Ocular Disease Final - Lens

Front 1

What are the three top cataract Tx?

Back 1

1. Glasses
2. Anti-cataract drops
3. Surgery

Front 2

What is the biggest risk of cataract surgery (according to Dr. S?)

Back 2

Infection

Front 3

What is GAVAL?

Back 3

Gradual Aggressive Visual Acuity Loss

Front 4

T/F - Emphysema is a contraindication to cataract surgery.

Back 4

True - coughing can cause pressure on ocular contents during surgery

Front 5

T/F - There is no upper or lower age limit for cataract surgery.

Back 5

True - well, Dr. S. said as young as 6 mo to as old as 105 yrs old.

Front 6

What is amaurosis? Is this a contraindication to cataract surgery?

Back 6

Total loss of vision. Yes, it is a CI since it is unnecessary to fix a cataract in an already blind eye.

Front 7

T/F - RD is a contraindication for cataract surgery.

Back 7

True

Front 8

T/F - Corneal endothelial problems is not considered a contraindication for cataract surgery.

Back 8

False - you lose ~500 endothelial cells, and need about ~2000 before surgery

Front 9

How many endothelial cells do you lose during cataract surgery? What is the minimum amount needed prior to surgery?

Back 9

~500 lost, ~2000 minimum

Front 10

You see bilateral 2+ NSCs in your 60 year-old male patient, and you obtain the following data:

Manifest = -3.00 DS OU
VA cc = 20/20-2 OD, 20/25 OS, 20/20-2 OU
All other signs WNL

How should you treat this patient?

Back 10

Tx = glasses. No surgery at this time since VAs can be corrected w/ SRx

Front 11

Should you should treat a mentally handicapped patient's cataracts?

Back 11

Treat only if improving visual function will improve patient's life functioning

Front 12

Why is keratometry necessary in evaluating a cataract surgery candidate?

Back 12

Necessary for A-scan ultrasound, estimate post-surgical cyl, important for multifocal implants

Front 13

T/F - Anomalous vitreal adhesions are not considered a contraindication in cataract surgery.

Back 13

False

Front 14

Name the three major acquired cataract types and their prevalences.

Back 14

NSC = 65.5%
Cortical = 27.7%
PSC = 19.7%
(There is overlap? hence totaling over 100%)

Front 15

NSCs = slow or fast progressing?

Back 15

Slow

Front 16

What is the #1 Sx from NSC?

Back 16

Glare from oncoming headlights while driving at night

Front 17

What visual disturbances occur with NSC?

Back 17

Glare, blur (myopic shift/"second sight"), distortion, reduced color perception esp reds/greens

Front 18

Your patient has NSCs and as you use your DO to look at the posterior pole, your view looks different - what is so different?

Back 18

The retina looks indistinct with direct ophthalmoscopy in NSCs

Front 19

NSCs are [color?] and located in the [what part?] of the lens

Back 19

yellow/brown, central

Front 20

Your 55-year old patient swears that she can see much better at close now, but her distance is getting worse. Without even doing an evaluation you can probably guess...

Back 20

it's an NSC

Front 21

What type of cataract is commonly associated with NSCs?

Back 21

Cortical cataracts

Front 22

If your patient has a 3+ NSC, what kind of VA should you expect?

Back 22

20/200

Front 23

Your patient has an NSC - what should the visual field look like?

Back 23

Generalized depression

Front 24

What type of cataract is typically seen in younger adults?

Back 24

Cortical and PSCs

Front 25

T/F - Cortical cataracts may cause symptoms.

Back 25

True - possible to have glare with headlights while driving at night; if grow in center, may result in VA loss

Front 26

Where do cortical cataracts start and expand?

Back 26

Start in periphery, then expand to anterior and posterior part of lens

Front 27

What is the Tx for symptomatic cortical cataracts?

Back 27

Same as NSC - cataract surgery

Front 28

PSCs are associated with what conditions?

Back 28

Retinitis pigmentosa, ocular inflammation, prolonged steroid use, DM, trauma, radiation exposure

Front 29

PSCs = rapid or slow loss of VA?

Back 29

rapid (weeks to months)

Front 30

PSCs = decreased VAs at near, distance, or both?

Back 30

Both

Front 31

T/F - PSCs are always in the visual axis.

Back 31

False - may or may not be in visual axis

Front 32

What illumination would best reveal PSCs?

Back 32

Retroillumination - appears dark against red reflex

Front 33

During dilated SLE you see a lens opacity in the periphery that has a "ground glass" appearance. The patient's VAs are 20/20 OD, OS, OU. What is this? How should you treat this patient?

Back 33

PSC. Monitor pt every 6 months and tell pt to watch VAs every 2-3 weeks to look for changes.

Front 34

T/F - Diabetic cataracts occur due to osmotic reasons.

Back 34

True

Front 35

What is associated with Hypocalcemic (tetanic) cataracts?

Back 35

Hypocalcemia, papilledema, diplopia, photophobia, strabismus.

Front 36

Your patient has developed cataracts due to an electrical injury - where do you see the opacities?

Back 36

Anterior and posterior cortex

Front 37

What kind of cataract does copper produce?

Back 37

Sunflower cataracts

Front 38

Iron produces what kind of cataract?

Back 38

Brownish subcapsular cataracts

Front 39

Where are lens colobomas usually located?

Back 39

Inferior

Front 40

You see a flattening of the lens edge inferiorly in the patient's left eye, and there are no zonules present. What do you suspect?

Back 40

Lens coloboma

Front 41

T/F - Microspherophakia is often assoc w/ high hyperopia.

Back 41

False - high myopia (-5.00 to -20.00)

Front 42

What is the etiology of microspherophakia?

Back 42

Interference with secondary fiberogenesis.

