Optho, thyroid, Presbycusis, Resp, Pain, Osteoporosis Flashcards
68 yo pt that presents to clinic c/o decreased vision, needs bright light for reading and has difficulty reading despite bifocals, night driving difficult, glare w/ headlights, worse in left eye - has had HTN for 28 yrs? Most likely dx?
- age related macular degeneration (AMD)
- leading cause of adult blindness in developed countries
Impact of AMD on adult elderly pt?
- ability to drive
- increased rates of falls
- ability to live independently
What is AMD? Classification?
- degenerative disease of central portion of retina (macula)
- early AMD is often asx
classified as: - dry (atrophic) - ischemia, retinal epithelial cell apoptosis/activating inflammation
- wet (neovascular or exudative) - balance b/t substances that promote or inhibit blood vessel development, VEGF
RFs for AMD?
- age
- smoking
- genetics
- CVD
- diet?
- cataract surgery?
- other:
heavy ETOH use, caucasians more than African Americans
eval for AMD - hx?
- be alert to complaints of visual disturbance
hx:
-rate of vision loss
-whether one or both eyes involved - loss near or far vision or both
- assoc sxs
- acute distortion of loss of central vision - may be wet AMD
- vision loss occurring over days or weeks reqrs urgent ophthalmic referral
- usually occurs worse in one eye than the other
Physical eval for dry AMD?
- drusen appears as bright yellow spots
- atrophy appears as areas of depigmentation
- there may be increased pigmentation
Physical eval for wet AMD?
- subretinal fluid/and or hemorrhage
- neovascularization: appears as grayish green discoloration
- often reqrs fluorescein angiogram (light up vessels)
Tx for dry AMD?
- none
- for slowing the progression:
antioxidants w/ Vit C, E, beta carotene, zinc and copper (in smokers - no beta carotene)
Tx for wet AMD? Tool used to detect progression?
- VEGF inhibitors
- photocoag
- surgery
- tool for detecting disease progression: amsler grid
Diff glaucomas?
- acute angle glaucoma
- secondary glaucoma: many subtypes
uveitis
old trauma
steroid therapy - congenital glaucoma
- primary open angle glaucoma (POAG): MC
- leading cause of irreversible blindness in world
What is POAG?
optic neuropathy - optic disc described as cupping
- peripheral visual field loss followed by central field loss - can’t be recovered
- no sxs initially
- disease must be screened for
RFs for POAG?
- elevated IOP:
normal range 8-22 Hg, exact relationship b/t elevated IOP and cupping not well understood
-increasing age w/ increased risk of blindness - African Americans 4-5x greater risk
- family hx
Screening and tx for POAG?
screening:
- generally done by specialist w/ specialized equipment
- can examine optic disc for cupping - cup greater than 50% of the vertical disc diameter is suspicious
tx:
- topical and systemic meds (BB timolol)
- laser therapy
- surgery
Primary and secondary angle closure glaucoma?
- primary:
pts anatomically predisposed, no identifiable secondray cause - secondary:
secondary process responsible for closure of anterior chamber angle, such as:
A fibrovascular membrane grows over the angle, a mass or hemorrhage in posterior segment pushes angle closed
RFs for ACG?
- family hx
- age older than 40-50s
- female
- hyperopia (farsightedness)
- pseuodexfoliation
- race: higheset in Inuit and Asian pop, lower in African and European origins
Presentation of ACG?
- pressure rising acutely: sxs decreased vision halos around lights HA severe eye pain N/V - signs: conjunctival redness corneal edema or cloudiness shallow anterior chamber mid-dilated pupil (4-6 mm), reacts poorly to light
Urgency of ACG? Tx?
- ophtho emergency
- immediate referral for further eval and definitive tx:
if there is an hr or more delay to tx empiric therapy should be started
this should be guided by consultant
it is aimed at lowering IOP
How common are cataracts?
- leading cause of blindness in the world
- approx 30 mill blind people in world - 50% due to cataracts
RFs for cataracts?
- age: predominant
- smoking: 2 fold increase
- alcohol
- sunlight exposure
- metabolic syndrome
- DM
- systemic corticoid steroid use
Presenation of Cataracts?
- painless, progressive process
- pts usually complain of problems w/ night driving, reading road signs or difficulty w/ fine print
- often increase in nearsightedness (myopic shift)
PE findings of cataracts?
- lens opacity can be confirmed by fundoscopic exam
- may see darkening of red reflex, opacities or obscuration of ocular fundus detail
Tx of cataracts? Complications?
- surgery pre-op - - extensive eval not necessary - HTN should be controlled - endocarditis prophylaxis not needed - risk of bleeding w/ aspirin or warfarin is low so meds can usually be taken
- complications:
endophthalmitis, retinal detachment**
MC etiologies of presbycusis?
- sensorineural
- bilateral
- beginning in high frequency rage (4000-8000Hz)
