Loss of Vision

Question 1

What should be asked when taking a history from a patient with loss of vision?

Answer 1

• Unilateral or bilateral
• Onset: sudden or gradual
• Type of visual loss: blurred/distorted/black
• Any associated symptoms: pain, redness or discharge

Question 2

Name tests that can be done in addition to the normal examination in patients with loss of vision?

Answer 2

• Amsler chart
• Colour vision
• Visual field assessment
• Flurescein angiography
• Optical coherence tomography

Question 3

Name two causes for sudden loss of vision

Answer 3

• Central retinal artery occlusion

- Anterior ischaemic optic neuropathy ( can be caused by giant cell arteritis)

Question 4

How can central retinal artery occlusion be managed?

Answer 4

• Identify and treat risk factors

- Intravitreal anti Vegf

Question 5

Describe the clinical presentation of anterior ischaemic optic neuropathy (caused by giant cell arteritis)

Answer 5

• Loss of vision
• Headache
• Loss of appetite
• Scalp tenderness
• Pain on chewing
• Tenderness of the superficial temporal arteries
• Raised inflammatory markers

Question 6

How can anterior ischaemic optic neuropathy caused by giant cell arteritis be treated?

Answer 6

High dose systemic steroids

Question 7

Describe how anterior ischaemic optic neuropathy (not caused by giant cell arteritis) present and how it can be treated

Answer 7

• Painless
• Loss of vision
• Identify and treat risk factors

Question 8

Name some causes of gradual loss of vision

Answer 8

• Cataract
• Glaucoma
• Age related macular degeneration
• Diabetic retinopathy

Question 9

How can cataracts be treated?

Answer 9

Surgery (phacoemulsification with intraocular lens implant)

Question 10

How does glaucoma present?

Answer 10

• Asymptomatic

- Gradual loss of peripheral field of vision

Question 11

How does age related macular degeneration present?

Answer 11

• Progressive loss of central vision
• Distorsion (on amsler chart
• Drusen (small yellow deposits on the retina)
• Pigment epithelial changes

Question 12

Name the two types of age related macular degeneration

Answer 12

• Dry AMD (90%)

- Wet (neovascular) AMD (10%)

Question 13

Which features are associated with dry AMD?

Answer 13

• Drusen

- Atrophy

Question 14

How can dry AMD be managed?

Answer 14

• Low vision aids

- Registration

Question 15

Which feature is associated with wet AMD and how is wet AMD investigated?

Answer 15

• Choroidal new vessels
• OCT
• Flurescein angiography

Question 16

How can wet AMD be managed?

Answer 16

• Intravitral antivegf
• Low vision aids
• Registration

Question 17

What are the signs of diabetic retinopathy?

Answer 17

• Microaneurysms
• Retinal haemorrhages and exudates
• Neovascularisation (disc/retina)

Question 18

How can diabetic retinopathy be investigated?

Answer 18

• Flurescein angiography

- OCT

Question 19

How can diabetic retinopathy be managed?

Answer 19

• Intravitreal antivegf
• Laser: panretinal photocoagulation
• Low vision aids
• Registration

Question 20

How can anterior ischaemic optic neuropathy be treated?

Answer 20

Identify and treat risk factors

Question 21

Name the signs of chronic glaucoma

Answer 21

• Raised IOP
• Visual field defects
• Optic disc damage

Question 22

How can chronic glaucoma be managed?

Answer 22

• Topical treatment

- Surgery (trabeculectomy)