causes traumatic cataracts

A

iris gets torn away from normal insertion causing damage

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16
Q

how do different types of trauma cause different types of traumatic cataracts

A

blunt trauma - rosette shape/posterior subcapsular

penetrating trauma whole lens opaque is large, is small usually a small area as it is self-sealing

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17
Q

What metabolic derangements cause cataracts

A 
Diabetes 
Galactosaemia (GUPT deficiency) 
Galactokinase deficiency 
Wilsons
Fabry's 
Lowes
Decreased calcium 
menosidosis (genetic lysosomal disorder)
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18
Q

what kinds of cataracts do diabetes cause

A

snowflake opacities (only if true diabetic cataracts - otherwise may be age related)

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19
Q

what kind of cataracts are caused by galactokinase deficiency

A

lamellar opacity (wheel spoke)

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20
Q

what are causes of toxic cataracts

A

corticosteroids
chlorpromazine (anterior capsule)
chemo (buslphan)

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21
Q

what primary eye conditions cause cataracts

A

Uveitis
Hereditary retinal degenerations
High Myopia
Post Surgical

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22
Q

what systemic disease causes cataracts

A

cutaneous disease (atopic dermatitis)
congenital ectodermal dysplasia
werners/rothmond/thomson syndrome

23
Q

what are immature, mature and hyper-mature cataracts

A 
immature = not opaque fully yet
mature = opaque
hyper-mature = small wrinkled lens leading to fluid leakage
24
Q

what are clinical features of cataracts

A

Decreased visual acuity

Glare (difficulty focusing in light)

Myopic shift (increase in refractive power causing slight-moderate myopia)

Mono-ocular Diplopia - double vision in one eye due to nuclear changes concentrating in inner refractive area in center of lens

25
Q

What is ‘second sight’ in cataracts

A

myopic shift in cataracts in long sighted people causing restoration of normal sight

26
Q

What investigations should be done for suspected cataracts

A

Diagnosis = history + slit lamp examination

If posterior-subcapsular pathology detected - ocular-B scan (ultrasonography)

refraction must be done

Accurate biometry also essential (axial length/keratometry) for lens replacement power calculation - must be equal to normal eye (if unilateral)

27
Q

what are post-surgical complications of cataract surgery

A

corneal odema

corneal decompensation

28
Q

What is the definitive treatment for cataract surgery

A

surgical lens extraction and replacement

29
Q

What are the types of surgery for cataracts

A

intracapsular cataract extraction (ICCE)
extracapsular cataract extraction
Phacoemulsification

30
Q

what are complications of intracapsular cataract extraction

A 
severe astigmatism
increased recovery
visual rehab required
leaks
macular odema
31
Q

when is intracapsular cataract extraction used

A

cases where zonular integrity is impaired severely, not allowing for ECCE

32
Q

what is extracapsular cataract extraction

A

Removal of the lens nucleus through opening in anterior capsule retaining the integrity of posterior capsules cuaaing decreased trauma of endothelium

33
Q

What is the most common catarct surgery

A

basically all of them are phacoemulsification

34
Q

What is phacoemulsification

A

small incision in anterior capsule, ultrasound destruction of the lens whilst fluid is pumped in to maintain the pressure, hoovering up the lens + injection of new lens

35
Q

How are patients acuity adjusted in cataract surgery

A

they’re made slightly myopic to enable some reading vision

36
Q

what are complications of phacoemulsification

A 
posterior capsule opacification (20%) 
vitreous loss (4%) 
retinal detachment (1%) 
endopthalmitis (0.1%)
37
Q

What is endopthalmitis

A

acute bacterial infection causing absent red reflex, marked visual loss, pain, exudates and corneal haze

38
Q

what bacteria cause endophthalmitis

A

pseudomonas
staph aureus
s.epidermidis

39
Q

how do you treat endophthalmitis

A

eye drop antibiotics

40
Q

what are the different types of macular degeneration

A

wet (10%)

dry (90%)

41
Q

what is dry macular degeneration

A

gradual central vision loss, causing issues with recognising faces/reading

42
Q

what fundoscopic feature is common with macular degeneration

A

drusen

43
Q

what is the treatment for dry macular degeneration

A

there is none

44
Q

what is wet macular degeneration

A

sudden onset of rapid visual loss and distortion due to choroidal vessel growth into the subretinal space, causing leakage and bleeding leading to retinal interference and atrophy

45
Q

What are the fundoscopic features of wet macular degeneration

A

significant subretinal hemorrhage (early) +/- exudates and fibrosis (late)

46
Q

what are the common features of wet and dry macular degeneration

A

loss of CENTRAL vision

distorted vision

47
Q

what is the timeline of visual defects seen in macular degeneration

A

Drusen (on fundoscopy) ➜ many drusen ➜ paracentral scotoma (in vision) ➜ atrophic central vison (blind spot centrally)

48
Q

what have protective effects (not curative) for macular degeneration

A

Vitamine A,C,E and Zinc

49
Q

what is the pathological mechanism for dry macular degeneration

A

incomplete recycling of photoreceptors in the RPE leading to lysosomal accumulation, causing decreased nourishment of the photoreceptors from the RPE due to decreased diffusion gradient - leading to drusen

50
Q

What are Drusen

A

Small deposits of lipid under the retina caused by the lysosomal accumulation

51
Q

how do you treat wet macular degeneration

A

Laser photocoagulopathy - attempt to stop bleeding under the retina

Retinal Photodynamic Therapy

Anti-VegF (take monthly for years)

52
Q

what is the treatment window for wet macular degeneration

A

1-2 week window from presentation to point where treatment is unavailable/unusable

53
Q

If neovascularised macular degeneration is diagnosed what is important to do next + why

A

fluorescein angiography as it guides anti-VEGF therapy

Opthalmology (16 decks)

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