Visual defects - clinical

Question 1

Symptoms of visual loss

Answer 1

• Blurred/out of focus
• Glare
• Distorted vision
• Things look pale
• Shadow
• Floater

Question 2

Blurred vision

Answer 2

Out of focus/not sharp, no distortion, refractive problem (cornea, lens, shape of eye), macular problem

Question 3

Glare

Answer 3

Difficulty seeing in bright light, corneal/lens problem (cataract)

Question 4

Distorted vision

Answer 4

Things look wavy, jumbled up, lines not straight, kink, affects retina (wet macular degeneration, macular hole/pucker, retinal detachment)

Question 5

Things look pale

Answer 5

Look darker/less colour

• Optic nerve disease (neuritis/compression)
• Retina (wet macular degeneration/central serous retinopathy)

Question 6

Floater

Answer 6

Opacity in vitreous, vitreous syneresis/post vitreous detachment, vitreous haemorrhage

Question 7

Cataracts symptoms

Answer 7

Blurred vision, glare, change in refraction, asymptomatic, gradual onset

Question 8

Retina supply from

Answer 8

Blood - inner retina (diffusion from choroid)

Retinal pigment epithelium maintain environment of photoreceptors

Question 9

Drusen

Answer 9

Reduced function of RPE

Question 10

Drusen presentation

Answer 10

Yellow deposits under retina (lipids)

Question 11

Treatment of cataracts

Answer 11

Phacoextraction with lens implant

Question 12

Dry ARMD

Answer 12

Age-related macular degeneration, gradual

Question 13

Dry ARMD signs

Answer 13

Drusen, RPE pigmentation/atrophy, decreased reading vision

Question 14

Treatment of dry ARMD

Answer 14

Stop smoking, dark glasses protect from bright, dietary changes, low visual aids

Question 15

Advantages of phacoextraction with lens implant

Answer 15

Vision could be improved near to normal, cataracts will deteriorate, performed under local anaesthetic, rapid rehabilitation

Question 16

Disadvantages of phacoextraction with lens implant

Answer 16

Risk of serious complication > loss of vision (2%), recovery may be limited, fear of operation, eye may feel swollen and gritty after not painful, topical steroid for 2 weeks after

Question 17

Causes of central retinal artery occlusion

Answer 17

• Embolic (carotid artery disease/valve disease)

- Giant cell arteritis (anterior ischaemic optic neuropathy)

Question 18

Metamorphosia

Answer 18

Distorted vision - grid of straight lines appears wavy and parts of the grid may appear blank

Question 19

Wet ARMD

Answer 19

Choroidal neovascular membrane, rapid loss of vision

Question 20

Wet ARMD treatment

Answer 20

Intravitreal injection of antiVEGF (vascular endothelial growth facotr), visual loss can be reversed

Question 21

Full thickness macular hole

Answer 21

Caused by natural movement of eyes only affects central vision > deteriorate

Question 22

Advantage surgery for FTMH

Answer 22

Close hole, visual improvement variable, performed under local anaesthetic

Question 23

Disadvantages surgery for FTMH

Answer 23

Risk of not closing (10%), serious complications (1%), cataracts