Ophthalmoscopy

Question 1

Causes of cataract

Answer 1

• Old age (commonest)
• Associated with other ocular and systemic diseases (diabetes,
uveitis, previous ocular surgery)
• Associated with systemic medication (steroids, phenothiazines)
• Trauma and intraocular foreign bodies
• Ionizing radiation (X-ray, UV)
• Congenital (dominant, sporadic or part of a syndrome, abnormal
galactose metabolism, hypoglycaemia)
• Associated with inherited abnormality (myotonic dystrophy,
Marfan’s syndrome, Lowe’s syndrome, rubella, high myopia)

Question 2

Cataract: definition

Answer 2

Opacity of the lens of the eye,
which occurs when fluid gathers between the
lens fibres. The refractive index alters and
causes light scatter with resultant blurred
vision. Acquired lens changes occur in 95%
of people over 65, however, not all these
people will require cataract surgery

Question 3

Pseudophakia: is what

Answer 3

An eye that has had a cataract removed and artificial

intraocular lens implanted.

Question 4

aphakia is what

Answer 4

An eye that has had a cataract removed without an artificial lens inserted.

Question 5

early psot-op problems with cataract surgery

Answer 5

raised IOP
leaking incision
subconjunctival haemorrhage
corneal oedema
epithelial erosion
conjunctivitis

Question 6

sight threatening post-op complications requiring urgen Tx

Answer 6

endophthalmitis: red eye with hazy cornea. RAPD indicates serious damage. at days 3-5

Question 7

macular oedema (retina)

Answer 7

poor vision during first 60days after surgery

Question 8

glaucoma; Sites of blockage:

Answer 8

1 Ciliary block
2 Pupil block
3 Pre-trabecular – neovascular membrane or cellular debris
4 Trabecular
5 Post-trabecular – elevated episcleral venous pressure

Question 9

normal eye pressure

Answer 9

10–21mmHg.

Question 10

Age-related macular degeneration (AMD):

Answer 10

Late stages of
ARM that lead to progressive central vision loss. Includes: geographic
atrophy of the RPE and subsequently photoreceptor cell
loss, CNV, pigment epithelial detachment, haemorrhages, exudates
and scar tissue.

(Age-related maculopathy (ARM): Disorder of the macular
area most often occurring after 50 years of age, characterized by
Drusen ± changes in the retinal pigment epithelium (RPE).)

Question 11

Drusen:

Answer 11

Yellowish deposits external to the neuroretina and
RPE. May be well defined and small (hard) or ill defined (soft).
Drusen may be discrete or confluent and are hallmarks of agerelated
change found at the level of Bruch’s membrane

Question 12

glaucoma signs

Answer 12

• Usually raised IOP >21 and <40mmHg.
• Normal open angle on gonioscopy.
• Characteristic optic disc changes with gradual thinning of the
neurosensory rim superiorly and inferiorly with time, nerve fibre
layer defect, optic disc rim notching and cupping, cup: disc ratio
enlarged and/or asymmetrical.
• Visual field changes on automated fields analysis with characteristic
arcuate scotoma.

Question 13

Risk factors for AMD

Answer 13

Genetic and environmental are implicated.
• Cigarette smoking is a known risk factor.
• Vascular disease, hypertension and light exposure are associated
with AMD but are not risk factors.
• Supplementation with extra carotenoids, certain vitamins and
antioxidants may be associated with a decreased risk of developing
AMD in certain types of ARM/AMD.

Question 14

diabetic retinopathy classes

Answer 14

1. non-proliferative (background) DR
2. pre-proliferative DR (severe non-proliferative)
3. proliferative DR
4. advanced proliferative DR
5. maculopathy

Question 15

NPDR criteria

Answer 15

Microaneurysms
Retinal haemorrhages
Cotton wool spots
Exudates outside
temporal arcades

Question 16

PDR criteria

Answer 16

NV at disc (NVD) or
elsewhere (NVE)
Traction on NV causes
vitreous haemorrhage
or retinal detachment

Question 17

Pre-PDR criteria

Answer 17

Multiple haemorrhages
in all four quadrants
Venous beading
Intraretinal new vessels
(NV)

Question 18

APDR

Answer 18

Vitreous haemorrhage
Tractional retinal
detachment
Neovascular glaucoma

Question 19

Maculopathy criteria

Answer 19

Focal or diffuse retinal oedema
near fovea
Focal oedema with ring of
exudates ('circinate') near fovea
Exudates near fovea
Haemorrhages near fovea
Loss of capillaries at macula
(macula ischaemia)

Question 20

pathology of diabetic retinopathy

Answer 20

Basement membrane thickening
Loss of endothelial cells and pericytes
Loss of vascular tone regulation
Altered cellular adhesion molecules

Acellular capillaries ‘Capillary closure’
Local areas of retinal ischaemia and hypoxia
‘VEGF response’ and intracellular activation (including protein kinase C)

‘Angiogenesis’ with formation of NV
Alteration of vascular permeability

(Early) non-proliferative DR
(Later) proliferative DR
(Early, especially in late-onset DM)
Maculopathy
Macular oedema
Macular ischaemia