RETINA - RETINOPATHIES ASSOCIATED W/ THIN RETINAS Flashcards
what are 4 conditions associated with thin retinas?
- lattice degeneration
- snail track degeneration
- angiod streaks
- pathological myopia
what is lattice degeneration?
It is peripheral retinal thinning with overlying areas of liquefied vitreous - it has strong adherence between the vitreous and the border of the lesion which leads to traction.
what other condtion can appear similar to lattice degeneration?
snail track degeneration
what is snail track degeneration?
it is comprised of cystic lesions which lead to the separation of the neurosensory retina, but does NOT have a strong adherence to between the vitreous and the border of the lesion.
what are symptoms of lattice degeneration and snail track degeneration?
asymptomatic
signs of lattice degeneration?
- long oval shape crack parallel to the ora serrata that occurs with dark crisscrossing areas.
- usually located mid-peripheral superior temporal retina
signs of snail track degeneration?
- long oval shape parallel to the ora that occurs with white crisscrossing areas.
- usually located in the far periphery.
what ocular condition can lattice and snail track degeneration lead to?
retinal detachment
tx for lattice and snail track degeneration?
- Edu pt on s/s of retinal detachment.
- if asymptotic - monitor.
- if symptomatic - can do cryoprexy or laser photocoagulation to prevent development of retinal holes or tear.
- if RD - tx with surgery
what is angioid streaks?
Large breaks in Bruch’s membrane that results from damage to the elastic layer (maybe collagenous too) of Bruch’s membrane.
what are the systemic Dz associated with angioid streaks?
hint: PEPSI
- Pseduoxanthoma Elasticum
- Ehlers Danlos syndrome
- Paget’s Dz
- Sickle cell disease
- Idiopathic (50%)
Note: not associated with myopia!!
what is the main vision concerning sign of angioid streaks?
CNVM
symptoms of angioid streaks?
- Asymptomatic OR
- Profound vision loss from CNVM
signs of angioid streaks?
- Spoke-like, linear, well-demarcated red/orange or brown lines in Bruch’s that appear around the optic disc.
- Possible CNVM
tx for angioid streaks?
- No tx, refer to r/o and tx underlying dz.
- Rec polycarbonate safety glasses for sports due to increased risk of subretinal heme or choroidal rupture.
- If CNVM - anti-vegf (SOC)
- F/U – every 6 months (monitor for CNVM).
what is pathological myopia?
it is excessive, progressive elongation of the eye that is defined as myopia with a SE > -6.00D or axial length of >26mm
pathological myopia is defined by what power and what axial length?
- SE > -6.00D
- axial length > 26mm
does every one with high myopia have pathological myopia?
No, only those where myopia continues to progress and who present with pathological myopia signs.
what are the risk factors for pathological myopia?
- Genetics - increase risk by x1.5 if one parent is myopic & x3 higher if both.
- Ethnicity - Asians
- Gender - 2x F > M
- Time outdoors - insufficient time outdoors.
- Myopia onset - developing myopia at younger age.
- Near work demands - closer WD & longer time periods of continuous near work (>45min).
symptoms of pathological myopia?
decreased vision
signs of pathological myopia?
Macular & posterior signs:
* Posterior staphyloma (hallmark).
* Tilted ONH.
* Lacquer cracks (“stretch marks” - fine, yellow irregular lines that represent breaks in Bruch’s membrane (in macula).
* Most serious macula outcome - Fuch’s spot.
Peripheral signs:
* Lattice degeneration
* Snail-tracking degeneration
* Pavingstone degeneration
* Retinal breaks - retinal detachment.
Non-retinal signs:
* Premature cataracts (NSC & PSC)
* PVD
* Axial length >26mm
what is a posterior staphyloma?
stretching & thinning of the retina & sclera - bulges eye posterior
what is pavinstone degeneration?
discrete, circular areas of yellow-white chorioretinal atrophy in the retina periphery.
what is fuch’s spot?
it’s RPE hyperplasia overlying CNVM in the macula.
tx for pathological myopia?
- contact lenses preferred b/c it causes less image minification and prismatic effect.
- if glasses - rec polycarbonate.
- if CNVM - anti-vegf or laser (for extrafoveal or juxtafoveal)
- If RT/RH/RD - treat with surgery
- may benefit from low vision devices
- F/U – every 6-12 months.
What quadrant does lattice degeneration more commonly occur?
Temporal or superior retina
