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Introduction to Eye Disease - Year 2 > Macula and Choroid 1 > Flashcards

Macula and Choroid 1 Flashcards

1
Q

What are maculopathies?

A

Conditions that affect the macula and choroid

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2
Q

Maculopathies can be acquired and hereditary - name examples of each.

A
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3
Q

What are symptoms common in all maculopathies?

A

Reduced vision - especially at near

Poaitive scotoma - this means either a black dot or blur ( which is usually in the centre of their vision)

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4
Q

What symptoms may a px with a maculopathy present with?

A

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
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5
Q

What does BCVA stand for?

A

Best corrected visual acuity

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6
Q

What techniques would we use to investigate any maculopathies?

A

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

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7
Q

What type of image has been used to produce this image?

A

Fundus Autofluorescence

[Where the optic nerve head (and vessels) appears black because there is no activity from RPE, therefore it does not autoflouresce]

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8
Q

What type of imaging has been used to produce this image?

A

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]

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9
Q

What is Central Serous retinopathy also known as?

A

Central serous choroidal retinopathy

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10
Q

What is Central Serous Retinopathy (CSR)?

A

An exudative detachment of sensory retina in macula area

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11
Q

Can sub retinal fluid be identified by direct ophthalmoscopy?

A

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.

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12
Q

Is central Serous Retinopathy a cause of central vision loss?

A

Yes - it is the fourth most common cause of central vision cost.

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13
Q

What is the pathogenesis of central serous retinopathy?

A
  • 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).
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14
Q

What is the epidemiology of Central Serous Retinopathy?

A
  • 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

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15
Q

What are the risk factors for Central Serous retinopathy?

A
  • Type A personality
  • Elevated testosterone levels
  • Systemic steroid use – key feature in px that present with CSR.
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16
Q

What are the symptoms of Central Serous Retinopathy?

A

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.
17
Q

What is the clinical presentation of acute CSR ( Cnetral Serous Retinopathy)?

A
18
Q

What is the clinical presentation of chronic CSR (central serous retinopathy)?

A

All clinical features of acute CSR + RPE atrophy and the risk of CNV ( choroidal neovascularisation)

19
Q

How would you diffrentiate between an eye with chronic CSR and wet AMD?

A

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.

20
Q

What is the optometric managment of CSR?

A
  • 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.
21
Q

What is the ophthalmological managment of CSR?

A
  • 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
22
Q

What are the two types of macula holes?

A

Full thickness macula hole

Lamellar macula hole

23
Q

Describe a full thickness macula hole and features associated with it.

A
24
Q

Describe a lamellar macula hole and features associated with it.

A
25
Q

What are the causes of a macula hole?

A

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

26
Q

What is the prevalence of macula holes?

A
  • 1 in 3,300
  • 6th and 7th decades of age
  • Typically female
  • Bilateral in 10-30 % of cases
27
Q

What are the symptoms of a macula hole?

A
  • Painless loss of vision
  • VA arround ~ 6/60
  • Positive scotoma
  • Metamorhopsia
28
Q

What is the treatment of macula hole?

A

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

Introduction to Eye Disease - Year 2 (40 decks)

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