Vision loss

Question 1

what are the types of ARMD

Answer 1

dry and wet

dry - develops very slow

wet - sudden onset requires urgent referral

Question 2

signs of ARMD

Answer 2

Foveal reflex is absent - pinpoint-sized “sparkle” of light that may be observed when light from an ophthalmoscope illuminates the interior of the eye

Question 3

treatment for dry ARMD

Answer 3

No specific treatment

stop smoking
counselling/education
vitamins
visual rehabilitation and aids

Question 4

investigations in someone with loss of vision

Answer 4

VA
Visual fields
fundoscopy - check cornea is clear, look for red reflex and examine the funds

Question 5

investigations in someone with loss of vision

Answer 5

VA
Visual fields
fundoscopy - check cornea is clear, look for red reflex and examine the fundus

Question 6

symptoms of wet ARMD

Answer 6

sudden loss of vision - days to weeks

Question 7

risk factors for dry ARMD

Answer 7

female
HTN
smoking
previous cataract

Question 8

prognosis of ARMD both dry and wet

Answer 8

WONT GO BLIND

peripheral vision sparred

Question 9

diagnosis of both ARMD

Answer 9

made based on appearance of retina

Question 10

management of wet ARMD

Answer 10

fluid and/or blood develops in the retina
intra-vitreal, anti VEG-F injections

needs urgent referral to ophthalmologist

Question 11

causes of central vision loss

Answer 11

ARMD - wet and dry

diabetic retinopathy cataract

Question 12

sudden painful loss of vision in a non inflamed eye

Answer 12

GCA
migraine
optic neuritis
benign intracranial hypertension

Question 13

sudden painless loss of vision

Answer 13

retinal detachment - floaters and flashes
vitreous haemorrhage
central retinal artery occlusion - check BP, pulse, carotids, heart look for murmur, bruits and afibrillation refer to cardiologist
central retinal vein occlusion - check intra-ocular pressure, BP, viscosity
wet ARMD
trauma

Question 14

gradual loss of vision

Answer 14

cataract
ARMD - dry and wet 
diabetic retinopathy
primary open angle glaucoma 
tumour

Question 15

anatomy of the aqueous production and IOP

Answer 15

IOP is due to the production of aqueous humour by the ciliary body, it flows over the anterior surface of the lens through the pupil and drains through the trabecular meshwork into Schlemm’s canal
alternative uveoscleral pathway drains 10% of aqueous

Question 16

normal range of IOP

Answer 16

10-21 mmHg

Question 17

What does glaucoma mean

Answer 17

multifactorial optic neuropathy, with acquired loss of optic nerve fibres

thinning of neuroretinal rim of the optic disc results in the characteristic optic cupping and a corresponding loss of the visual field

can occur with or without increased IOP

Question 18

classification of glaucoma

Answer 18

1) primary or secondary (absence or presence of causative factors)
2) open angle or closed angle
3) acute or chronic
4) age of onset: congenital, juvenile, adult
5) level of IOP: normal tension glaucoma, or ocular hypertension

Question 19

most common type of glaucoma

Answer 19

primary open acute glaucoma - POAG

Question 20

signs and symptoms of POAG

Answer 20

usually asymptomatic until disease is advanced
painless loss of vision, can cause blindness if not treated
optic disc cupping, thinning of optic disc rim thinning and notching
raised IOP

peripheral vision affected - patients can’t drive

Question 21

treatment of POAG

Answer 21

can cause blindness if not treated 
aim to control IOP 
topical drops - carbonic anhydrase inhibitors, beta blocks, prostaglandin analogues, pilocarpine all lower IOP
laser and surgical options 
regular monitoring

Question 22

RF for POAG

Answer 22

DM
FH - relatives should be tested regularly 
race - afro Caribbean 
old age
raised IOP 
corneal thickness 
being short sited - myopia 
vascular features - CVD, vasospasm, systemic HTN