Retina Mnemonic Flashcards
Blood supply to retina
Mnemonic- COIN: Choriocapillaris supplies up to the Outer third of the Inner Nuclear layer
Cells in inner plexiform layer
Usefulmnemonic: “cells IN a B.A.G.”……“IN” for Inner plexiform layer; “BAG” forBipolar,Amacrine,Ganglion
outer plexiform layer: PHB (photoreceptors, horizontal, and bipolar cells)
Tritanopsia
Tritan is mighty - so tRitan is autosomal DOMINANT.
Mnemonic: blue is my favorite color, Shieh is sensitive to blue wavelengths; little mermaid’s dad carries a trident (triton [sic])
MC hereditary color vision defect is”deuteranomalous” = abnormality of the green-sensitive cone pigment. Individuals with this condition have difficulty distinguishing between lighter shades of red and green (i.e.”color weak”), but can distinguish between pure red and pure green (i.e. they are not color deficient).
Humans have 3 types of cone photoreceptors: L-cones (sensitive to red wavelengths), M-cones (sensitive to green wavelengths), and S-cones (sensitive to blue wavelengths). “L” stands for long wavelengths; “M” stands for medium wavelengths; and “S” stands for short wavelengths.
Since we use a mixture of 3 colors (i.e. red, green, and blue) to match any color of light,normal humans are trichromats.
Color deficiency
If any of these 3 cone photoreceptors is either ABSENT (“-ANOPIA”) or merely deficient (“-anomalous”), then a color deficiency exists. The prefixes for L-cone problems is “protan-“; for M-cone is “deuter-“; and for S-cone is “tritan-“.
Mnemonic: the letter “M” has 2 bumps - deuter
Hermansky-Pudlak
oculocutaneous albinism, one should rule out the possibility of two life-threatening systemic disorders: (1)Chediak-Higashi syndrome; and (2)Hermansky-Pudlak syndrome.
Hermansky-Pudlak syndrome: oculocutaneous albinism, ableeding diathesis, pulmonary fibrosis (major cause of death), and colitis. This syndrome has been described mainly inPuerto Rican individuals.
Mnemonic = “Four P’s of Hermansky-Pudlak”:Platelet disorder,Pulmonary Fibrosis,Puerto Ricans, andPigment-less
Angoid streaks DDx
“P-E-P-S-I”
Angioid streaks: associated withbeta-thalassemia(not alpha). It also can be associated with:
pseudoxanthoma elasticum, Paget disease of bone, sickle cell anemia
Ehlers-Danlos syndrome.
(the “I” standing for “idiopathic”).
Bardet-Biedl syndrome
-pigmentary retinopathy
-bull’s eye maculopathy occurs in most cases, few cases similar to typical RP with “bone spiculue” pigmentation
systemic features: OBESITY, mental handicap, polydactyly, hypogenitalism, renal abnormalities
Mnemonic: JK rowling wrote a book called Beddle the Bard. The bard plays an instrument (magic extra finger). eats well (obesity), but cannot sleep with the royals (hypogenitalism), can’t pee during performance (renal abnormalities), dumb way to make a living (mental handicap).
Ocular melanoma
Nevus thickness = reported to be the MOST important risk factor for malignant transformation, other factors are also predictive. The mnemonic
“To Find Small Ocular Melanoma Using Helpful Hints Daily” (TFSOM-UHHD) has been proposed [in order from most important to least important]
Thickness > 2 mm Fluid (subretinal) Symptoms Orangepigment present Marginwithin 3 mm of the optic disc
Ultrasonographic Hollowness(versus solid/flat),
absence ofHalo*
absence ofDrusen.
*halo refers to a pigmented choroidal nevus surrounded by a circular band of depigmentation
Causes of VH
MCC: of spontaneous vitreous hemorrhage in decreasing order are: (1) diabetic retinopathy; (2) retinal break without detachment; (3) posterior vitreous detachment; (4) rhegmatogenous retinal detachment; and (5) neovascularization after branch or central vein occlusion.
Vitreous hemorrhage causes in descending order, mnemonic: Diabetics Break (water) Without Pushing; Virgins Really Don't Need Birth Control Very Often.
AMD risk factors
3x FH, blue smoke
Fat, female, family history
HTN, hypercholesterolemia, hyperopia
blue eyes, smoking
Chorioretinal folds
THIN RPE Tumor (melanoma/mtz) Hypotony Inflammation (scleritis) Neovascular membrane
Retrobulbar mass
Papilledema
Extraocular hardware
MEWDS
MEWD= Monocular
Bartonella affects which retina layer?
Bartonella henselae in Henle’s layer (OPL) and hangs out in the old people layer
MPS causing retina dystrophy
Heparan Sulfate in (H)urler, (H)unter, (S)cheie, (S)anfilippo- a way to remember which MPS causes retinal dystrophies.
Retinal dystrophy only occurs in those MPS diseases that result in abnormal storage of heparan sulfate. These diseases are: (1) Hurler syndrome; (2) Scheie syndrome; (3) Hunter syndrome; and (4) Sanfilippo syndrome. Please also note that all of the MPS’s are autosomal recessive diseases except for Hunter syndrome which is X-linked recessive.
