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Ocular Disease 3 > Ocular Disease III: Lecture 3: Electrodiagnostics > Flashcards

Ocular Disease III: Lecture 3: Electrodiagnostics Flashcards

1
Q
  1. ERG
  2. VEP
  3. mfERG
  4. EOG
  5. PERG
A
  1. Checks Retinal Function Health a. ERG response mostly comes from Photoreceptors and Bipolar cells (OUTER RETINA)
    b. *Most important test in her opinion
  2. Checks Health of VISUAL SYSTEM
  3. Health of Foveal Cones
  4. Health of RPE
  5. Health of Ganglion/Amacrine Cells (non linear and Spiking)
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2
Q

ERG Wave

  1. the First Dip (A-WAVE): Due to what cells?
  2. The bumps in the middle
  3. The peak?
A
  1. Photoreceptors
  2. Oscillatory Potentials (AMACRINES)
  3. B-Wave (BIPOLARS, GLIA)
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3
Q

Which wave would be SLOWER in time but LARGER in size?

A
  1. SCOTOPIC WAVE
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4
Q

How is the test done?

A
  1. Dilate
  2. Ground Electrode attached to EAR
  3. Dark Adapt
  4. Insert Lenses
  5. Run both eyes at ONE (SCOTOPIC TESTING)
  6. LIGHT ADAPT
  7. Run PHOTOPIC TESTING
  8. Check Fundus
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5
Q

When performing the ERG, if you were using a DIM LIGHT, what wave(s) would you expect on the graph?

A
  1. ONLY a B WAVE! (so not big enough to get an A Wave)
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6
Q

Everyone w/a NORMAL PERG, will have a PEAK when

A
  1. At 50 msec (P50) (stimulus is 50% light and 50% dark at every moment)
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7
Q
  1. When is a PERG good to use on a patient?

2. What other diseases?

A
  1. When they can’t do a VF
  2. NERVE TOXICITY, (Glaucoma…pts that cant do other functional tests)
    * Usually used in Conjunction w/a VEP!
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8
Q

VEP

  1. What Electrical Potential does it measure?
  2. Check sizes are about what?
    a. Gives response of what?
  3. Does it localize the problem?
A
  1. At The OCCIPITAL CORTEX created by stimulus to the RETINA, especially the fovea. (Electrodes on the back of the head)
  2. 20/200 and 20/50 (pt fixates in the center)
    a. of the ENTIRE PATHWAY
  3. NO! It just tells us that there’s a problem somewhere.
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9
Q

EOG

  1. Dark Trough = ?
  2. Normal ARDEN Ratio is usually WHAT? (KNOW!)
  3. She said to go with what Arden Ratio?
  4. Patient looks back and forth..(eye acts like a battery, w/+ and - electrode on each side of the eye)
A
  1. ARDEN Ratio
  2. usually greater than 2/1
  3. 1.75! (Ratio from the number you get in the light, and the number you get in the dark)
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10
Q

1st Thing to ask EVERY PATIENT before doing an ERG?

A
  1. Is it PROGRESSIVE or STATIONARY
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11
Q

Stationary: Examples

A
  1. Born w/bad vision or early on has poor vision and stays the same

CSNB, Oguchi Disease,

Fundus Albipunctatus

Fleck Retina of Kandori

Achromatopsia

and LEBERS (Congenital Amarosis)

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12
Q

CSNB

  1. Genetic? (think who)
  2. What happens to the ERG?
    a. ERG will be what?
A
  1. X-linked (think BOYS more likely)
    * Normal Looking Retina (No RPE Changes)
    * No photoreceptor to Bipolar Signaling
  2. Decreased B Wave (Bipolar Cell), but Intact A wave (Photoreceptors)
    * How they’re diagnoses
    a. Will be Electro Negative
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13
Q

Lebers

  1. Not the same as what?
  2. Blind since when?
  3. Genetics?
  4. What does the retina look like?
  5. ERG?
A
  1. Lebers Optic Atrophy
  2. from Birth (FC to LP)
  3. Autosomal Recessive
  4. Normal, pigment changes w/aging (starts normal but starts to change as they get older)
  5. No/little measurable ERG
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14
Q

Progressive Retinal Dystrophies

  1. What one’s are Central? (5)
A
  1. Cone Dystrophy
  2. Stargardts
  3. Best Disease
  4. Pattern Dystrophies
  5. Macular Dystrophies
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15
Q

2 other questions to ask?

A
  1. dark or light problem, or both?
    a. Scotomas…?
  2. Who else in your family has this?
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16
Q

What are the first two things you would think of as a differential for night blindness?

