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Ophthalmology > Macular Disorders > Flashcards

Macular Disorders Flashcards

1
Q

What makes the macula a darkened circular area at the center of the retina?

A

High content of macular pigments: Lutein & Zeaxanthin (fine vision)

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2
Q

What are the structures found within the macula?

A

Fovea centralis
Umbo
Parafovea and Perifovea

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3
Q

What is considered to be the clinical macula where diseases are seen & has a profound effect on central vision?

A

Fovea + Parafovea

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4
Q

What is the significance of the macular region?

A

Responsible for finely detailed/high resolution, color vision, & focusing for central vision

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5
Q

What are the symptoms of macular disease?

A

Loss of central vision
Difficulty seieng fine details and colors
Metamorphopsia (distortion of lines)
Macropsia (large perceived image size)
Micropsia (smaller perceived image size)
Change in image size

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6
Q

When there is pain present along with symptoms of macular disease, what does it indicate?

A

Inflammatory condition/assoc with neovascular glaucoma

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7
Q

What are prescription drugs that can cause macular disease?

A

Hydroxychloroquine
Thioridazine
Plaquenil

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8
Q

What are the different examination techniques in diagnosing macular dis?

A

Direct ophthalmoscopy
Binocular indirect ophthalmoscopy
Slit lamp indirect ophthalmoscopy
Amsler grid

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9
Q

What examination technique enables the examiner to monocularly view the central 15deg of retina?

A

Direct ophthalmoscopy

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10
Q

What can be seen in direct ophthalmoscopy?

A

Optic disc, proximal retinal vessels, and parts of the macula

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11
Q

What is produced by the binocular indirect ophthalmoscopy?

A

Inverted & reversed image
= upside down, reversed from L to R

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12
Q

What are the advantages in using a slit lamp indirect opthalmoscope?

A

Retina is:
- Wider
- Stereoscopic or 3D view
- varying magnifications

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13
Q

What are the different ancillary examination for macular diseases?

A

Fundus fluorescein angiography
Optical coherence tomography

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14
Q

What is the significance of fundus fluorescein angiography?

A

Retinal vasculopathoes and maculopathies

Allows correlation betw histopatho and angiographic findings

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15
Q

What is seen in fundus fluorescein angiography?

A

Outline of the retinal and choroidal circulation

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16
Q

In fundus fluorescencein angiography, what can be seen if there is hyper/hypofluorescence?

A

HYPERfluorescence = due to leakage from retinal new vessels

HYPOfluorescence = from areas of capillary non-perfusion

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17
Q

What type of imaging modality for macular disease is uses coherent light interferometry to analyze reflrected light to create cross-sectional image of the retina?

A

Optical coherence tomography

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18
Q

What is the major cause of central vision loss in >50 yrs of age?

A

Age-related macular degeneration

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19
Q

What structures to the outer retina is affected during degeneration?

A

Photoreceptor ells, retinal pigment epithelium, & choroid

20
Q

What are the factors related to age-related macular degeneration?

A

Female gender
Cigarette smoking
Hypertension
Light iris color
Undue exposure to UV light
Lack of vitamin C

21
Q

What is a sign of early stage macular degeneration?

A

Painless central blurring of vision

22
Q

What are the 2 AMD subtypes?

A

Non-neovacsular type (Atrophic AMD /Dry AMD)
Neovascular type (aka exudative AMD or Wet AMD)

23
Q

What are precursor lesions that is characterized by yellowish, well-demarcated, small to medium size, irregular deposits in the outer retina??

A

Drusen
- accumulate in the central macular region

24
Q

When Drusen increases in number or size, it results to what?

A

Geographic atrophy in non-neovascular AMD

25
Q

Increase in number/size of Drusen can herald the growth of what structure in neovascular AMD?

A

Choroidal neovascular membranes

26
Q

What is the precursor lesion of AMD?

A

Drusen (Wet or dry AMD)

27
Q

What is the progression of RPE or Neurosensory Retinal Detachment?

A

Elevation & Fluid acculumation of the neuroretina

28
Q

What is the presentatoin of Non-neovascular, atrophic, & dry AMD?

A

Irregular shaped “geographic” patches or chorioretinal atrophy at the macular center

29
Q

What are the clinical manifestastions of progression of non-neovscular AMD?

A

Drusen & non-specific RPE changes such as RPE hypertrophy/hypotrophy

30
Q

What is the management of non-neovascular AMD?

A

Fluorescein angiography = reveals INC transmissibility of underlying choroidal fluoresces

Micronutrient supplementation (VIt C, E, Lutein, Zexanthein, zinc, etc)

Low vision aids (magnifying lenses)

31
Q

What is the initial symptom of nevoascular/exudative/wet AMD?

A

Metamorphosia

32
Q

What is the hallmark of Neovascular AMD?

A

Choroidal neovascular membrane formation = growth of new vessels from the choroid

33
Q

What is the gold std in dx Neovascular AMD/wet age-related macular degenereation?

A

Fundoscopic Fluorescein Angiography
- delineates “classic” choroidal neovascular membranes

34
Q

In fundoscopic fluorescein angiography, what is the significance of neovascular lesions?

A

Typically hyperpermeable & leakage effusively

35
Q

What are the abnormal OCT findings in wet AMD?

A
  • neural retinal thickening & cystic itnraretinal spaces
  • metamorphopsia
  • sudden & profound decrease or darkening of vision in the central field
36
Q

What are the managements of Wet AMD?

A

Laser photocoagultiation
Photodynamic therapy
Anti-angiogenic therapy

37
Q

What happens if px goes for laser photocoagulation to tx Wet AMD?

A

Full thickness burns in the retina so subfoveal lesions are not amenable to this type of interventoin

38
Q

What is the most preferred tx for Wet AMD?

A

Intravitreal injfection of anti-VEGF drugs

39
Q

What are the significance of Intravitreal injection of anti-VEGF drugs?

A

Induce regression of choroidal neovascular membrane growth => inhibit hyperpermeability from CNVM lesions => decrease with wet AMD

40
Q

What is the epidemiology of central serous chorioretinopahty?

A
  • males (22-45 yrs old)
  • stressful life
  • type A personality
  • chronic steroid use
  • working age population
41
Q

What are the clinical presentations of Central Serous Chorioretinopathy?

A

Sudden onset of blurred vision
Micropsia
Metamorphopsia
Central scotoma = typical rounded central scotomas wherever they look

42
Q

What are the abnormal FFA findings in CSCR?

A

Rounded area of neuroretinal elevation

Focal eye dye leakage -> within arteriovenous phase -> solitarywhite hyperfluorescent focus

Recirculation phase -> leakage seen to progress in smokestack pattern

Late phase => pulling of dye in the subretinal phase

43
Q

What are abnormal OCT findings in CSCR?

A

Hyporeflective space = fluid accumulation

Mound-like elevation fo the retina

44
Q

What is the significance of OCT in diagnosing CSCR?

A

Monitor & quantify progression and or resolution of disease

45
Q

What are S/Sx of macular hole?

A

Impaired vusl acuity
Metamorphopsia
Central scotoma are present in amsler grid testing

46
Q

What causes macular hole?

A

After blunt trauma
Rately in rheumatogenou retinal detachmen

47
Q

What is the bext mode of Dx in macular hole?

A

OCT

Ophthalmology (4 decks)

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