LV - Low Vision Conditions - Week 9 Flashcards by B H

Can pigment change without drusen be considered AMD? Is there a significant risk of progression to late AMD?

No
-no significant risk of progression

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Define the following classifications of AMD
Normal ageing changes
Early AMD
Intermediate AMD
Late AMD

Normal ageing changes - only druplets and no AMD pigmentary changes
Early AMD - medium drusen and no AMD pigmentary abnormalities
Intermediate AMD - large drusen and/or any AMD pigmentary abnormalities
Late AMD - neovascular AMD and/or geographic atrophy
-within 2DD of the fovea in either eye

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What kind of advice can be given to all AMD patients (2)?

Stop smoking if they do so
Self-monitor with amsler

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What is the treatment for atrophic AMD?

None available

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What is the treatment for neovascular AMD (3)? Note the costs and whether or not they are TGA approved for AMD.

Anti-angiogenesis therapies
-lucentis (ranibizzumab) - more expensive
-avastin (not TGA approved for AMD) - less expensive
Eyelea (aflibercept) - same cost as lucentis but better half-life

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Describe the effectiveness of lucentis for AMD treatment. Compare it to avastin and eyelea.

After 24 months of monthly lucentis injections, visual acuity stabilises or improves in 90% of patients
-reduces retinal thickness
-promotes resoprtion of fluid
Studies have found similar effectiveness with avastin
Eyelea injected every 2 months was found to be similar to avastin and lucentis as well

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What do studies suggest of the effectiveness of vitamin and mineral supplements? For which severities of AMD are of particular note?

AREDS supplements were found to reduce the risk of moderate visual loss among some patients with AMD

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List the components of AREDS supplements (5). Compare it to AREDSII.

Beta-carotene
Vitamin C
Vitamin E
Zinc oxide
Cupric oxide
AREDSII removed beta-carotene, zince lowered
Role of lutein, zeaxanthin, and long chain polyunsaturated fatty acids

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List some foods rich in lutein and xeaxanthin antioxidants.

Spinach
Silver beet
Corn
Capsicum
Peas
pumpkin
Brussels sprouts
Broccoli

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List some fish rich in omega-3.

Salmon
Mackerel
Anchovies
Trout

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List some foods rich in vitamin E.

Nuts
Whole grains

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List some foods rich in zinc.

Oysters
Seafood
Nuts
Legumes

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List some foods rich in selenium.

Nuts, especially brazil nuts

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What is the incidence of fellow eye involvement during the first two years of AMD? What about five years after that?

28-36%
6-12% for the five years after

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Is useful peripheral vision maintained indefinitely with AMD?

Yes, never will go black blind

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What level of visual acuity loss can be expected with exudative and non-exudative AMD and what effect does antiVEGF treatment have?

Non-exudative - to about 6/120
Exudative - can be worse than 6/120
AntiVEGF can hold vision at the level it was when treatment started

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What kind VF defects do you expect to see in those with AMD (2)?

Central or paracentral scotoma with normal periphery

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What would symptom would you expect of AMD patients related to near work?

Difficulty reading

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What would symptom would you expect of AMD patients related to distance work (3)?

Loss of detail in distance
Difficulty recognising faces
Television difficulties

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What is colour vision like with AMD?

Decreased

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Do AMD patients tend to struggle with mobility?

Generally no, mobility is fair even in advanced cases

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What visual hallucination is common with AMD and what is generally required for this to occur? Note percentage of cases among AMD patients.

Charles bonnet syndrome
-requires low bilateral visual acuity
-10 to 25% of patients with macular degeneration report it

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How do individuals with AMD tend to view things and why?

Eccentrically view because of the central scotoma
-some people automatically develop this technique, others do not, while some dont adopt the best eccentric viewing position

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List distance low vision management options for AMD patients. List 3 for glare.

Distance
-magnification
-telescopes
-decreased viewing distance (closer, larger screen)
Glare
-UV shields
-tinted lenses
-hat with brim

What is the management for charles bonnet syndrome?

Advice and reassurance

Can eccentric viewing be trained? Explain.

Yes, but benefits are controversial Good for enhancing awareness of scotoma

What often precedes progression to late AMD and what form?

Spontaneous drusen regression -geographic atrophy

Briefly describe retinitis pigmentosa.

Rod-cone dystrophies that represent an inherited group of disorders characterised by progressive visual field loss and night blindness

What mode of inheritence do majority of retinitis pigmentosa forms have?

