OPTH Lec03

Question 2

What are the characteristics of glaucoma?

Answer 2

Characterized by arcuate visual field defects that correspond to optic nerve damage. Involves elevated IOP (but IOP CAN be normal)

Question 3

What is normal IOP?

Answer 3

8-21 mmHg

Question 4

What is the normal course of aqueous in the eye?

Answer 4

Aqueous is produced by the ciliary body percolates through the conules over the lens, across the pupil into the AC and exits through the trabecular meshwork into the canal of Schlemm into episcleral veins

Question 5

What causes glaucoma?

Answer 5

When the flow of aqueous is altered

Question 6

What is the most common form of glaucoma?

Answer 6

open angle

Question 7

What does Acute narrow angle glaucoma do?

Answer 7

Causes sudden elevated IOP by mechanical blockage of flow. Medical emergency

Question 8

What is angle closure glaucoma?

Answer 8

When the canal of schlemm is occluded and the aqueous cannot flow out.

Question 9

What are characteristics of optic nerve problems?

Answer 9

PAIN, colored halos around lights, red eye with tearing and steam cornea, mid fixed and ciliated pupil, nausea, vomiting, chest pain, firm eye to palpation

Question 10

What is the path of the optic nerve?

Answer 10

Nerve fibers will begin as retinal ganglion cells and become a nerve fiber layer gathering at the optic nerve. They will travel retro orbitally to and through the sphenoid optic canal, cross in the optic chiasm and end in the lateral geniculate body

Question 11

What can cause damage to the optic nerve?

Answer 11

interruption of blood flow to nerve fibers at the optic nerve head or mechanical pressure pushing the nerve fibers against the lamina cribrosa which will interrupt axoplasmic flow

Question 12

What are risk factors of glaucoma?

Answer 12

over 40 years of age, black race, family history, chronic steroid us, cup to disc ratio of 0.5 or more, asymmetry

Question 13

What do you examine when assessing for glaucoma?

Answer 13

optic nerve but unless there is extreme visual loss will not be found on confrontation VF

Question 14

What is this?

Answer 14

Enlarged chronic nerve due to glaucoma

Question 15

What is cataracts associated with?

Answer 15

age related, congenital, traumatic, nutritional, environmental or systemic

Question 16

What causes cataracts?

Answer 16

changes in the crystalline lens

Question 17

What are the symptoms of cataracts?

Answer 17

blurred vision, “second sight” can occur in nuclear sclerotic induces myopia, and diplopia and or glare from light scatter

Question 18

Where can cataracts occur?

Answer 18

nuclear, cortical and posterior subscapular

Question 19

What will determine the degree of visual disability?

Answer 19

the size and location of the opacity

Question 20

What is cataracts?

Answer 20

An opacity (clouding) of the normally clear lens which may develop as a result of aging, metabolic disorders, trauma or heredity

Question 21

What is this?

Answer 21

Cataracts

Question 22

What should a PCP do when examining for cataracts?

Answer 22

check VA, pupils and red reflex to look at the lens and lastly ophthalmoscopy

Question 23

What is the treatment for cataracts?

Answer 23

surgical treatment is considered if the patient’s best corrected vision is impairing quality of life. Treat by removing the nucleus of the lens and replace with an implanted artificial lens. Make sure to leave the capsule in the eye.

Question 24

When is macular degeneration more prevalent?

Answer 24

Prevalence increases with age (25% at 70, 33% at 80, and 50% at 90

Question 25

What is macular degeneration?

Answer 25

Vision loss of the macula

Question 26

Where is the macula located?

Answer 26

An oval region 2 disc diameters temporal and slightly inferior to the disc. The rods and cones provide the detailed central vision. Fovea in the central macula I avascular without rods

Question 27

How do you diagnose macular degeneration?

Answer 27

The foveal reflex will not be present in the macular degeneration

Question 28

What are the symptoms or macular degeneration?

Answer 28

Painless loss of vision or metamorphopsia. Gray-green lesion visible in wet AMD. May have RPE tears or fold. Age related changes will include drusen (yellow or white extracellular accumulations between Bruch’s membrane and extracellular retinal pigment epithelium and choroid). Can be hard or soft and RPE may be hyperpigmented or atrophic (dry)

Question 29

What is neovascular AMD?

Answer 29

Dry AMD can progress to the wet form (20%). Wet AMD is when the vessels extend from choroid capillaries through Bruch’s membrane into the subretinal space.

Question 30

What is Dry AMD?

Answer 30

When there are spots accumulating

Question 31

What is Wet AMD?

Answer 31

When the blood vessels infiltrate the rods and cones, RPE and nuclear layer of the macula

Question 32

What is this?

Answer 32

Dry Macular Degeneration

Question 33

What is this?

Answer 33

Wet AMD

Question 34

How do you diagnose Macular Degeneration?

Answer 34

Flourescein angiography will help diagnose, examine using VA, Amsler Grid(will present with metamorphosia or distortion of central vision) and Central scotoma (will report a spot in the center where cannot see). Use ophthalmoscope or slit lamp biomicroscopy

Question 35

What is the treatment for AMD?

Answer 35

Refer to ophthalmologist. Laser treatment

Question 36

What are the long term complications of AMD?

Answer 36

Central vision will be lost but peripheral vision will be preserved = low vision (can be referred for low vision rehabilitation