visual impair, diabetic retinopathy, cataracts

Question 1

Which of the following is/are false?
A. all diabetic pts should be re-screened at least yearly if no diabetic retinopathy is identified at current screening
B. pts w/ diabetic retinopathy may benefit from lipid-lowering therapy
C. diabetic retinopathy is associated with a 4x increased risk of premature death
D. macular edema is the most common form of diabetic retinopathy
E. none of the above
F. all of the above

Answer 1

correct: E

A. true
B. true
C. true
D. true - lowering lipids associated with delayed onset and progression of diabetic retinopathy

Question 2

Which of the following is/are true?
A. pts with diabetic retinopathy should aim for an A1C < 6.5%
B. rapid improvement of glycemia in T1DM pts is associated with worsening of retinopathy
C. ACEi or ARBs are indicated for the prevention of diabetic retinopathy in T1DM normotensive pts
D. pregnancy, dyslipidemia and hypertension are risk factors for diabetic retinopathy
E. A and B
F. B and C
G. B, C, D
H. A, B, C, D
I. none of the above

Answer 2

correct: I - none of the above (B and D are true)

A. false - <7%
B. true - but early worsening is transient and effect is offset by long-term benefits
C. false - not indicated; insufficient evidence
D. true

Question 3

A. retinal capillary nonperfusion involves the closure of retinal vessels

Answer 3

correct:

A. true - leads to reduced retinal perfusion and increased retinal ischemia

Question 4

assess the appropriateness of the following rx for a newly-diagnosed diabetic retinopathy 45 y.o. pt w/ T1DM; no renal impairment

fenofibrate 145mg tab PO once daily
rosuvastatin 10mg PO once daily

“my MD said this rx will stop my bad eyes from getting worse”

Answer 4

rosuvastatin indicated for heart protection in diabetic pt

fenofibrate indicated in combo w/ statin to slow progression of established retinopathy in those with T2DM, NOT T1DM

i.e. FENOFIBRATE NOT INDICATED

Question 5

assess the indication of the following rx:

T2DM pt, LDL WNL

rosuvastatin 10mg PO once daily

“My doc said this new rx will help prevent me from getting bad eyes. I can see normally right now.”

Answer 5

not indicated

the role of statins in preventing development / progression of retinopathy has not been established

Question 6

Which of the following are true about anti-VEGFs?
A. anti-VEGFs suppress neovascularization
B. intravitreal injection of anti-VEGF is 1st-line tx for diabetic macular edema
C. anti-VEGFs reduce central macular thickness
D. AEs include cataracts
E. inhibits binding and activating of endothelial cell receptors
F. A and C
G. B and D
H. all of the above
I. none of the above

Answer 6

correct: H - all of the above

A. true
B. true
C. true
D. true
E. true

Question 7

Which of the following is/are FALSE?
A. loss of attentional visual field with age is due to decrease in ability to move eyes laterally
B. loss of attentional visual field may result in car accidents and balance and mobility issues
C. onset of diabetic retinopathy commonly occurs before age = 10 yrs in T1DM pts

Answer 7

correct:

A. FALSE - due to decrease in higher-order visual processing
B. true
C. FALSE - rare in age < 10 yrs; sharp increase 5yrs post-puberty

Question 8

Which of the following is/are true about intraocular steroids?
A. triamcinolone is associated with increased rates of glaucoma and cataracts
B. all intraocular steroids are associated with improvement of visual acuity and macular edema
B. dexamethasone
C. fluocinolone

Answer 8

correct:

A. true - all the intraocular steroids are associated with increased rates of glaucoma and cataracts
B. FALSE: anti-VEGFs