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54 Cards in this Set

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  • Back
  • 3rd side (hint)
What are 3 common causes of chronic visual loss in the adult patient?
macular degeneration
Glaucoma is the leading cause of blindness in what demographic
African Americans
What is characteristic of visual field defects in patients with glaucoma (3)
arcuate-shaped scotomas
contraction of the peripheral field
sparing of central vision until late in disease
What test is used to screen for glaucoma
tonometry and exam of optic nerve
What is the pathway taken for drainage of aqueous humor?
made in ciliary body
through pupil
anterior chamber
through trabecular meshwork ot Schlemm's canal
venous system
Where in aquous humor drainage is there most resistence?
trabecular meshwork and Schelmm's canal
What are the symptoms of abrupt rise in IOP in acute angle-closure glaucoma (3)
visualization of colored haloses or rainbows around light
What are the physical findings in acute angle closure attack
red teary eye
hazy cornea
fixed, middilated pupil
firm eye
What is the optic disc
point of origin of the optic nerve, includes the cup
What artery supplies the optic nerve
ophthalmic artery (branch of internal carotid)
What test is used to assess for glaucomatous visual loss
visual field testing
What are 3 risk factors for glaucoma?
age over 40
What is gonioscopy
exam of the anterior chamber angle structures using a special contact lens and anesthetized cornea
What is the cup:disc ratio
ratio fo the horizontal diameter of the cup to the disc
What is the effect of aging on the optic cup
very little
What 3 things cause temporal optic nerve pallor
brain tumors
Why do vellsels seem to bend at the edge of the cup
because the cup is a depression in the optic disc
The larger the cup, the ____ the possibility of a glaucomatous optic nerve.
In what case does the optic cup seem reduced or obliterated
papilledema due to increased ICP
What are 6 reasons to suspect glaucoma
IOP >21.5
IOP difference >5 btw eyes
optic cup diameter greater than 1/2 of disc diameter
one cup significantly larger than that of the other eye
symptoms of acute glaucoma
At what age should some cataract be expected
What attaches the lens to the ciliary body?
filamentous zonules
___ lies in front of the lens and ___ lies behind the lens
iris, vitreous humor
What focuses the lens
ciliary muscle
What is found in the lens capsule (3)
single anterior layter of cuboidal epithelium
What nourishes the lens?
aqueous fluid and vitreous (it has no blood supply or innervation)
How does the lens change over time
It grows, epithelial cells produce new cortical lens fibers, slow increase in size, weight and density, 35% protein by mass, more protein in a cataract
Define cataract
opacity of the lens that affects visual acuity
What are the zones of the lens
subcapsular, cortical and nuclear
either anterior or posterior
What defines a cataract as immature
clear cortex
Causes of cataract (6)
matabolic defect
nutritional defect
radiation damage
What are the symptoms of cataract?
image blurring, yellowing
decreased vision
failure of vision
Opacities in what zones of the lens cause the most disability
nuclear or central subcapsular opacities
What causes lenticular myopia and why
nuclear sclerosis
because the denser nuclear has more refractive power - may cause "second sight"
May cause monocular double or multiple images
What types of conditions are associated with subcapsular cataracts (2)
DM and corticosteroid use (metabolic causes)
What effect does an advanced cataract have on the afferent pupillary response
No effect
In what case should cataract extraction be done?
If it interferes with the pts activities
What is the treatment for opacification of the posterior capsule after cataract extraction
What is the potential treatment for macular degeneration?
argon laser photocoagulation of subretinal neovascular membranes
Where is the macula?
2 disc diameteres temporal to the optic disc
What makes the central macula appear darker than the rest of the retina
increased vascularity
What is the fovea
oval depression in the center of the macula
The fovea contains a high density of ____, but no _____
cones, rods
3 changes due to aging of the macula
degenerative changes in retinal pigment epithelium
subretinal neovascular membranes
What are drusen?
hyaline nodules (colloid bodies) deposited in Bruch's membrane, which separates inner choroidal vesselss form retinal pigment epithelium, come in various shapes, sizes and distribution
What is seen in degeneration of retinal pigment epithelium?
clumps of hyperpigmentation or depigmented atrophic areas
About 20% of eyes with age-related macular degeneration develop ___2____
subretinal neovascularization
The extension of vessels form the choriocapsularis into the ____ epithelial space and eventually into the ____ space means that a defect has developed in Bruch's membrane
subpigment, subretinal
What 4 things are associated with subretinal neovascular net formation
subretinal hemorrhage
pigment epithelial degeneration
photoreceptor atrophy
What test is used to identify neovascularization and is manditoyr before laser surgery
flourescein antiography
What can be seen with flourescein angiography?
new leaky vessels
defects in retinal pigment epithelium
What is true of central vs. peripheral vision in pts with macular degeneration?
poor central vision, good peripheral vision
pts get round okay
What test is useful for evaluating function of the macula?
Amsler grid testing
What findings on Amsler grid testing indicate a scotoma
lines that are wavy, seem to bow or bend or appear gray or fuzzy