Visual (Macular Degeneration & Glaucoma) Flashcards
Age-related Macular Degeneration (AMD) is related to:
a. retinal aging
b. retinal detachment
c. excessive glare
d. I really don’t know
a. retinal aging
A patient who has Macular degeneration will have a vision that looks like:
a. a loss of periphery
b. a loss of central vision
c. splotchy patches
d. a complete loss of vision
b. a loss of central vision
Name the 2 forms of AMD (Macular degeneration)
- Dry (non-exudative) - 90%
2. Wet (exudative) - 10%
Dry AMD is more threatening to vision loss than wet AMD:
True or False
False. Wet AMD is more threatening to vision loss
_______ may increase the risk of progression of AMD.
Smoking
What is causing an increased progression of Dry AMD?
Macular cells start to atrophy, which leads to progressive and painless vision loss. This can occur over many years. It is insidious.
Can dry AMD develop into wet AMD?
Yes. 7% over 5 years.
What is the treatment for dry AMD?
There is no proven effective treatment for dry AMD.
Wet AMD accounts for __% of cases of AMD-related blindness
90%
What is causing the progression of wet AMD?
a more rapid onset that is characterized by the development of abnormal blood vessels in or near the macula
Patients with wet AMD experienced dry AMD first:
True or False?
True. Patients with wet AMD had dry AMD first.
What type of care can help slow the progression of both dry and wet AMD?
Antioxidant vitamins and zinc
You should quit ______ if you have dry or wet AMD.
Smoking
What vision is lost in a patient with Glaucoma?
Peripheral vision is lost.
(Central vision is good).
What test can help determine if you have glaucoma?
Field of vision test
Why is glaucoma concerning?
It is painless and usually goes unnoticed because it is the periphery that is impacted.
What is glaucoma?
It is an eye disorder that increases IOP and is a major cause of blindness (second behind cataracts).
What does IOP stand for?
Intraocular pressure
What is IOP?
The pressure in the eye
____-angle glaucoma is when the trabecular meshwork is clogged and causes a problem with the reabsorption of aqueous humor.
Open-angle glaucoma
Is there a problem with the circulation of aqueous humor in open-angle glaucoma?
No, the problem is related to clogged trabecular meshwork. It is a faulty “pumper station”
Another name for spongy tissue (relating to glaucoma)?
Trabecular meshwork
Is Open-angle glaucoma symptomatic or asymptomatic?
usually asymptomatic
Open-angle glaucoma is a structural problem:
True or False?
False. Closed-angle glaucoma is a structural problem.
Describe what causes Closed-angle glaucoma:
- Also known as Angle-closrure
- It is a narrow angle between the cornea and iris that prevents aqueous humor from being reabsorbed.
- The aqueous humor is unable to get to the trabecular meshwork
How does closed-angle glaucoma patient present?
The patient has a painful red eye that must be treated within 24 hours or blindness may be permanent.
EMERGENCY
What is the first line of care for a patient with chronic Open-angle glaucoma?
Medications (eye drops)
How might the medications for open-angle glaucoma help the problem?
Medications/eye drops can:
- decrease the aqueous humor production
- can cause miosis/opening of the trabecular meshwork
What is usually a problem associated with Chronic open-angle medication administration?
Compliance.
It is an asymptomatic disease, so patients often forget or don’t see the significance is taking it.
This is a great teaching opportunity!
The alternative option if drug therapy does not work for a patient with Chronic Open-angle glaucoma is called:
Argon Laser Trabeculoplasty (ALT) (Out-patient procedure)
How does the ALT procedure work?
The laser hits the damaged trabecular meshwork and opens the outflow channels.
______ anesthesia is used during an ALT procedure for Chronic Open-angle glaucoma.
Topical
Acute Angle-Closure Glaucoma is NOT an emergency:
True or False?
False. It is an ocular emergency. Head to the ED!
This diagnostic test is considered the gold standard for Acute Angle-closure Glaucoma:
Gonioscopy
The initial therapies you will have in the ED with acute angle-closure glaucoma consist of:
- Beta-blocker topical agent
- Carbonic anhydrase inhibitor (acetazolamide)- PO
- Miotic eye drops (helps lower the IOP by constricting the pupils)
GOAL: immediate relief!
Further care associated with Acute Angle-Closure Glaucoma that a patient may experience in the ED includes:
- aggressive treatment of pain and nausea
- measures to avoid activity and to keep calm
- apply a patch or covering to the affected eye
- Prepare for iridotomy once the IOP is stabilized
Why does do pain and nausea need to be aggressively controlled in a patient with acute angle-closure glaucoma?
Pain and nausea can aggravate the situation and significantly increase the IOP
Punching holes in the iris that allows for the aqueous humor to get to the other side is a procedure called:
Iridotomy
The two types of surgical interventions for acute angle-closure glaucoma are:
- Laser Peripheral Iridotomy
2. Surgical Iridectomy
Glaucoma
Early detection and treatment to prevent complications is important!
List the recommendations by the AAO for regular comprehensive ophthalmologic exams are recommended:
- Every 3-5 years (40-60 y.o.)
- Every 1-2 years (> 60 y.o.)
- African American –> periodic exam for ages 20-39
Acute Interventions for a patient with Acute Angle-closure Glaucoma:
- Quick and appropriate drug therapy
- For acute pain:
- If light sensitive = darken room (after the eye is fully constricted)
- Apply cool compress to forehead
- Find a quiet/private environment
- Keep the patient and family informed
- Ensure support and teaching for patient/family
