Macular Disorders Flashcards
What makes the macula a darkened circular area at the center of the retina?
High content of macular pigments: Lutein & Zeaxanthin (fine vision)
What are the structures found within the macula?
Fovea centralis
Umbo
Parafovea and Perifovea
What is considered to be the clinical macula where diseases are seen & has a profound effect on central vision?
Fovea + Parafovea
What is the significance of the macular region?
Responsible for finely detailed/high resolution, color vision, & focusing for central vision
What are the symptoms of macular disease?
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
When there is pain present along with symptoms of macular disease, what does it indicate?
Inflammatory condition/assoc with neovascular glaucoma
What are prescription drugs that can cause macular disease?
Hydroxychloroquine
Thioridazine
Plaquenil
What are the different examination techniques in diagnosing macular dis?
Direct ophthalmoscopy
Binocular indirect ophthalmoscopy
Slit lamp indirect ophthalmoscopy
Amsler grid
What examination technique enables the examiner to monocularly view the central 15deg of retina?
Direct ophthalmoscopy
What can be seen in direct ophthalmoscopy?
Optic disc, proximal retinal vessels, and parts of the macula
What is produced by the binocular indirect ophthalmoscopy?
Inverted & reversed image
= upside down, reversed from L to R
What are the advantages in using a slit lamp indirect opthalmoscope?
Retina is:
- Wider
- Stereoscopic or 3D view
- varying magnifications
What are the different ancillary examination for macular diseases?
Fundus fluorescein angiography
Optical coherence tomography
What is the significance of fundus fluorescein angiography?
Retinal vasculopathoes and maculopathies
Allows correlation betw histopatho and angiographic findings
What is seen in fundus fluorescein angiography?
Outline of the retinal and choroidal circulation
In fundus fluorescencein angiography, what can be seen if there is hyper/hypofluorescence?
HYPERfluorescence = due to leakage from retinal new vessels
HYPOfluorescence = from areas of capillary non-perfusion
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?
Optical coherence tomography
What is the major cause of central vision loss in >50 yrs of age?
Age-related macular degeneration
What structures to the outer retina is affected during degeneration?
Photoreceptor ells, retinal pigment epithelium, & choroid
What are the factors related to age-related macular degeneration?
Female gender
Cigarette smoking
Hypertension
Light iris color
Undue exposure to UV light
Lack of vitamin C
What is a sign of early stage macular degeneration?
Painless central blurring of vision
What are the 2 AMD subtypes?
Non-neovacsular type (Atrophic AMD /Dry AMD)
Neovascular type (aka exudative AMD or Wet AMD)
What are precursor lesions that is characterized by yellowish, well-demarcated, small to medium size, irregular deposits in the outer retina??
Drusen
- accumulate in the central macular region
When Drusen increases in number or size, it results to what?
Geographic atrophy in non-neovascular AMD
Increase in number/size of Drusen can herald the growth of what structure in neovascular AMD?
Choroidal neovascular membranes
What is the precursor lesion of AMD?
Drusen (Wet or dry AMD)
What is the progression of RPE or Neurosensory Retinal Detachment?
Elevation & Fluid acculumation of the neuroretina
What is the presentatoin of Non-neovascular, atrophic, & dry AMD?
Irregular shaped “geographic” patches or chorioretinal atrophy at the macular center
What are the clinical manifestastions of progression of non-neovscular AMD?
Drusen & non-specific RPE changes such as RPE hypertrophy/hypotrophy
What is the management of non-neovascular AMD?
Fluorescein angiography = reveals INC transmissibility of underlying choroidal fluoresces
Micronutrient supplementation (VIt C, E, Lutein, Zexanthein, zinc, etc)
Low vision aids (magnifying lenses)
What is the initial symptom of nevoascular/exudative/wet AMD?
Metamorphosia
What is the hallmark of Neovascular AMD?
Choroidal neovascular membrane formation = growth of new vessels from the choroid
What is the gold std in dx Neovascular AMD/wet age-related macular degenereation?
Fundoscopic Fluorescein Angiography
- delineates “classic” choroidal neovascular membranes
In fundoscopic fluorescein angiography, what is the significance of neovascular lesions?
Typically hyperpermeable & leakage effusively
What are the abnormal OCT findings in wet AMD?
- neural retinal thickening & cystic itnraretinal spaces
- metamorphopsia
- sudden & profound decrease or darkening of vision in the central field
What are the managements of Wet AMD?
Laser photocoagultiation
Photodynamic therapy
Anti-angiogenic therapy
What happens if px goes for laser photocoagulation to tx Wet AMD?
Full thickness burns in the retina so subfoveal lesions are not amenable to this type of interventoin
What is the most preferred tx for Wet AMD?
Intravitreal injfection of anti-VEGF drugs
What are the significance of Intravitreal injection of anti-VEGF drugs?
Induce regression of choroidal neovascular membrane growth => inhibit hyperpermeability from CNVM lesions => decrease with wet AMD
What is the epidemiology of central serous chorioretinopahty?
- males (22-45 yrs old)
- stressful life
- type A personality
- chronic steroid use
- working age population
What are the clinical presentations of Central Serous Chorioretinopathy?
Sudden onset of blurred vision
Micropsia
Metamorphopsia
Central scotoma = typical rounded central scotomas wherever they look
What are the abnormal FFA findings in CSCR?
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
What are abnormal OCT findings in CSCR?
Hyporeflective space = fluid accumulation
Mound-like elevation fo the retina
What is the significance of OCT in diagnosing CSCR?
Monitor & quantify progression and or resolution of disease
What are S/Sx of macular hole?
Impaired vusl acuity
Metamorphopsia
Central scotoma are present in amsler grid testing
What causes macular hole?
After blunt trauma
Rately in rheumatogenou retinal detachmen
What is the bext mode of Dx in macular hole?
OCT
