Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Optometry Class OP2503 > Retinal Vascular Diseases > Flashcards

Retinal Vascular Diseases Flashcards

1
Q

what are the 4 common categories of diabetes?

A
  • Type 1 – Insulin deficiency
  • Type 2 – Insulin resistance
  • Gestational diabetes
  • Specific types (monogenic diabetes syndrome etc.)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

name 3 of the most common complications of diabetes?

A
  • Diabetic Retinopathy & Diabetic Maculopathy
  • Refractive
  • Iridopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the less common complications of diabetes?

A
  • (early onset) Senile Cataract (age related)
  • Styes, Blepharitis & Xanthelasmata
  • Recurrent subconjunctival haemorrhages
  • Ocular motor palsies
  • Corneal ulcers and sensitivity
  • Rubeosis Iridis (Neovascular glaucoma)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is primary hypertension?

A

high blood pressure that does not have a known cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

name 6 risk factors of diabetic retinopathy

A

Diabetes duration
Poor control of diabetes
Pregnancy
Hypertension
Nephropathy (kidney disease)
Obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the pathogenesis of diabetic retinopathy?

A
  1. hyperglycaemia causes increased blood viscosity
  2. this causes damages to retinal pericytes (this usually goes undetected)
  3. when the pericytes are damaged, capillary walls in microvasculature of the retina weaken leading them to close as microaneurysms
  4. chronic leakage from the vasculature results in oedema and exudates which can be seen as white flecks on the retina (this may or may not be symptomatic
  5. proliferative diabetic retinopathy is where there is retinal ischaemia which stimulates production of growth factors such as VEGF, IGF-1
  6. this causes neovascularisation which could lead to vitreous haemorrhages and retinal detachment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do you manage diabetic retinopathy at each of the stages?

A

-background: inform GP
-pre proliferative: inform GP
-proliferative: urgent referral to HES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the signs associated with background diabetic retinopathy?

A

-microaneurysms
-dot and blot haemorrhages
-flame haemorrhages
-hard exudates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the signs associated with pre proliferative diabetic retinopathy

A

-cotton wool spots
-venous irregularities
-intraretinal microvascular abnormalities (IRMA) (this is where there is abnormal branching or dilation of existing vessels)
-dark blot haemorrhages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the signs associated with proliferative diabetic retinopathy

A
  1. Neovascularisation at the Disc (NVD)
  2. Neovascularisation Elsewhere (NVE)
  3. Pre-retinal & Vitreous haemorrhages
  4. Tractional retinal detachment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the signs associated with diabetic maculopathies?

A

Exudative, focal/diffuse, cystoid/diffuse oedema, Ischaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

when is macular oedema clinically significant?

A

-Retinal oedema within 500um of the centre of the fovea
-Hard exudates within 500um
of centre of fovea, if associated
with retinal thickening (can be
outside 500um area
-Retinal oedema 1 disc area or larger, any part of which is within 1DD (1500um) of the
centre of fovea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what complications can diabetic retinopathy cause?

A

-earlier onset of age-related cataract
-extraocular muscle palsies
-iris complications
-Lids and lash complications like blepharitis, styes and infections and xanthelasma
-corneal complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What iris complications can diabetic retinopathy cause?

A
  • Iris transillumination
  • Rubeosis iridis
  • Pupil size - small irregular - sympathetic denervation
  • Increased IOP due to leakage of cells from new blood vessels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what corneal complications can diabetic retinopathy cause?

A

Recurrent epithelial erosions
Transient punctate keratitis
Stromal oedema
Reduced corneal sensitivity
Reduced healing rate
Increased fragility
Reduced resistance to infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what ocular signs in the retina are caused by hypertension?

A
  • Hypertensive Retinopathy
  • Choroidopathy
  • Disc oedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the 2 types of hypertension?