Autosomal recessive

What occurs in retinitis pigmentosa?

Progressive atrophy of rods and cones

Which modes of inheritence of retinitis pigmentosa have the worst prognosis (2)?

X-linked and autosomal recessive

What causes the bony spicule appearance in retinitis pigmentosa?

Migration of pigment into neural retina

How do arterioles appear in retinitis pigmentosa? What about the ONH?

Attenuated ONH has waxy pallor

What can be expected of dark adaptation on first presentation in patients with retinitis pigmentosa?

They present with defective dark adaptation

What are the first posterior signs of retinitis pigmentosa you expect to see (3)?

Arteriolar narrowing Fine dust-like intra-retinal pigmentation Loss of pigment from RPE

What are mid-stage posterior signs of retinitis pigmentosa you expect to see (1) and where first?

More pigmentary changes with a perivascular bone-spicule configuration seen initially in the midperiphery

What eventually occurs with retinitis pigmentosa?

Pigment spreads both posteriorly and anteriorly

Describe what happens to visual fields as retinitis pigmentosa progresses.

Contraction of the visual field ultimately leaving a tiny island of central vision

When does the optic nerve begin to take on a waxt pallor with retinitis pigmentosa? Is VA typically good? Explain.

When visual fields are significantly affected, is around the time the optic nerve head looks waxy VA is generally good until this later stage

What typically occurs after visual fields are significantly contracted with retinitis pigmentosa? Why does this occur and what can be said of the arterioles and ONH appearance?

Unmasking of larger choroidal blood vessels give the fundus a tessellated appearance Severe aerteriolar attenuation Marked optic disc pallor

List 6 associated ocular findings that may be present alongside retinitis pigmentosa.

Maculopathy -atrophic or cystoid macular oedema Cataract -posterior subcapsular Myopia Optic disc drusen Open agle glaucoma Keratoconus

What do you expect to see on electroretinogram of retinitis pigmentosa? What about early stages?

Abnormal, even early stages

What is dark adaptation like in retinitis pigmentosa? What happens to the threshold and what can be said of the rod-cone break?

Delayed Elevation of dark adaptation threshold Absence of rod-cone break

Describe the range of vision that individuals with retinitis pigmentosa may have.

6/6 to NLP

Describe what vision is usually like with retinitis pigmentosa (prognosis).

Typically good until late stages -unless associated conditions like cataract or maculopathy

What kind of decline do you expect to see on visual fields of retinitis pigmentosa? Where does decline begin and which region is more often abnormal?

Exponential -approx 5% per year Begins in the mid-periphery Often superior visual field abnormal

Is visual field loss symmetrical between the eyes in retinitis pigmentosa?

Yes

List two common syndromes associated with retinitis pigmentosa. Note what each is characterised by.

Ushers syndrome -characterised by congenital profound deafness Laurence-moon-biedl syndrome -characterised by RP, intellectual impairment, polydactyly, obesity, hypogenitalism

What is the treatment for retinitis pigmentosa?

None at present -future treatments are likely to come from genetic therapy or retinal transplants

Describe the prognosis for retinitis pigmentosa for each of the following modes of inheritence X-linked Autosomal recessive Autosomal dominant

X-linked - blindness may occur by fifth decade Autosomal recessive - blindness may occur by sixth or seventh decade Autosomal dominant - blindness may occur by eighth decade

Do patients with retinitis pigmentosa often have difficulty with mobility symptoms?

Yes, particularly at night

Do patients with retinitis pigmentosa often struggle with glare?

Yes

Does retinitis pigmentosa affect colour vision?

Yes, in the late stages it decreases

What effect does having peripheral constrictions have on the benefits of magnification as a low vision aid for patients with retinitis pigmentosa?

Limits the benefit, better to use hand magnifier away from the eye where the field area is larger

What can be done to aid mobility in individuals with retinitis pigmentosa (5)?

Reverse telescopes or concave lenses for scanning Scanning strategies Guide dogs Canes Wide angle torches for low light levels

Does cataract affect colour vision?

Yes, faded

Give some examples of low vision aids for individuals with cataracts (3).

Magnification Telescopes and magnifiers Focal illumination for near tasks

List four conditions in children that may contribute to them having low vision. What is one thing to keep in mind with children and low vision?

Albinism Retinopathy of prematurity Stargardts Congenital nystagmus Children have accommodation - allows even children with 6/120 vision to manage with little magnification assistance