Opthamology - Retinal Vascular Disease

Front 1

Diabetic Retinopathy: Epidemiology

Back 1

Leading cause of legal blindness age 20-70

Front 2

Diabetic Retinopathy: Prevalence

Back 2

Type 1 - 98% of >15 yrs duration
Type 2 -78% of >15 yrs duration

Front 3

Diabetic Retinopathy: Risk Factors

Back 3

Hypertension
Renal status
Puberty
HbA1c
Pregnancy

Front 4

Diabetic Retinopathy: Pathophysiology

Back 4

glucose causes destructin of small blood vessels:
-capillary basement membrane thickening
-pericyte loss
-breakdown of blood-retinal barrier

Front 5

Diabetic Retinopathy: Classification

Back 5

Non-proliferative Diabetic Retinopathy (NPDR)
Proliferative Diabetic Retinopathy (PDR)

Front 6

Non-proliferative diabetic retinopathy (NPDR)

Back 6

Increased glucose causes:
-retinal vessel closer and altered vascular permeability
Findings: hard exudates, dot-blot hemorrhages, NFL hemorrhages, microaneurysms, macular edema

Front 7

Severe non-proliferative diabetic retinopathy (NPDR)

Back 7

Findings: NFL infarcts (cotton wool spots), venous dilation/bleeding/reduplication, intraretinal microvascular anomalies, extensive capillary non-perfusion

Front 8

What's the most common cause of visual loss in NPDR?

Back 8

Diabetic retinal edema (retinal thickening +/- exudate)

Front 9

Non-proliferative diabetic retinopathy treatment

Back 9

Laser cauterization of blood spots
Result is decreased macular edema/vision loss

Front 10

Proliferative diabetic retinopathy (PDR): pathogenesis

Back 10

Retinal ischemia results in expression of VEGF
VEGF causes neovascularization of the retina elsewhere (NVE)

Front 11

Proliferative diabetic retinopathy (PDR): symptoms

Back 11

Sudden vision loss with floaters in diabetic (caused by vitreous hemorrhage)

Front 12

Proliferative diabetic retinopathy (PDR): complications

Back 12

Vitreous hemorrhage
Tractional retinal detachment
Neovascular glaucoma

Front 13

Proliferative diabetic retinopathy (PDR): treatment

Back 13

panretinal photocoagulation (PRP) - decreases blood supply needs therefore decreasing VEGF production
Vitrectomy Surgery

Front 14

Diabetic Retinopathy: Systemic Treatment

Back 14

Blood sugar and BP control
Maximize cardiac and renal function
monitor blood lipids

Front 15

Diabetic Retinopathy: Long term prognosis

Back 15

Excellent at 15 years

Front 16

Hypertensive Retinopahty

Back 16

HTN = SBP >140 or DBP >90
Choroid, retina and optic nerve involvement
Cranial nerve palsy (decreased EOM)
Ocular Strokes (visual field defects

Front 17

Hypertensive retinopathy: pathology

Back 17

Narrowing of retinal arterioles causing physiological constriction
Chronic HTN causes sclerosis and permanent narrowing of arterioles

Front 18

Hypertensive retinopathy: manifestations/signs

Back 18

NFL micro-infacts - cotton wool spots
Dot/blot hemorrhages (deep and perpendicular to NFL)
Flame shaped hemorrhages (along NFL)

Front 19

Ocular hypertension: Classification (Modified Scheie)

Back 19

Grade 1 - minimal arteriolar narrowing
Grade 2 - Obvious areteriolar narrowing with focal irregularities
Grade 3 - Grade 2 + retinal hemorrhages and/or exudate
Grade 4 - malignant hypertension - Grade 3 + swollen optic nerve

Front 20

Malignant Hypertension

Back 20

Grade 4 Modified Scheie Classification
Swollen optic nerve, retinal arteriolar narrowing, CW spots, blot hemorrhage

Front 21

Malignant Hypertension: Management

Back 21

Lower blood pressure gradually

Front 22

Central Retinal Vein Occulusion (CRVO): Findings

Back 22

Acute or semi-acute unilateral vision loss
venous dilation and tortuosity, intra-retinal hemorrhage everywhere, scattered CW spots, local thrombosis
"Blood and Thunder"

Front 23

Central Retinal Vein Occulusion (CRVO): Complication

Back 23

Neovascular glaucoma (painful)

Front 24

Central Retinal Vein Occulusion (CRVO): Risk Factors

Back 24

Common - diabetes, hypertension, atherosclerosis, glaucoma, old age
Rare - blood dyscarias, leukemia, polycythemia, macroglobulinemia

Front 25

Branch Retinal Vein Occlusion (BRVO): Findings

Back 25

Some vision loss
Sectoral "blood and thunder"
Complication is macular edema

Front 26

Branch Retinal Vein Occlusion (BRVO): Risk Factor

Back 26

Hypertension is major

Front 27

Branch Retinal Vein Occlusion (BRVO): Treatment

Back 27

Laser coagulation to treat edema

Front 28

Central Retinal Artery Occlusion (CRAO): Findings

Back 28

sudden severe vision loss
afferent pupil defect, retinal pallor cherry red spot, embolus in central retinal artery

Front 29

Central Retinal Artery Occlusion (CRAO): management

Back 29

Carotid doppler and ECG to rule out carotid occlusive disease (stroke risk)

Front 30

Amarosis Fugax

Back 30

Occular TIA (<10min usual)
Painless monocular vision loss
Cause - retinal embolus, temporal arteritis