ophthalmology III

Question 1

what is diabetic retinopathy and risk factors

Answer 1

1 cause blindness working age adults. Risk factors:

Duration of diabetes(50% at 10 yrs, 90% at 30 yrs), Glycemic control – DCCT and UKPDS, Blood pressure –UKPDS, Pregnancy #1 cause blindness working age adults. Risk factors:
Duration of diabetes(50% at 10 yrs, 90% at 30 yrs), Glycemic control – DCCT and UKPDS, Blood pressure –UKPDS, Pregnancy

Question 2

diabetic retinopathy pathophys

Answer 2

Microvascular injury, Hemorrhage, Leakage, Ischemia, Neovascularization

Question 3

non-proliferative diabetic retinopathy signs

Answer 3

Microaneurysms, Flame hemorrhages, Dot-blot hemorrhages, Venous beading and dilation, Macular edema (#1 cause of vision loss in DM), Hard exudates – Lipoprotein, Capillary non-perfusion

Question 4

proliferative diabetic retinopathy sgns

Answer 4

Neovascularization (Optic disc and Retina), Fibrovascular proliferation, All pt’s with DM – 5-10%, Type 1 DM for 30 yrs – 60%

Question 5

proliferative diabetic retinopathy complications

Answer 5

Vitreous hemorrhage, Tractional retinal detachment, Neovascularization of iris leading to Obstruct trabecular meshwork leading to Neovascular glaucoma

Question 6

diabetic retinopathy management

Answer 6

Glycemic control, Blood Pressure control, Screening eye exams, Laser photocoagulation. Diabetic macular edema – Focal laser. PDR – Panretinal photocoagulation. Anti-VEGF injections (improve macular edema), pars plana vitrectomy (for vitreous hemorrhage)

Question 7

Central retinal vein occlusion- what is it, risk factors, findings, treatment

Answer 7

Blockage of the main vein carrying blood from the retina. Risk factors: HTN, age, glaucoma. Findings: dilated and tortuous retinal veins, swollen optic nerve, intraretinal hemorrhages, macular edema. Treatment: anti-VEGF injections (improves macular edema) and laser photocoagulation

Question 8

Hypertensive retinopathy- causes and treatment

Answer 8

Vasoconstriction (Arteriole narrowing), Arteriosclerosis (treatment: Copper and silver wiring, Arterio-venous nicking)

Question 9

Hypertensive retinopathy- symptoms

Answer 9

Retinal hemorrhage, Macular edema and exudate, Optic disc edema (Papilledema-Due to acute, severe HTN)

Question 10

Age related macular degeneration- risk factors

Answer 10

1 cause blindness >50 yr old

Risk factors: Age – 6% age 65-74, 20% ≥75 yrs, Race – Caucasians , Gender – females, Tobacco smoking, Cardiovascular disease#1 cause blindness >50 yr old
Risk factors: Age – 6% age 65-74, 20% ≥75 yrs, Race – Caucasians , Gender – females, Tobacco smoking, Cardiovascular disease

Question 11

nonexudative (dry) age related macular degeneration- symptoms

Answer 11

Drusen (yellow lipoprotein deposits under retina. Can be hard or soft, soft have higher risk of progression). Retinal pigment epithelium changes (atrophy, hyperpigmentation), geographic atrophy, AREDS vitamins (antioxidants and zinc can prevent AMD)

Question 12

exudative (wet) age related macular degeneration- symptoms

Answer 12

more vision loss, choroidal neovascularization into retinal pigment epithelium (Macular edema and hemorrhage, Pigment epithelial detachment, Fibrotic disciform scar)

Question 13

exudative AMD treatment

Answer 13

Anti-VEGF intravitreal injections - regression of choroidal neovascularization

Question 14

components and attachments of vitreous fluid

Answer 14

main fluid of eye- Water, hyaluronic acid and collagen type II. Attachments to ora serrata, macula, optic nerve

Question 15

posterior vitreous detachment- causes

Answer 15

retinal detachment, epiretinal membrane, macular hole

Question 16

what is the choroid

Answer 16

Vascular layer btw retina and sclera. Aka posterior uvea

Question 17

disease of choroid

Answer 17

age related macular degeneration, choroid neovascular membranes, uveitis, tumors

Question 18

average size of optic disc

Answer 18

Average cup-to-disc ratio 0.3 and 98% of normal eyes are <0.7

Question 19

glaucoma findings

Answer 19

elevated intra-ocular pressure, optic disc hemorrhage, visual field defects, enlarged cup to disc ratio or asymmetry

Question 20

glaucoma management

Answer 20

lower intra ocular pressure with meds (decrease aqueous production or increase outflow), laser, surgery

Question 21

Anterior ischemic optic neuropathy- what is it, risk factors

Answer 21

infarction of optic disc, risk factors: age, caucasians, small C/D ratio, cardiovascular risk factor

Question 22

non-arteritic Anterior ischemic optic neuropathy- symptoms

Answer 22

Painless, Afferent pupillary defect, Visual field defect, Optic disc edema, No specific treatment, Treat comorbidities

Question 23

arteritic Anterior ischemic optic neuropathy symptoms and treatment

Answer 23

Giant cell arteritis, Systemic symptoms – HA, fatigue, Jaw claudication, Scalp tenderness, Worse vision loss, Pallid disc edema. Treatment: steroids, prevent progression, rare vision improvement