A

-Primary hypertension (no distinct cause)
-Secondary which can be caused by renal disease or endocrine disease, rarely congenital coarctation (narrowing) of the aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what ocular complications arise as a result of hypertension

A
  • AION (non-arteritic– often reduced VA and swollen disc)
  • Retinal arteriole and vein occlusions
  • Retinal macro-aneurysms (and retinal emboli)
  • Ocular motor nerve palsy
  • Glaucomatous optic neuropathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

give the pathogenesis of hypertensive retinopathy

A
  1. VASOCONSTRICTIVE PHASE autoregulation mechanism results in vaso-constriction visible as generalised arteriole narrowing
  2. SCLEROTIC PHASE - persistent high blood pressure causes both arterial sclerosis = wall narrowing and atherosclerosis which leads to the lumen to narrow. associated with changes in arterial light reflex and A/V crossing
    3.EXUDATIVE PHASE blood retinal barrier disrupted due to loss of smooth muscles and
    endothelial cells.
  3. COMPLICATIONS OF SCLERIOTIC PHASE - macroaneurysms, microaneurysms, CRA & CRV
    occlusions, epiretinal membrane formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are the different signs of arteriovenous nipping?

A

-Gunn’s sign
-Salus’s sign
-Bonnet sign

see more in screenshots folder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what retinal grading system would you use for hypertensive retinopathy?

A

Keith–Wagener–Barker Classification System:

Grade 1 -Mild narrowing of the retinal artery.
Grade 2 -Severe or tighter constrictions of the retinal
artery. This is called arteriovenous, or AV, nipping.
Grade 3 - As above plus retinal oedema, microaneurysms, cotton-wool spots and retinal haemorrhages.
Grade 4 –As above plus optic disc swelling (papilledema) and macular oedema, associated with a higher risk of stroke,
kidney or heart disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what retinal grading system would you use for Arteriosclerotic Retinopathy - Arteriolar sclerosis

A

Scheie Classification System
Grade 1 –Broadening of arteriole light reflex /
narrowing
Grade 2 –As above + deflection of vein at A/V
crossing (Salus’ sign)
Grade 3 - As above + copper wiring of arterioles,
banking of vein (Bonnets sign), tapering of vein
(Gunn’s sign)
Grade 4 –As above + silver wiring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are the signs of the exudative phase of hypertensive retinopathy?

A

-Haemorrhages, Oedema and Cotton Wool Spots (CWS)
-Maybe associated with disc swelling which usually indicates severe HBP/malignant
hypertension.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are the main retinal signs of hypertensive retinopathy?

A
  • Retinal oedema
  • Hard exudates (lipid deposits)
  • Cotton wool spots
  • Retinal haemorrhages
  • FIPTs (focal intraretinal periarteriole transudates) ,round/oval white lesions <1/4 DD size, plasma macromolecules along deep retinal arterioles, Specific to hypertension
  • IRMA (due to capillary occlusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are the two theories for the cause of disk oedema and malignant hypertension?

A
  • raised intracranial pressure
    (papilloedema)
  • disc ischaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what is a sign that the retinopathy is caused by hypertension rather than diabetes?

A

macroaneurysms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

for hypertensive choroidopathy, who does it occur in? what is it associated with? what are its clinical signs? what could it develop into?

A

-Occurs in severe hypertension - often in relatively young individuals
-Often associated with renal disease, toxaemia of pregnancy or collagen vascular diseases.
-clinical signs are RPE lesions called Elschnig’s spots and Siegrists streaks
-May develop serous detachments of neurosensory retina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

which retinopathy sign has the highest association of stroke risk?

A

cotton wool spots and 2nd is microaneurysms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the most severe sign of hypertensive retinopathy?

A

swelling of the optic disk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

for the severities of mild, moderate and severe/malignant hypertensive retinopathies, what is the referral guide?

A
  • Mild
    (Routine referral to GP if undiagnosed)
    -Moderate
    (Referral to GP / consider HES if diabetic, visual symptoms or vascular complications)
  • Severe / Malignant
    (Same day referral to HES / Emergency to A&E if BP
    >180/120)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what are the most common causes of retinal vein and retinal artery occlusion?

A

-atherosclerotic vessels
-high intra-cranial pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what diseases can cause retinal vein and retinal artery occlusion?

A

those that cause increased blood viscosity:
* Diabetes
* Vasculitis
* Phrombophilicdisorders

33
Q

how does Central retinal vein occlusion - CRVO occur?

A

thrombosis of the central
retinal vein at the lamina cribosa or retro-laminar

34
Q

how does branch retinal vein occlusion (BRVO) occur?

A

Occlusion typically at AV crossing. its 7x more common than CRVO

35
Q

how does hemi-retinal vein occlusion occur?

A

by occlusion at the optic disk

36
Q

what might tell you a retinal vein/ artery occlusion is ischaemic?

