Ophthalmology Flashcards
Glaucoma, macular degeneration, cataracts,
Presentation of macular degeneration
What is characteristic?
- Progressive reduced vision, blurriness, worse in night time
- More rapid in ‘wet’ macular degeneration
- Central scotomas
- Seeing ‘wavy’ lines
Which type of macular degeneration carries a worse prognosis?
Wet macular degeneration
Amsler grid test indication
Suspected macular degeneration – metamorphopsia
Detects central visual field defects, metamorphopsia and any dark areas/blind spots (scotomas)
Investigations for macular degeneration
List 4
- Visual acuity test
- Amsler grid test
- Slit lamp / fundoscopy to look at retina
- OCT to look at retinal layers
Fundoscopic findings in dry macular degeneration
Drusen (‘d’ for drusen) around the macula.
Fundoscopic findings in wet macular degeneration
Subretinal fluid/blood (Leakage)
Management of ‘dry’ atrophic macular degeneration
No definitive treatment.
Antioxidants e.g. vit A/C/E and zinc and healthy lifestlye (no smoking.)
Management of ‘wet’ neovascular macular degeneration
Anti-VEGF injections (e.g., ranibizumab, aflibercept)
Presentation of cataracts
- Gradual, painless visual loss
- Loss of colour
- Halos/glares
- Reduced/absent red reflex
- Asymmetrical
- Often in older adults
Diagnosis of cataracts
- Opacity on slit lamp
- Snellen chart - reduced visual acuity
- Possible reduced red reflex
Treatment of cataracts
Phacoemulsification + lens replacement surgery
Lens being broken down by US
A patient presents with a sudden, painless loss of vision, what might this be?
Occlusion to a cetnral blood vessel supplying the eye:
- Central retinal artery occlusion
- Central retinal vein occlusion
How might you differentiate a central retinal artery vs vein occlusion through a fundoscope?
Artery: cherry red spot (macula) - blood not going to the eye, white retina
Vein: flame haemorrhages in all quadrants - backlog of blood from blocked vein
What is glaucoma?
A group of eye conditions that damage the optic nerve, often due to high intraocular pressure (IOP).
What are the types of glaucoma?
Primary open-angle glaucoma (POAG), angle-closure glaucoma, secondary glaucoma, congenital glaucoma.
Most significant risk factor for glaucoma?
Raised IOP
Others: Age, FH, ethnicity, myopia,
Acquired: diabetes, hypertension, steroid use.
Pattern of visual loss in primary open-angle glaucoma (POAG)?
Characterise the vision loss.
Often asymptomatic in early stages;
If symptomatic: gradual loss of peripheral vision, then progressing centrally. > tunnel vision.
What is the characteristic visual changes in angle-closure glaucoma?
Halos around lights.
+ Sudden, severe eye pain, blurred vision with systemic features e.g. headache, N/V.
How is intraocular pressure (IOP) measured?
Applanation tonometry
Automated test to measure visual field defect.
Perimetry
Peri- peripheral eyes
How is open-angle glaucoma diagnosed?
- characteristic optic nerve damage (not necessarily with raised IOP)
- Visual field defects
IOP may not be raised, but nerve damage may still have occured. This is called ‘Normal-Tension Glaucoma’: treated in basically the same way as POAG
First-line management of primary open-angle glaucoma/OTN.
How does it work?
360° Selective Laser Trabeculoplasty (SLT)
Delays the need for eye drops and a reduced risk of long-term medication use.
SLT helps reduce IOP by improving aqueous outflow through the trabecular meshwork. However, potential side effects include transient discomfort, blurred vision, and photophobia.
A second SLT may be necessary if the initial effect diminishes over time.
How is the angle in the anterior chamber of the eye assessed?
Goinoscopy
