Vision

Question 1

2022 BMJ systematic review - is visual impairment associated with CI?

Answer 1

83% studies reported yes

Question 2

2021 Cataract extraction and development of dementia

Answer 2

Cataract surgery associated with sig reduced risk of dementia compared to those without surgery
Glaucoma surgery did not

Question 3

5 changes in vision with aging

Answer 3

1. Dec visual acuity
2. Dec depth perception
3. Dec dark adaptation
4. Dec contrast sensitivity
5. Impaired accommodation of lens (due to rigidity, presbyopia lose near sight)

Question 4

Ways to improve communication in clinic if visual changes

Answer 4

1. Avoid low lighting (dark adaptation)
2. Large lettering on documents/cognitive test (visual acuity)
3. Magnifying glass (presbyopia)

Question 5

What are symptoms of macular degeneration (wet or dry)?

Answer 5

1. Progressive loss of central vision (rapid in wet)
2. Loss of contrast sensitivity
3. Difficulty with dark adaptation
4. Difficulty reading/watching TV/driving
5. Dark/gray patch in central vision

Question 6

What are pathophysiologic features of wet MD?

Answer 6

1. Neovascularization into retina
2. Retinal fluid leaks (vitreous fluid)
3. Retinal hemorrhage
4. Retinal epithelial detachments
5. Scar tissue

Question 7

Risk factors for age related MD

Answer 7

1. Smoking
2. Family history
3. Metabolic syndrome (HTN, DM, atherosclerosis, obesity, lack of exercise)
4. Low dietary intake of antioxidants (zinc, carotenoids)

Question 8

Which is more common, wet or dry MD?

Answer 8

Dry 75-80% of cases

Question 9

Pathophysiologic features of dry MD

Answer 9

1. Lipid rich deposits of drusen under retinal epithelium
2. Retinal pigment changes
3. Retinal atrophy

Question 10

Differential dx for acute bilateral vision loss

Answer 10

1. Keratitis (bilateral exposure to UV light, chemical, contact lens)
2. Toxin (methanol)
3. Metabolic (hypo/perglycemia)
4. Bilateral wet MD
5. Stroke at chasm or occipital
6. GCA
7. PRES

Question 11

Investigations for acute bilateral vision loss

Answer 11

1. Fundoscopy
2. Slit lamp exam
3. IOP tonomoter
4. CT head

Question 12

What is Charles Bonnet syndrome?

Answer 12

1. Vision loss
2. Clearly formed and recurrent visual hallucinations (people, animals, patterns, non threatening, short)
3. Insight into unreal nature

10-40% in those with VI
Variety of hallucinations (colour patterns to well formed)

Question 13

Ddx for visual hallucinations + CI

Answer 13

1. Dementia (AD, LBD, PDD, vascular)
2. Delirium
3. Depression with psychotic features
4. Medication related (DA, anticholinergic, alcohol/benzo withdrawal)

Question 14

Risk factors for cataracts

Answer 14

1. Age
2. Female
3. Family history
4. Non Caucasian
5. Smoker
6. Sun exposure
7. Metabolic syndrome (DM, HTN)
8. Glucocorticoid use
9. Drugs like antidepressants, miotics, phenothiazines

Question 15

Three types of glaucoma

Answer 15

Open angle glaucoma (blocked drainage of aqueous fluid, slowly rising IOP, central vision loss)
Angle closure glaucoma (obstruction blocks drainage, rapid rise in IOP, emergency)
Low/normal pressure glaucoma (VF loss characteristic, but IOP <21)

Question 16

Adverse effects of topical beta blockers

Answer 16

Local: burning, redness, dry, blurry, hyperaemia, long/dark lashes, loss of orbital fat
Systemic: HOTN, bradycardia, CHFe, masked hypoglycemias

Question 17

Herpes zoster ophthalmicus presentation and etiology

Answer 17

Presentation: blurry vision, pain in eye, photophobia, reduced corneal sensation
V1 distribution
Reactivation of latent VZV within sensory nerve ganglion, often decades later
Ocular disease in about 50%
Hutchinson sign (lesions on tip of nose, can indicate ophthalmic involvement)

Question 18

Investigations for herpes zoster

Answer 18

Fundoscopy
Slip lamp
IOP - tonomoter
Scrape newly unroofed vesicles and send fluid for PCR for VZV DNA

Question 19

Tx for Herpes zoster ophthalmicus

Answer 19

Immediate referral to Ophtho
Antiviral therapy - valacyclovir oral or acyclovir IV
May need steroids