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Year 2 C&M Clinical Symposia > Visual Defects and Repair > Flashcards

Visual Defects and Repair Flashcards

1
Q

What are the 6 main symptoms of visual loss?

A

1) Blurred/ out of focus vision
2) Glare
3) Distorted vision
4) Things look pale
5) Shadow
6) Floater

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2
Q

What are the 2 possible problems causing blurred vision?

A

1) Refractive problem - to do with cornea, lens, shape of eye
2) Macular problem

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3
Q

What is glare?

A

Difficult seeing in bright light - eg. low sun or fluorescent light at supermarkets - vision may be good otherwise

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4
Q

Glare is usually due to a problem with what?

A

Cornea or the lens - often due to cataract

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5
Q

What 4 conditions can lead to distortion of vision, what structure do they all affect?

A

All conditions affecting the retina:

1) Wet macular degeneration
2) Macular hole
3) Macular pucker
4) Retinal detachment

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6
Q

The symptom of things looking paler is due to what 2 types of conditions?

A

1) Optic nerve disease - optic neuritis or compressive optic nerve disease
2) Conditions affecting the retina - wet macular degeneration, central serous retinopathy

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7
Q

If a field defect is homonymous what is affected?

A

Its a defect of the visual pathways

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8
Q

If a field defect is not homonymous it is likely to be a defect of one of which 2 structures?

A

1) Retina

2) optic nerve

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9
Q

What is a floater and what 3 conditions can it be due to?

A 
Opacity in the vitreous
Can be due to:
1) Vitreous syneresis
2) Posterior vitreous detachment
3) Vitreous haemorrhage
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10
Q

What is a cataract?

A

Opacity of the lens - get yellowing of the lens

This is a common ageing change

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11
Q

How can you examine for cataract?

A

Examine against red reflex or using a slit lamp

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12
Q

What are the symptoms of cataract?

A

The symptoms depend on the type of cataract and can include: blurred vision, glare, change in refraction
These can also be asymptomatic - it is difficult to judge the effect on vision from examination

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13
Q

What is the vascular supply to the retina?

A

Inner retina - from retinal vessels
Outer retina requires diffusion from the choroid - the retinal pigment epithelium maintains the environment of photoreceptors

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14
Q

What is involved in removing waste products from the cones and rods, what does reduced function of this structure lead to?

A

Retinal pigment epithelium removes waste products from rods and cones
Reduced function leads to drusen - deposits of waste products at the macula

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15
Q

What are the 3 signs of dry age related macular degeneration (ARMD)?

A

1) Drusen
2) RPE pigmentation
3) RPE atrophy

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16
Q

What are the symptoms of dry ARMD?

A

Loss of small area of retina leads to severe visual loss

Reading vision is particularly affected but early stages are often asymptomatic

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17
Q

Sudden deterioration of dry ARMD may indicate development of what?

A

Wet ARMD

18
Q

There is no effective medical treatment for dry ARMD but what 4 pieces of advice can be given to patients?

A

1) Stop smoking
2) Wear dark glasses to protect from bright sunshine
3) Dietary changes/ supplement
4) Low visual aids

19
Q

What is the treatment for cataracts?

A

Surgery: Phacoextraction with lens implant

20
Q

What is Biometry used for in cataract surgery?

A

To decide on the power of the lens implant

21
Q

Under what anaesthetic is phacoextraction with lens implant (cataract surgery) performed, will the patient experience any pain afterwards?

A

Usually under local anaesthetic

Eye may feel swollen and gritty afterwards but not painful

22
Q

How long does phacoextraction with lens implant take?

A

10 mins

23
Q

What is the post operative treatment for phacoextraction with lens implant?

A

Topical steroid for 2 weeks, review at 2 weeks if no problems, new glasses after 2 weeks

24
Q

What are the 4 risk factors for carotid artery disease?

A

1) Hypertension
2) Smoking
3) Diabetes
4) High cholesterol

25
Q

What are the 3 possible causes of central retinal artery occlusion (CRAO)?

A

1) Embolic: carotid artery disease (most common cause)
2) Embolic: heart disease (valve disease)
3) Giant cell arteritis

26
Q

How can carotid artery disease be treated? 3

A

1) Reduce risk factors
2) Antiplatelet agents
3) Carotid endarectomy if greater than 70% stenosis

27
Q

Why is important that carotid artery disease causing CRAO is treated?

A

There is a risk of further emboli to eye or brain

28
Q

Giant cell arteritis can cause visual loss due to which 2 conditions, is either treatable?

A

1) Central retinal artery occlusion (CRAO)
2) Anterior ischemic optic neuropathy (AION)
Neither is treatable

29
Q

Neither condition causing visual loss due to giant cell arteritis is treatable, why is urgent treatment of giant cell arteritis required if suspected (in regard to vision)?

A

Because there is a high risk of CRAO or AION to other eye

30
Q

How can a diagnosis of giant cell arteritis be confirmed?

A

Temporal artery biopsy

31
Q

How can a diagnosis of carotid artery disease be confirmed?

A

Doppler of carotids

32
Q

What is metamorphosia?

A

A type of distorted vision

33
Q

Metamorphosia is a symptom of disruption of what structure in the eye?

A

Distortion of the retina

34
Q

What are the 4 differential diagnoses with symptoms of distorted vision?

A

1) Wet macular degeneration
2) Macular hole
3) Macular pucker
4) Retinal detachment

35
Q

What is Wet age related macular degeneration (ARMD)?

A

Get a choroidal neovascular membrane beneath the retina

Causes a rapid loss of vision and is a common cause of severe visual loss

36
Q

Can Wet ARMD be treated?

A

Effective treatment is now available

37
Q

How is Wet ARMD treated?

A

Intravitreal injection of antiVEGF
VEGF (vascular endothelial growth factor) stimulates growth of choroidal neovascular membrane (CNM)
AntiVEGF binds to VEGF and prevents it acting on CNM
Visual loss can then be reversed

38
Q

How does a full thickness macular hole affect vision?

A

Only affects central vision but will probably deteriorate if no treatment is given - there is a 10% risk of the other eye being affected

39
Q

What is the treatment for macula hole?

A

Surgery - performed under local anaesthetic and need to posture face looking down for a period after the operation

40
Q

What are the 4 disadvantages of an operation to treat macula hole?

A

1) Risk of not closing the hole is about 10%
2) Risk of serious complication leading to loss of vision is 1%
3) Will develop cataract
4) Visual recovery is variable

41
Q

What is macular hole?

A

Literally a hole in the retina at the macula

Year 2 C&M Clinical Symposia (21 decks)

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