DRS
PRP = 3 letters DRS = 3 letters
Diabetic Retinopathy Study (DRS) was a RCT looking at PDR for PRP vs. observation.
PRP reduced the risk of severe visual loss by 50% or more in subjects with high-risk PDR. High-risk PDR was defined in this study according to: (1) eyes with new vessels and preretinal or vitreous hemorrhage; and (2) eyes with new vessels on or within one disc diameter of the optic disc (NVD) equaling or exceeding 1/4 to 1/3 disc area in extent in the absence of preretinal or vitreous hemorrhage. PRP technique was also defined by this study. The DRS established PRP as the standard of care for high-risk PDR during this time period.
Pigmentary retinopathy - two of them AD
Silly memory tool: For Waardenburg (AD)- think of the aa's as the inter canthi, and think of them laterally displaced. white forelock, cochlear deafness, heterochromia, normal to subnormal ERG
Myotonic dystrophy (AD) think of “My christmas” for christmas tree cataract, pattern dystrophy, ERG subnormal to abnormal, muscle wasting, cardiac conduction defects, frontal balding (remember Frankstein)
hereditary hyaloideoretinopathy
Wall Street Journal Primarily Republican = Wagner Stickler Jansen Pierre Robin
hereditary hyaloideoretinopathies = group of disorders with an “optically empty vitreous cavity” 2/2 premature vitreous breakdown. Have a high incidence of RD thought to be related to scattered lattice and thinning of the retina (excluding Wagner disease which does not have a predilection for retinal detachment). Other ocular abnormalities including cataract, myopia, glaucoma and strabismus are more common in these disorders compared to normal eyes.
Jansen and Wagner disease = have no associated systemic features.
Stickler syndrome is associated with skeletal abnormalities including facial dysgenesis in a pattern known as Pierre Robin sequence with micrognathia (small jaw), cleft palate, and glossoptosis (downward displacement of the tongue). Other skeletal pathology associated with Stickler syndrome includes hyperflexible joints and arthritis.
Haller and Sattler
Haller for huge, sattler for small
think of halo as peripheral and the settlers settle in the center.
The arterial pressure in the choroidal vasculature is much lower than that arriving via the SHORT posterior ciliary arteries because the blood is rapidly re-distributed by a network of choroidal vessels.
outer layer of (large-diameter) choroidal vessels is called the Haller layer while the inner layer of (smaller-diameter) choroidal vessels is called the Sattler layer.
DUSN
DUSN is caused by Baylisascaris and Ancylostoma, and that photocoagulation is the treatment:
“Zap DUDES in ANY BAY”
BRVO vs CRVO risk factors
Diabetes associated with CRVO : A B C D (C&D are next to each other)
Diabetes not associated with BRVO : A B C D (B&D are not next to each other)
Describe the difference between the structure of the outer segments of the rods vs the cones.
Mnemonics: CONE –> disks are “CONEcted” to the cell membrane
rod disks are not attached to the cell membrane whereas cones disks are not
Stargardt
Think: STARgardts you a Star , so you are number 1 (chr 1) and because you are a Star you know your ABCs therefore ABCA4 also AR is m/c autosomal recessive.
Peripheral NVE
Fires of Thor FEVR Incontienti pigmenti ROP Eales Sickle Cell
Thalaseemia
Hyperviscosity syndrome
OIS
Retinal vein occlusion
crystalline retinopathy
“Too Many Nits Can BE retinal crystals”
Tamoxifen, methoxyflurane, nitrofurantoin, canthaxanthine*, bietti, ethylene glycol
Other causes of a crystalline retinopathy include: talc and primary hereditary hyperoxaluria
*food colorant, also in make-up. Canthaxanthine maculopathy = generally aSx
Tamoxifen: macular edema w/moderate functional loss and anatomic degeneration.
Purtscher vs. Terson
Mnemonic: “Tearing” of blood vessels –> intraocular hemorrhage while “Pressure” (e.g. compressive injuries) or “Pancreatitis” would result in Purtscher retinopathy.
Negative ERG
Mnemonic: Goldman Sachs is Juvenile. MD takes Quinine for Birdshot, but this MARs night vision (CSNB) by clotting (CRVO/CRAO).
Or: Cook County X MD
Goldmann favre disease or Enhanced S-cone syndrome X-linked juvenile Retinoschisis MD (musc dystrophy?) Quinine Toxicity Birdshot retinopathy MAR CSNB, Oguchi disease CRVO (choroid circ to photoreceptors)/ CRAO
CSNB CRVO/CRAO X-linked retinoschisis Maculary dystrophy Drugs
DDx of CME w/o leakage?
Goldman-Favre (enhanced S-cone)
Juvenile X-linked retinoschisis
RP
Nicotinic acid
Good Young Retinas Never Leak
Non-pathologic DDx of decreased ERG?
High myopia (farther from electrodes) Large VH Not AMD (full-field ERG normal)
Refsum’s
Rain RP Ataxia Ichthyosis Neuropathy