A

*The findings are more pronounced in ischaemic occlusions
* VA commonly less than 6/60
* RAPD present
* Severe disc / macula oedema
* Neovascular changes –disc (NVD) retina (NVE)
or iris (NVI)

37
Q

what are the differential diagnosis of retinal vein occlusions?

A
  • Ocular ischaemic syndrome
  • Asymmetrical diabetic retinopathy
  • Hypertensive retinopathy
  • Macroaneurysm
  • Peripheral choroidal neovascularisation
38
Q

what investigations should you do if you think someone has a retinal vein occlusion?

A
  • best corrected visual acuity
  • colour fundus photography
  • gonioscopy (if available and if ischaemic CRVO is
    suspected)
  • optical coherence tomography (OCT) (if available)
  • IOP check
39
Q

what are the signs of central retinal vein occlusion?

A

-blot and flame haemorrhages
-dilated and tortuous veins
-optic disk oedema
-cotton wool spots
-all four quadrants are involved

40
Q

what are the signs of branch retinal vein occlusion?

A

-disk swelling (uncommon)
-cws and localised oedema (possible)
-haemorrhages along one arcade only

41
Q

what are the signs of hemi-retinal vein occlusion?

A

-haemorrhages in one half of the fundus
-may have disk swelling

42
Q

how is the outer retina supplied with blood?

A

via ciliary arteries and choriocapillaris

43
Q

how is inner retina supplied with blood

A

via central retinal artery

44
Q

what is the pathogenesis of artery occlusion?

A

-emboli where usually atherosclerotic plaque causes blockage
-vasospasm where contraction of the arterial wall causes interruption of blood supply

45
Q

what is rubeosis iridis? (neovascular iris NVI)

A
  • Ischaemia in the eye
  • Starts at the iris margin
  • May cause intractable Neovascular glaucoma
  • ‘100-day glaucoma’ following
    ischaemic central retinal vein
    occlusion
46
Q

what can thrombosis be due to?

A
  • Diabetes
  • High blood pressure
  • Clotting disorders
47
Q

what can atherosclerosis be due to?

A
  • High cholesterol
  • High blood pressure
  • Diabetes
48
Q

what are the risk factors for retinal artery occlusion?

A

-inflammation
-atherosclerosis
-vasospasm
-thrombophilic disorders

49
Q

for inflammation,
-how does it increase risk for arterial vein occlusion?
-what kind of conditions is it linked to?

A

by increasing blood viscosity
linked to
* Sickle cell
* SUSAC syndrome
* Polyangitis
*giant cell arteritis MOST COMMON

50
Q

as a risk factor for retinal artery occlusion, where is atherosclerosis commonly found what part of vessels is it most commonly found in?

A

-Commonly found in the carotid arteries
-Most common in the bifurcations of vessels

51
Q

what are the 4 types of retinal artery occlusion?

A

-Central retinal artery occlusion (CRAO)
-Branch retinal artery occlusion (BRAO)
-cilioretinal artery occlusion
-amarosis fugax

52
Q

what are the signs and symptoms of CRAO?

A
  • Sudden and complete painless loss of vision
  • Pale and oedematous retina ‘whitening’
  • Cherry red spot & Very attenuated blood vessels
  • Dense RAPD
53
Q

what are the signs and symptoms of BRAO

A
  • Scotoma
  • Visual acuity dependent on location
  • May be asymptomatic
  • RAPD Mild or absent
54
Q

what are the signs and symptoms of amarosis fugax?

A
  • Examination normal
  • Very specific history
  • Curtain coming over vision to blackness
  • Recovery is similar
  • Frequent occurrence indicates very high
    risk of stroke
  • Falls under transient ischemic attack
55
Q

What are the treatments for diabetic retinopathy?

A
  • Focal/Grid Laser or Pan-retinal photocoagulation (Pre
    or proliferative retinopathy)
  • Corticosteroids (oedema)
  • Anti-VEGF (neovascularisation)
  • Pars plana vitrectomy (traction or vitreous
    haemorrhage)
56
Q

how do you treat tractional retinal detachment?

A

via vitrectomy

57
Q

why is the rnfl thinner in diabetes patients?

A

because loss of retinal ganglion cells in diabetes means diabetic retinopathy causes abnormal retinal function due to thinning of the axon (panretinal photocoagulation)

58
Q

how can you systemically control diabetic retinopathy?