Front 43

Microspherophakia = unilateral or bilateral?

Back 43

Bilateral

Front 44

Long, lax zonules and a lens entirely visible on dilation are associated with

Back 44

Microspherophakia

Front 45

What kind of glaucoma is possible with microspherophakia? Does it occur on miosis or mydriasis?

Back 45

Inverse angle closure - occurs on miosis, must dilate to break. (Since the lens is small, miosis will block communication between AC and PC?)

Front 46

What is microspherophakia associated with?

Back 46

Marfan's, Weill-Marchesani, Homocystonuria; can also be isolated

Front 47

What is the difference between lentiglobus and lenticonus?

Back 47

Lenticonus = conical shaped distortion of lens (mostly anterior but can be posterior)

Lentiglobus = rounded bulging of lens, anterior or posterior

Front 48

Lenticonus = bilateral or unilateral?

Back 48

Often bilateral

Front 49

T/F - Lenticonus/globus is treatable with SRx.

Back 49

True - if early onset SRx necessary to prevent amblyopia; if SRx not adequate need cataract surgery.

Front 50

T/F - Simple ectopia lentis is associated with Marfan's syndrome

Back 50

False - not associated with any systemic abnormalities

Front 51

What condition involves both an ectopic lens and pupil?

Back 51

Ectopia lentis et pupillae

Front 52

T/F - Ectopia lentis et pupillae can involve microspherophakia

Back 52

True

Front 53

T/F - Ectopia lentis et pupillae is autosomal dominant.

Back 53

False - recessive inheritance

Front 54

Simple ectopia lentis = AD or recessive?

Back 54

autosomal dominant

Front 55

How is the lens oriented in simple ectopia lentis?

Back 55

up & out

Front 56

Name the inheritances of the conditions below (AD or recessive):
1. Simple ectopia lentis
2. Ectopia lentis et pupillae
3. Marfan's
4. Homocystinuria

Back 56

1. AD
2. Recessive
3. AD
4. Recessive

Front 57

T/F - Simple ectopia lentis can be either congenital or spontaneous.

Back 57

True

Front 58

What kinds of problems are associated with Marfan's (in general)?

Back 58

Ectopia lentis with skeletal, cardiovascular, and ocular defects

Front 59

You see a (decreased/increased) corneal diameter in Marfan's.

Back 59

Increased (think collagen problem, stretching?)

Front 60

Marfan's is associated with (myopia/hyperopia)?

Back 60

Myopia (high)

Front 61

Marfans = miotic or mydriatic pupil?

Back 61

miotic

Front 62

T/F - Marfan's involves bilateral subluxation that is up and out.

Back 62

False - bilateral ECTOPIA not subluxation

Front 63

T/F - Homocystinuria involves bilateral subluxation that is down and in.

Back 63

True

Front 64

What is the most common cause of ectopia lentis?

Back 64

Trauma

Front 65

Where is mittendorf's dot found?

Back 65

On the posterior capsule of the lens, inferior nasal to lens axis.

Front 66

A white crescent a the former attachment of the hyaloid artery...

Back 66

Vogt's reflex arc

Front 67

The anterior epicapsular remnants of the tunica vasculosa lentis...

Back 67

Persistent pupillary memb

Front 68

Persistent pupillary membrane is found in __% newborns, __% adults.

Back 68

95, 20

Front 69

Persistent pupillary membranes connect from the ___ to the ___.

Back 69

Anterior capsule, collarette of iris

Front 70

What are epicapsular pigment stars? Where are they found?

Back 70

Stellate pigment on anterior capsule, in pupillary region, typically no decrease in VA

Front 71

You see radially oriented fine pigment lines in the anterior capsule on dilation, peripheral to the pupillary region...what is this?

Back 71

Retroiridal pigment lines

Front 72

Location of a congenital cataract/lens opacity signifies...

Back 72

time of development

Front 73

Name the causes of congenital cataract.

Back 73

Isolated hereditary (AD) = 20-25%
Rubella
Maternal disease = 20%
Other ocular anomalies = 5%
Sporadic, idiopathic = 1/3-1/2

Front 74

T/F - Capsular cataracts are only found in the capsule.

Back 74

False - both capsule and epithelium

Front 75

Polar cataracts are found...

Back 75

at the level of subcapsular cortex, anterior or posterior pole (latter more common)

Front 76

If you see a white persistent pupillary membrane, what should you be suspicious of?

Back 76

Intra-uterine infection - uveitis - strands to pupil margin (in Polar cataracts)

Front 77

Small white dots in axial region generally near white suture, found in 20-30% of all children...

Back 77

Anterior axial embryonic cataract

Front 78

You see bilatera, very dense whitish/bluish opacities that is in the Y suture. The patient's VAs are normal. What do you suspect?

Back 78

Anterior or posterior stellate cataracts (sutural cataracts)

Front 79

Where do you find zonular or lamellar cataracts?

Back 79

Outer fetal nucleus or inner juvenile (adolescent) nucleus

Front 80

What causes a zonular or lamellar cataract?

Back 80

Brief exposure to cataractogenic substance or event, thus lamellar nature which roughly dates time of development

Front 81

You see a cerulean cataract ("blue dot" cataract), which involves small opaque dots throughout the lens - what is this?

Back 81

Punctate cataract (very common, 25% infants)

Front 82

What is the most common cause of total congenital cataract?

Back 82

Rubella

Front 83

What classic syndrome is associated with Rubella?

Back 83

Eye, ear, heart defects

Front 84

T/F - Total congenital cataract due to Rubella is associated with megaophthalmos.

Back 84

False - microphthalmos

Front 85

Name the ocular anomalies associated with total congenital cataract due to Rubella.

Back 85

Microphthalmos, shallow AC, miotic pupils, salt and pepper fundus lesion (like syphillis)