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Clinical symposium > Visual defects: a clinicans perspective > Flashcards

Visual defects: a clinicans perspective Flashcards

1
Q

what are the typical characteristics which are asked about in visual loss

A 
character of visual loss
out of focus
glare
distorted vision
things look pale
shadow floater
timing
associated factors
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2
Q

what causes blurred vision (what is the problem in the eye)

A

Refractive problem: cornea, lens, and shape of eye.

macular problem

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3
Q

what is one of the treatments for blurred vision

A

glasses to help correct the focusing problem.

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4
Q

what is glare and what causes glare.

A

difficulty seeing in bright light.

corneal lens problem- often due to cataract.

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5
Q

what is distortion of vision and why causes it

A

Things look wavy, jumbled up. Lines with kinks.
Affects retina
Wet macular degeneration- proliferation of blood vessels, which leads to fluid and protein leaking into the macula.
Macular hole- due to unequal distribution of fluid in eye.
Macular pucker- scar tissue on the retina especially macula
Retinal detachment

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6
Q

what causes things to look pale

A

Optic nerve disease
– Optic neuritis
– Compressive optic nerve disease- due to mass in orbit.

Condition affecting retina
– Wet macular degeneration
– Central serous retinopathy

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7
Q

if a visual field defect is homonymous where is the lesion

A

visual pathway

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8
Q

if the visual field pathway is not homonymous

A

retinal (retinal detach,ent)

optic nerve

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9
Q

what are the discs of a visual field defect.

A

Patient will not say they cannot see on one side.

They will say that bump into things on the right- then you have to test them and diagnose them

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10
Q

what causes floater

A

Problems with the gel behind the lens (vitreous)
vitreous floats around, and isn’t uniform.
Vitreous syneresis- older (gel behind the vitreous becomes more fluid.
Posterior vitreous detachment
Vitreous haemorrhage.

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11
Q

what is the slit lamp examination used to check

A

look at the surface of the eye.

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12
Q

what is cataracts

A

opacity of the lens.

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13
Q

what are the main signs and symptoms of cataracts

A

gradual onset

symptoms- blurred vison, glare ,change in refraction

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14
Q

what is the blood supply to the photoreceptor layer of the retina

A

choroid

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15
Q

what is the blood supply to the inner retinal layer of the eye

A

retinal artery.

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16
Q

what is the function of the retinal epithelium

A

maintains environment of photoreceptors remove waste products and reduced function leads to drusen (fatty yellow deposits under the retina)

17
Q

define dry macular degeneration

A

Supporting cells have to survive a lifetime they are not replicated, and therefore they cannot protect photoreceptor- so they die

18
Q

define wet macular degeneration.

A

fluid between photoreceptor and epithelium, photoreceptors no longer get blood supply from the choroid.

19
Q

what are the signs if age related macula degeneration.

A

Drusen
RPE (retinal pigment epithelium) pigmentation
RPE atrophy
Gradual deterioration

20
Q

which one of these is slow onset and which one is fast onset ; dry ARMD and wet ARMD.

A

dry-Slow

wet-Fast

21
Q

why does a loss of small area leads to severe visual loss in dry ARMD

A

high density of photoreceptors in fovea

22
Q

what is a phacoextraction

A

replacement of the lens of the eye.

23
Q

what are the disadvantages of phacoextraction with lens implant.

A

Risk of serious complication leading to loss of vision (1-2%)
Visual recovery may be limited by ARMD in this case
Fear of operation – may request general anaesthetic

24
Q

what normal and lifestyle changes can be made by a patient with cataracts

A
  • No effective medical treatment
  • Stop smoking
  • Dark glasses to protect from bright sunshine
  • Dietary changes / supplement
  • Low visual aids.
  • do not to drive until after the operation.
  • Cataracts are likely to deterioarate.
25
Q

what is involved in the premedical assessment

A

drugs patient may be taking - anticoagulants.
Counselled
Consented
Biometry to decide on power of lens implants.

26
Q

what is the treatment after phacoextraction.

A

topical steroids for 2 weeks

27
Q

what causes central retinal artery obstruction.

A

Carotid artery disease- Most common causes
Heart disease- Valve disease.

Giant cell arteritis- systemic vasculitis of head and neck

28
Q

what are the symptoms of giant artery arteritis

A
  • Headache
  • Malaise
  • Visual loss
29
Q

what are the risk factors of carotid artery disease

A

Hypertension, Smoking, Diabetes, High Cholesterol

30
Q

how is carotid artery disease managed

A

Antiplatelet agents- typical management.

Carotid endarectomy- remove clot.

31
Q

what is the risk of visual loss in the second eye is patient has CRAO or AION (Anterior Ischemic Optic Neuropathy

A

30 days before sdond eye is affected

32
Q

what is the treatment for CRAO or AION (Anterior Ischemic Optic Neuropathy

A

Nothing.

33
Q

what symptom often predisposes to CRAO

A

frontal headache.

34
Q

define metamorphosia

A

type of distorted vision in which a grid of straight lines appears wavy and parts of the grid may appear blank

35
Q

where are the climcl presentation signs of metamorphosia

A

vision blurry

no changes in level of blurriness.

36
Q

what treatment is used for choroidal neovascular membrane (new blood vessels in the retina cause visual disturbance)

A

antiVEGF binds to VEGF and prevents it acting on CNM

37
Q

which part of the vision does macular hole affect

A

central vision

38
Q

what is the treatment for a macular hole

A

closing hole but visual improvement variable

39
Q

what are the disadvantages of the macular hole operation

A

Risk of not closing hole about 10%
Risk of serious complication leading to loss of vision (1%)
Will develop cataract

Clinical symposium (20 decks)

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