Opthalmology

Question 1

Subtypes and appearance of cataracts. One presentation feature of each.

Answer 1

Nuclear - yellowy diffuse - miopic with low saturation
Subcapsular - plaque like - effects near vision
Cortical - radial spoke appearance - problems with glare and night vision

Question 2

Signs and symptoms of cataracts

Answer 2

Blurred vision, glare, halos, poor night vision, poor contrast, monocular diplopia
Loss of red reflex, cloudy fundal view, refractive error/decreased acuity

Question 3

Risk factors for cataracts?

Answer 3

Age
Smoking and etoh 
Diabetes
Corticosteroids
Radiation inc. UV
Trauma
Genetic

Question 4

Risks of cataract operation

Answer 4

Retinal detachment
Vitreous haemorrhage
Glaucoma
Infection

Question 5

Realistic outlook to cataract operations

Answer 5

90% get big improvement however:
Dazzle effect remains often
Ability to adjust lens lost so distance specific glasses needed
Anisometropia occurs - different prescription for each eye

Question 6

What needs doing before a cataract operation

Answer 6

Ocular biometry to predict power and shape of lens replacement

Question 7

Pathology behind armd

Answer 7

Retinal pigment epithelium dysfunction results in debris build up called drusen between rpe and choroid
Coalescence of these drusen cause dry macular degeneration by ischemia
In some cases vegf released resulting in neovascularisation of the choroid through bruches membrane into the outer retina. These vessels are weak and bleed.

Question 8

Presenation of armd

Answer 8

Over weeks/months (wet) or years (dry) progressive decrease in visual acutity, contrast and sensitivity. Positive central sctoma obscures faces. Vision is distorted.

Question 9

What complication of armd may make the pt think they were psychologically unwell?

Answer 9

Charles bonnet syndrome - visual hallucinations

Question 10

What tests should be performed on suspected armd in clinic? Likely findings?

Answer 10

Visual acuity - decreased
Amsler grid - distortion and blind spots
Fundoscopy - drusen and geographic atropy (dry) or bruise like dark patch (wet)

Question 11

Investigations in armd, showing what?

Answer 11

Optical coherence tomography. Cyst like apperence and damage to the rpe layer

Question 12

Management of dry armd

Answer 12

Stop smoking
Increase omega 3 and green leafy veg
Vitamin supplementation

Question 13

Management of wet armd

Answer 13

Anti vegf injections every few months intervitriol

Photodynamic therapy

Question 14

Complication of anti vegf injections in wet armd

Answer 14

Infections
Vitreous haemorrhage
Retinal detachment
Cateracts