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73 Cards in this Set
- Front
- Back
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What is the most common cause of legal blindness in the US? |
Age-Related Macular Degeneration |
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Age-Related Macular Degeneration Etiology? Possible Risk Factors? |
Unknown etiology R/F: -Advanced Age -Female -Lighter Pigmentation -Smoking -Genetic predisposition |
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What is the pathophysiology of age-related macular degeneration (AMD)? |
A degeneration of the supporting structures of the outer retina and photoreceptors resulting in a deterioration of vision Can be bilateral |
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What is the most common type of age-related macular degeneration? |
Nonexudative (Dry) Atrophy of the retinal pigment epithelium (no cones/rods =cannot see) |
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What are the signs/symptoms of Age-Related macular degeneration? |
Symptoms: -Blurry vision -Metamorphopsia (grid of straight lines appears wavy) -Scotoma (partially diminished or entirely degenerated visual acuity) Signs: -Decreased visual acuity -amsler grid distortion -multiple large, soft drusen (yellow fatty protein/lipid deposits being the retina) -geographic atrophy (pitting on retina) -subretinal or intraretinal blood or serous fluid -serous or hemorrhagic retinal detachment |
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What is the less common form of Age-Related Macular Degeneration? How does it present? |
Exudative (Wet) Choroidal neovascular membranes (CNVM): new blood vessels that grow beneath the retina in the choroid and disrupt vision. |
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What is the treatment for Wet AMD? |
Intravitreal Injections - GOLD STANDARD - air pressure used to push deposits out from in front of macular area to non vision areas of the eye - done every 4-6 weeks -Ocular photodynamic therapy - cold laser - shrinks vessels that are bleeding -Surgery - hemorrhage -Low vision aids |
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What prevention can be done for Age-Related Macular Degeneration (AMD)? |
Age related eye disease study (ARED) Multivitamins (C, E, beta-carotene, zinc, copper UV Protection
No Smoking Diet- green, leafy vegetables, Omega 3's Future - genetic testing |
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What procedure is near the top of the list of most frequently performed medical procedures? What are the medications used? |
Intravitreal injections Lucentis Avastin - not FDA approved Eylea Macugen ***very expensive*** |
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What is the leading cause of blindness among adults aged 20-74 in the US? What are the greatest risk factors? What are the comorbid factors? |
Diabetic Retinopathy -occurs in both IDDM and NIDDM *duration of the disease* *severity of hyperglycemia* are the greatest risk factors -hypertension -smoking -hyperlipidemia are comorbid factors |
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What are the classifications of diabetic retinopathy? |
Nonproliferative diabetic retinopathy (NPDR) - Early Proliferative diabetic retinopathy (PDR) - Advanced Maculopathy - affects macula |
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What occurs during the earliest stages of non proliferative diabetic neuropathy? |
Microaneurysms Retinal Hemorrhage Hard Exudates - white hard spots - deposits of exudates Macular Ischemia - retina not nourished |
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What occurs during proliferative diabetic retinopathy? What area does is affect? |
more sever vision loss -affects central and peripheral retina Neurovascularization - body creates vessels to compensate blood flow but they are weak and bleed easily Vitreous hemorrhage - separation of the virtrea from the retina Tranctional retinal detachment Neovascular glaucoma |
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What occurs during diabetic macular retinopathy? (macular edema)? |
Micro aneurysms leak intravascular fluid into the retinal tissue often near the fovea Retinal thickening |
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How is diabetic retinopathy treated? |
-Intravitreal injections - macular edema -Focal grid laser - microaneurysms -Grid laser - diffuse retinal edema (large areas of swelling -Panretinal photocoagulation - peripheral retina **INTENSIVE CONTROL OF BLOOD GLUCOSE** |
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What are the recommended eye exam schedules for: Type I Diabetics Type II Diabetics When is diabetic retinopathy disease seen? |
Type I - initial exam 3-5 years after diagnosis with follow-up at least yearly Type II - initial exam at time of diagnosis with follow-up at least yearly Disease begins when regular exams are not being done |
