Trans 007 Aging Eye And Systemic Diseases

Question 1

• Opacification of human crystalline lens  The most common problem when a person ages  Anybody can have cataract

Answer 1

Cataract

Question 2

Anterior versus posterior subscapular cataract

Answer 2

Ant-Lies directly under the lens capsule

Post -Lies in front of the posterior capsule

Question 3

Typically appears black and vacuolated on retroillumination anterior/posterior subscapular cataract?

Answer 3

Posterior

Question 4

Cataract that involves the nucleus of the lens

o 

Yellow to brown coloration Usually in the medial part of the lens

Answer 4

Nuclear cataract

Question 5

Associated with myopia due to an increase in the refractive index of the nucleus, resulting in some elderly patients being able to read without spectacles again (‘second sight of the aged’)

Yellowish hue due to the deposition of urochrome pigment, best assessed with an oblique slit lamp When advanced, nucleus may appear brown, or even black (typical of marked post-vitrectomy opacity)

What cataract?

Answer 5

Nuclear cataract

Question 6

Wedge-shaped or radial spoke-like opacities Opacities are usually in the periphery of the lens Located in the cortical part, not the nuclear part Only seen when you dilate the pupils Glare is a common symptom

Answer 6

Cortical cataract

Question 7

Opacity is in the posterior pole of the lens

Answer 7

Polar cataract

Question 8

Not yet fully opacified  Red-orange reflex can still be seen through ophthalmoscope

What classification of cataract

Answer 8

immature cataract

Question 9

Red-orange reflex cannot be seen

Opacity has reached the stage where most of the ophthalmoscope lights cannot reflect anymore

What classification of cataract

Answer 9

Mature cataract

Question 10

What classification of cataract

Usually wrinkled appearance of capsule

Answer 10

Hyper-mature cataract and there is Thinning of lens

Question 11

More mature than hypermature Lens shrinks Lens will be smaller than capsule. Parang wala nang laman

Answer 11

Morgagnian cataract

Question 12

o Denaturation and coagulation of lens proteins o Decrease level of amino acids and protein synthesis o Increased hydration brought by decrease in potassium due to reversal of Na’K pump mechanism

This is path physiology of what cataract?

Answer 12

Cortical cataract

Question 13

o Degenerative changes occurring as nuclear sclerosis o Increase in water insoluble proteins o Compaction of nucleus resulting in a hard cataract o Disturbance of lamellar arrangement in fibers

This is pathophysiology of what cataract

Answer 13

Nuclear cataract

Question 14

• Painless progressive visual loss
• Glare  Earliest to be detected by the patient  Complaint especially when driving and there’s oncoming light  Diff dx: Error of refraction
• Reduced color perception
• Color haloes
• Uniocular diplopia  Usually described by the patient as doble parin yung paningin kahit na nakatakip na yung isang mata
• Based on the location and density

What cataract

Answer 14

Age related (senile) cataract

Question 15

Some of the signs of senile cataract

Answer 15

• Opacification of the normally clear lens senn through the pupil
• Indistinct on retina examination
• Red reflex may be dim
• No afferent pupillary defect
• Myopic shift

Question 16

Most common surgery done in ophthalmology

Answer 16

Cataract extraction with intra-ocular lens implantation

Question 17

Treatment of cataract

Answer 17

• Refraction and corrective eyeglasses  Consider this first before proceeding to surgery

• Surgical
o Cataract extraction with intra-ocular lens implantation  If there is difficulty in life even if all other solutions have been tried, then consider surgery  Most common surgery done in ophthalmology  Some patients have cataract surgery even at 80 years old  When doing surgery, don’t look at the age. Look at the quality of life of the patient.

Question 18

Result of increased intraocular pressure (IOP) caused by a malformation or malfunction of the eyes drainage system

Increased pressure causes compression of retina and the optic nerve

Causes progressive, permanent loss of eyesight if left untreated

Answer 18

Glaucoma

Question 19

Normal IOP is

Answer 19

19-21 inches of mercury

Question 20

Normal drainage system of the eye becomes partially blocked, causing pressure to build within eye

o Usually affects the perimitery vision first, with sight gradually being lost towards the center of the eye
What glaucoma

Answer 20

Primary Open Angle Glaucoma (POAG)

Question 21

Symptom

Of primary open angle glaucoma

Answer 21

o No symptoms in early stages
o Mild pain in the eye, increasing gradually over time
o “Halos” appearing around lights
o Gradual loss of peripheral vision o Loss of night vision

Question 22

People at risk in primary open angle glaucoma

Answer 22

People at risk 
o Family history of glaucoma 
o African-americans 
o Px suffering from Myopia 
o Patients suffering from Diabetes 
o >35 years of age