A
  1. Cataracts and Glaucoma
17
Q
  1. Inflammatory Disorders: Central or GENERAL?
A
  1. ALL GENERAL

(Birdshot, MEWS, AZOOR, ORV (Histoplasmosis common), Behcet’s Disease

18
Q

Toxic Retinopathy: What major drug?

19
Q

Best’s Disease

  1. 2 Types: When are they each diagnosed?
  2. Appearance of the Macula?
  3. WHAT TEST is ABNORMAL?
  4. What is the SAME GENE?
A
  1. AUTOSOMAL DOMINANT RPE Disorder (Childhood)
    a. Vision loss not bad w/best until LATE STAGES (Age 50)
  2. EGG Appearance
  3. EOG (ERG: A and B wave are normal, but c wave is reduced)
  4. PATTERN DYSTROPHY VITELLIFORM
20
Q

Best Disease: 5 Stages

  1. Stage 1
  2. Stage 2
  3. Stage 3
  4. Stage 4
  5. Stage 5
A
  1. Normal fundus. Abnormal EOG
  2. EGG YOLK: sunny side up Vitelliform Lesion
  3. Pseudohypopyon (partly absorbed)
  4. Vitelliruptive (scrambled Egg)
  5. End Stage. Scarring, CNV, ATROPHY
21
Q

2 Disorders that Best Disease tends to be confused with?

A

Central disorders that cause Scarring or Lipofuscin Changes (Mostly Stargardts)

22
Q

Stargardts Disease

  1. AKA?
  2. Genetics?
  3. What age does this normally present?
  4. ERG Changes are correlated with change in what? Is this common?
  5. A and B wave amplitudes. What happens to them?
  6. What test is non-detectable, even though VAs are good?
  7. Mutations in what gene?
  8. ERG
A
  1. Fundus Flavimaculatus
  2. Autosomal Recessive
  3. 10-20 yrs
  4. In Fundus. It’s rare in early disease, except mfERG
  5. They decrease
  6. PERG
  7. ABCA4 gene
  8. ERG: centrally decreased…
    * 20/30 is a best case scenario, but by age 30, they’re low vision patients (20/200)
23
Q

Retinitis Pigmentosa

  1. Most common hereditary disorder of what?
  2. Needs to be on your RADAR for every case of what?
  3. Major patient complaints
  4. Is Central Blindness common?
A
  1. of RODS
  2. Night blindness
  3. PHOTOPHOBIA, Reduced Fields, and Nyctalopia (night blindness)
  4. No. RARE. But can come later on in late disease
24
Q

Retinitis Pigmentosa

  1. Triad
A
  1. Arteriole Attenuation
  2. Bone Spicules
  3. Optic Atrophy
25
Q

Toxic Retina: Plaquenil

  1. What is this taken for?
    a. Where does it accumulate?
  2. 4 Side effects from High Dosages
  3. NEW STANDARD OF CARE?
A
  1. RA and Lupus
    a. Choroid, CB, RPE (binds melanin)
  2. a. Attenuated Vessels
    b. Depressed Peripheral Fields
    c. Impaired Central Vision
    d. Pigment changes (Bull’s eye macula)
  3. mfERGS (for high risk patients: High daily doses, progressive vision loss, kidney issues, long term treatment)
26
Q

New Exam for Plaquinil

1 What are the 3 BIG THINGS to do?

A
  1. VA; VF (Central: 10-2), and HD-OCT and/or mfERG/ or FAF
27
Q

MEWS (white dot)

  1. UNI/BI?
  2. usually have what?
  3. Associated with what?
  4. ERG will show what?
A
  1. USUALLY UNILATERAL
  2. Vitritis but self limiting
  3. HLA-B51
  4. Decreased Photoreceptor over time
28
Q

AZOOR

  1. Acts like MEWS (a White dot) but with no what?
  2. Blindspot?
  3. Uni/bi?
  4. in whom?
A
  1. with no actual dots
  2. Larger
  3. Uni
  4. young women

usually gets better over time

29
Q

AMPPE

  1. common?
  2. UNI/BI?
A
  1. very uncommon
  2. Bilateral
    * HLA-B27

Short term, active phase resolves quickly

30
Q

MC (Multifocal choroiditis)

  1. Uni/bi?
  2. type of uveitis
  3. Short/long term?
A
  1. Bi
  2. Panuveitis
  3. middle aged women; LONG TERM
    * anterior uveitis in 50%
31
Q

Birdshot

  1. Typically presents with what?
  2. uni/bilateral lesions
  3. ERG in birdshot
A
  1. floaters (vitritis)
  2. bilateral creamy lesions
  3. usually found disc to equator and progresses inward

can lead to scarring and atrophy

HLA-A29

  1. gets more electronegative over time; B wave issues more common in birdshot

Ocular Disease 3 (11 decks)

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