Pathology, Evaluation and Management

Question 1

cause of presbyopia

Answer 1

lens hardening

Question 2

relative lens cytoplasmic concentration of glutathione, potassium, sodium, and calcium as we age?

Answer 2

glutathione and potassium decrease

sodium and calcium increase

Question 3

what is “second sight?”

Answer 3

ability of hyperopic patient to read without spectacles after a myopic shift caused by a cataract

Question 4

nuclear cataracts affect distance or near vision more?

Answer 4

distance

Question 5

brunescent cataract?

Answer 5

advanced nuclear cataract that is very brown and opaque

Question 6

first signs of cortical cataract

Answer 6

vacuoles and water clefts in posterior cortex

Question 7

opacification of the entire cortex from the capsule to nucleus? swelling of this cataract?

Answer 7

mature cortical cataract; intumescence

Question 8

wrinkled and shrunken capsule in cortical cataract? free moving nucleus in liquefied cortex?

Answer 8

hypermature; morgagnian

Question 9

which major class of adult cataract is generally seen in younger patients?

Answer 9

PSC

Question 10

PSC presenting symptoms?

Answer 10

glare and decrease vision in bright light (miotic conditions)

Question 11

pathophys and histology of PSC?

Answer 11

posterior migration of enlarged lens epithelial cells, which histologically are called Wedl, or bladder, cells

Question 12

lens changes with the following drugs:

1. steroids
2. phenothiazines
3. anticholinesterases
4. amiodarone
5. statins
6. tamoxifen

Answer 12

1. PSC
2. ASC
3. ASC
4. stellate pigment deposition in anterior cortical axis
5. DECREASED rate of nuclear cataract
6. no effect

Question 13

name of annular pigment deposition on anterior lens capsule following blunt trauma?

Answer 13

Vossius ring

Question 14

common appearance of traumatic cataract from blunt force?

Answer 14

stellate opacity in axial location

Question 15

early anterior segment findings of siderosis bulbi?

Answer 15

heterochromia and yellowish anterior lens capsule discoloration

Question 16

first sign of cataract from electrical injury

Answer 16

vacuoles in anterior midperiphery

Question 17

location of deposition in chalcosis?

Answer 17

(copper) Descemet’s (Kayser-Fleischer ring) and anterior lens capsule, leading to a “sunflower cataract,” which usually is not visually significant

Question 18

snowflake cataract

Answer 18

acute, bilateral, widespread subcapsular lens opacification, usually in a young patient with uncontrolled diabetes

Question 19

oil droplet cataract: cause and inheritance

Answer 19

galactosemia; AR

Question 20

differential for christmas tree cataract? Inheritance and findings in the inherited cause?

Answer 20

Hypoparathyroidism and Myotonic dystrophy (AD; low IOP from presumed ciliary body detachments, ptosis, delayed relaxation of controlled muscles, cardiac conduction delays, frontal balding)

Question 21

food that can decrease cataract formation?

Answer 21

eating cooked spinach twice a week

Question 22

cause of smoking and excessive alcohol intake on the lens? any affect from smokeless tobacco products?

Answer 22

nuclear cataracts. yes (also nuclear cataracts)

Question 23

affect of vitamins C and E and beta carotene on cataract formation in AREDS?

Answer 23

no effect

Question 24

type of cataract in Fuchs heterochromic iridocyclitis? how common?

Answer 24

cortical; 70%

Question 25

most common overall cataract in uveitis

Answer 25

PSC

Question 26

type of cataract post vitrectomy? etiology?

Answer 26

nuclear. increased intra- and post-operative oxygen tension

Question 27

refractive change cause by hyperbaric oxygen treatment? cataract formation? threshold for cataract?

Answer 27

myopic shift, due to nuclear sclerosis. 150 times in a 1 year period

Question 28

tissues affected by pseudoexfoliation syndrome? ocular complications?

Answer 28

all over the body (not limited to eye). capsular weakness, zonular fragility and possibly spontaneous lens subluxation, pigmented TM leading to POAG

Question 29

cataract in atopic dermatitis? when do these present?

Answer 29

ASC opacities resembling shield-like plaques; usually appear in teens or twenties

Question 30

pacoantigenic v phacolytic v lens particle v phacomorphic glaucoma

Answer 30

phacoantigenic: severe zonal granulomatous inflammation related to retained cortex or leakage of lens particles from traumatized capsule phacolytic: noninflammatory condition caused by the ingestion of lens particles, which have leaked out of an intact capsule in the setting of a mature cataract, by macrophages that can clog the TM lens particle: retained lens material after surgery or trauma where lens material directly blocks TM phacomorphic: intumescent lens causes pupillary block or anterior displacement of lens-iris diaphragm

Question 31

which wavelengths undergo more scatter by cataractous lenses?

Answer 31

short (blue)

Question 32

which eye to operate on first?

Answer 32

usually most visually significant. may take into consideration which eye is dominant. also may do better eye first if patient is very sick and might not make a second operation

Question 33

management of blood thinners and diabetic meds prior to ocular surgery?

Answer 33

blood thinners are generally not discontinued. if desired, warfarin should be stopped 3-5 days in advance, and aspirin 10-14 days hold all oral hypoglycemics and short acting insulins, and only take half of long acting insulin the morning of surgery

Question 34

cutoff for acceptable difference in axial length between two eyes in the absence of pathology?

Answer 34

0.3 mm

Question 35

principles of A-scan. affect of silicone oil?

Answer 35

measures axial length by the time it takes ultrasound waves to travel through ocular structures with presumed velocity values through each structure. ultrasound travels more slowly through silicone oil and thus it will take longer for sound waves to travel, leading to an overestimation of axial length.

Question 36

what may cause errors in values obtained by optical biometers?

Answer 36

corneal scar, dense PSC, vit heme

Question 37

SRK formula

Answer 37

P = A - 2.5L - 0.9K | P = power, A = A constant of specific lens, L = axial length, K = average keratometric reading in diopters

Question 38

RK patients generally have what type of refractive surprise after cataract surgery?

Answer 38

undercorrection (hyperopia)

Question 39

formula for hard contact lens overrefraction in estimation of corneal power of post RK eye

Answer 39

K = conact lens base curve + contact lens power + overrefraction - MRx done without conact

Question 40

strongest modifiable risk factor for the development of cataracts?

Answer 40

smoking