A
  • Glycaemic control -HbA1c <7% (53mmol/mol)
  • Hypertension control -BP <130mmHg
  • Lowering blood lipids
59
Q

how can you treat neovascularisation of the iris?

A
  • PRP (pan retinal photocoagulation)
  • Intravitreal injections of anti VEGF
60
Q

what can anti VEGF injections be used to treat? why should you be careful when using them in long term?

A
  • Neovascularisation
    -due to link with atrophy of photoreceptors/Muller cells.
61
Q

how do you carry out diabetic eye screening in wales? what is is called?

A

Diabetic retinopathy screening service for Wales (DRSSW)
1. All people aged 12 and over with a diagnosis of diabetes and
who are registered with a GP in Wales should undergo diabetic eye screening, if not inform GP
2. Annual (or bi-annual if low risk) Stereo-photography with
dilation.
3. Visual Acuity recorded.
4. Automatic referral to Ophthalmology or Community
Optometrists.

62
Q

what lifestyle changes can you recommend to prevent hypertension?

A
  • Weight loss
  • Reduce dietary sodium intake
  • Balanced diet
  • Exercise -regular aerobic physical activity
  • Limit alcohol consumption
63
Q

name a classification system for hypertensive retinopathy

A

Wong and Mitchell classification system

64
Q

What are the management guidelines for retinal vein occlusion?

A

“Urgent referral to an ophthalmologist (the time to referral should not exceed 2–4 weeks from
presentation) PLUS Urgent referral to GP for medical management and investigation” - college of optometrists

65
Q

what systemic investigations can you do if you suspect a patient has retinal vein occlusion?

A
  • make sure there is no increase in risk of stroke in patients with RVO
  • Medical history
  • Blood pressure
  • Blood glucose
  • Bloods –full blood count and ESR (marker of inflammation)
66
Q

what conditions can retinal vein occlusion be associated with in younger patients (<50)

A
  • Hypertension
  • Dyslipidaemia
  • Diabetes
  • Possible role for
    dehydration
67
Q

what ophthalmic investigations can you do if you suspect retinal vein occlusion?

A
  • OCT
  • OCTA
  • Fundus photography
  • Fluorescein angiography (less
    common now)
68
Q

what are the ophthalmology treatments for
-macula oedema
-neovascular changes
in someone with retinal vein occlusion?

A

-anti-VEGF and corticosteroids
-PRP

69
Q

what do anti-VEGF injections do?

A

they prevent leakage by reducing permeability of vessels

70
Q

what do corticosteroids do?

A

act as an anti-inflammatory but have side effects of cataracts and increased IOP

71
Q

when is there risk of neovascular changes in the retina?

A

-in ischemic RVO
-when capillary non-perfusion of >10 disc areas at the posterior pole of eyes with CRVO suggests high risk of neovascularisation
-when widefield imaging has shown that there are larger areas of peripheral
non-perfusion, >75 disc areas, associated with risk of neovasc

72
Q

what types of VO have better prognosis?

A

brvo has better prognosis than crvo

73
Q

when should treatment for rvo be discontinued?

A

if there is no response after 6 treatments

74
Q

what does prognosis of rvo depend on?

A

levels of ischaemia

75
Q

what are the main causes of vision loss in RVO?

A

Macular oedema or ischaemia

76
Q

give some acute treatments of retinal artery occlusion

A
  • Supine position
  • Ocular massage
  • Anterior chamber paracentesis
  • Medical reduction of IOP
  • Rebreathing into a paper bag
  • Hyperosmotic agents
  • YAG laser
  • Thrombolysis
77
Q

give the systemic managements of retinal artery oclusion

A
  • Referral to stroke team from Ophthalmology
  • Addressing general cardiovascular risk factors
  • Anti-platelet therapy
  • Carotid endarterectomy where appropriate
78
Q

what is the prognosis for retinal artery oclusion?

A
  • Acute onset -Emergency referral
  • Recovery of vision has a low probability
  • Nerve fibre loss can be irreversible within as little as 2-4 hours
  • BRAO may have apparent improvement as adaptation to the scotoma occurs
79
Q

what type of retinal artery occlusion is an emergency?

A

central retinal artery occlusion

Optometry Class OP2503 (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions