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Refracting Skills 2 > unit 3 > Flashcards

unit 3 Flashcards

1
Q

Corneal Inlays

A

-INTACTS
-KARMA

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2
Q

Types of refractive surgery

A

-LASIK
-PRK
-RK
-LRI
-CRI

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3
Q

Corneal procedures

A

-PK
-CXL

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4
Q

Lens based correction

A

-RLE
-IOLS (standard, toric, presbyopic, phakic, piggyback)

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5
Q

4 surgical alternatives to eyelgasses

A

-refractive sx
-corneal procedures
-corneal inlays
-lens based correction

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6
Q

4 non surgical alternatives to eyeglasses

A

-contact lenses
-low vision aids
-occlusion therapy
-pharmacological

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7
Q

occlusion therapy

A

-patching
-atropine penalization

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8
Q

low vision aids

A

-hand held magnifiers
-telescopes
-tech based magnifiers

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9
Q

-pharmacological

A

-botox for strabismus
-low dose atropine for myopia control

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10
Q

basic types of corneal refractive surgery

A
  1. laser based surgeries
  2. blade-based surgeries
  3. corneal inlay
  4. other corneal procedures
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11
Q

laser based sx

A

-use a laser to adjust the corneal shape by removing tissue or creating incisions
(photoablate or photodisrupt the corneal tissue)
-can be preformed for all types of refractive errors

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12
Q

how LASIK works

A

-local anesthetic is used
-treatment is done by sculpting the corneal stroma
-a thin anterior corneal flap is created with a femtosecond laser or mechanical keratome (blade)
-the flap (epithelium and bowmans) remains attached by a hinge of tissue and is lifted to expose the stroma layer
-the intrastromal tissue is respahed using the excimer laser

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13
Q

what is LASIK done for

A

treat myopia, hyperopia and astigmatism (+4.00 to -12.00)
cyl - -0.5 to -4.00

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14
Q

how long does it take for the acuity and comfort to be better after LASIK

A

first few days after sx

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15
Q

SBK (Sub-bowmans keratectomy)

A

-similar to LASIK
-a femtosecond laser creates a VERY THIN anterior corneal flao. (blade less lasik)
-desired power treatment is applied to the exposed corneal bed
-sometimes know as “FS-assisted) LASIK

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16
Q

complications with LASIK

A

-dry eyes
-glare/halos
-double vision
-over or under-correction or regression
-vision loss or change
-quality of vision decrease
-corneal neuralgia
-epithelilal ingrowth
-diffuse lamellar keratits

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17
Q

flap complications with LASIK

A

-microstriae
-debris
-taco flap
-incomplete flap
-buttonhole
-flap displacement
-decentered flap
-free cap

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18
Q

corneal neuralgia

A

-neuropathic corneal pain / damage to corneal nerves
-causes your eyes, face or head to be “over sensitive”
-doctors dont know the exact cause of the neuropathic corneal pain
-pxs are typically referred to a pain management clinic
-condition where corneal pain is seen in response to normally non-painful stimuli

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19
Q

DLK

A

diffuse lamellar keratitis
-non infectious inflammatory infiltrates
-treated with a steroid drop such as predforte or maxidex

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20
Q

PRK (photorefractive keratectomy)

A

-Similar to LASIK, but no corneal flap
-epithelium is removed and excrimer laser treatment is done on the anterior stromal surface

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21
Q

people who do combat / competitive sports , is it recommended to get LASIK or PRK

A

PRK - for the reason being that their is no flap

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22
Q

does PRK or LASIK take longer to recover?

A

PRK

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23
Q

how long till your VA gets better with PRK

A

5 to 7 days

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24
Q

what does PRK treat

A

myopia and astigmatism
-can treat hyperopia but not ideal as its less predictable

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25
Q

who is PRK typically done on?

A

-pxs with thin corneas
-abnormal corneal topographies (not kerataconus)
-px into combat competitive sports

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26
Q

how to remove the tissue in PRK

A

-excimer laser
-alchohal and saline then scrapped off

27
Q

what is used after reshaping the cornea (PRK)

A

mitomycin-C
which helps prevent scaring/haze
-then a bandage contact lens is inserted for approx 5-7 days

28
Q

complications with PRK

A

-delayed visual recovery
-over or under correction
-decentered treatment
-haze or scaring
-dry eyes
-corneal ectasia
-infection
-corneal neuralgia

29
Q

blade based surgeries

A

-a blade is used to ‘relax” the cornea
-now mostly used to correct astigmatism

30
Q

radial keratotomy (RK)

A

was a blade based method used for spherical and astigmatic errors
-results did not provide refractive stability
-largely abandoned

31
Q

SMILE: small incision lenticule extraction

A

-laser-based correction of refractive error
-considered minimally invasive
-involves a small incision and the creation of a lenticule (disc shaped piece of cornea)

32
Q

Corneal Inlay procedures

A

-artificial material is involved
-tissue is not removed
-may have greater reversibility
-plastic device is placed between the layers of the cornea to flatten or steepen it.
-may be used for small amounts of myopia and astigmatism, to bolster a weak cornea or for correction of presbyopia

33
Q

what is lenticule

A

disc shaped piece of cornea

34
Q

INTACTS corneal inlay

A

-optically clear, arc-shaped devices
-two separate effects:
-to flatten the corneal surface in cases of mild myopia associated with keratoconous
-to flatten certain meridians to help correct astigmatism associated with keratoconus

35
Q

KARMA corneal inlay

A

-small opaque device implanted centrally
-allows only central light through
-increases depth of foucs (like a pinhole), with the intent to eliminate the need for reading gls
-FDA restricts KARMA to one eye in pxs who have not had cataract sx

36
Q

Penetrating keratoplasty

A

Corneal transplant - full thickness replacement from a donor cornea

37
Q

Corneal cross-linking (CXL)

A

-a special concentration of sterile riboflavin (Vitamin B2) eye droped are applied at specific interals before stictly timed UV exposure
-Strengthens the chemical bonds within the cornea to halt progressive and irregular changes in corneal shape due to conditions like keratoconus
-refractive changes are mostly minor

38
Q

pre-op evaluation

A

-a full EE is recommneded prior to referring the px
-ocular and health history
-refractive status
-dilated ocular health exam
this allows surgical team to pre screen and discuss any issues
-px is required to discontiune soft CL wear for a min of 48 hours prior to testing and 2 weeks for RGPS

39
Q

Contraindications for corneal refractive sx

A

-ocular pathology
-corneal scar/disease
-extreme dry eyes
-systemic pathology (autoimmune disorders, rheumatoid arthritits, lupus)
-medications (accutane)

40
Q

post op evaluation

A

-after the 1 day follow up visit, the px is encouraged to return to the co-managing optometrist for their f/u care
-f/u frequency and testing differs for each type of procedure
-post op follow up referral form should be sent to the surgical centre for review
-ensure we are monitoring infection and inflammatory response

41
Q

LASIK post op care/medications

A

-steroid
-antibiotic
-AT - q15-30mins x 2day
-eyesheilds 5-7 nightsf

42
Q

follow up schedule for LASIK

A

day 1
week 1
month 1
yearly

43
Q

PRK post op care/medication

A

-steroid
-antibiotic
-pain relief
-AT - q15-30 mins until bandage CL removed
-eye shield 5-7 nightsf

44
Q

follow up schedule for PRK

A

day 1
day 3
week 1
month 1
yearly

45
Q

POST OP PRESENTATION FOR LASIK

A

-VA 20/15 to 20/50 (may take 3-5 days to start improving)
-Foreign Body Sensation (48 H)
-Tearing/Photophobia (72 H)
-Dry Eyes (up to 6M)
-Sub-conjunctival hemorrhage (2-3W)
-Ghosting/Halos/Glare (2-3M)

46
Q

POST OP PRESENTATION FOR PRK

A

-VA 20/30 to 20/400 (up to 1W)
-Mild to severe pain (48H)
-Foreign body sensation (3-5D)
-Tearing, Photophobia (3-5D)
-Lid edema (3-5D)
-Ghosting (2-4W)
-Dry eyes (up to 3M)
-Halo/Glare (2-3M)
-Drop in VA/diplopia (occurs at day 3-5)

47
Q

What NOT to do after sx

A

-No pets in the bed
-No eye make-up
-No swimming, hot tub, water sports
-No dusty/smoky environments
-No eye rubbing
-UV protection
-Safety glasses during appropriate activities

48
Q

Non-surgical alternatives to eyewear

A

-orthokeratology
-presbyopia eye drops
-patching
-atropine therapy

49
Q

Presbyopic drops 2 methods

A

-Miotics
-Lens softening

50
Q

Miotics (presbyopic drops)

A

-Change the size of the pupil (Creates pinhole effect)
-Pilocarpine drop
-Daily rx eye drop that works in as little as 15 mins and lasts 6 hours
-most common adverse effects were headaches and eye redness

51
Q

Lens softening

A

-Softens the eyes aging lens
(lens regains flexibility, the eye can better focus up close)
-Cannot completely restore near vision
-May work best for ppl w/o cataracts who are in the early stages of presbyopia

52
Q

what age is treatment for amblyopia most successful?>

A

before the age of 7
-early detection is crucial

52
Q

Treatment success for amblyopia depends on..

A

-the age of onset
-cause
-severity
-duration of amblyopia
-type of treatment
-adherence to therapy

52
Q

2 methods of treating amblyopia

A

-surgery
-patching
-penalization

53
Q

surgery for amblyopia

A

strabismus sx is performed to align the eyes
-involves loosening or tightening the muscles
-goal is to include reduction/ellimination of diplopia, improvement of stereopsis and cosmesis
-amblyopia is treated first so both eyes have the best VA before surgery

54
Q

patching for amblyopia

A

-occlusion involves covering the stronger eye
-continued until the VA becomes equal in each eye or until there is no improvement after 3 to 6 months

55
Q

types of patches available

A

-sticky patches
-cloth patches that fit over gls

56
Q

Penalization

A

involves blurring the good eye through cycloplegic eye drops (atropine 1%)
-decrease accommodation and the ability to focus

57
Q

Manahement of strabismus

A

-spectacle correction
-prism
-botox
-surgery

58
Q

Spectacle correction for strabismus

A

-cycloplegic refraction
-prescription - mainly based on objective findings until around age6
-bifocal - allows for sufficient relaxation of accomodation to allow for near fusion
-sometimes prism is needed to help control diplopia (try w fresnel then u can prescribe it)

59
Q

Fully accomodative esotropia may correct with a full time plus or minus rx?

A

PLUS

60
Q

Botulinum Toxin

A

Injection of botulinum toxin type A into an EOM produces dose dependent paralysis
-several days after the injection the chemical paralysis of the muscle allows the eye to be moved into the field of action
-chemically paralyzed muscles it stretched / lengthend

61
Q

Surgery for strabismus

A

-goal is to improve ocular alignment and help the eyes achieve binocular single vision
-muscle weakening / strengthening
-the muscle is detached from the eye and resewn to the eye at a measured distance
-the muscle is detached, shortneed and then resewn
-not performed on small deviations (<10D)

Refracting Skills 2 (5 decks)

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