Macula and Choroid 1 Flashcards
What are maculopathies?
Conditions that affect the macula and choroid
Maculopathies can be acquired and hereditary - name examples of each.
What are symptoms common in all maculopathies?
Reduced vision - especially at near
Poaitive scotoma - this means either a black dot or blur ( which is usually in the centre of their vision)
What symptoms may a px with a maculopathy present with?
Reduced vision - especially at near
Positive scotoma - this is a black dot or blur in vision ( it will usually be central in this case)
Distortion - which is referred to as metamorphopsia ( px may describe this as staright lines appearing wobbly or door frames being bent)
Rarer symptoms include:
- Micropsia
- Macropsia
What does BCVA stand for?
Best corrected visual acuity
What techniques would we use to investigate any maculopathies?
Test BCVA at near vision especially
Amsler grid
Test pupil light reactions ( expect them to be normal - this allows diffrentiation of optic nerve legions)
Direct fundus examinaton - SL-BIO
OCT
Fundus AutoFluorescence
HES may use Fluorescein Angiography
What type of image has been used to produce this image?
Fundus Autofluorescence
[Where the optic nerve head (and vessels) appears black because there is no activity from RPE, therefore it does not autoflouresce]
What type of imaging has been used to produce this image?
Fluorescein angiography
[You know this because the blood vessels and optic disk are light from having the fluorescein injected into the vessels and being reflected back in the scan]
What is Central Serous retinopathy also known as?
Central serous choroidal retinopathy
What is Central Serous Retinopathy (CSR)?
An exudative detachment of sensory retina in macula area
Can sub retinal fluid be identified by direct ophthalmoscopy?
No - you have to remember that sub-retinal fluid presents between layers and as an elevation - therefore it is only really identifiable with indirect ophthalmoscopy or any type of image that shows 3D structure.
Is central Serous Retinopathy a cause of central vision loss?
Yes - it is the fourth most common cause of central vision cost.
What is the pathogenesis of central serous retinopathy?
- Multiple leaks in the extrafoveal RPE .
(In FA this looks like multiple ink blots)
- Active choroidal leakage ( this can be seen on ICG and indicates impaired choroidal circulation).
What is the epidemiology of Central Serous Retinopathy?
- Incidence 10 per 100,000 in M
- M to F 6:1 to 10:1 ratio
- 25 – 50 year age group
- Unilateral (80%)
- 30% recur
–in ipsilateral or contralateral eye
What are the risk factors for Central Serous retinopathy?
- Type A personality
- Elevated testosterone levels
- Systemic steroid use – key feature in px that present with CSR.
What are the symptoms of Central Serous Retinopathy?
Symptoms
•Sudden onset reduce/ low level blurring
–VA 6/9 to 6/18
–Possible hyperopic shift due to elevation of retina (from sub-retinal fluid).
- Positive scotoma
- Metamorphopsia
- Micropsia may present although this is rare.
What is the clinical presentation of acute CSR ( Cnetral Serous Retinopathy)?
What is the clinical presentation of chronic CSR (central serous retinopathy)?
All clinical features of acute CSR + RPE atrophy and the risk of CNV ( choroidal neovascularisation)
How would you diffrentiate between an eye with chronic CSR and wet AMD?
Cruicial diffrentiation is based on age of onset ( px with CSR are far younger than those with wet AMD)
Progression - CSR is liekly to resolve on its own accord, however wet AMD shall not.
What is the optometric managment of CSR?
- Reassure patient
- CSR tends to resolve spontaneously within 2-3 months
- VA recovers in approx 90% of patients
- Subtle metamorphopsia may persist in which they may require referal to ophthalmologist.
What is the ophthalmological managment of CSR?
- Confirmation of diagnosis
- Observation
- Tapering of systemic steroids ( if px is on any systemic steroids, because we know this is a key risk factor, their medication may be changed)
- In chronic conditions PDT (photodynamic therapy) or focal laser
–hastens resolution but does not affect visual outcome
- Anti-VEGF treatments are considered by case
- Guarded prognosis would be offered (i.e. that no promises would be made to the px about treatment solving the problem) if recurrent /chronic
What are the two types of macula holes?
Full thickness macula hole
Lamellar macula hole
Describe a full thickness macula hole and features associated with it.
Describe a lamellar macula hole and features associated with it.
What are the causes of a macula hole?
A macula hole may be caused by traction - thos is where the retina is lifted from the RPE pump, causing macula oedema. This is a tugging of the posterior vitreous face where it is tightly adhered to the centre of the macula face.
Idiopathic cause.
Trauma
Inflammation
What is the prevalence of macula holes?
- 1 in 3,300
- 6th and 7th decades of age
- Typically female
- Bilateral in 10-30 % of cases
What are the symptoms of a macula hole?
- Painless loss of vision
- VA arround ~ 6/60
- Positive scotoma
- Metamorhopsia
What is the treatment of macula hole?
Px need to be referred but it is not an urgent referral (routine referral)
Px reasurrance
Px will be put under observation as some lamellar holes can self resolve.
For a fresh full thickness macula hole surgery may be an option:
–Vitrectomy and peel surgery
–Post-operative positioning - post op things to do.
–Visual outcome depends on presenting VA
–Risk of cataract post-sx