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How many people does diabetic retinopathy affect? What % receives standard care? What are the barriers to care? |
25 million affected Less than 50% receive standard care Barriers -insufficient referrals -socioeconomic factors -poor geographical access to care |
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What is crucial to prevent blindness with diabetic retinopathy? What is a key strategy for improving DR screening through retinal images? |
Early detection is crucial Telemedicine is key strategy for improving DR screening through retinal images with remote expert interpretation. |
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This occurs when there are changes in the retina, choroid, and optic nerve due to systemic arterial hypertension. Acute or chronic? Men or women? Unilateral or Bilateral? Race affected most? |
Hypertensive Retinopathy Most cases are chronic Men and Women affected equally Bilateral No racial predilection |
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What are the signs/symptoms of hypertensive retinopathy? |
**Arteriovenous (AV) Nicking** **Cotton wool spots** (fluffy areas of ischemia) Retinal arteriole narrowing Nerve fiber layer hemorrhage Microaneurysms Lipid exudate Macular edema Sclerotic vessels |
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What is the treatment for hypertensive retinopathy? What is the treatment for acute hypertensive retinopathy? |
Treat the underlying hypertension and systemic vascular or renal disorders Acute - prompt control of hypertension by inpatient management -imaging for intracranial lesion |
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This occurs when fluid separates the retina from the underlying retinal pigment epithelium. |
Retinal Detachment |
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What are the risk factors for retinal detachment |
-Myopia - long/stretched out eyeballs -Trauma -Acute posterior vitreous detachment (PVD) - a normal aging process -Pseudophakia (cataract surgery) or aphakia (no lens at all) |
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What are the signs and symptoms of retinal detachment? |
**Visual field loss - explained as a Curtain or Shadow in the field of vision** Symptoms: Flashes Floaters Metamorphopsia (distorted line vision) Decreased vision Signs: Decreased visual acuity Visual field loss PVD (posterior vitreous detachment) Vitreous hemorrhage (blood in vitreous) Elevated Retina |
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What is the treatment for Retinal Detachment? |
Immediate opthalmologic referral -surgical intervention -Pneumatic retinopathy -Pars Plana virectomy -Laser retinoplexy -Cryopexy -Gas bubble -Silicone oil tamponade -Scleral Buckle |
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The leading cause of irreversible blindness worldwide and the second leading cause of blindness in the US is? |
Glaucoma |
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What racial group is glaucoma the LEADING cause of blindness in? |
Blacks |
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What is the modifiable risk factor for glaucoma? What does glaucoma cause? |
Raised intraocular pressure is a risk factor for glaucoma Glaucoma causes damage to the optic nerve, eventually leading to blindness if not treated. |
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What are the risk factors for glaucoma? What are the symptoms? |
R/F -Age -Race - African/Americans and Hispanics -Family History -Intraocular pressure (IOP) - Only one that can be modified Symptoms: -In most cases, NONE -Substantial optic nerve damage can occur before loss of peripheral vision is noticed -Tunnel vision in late stages (central vision is maintained, peripheral vision is lost) -Blindness |
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What is the appearance of the optic nerve/disc in glaucoma? When do you refer to a surgeon? |
Cupping of the optic disc - optic nerve loss and damage Disc ration of 0.7 - REFER |
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What are the different types of Glaucoma? |
Angle Closure Glaucoma (medical emergency) -Primary -Secondary Open-Angle Glaucoma Congenital Glaucoma |
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This occurs when aqueous humor is able to reach the drainage area (angle) but there is a problem in the outflow channels leading to aqueous build up and higher intraocular pressure. |
Open Angle Glaucoma |
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This occurs when the aqueous collection behind the iris pushes the iris forward and the iris blocks the angle (drainage area). It impedes the aqueous outflow and causes pressure to rise, often rapidly. |
Angle Closure Glaucoma |
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How does acute angle closure glaucoma present? What can this result in? |
Rapid rise in pressure -circumcorneal injection (redness) -corneal clouding (blurry vision) -Mid-dilated pupil that reacts poorly to light Severe Eye Pain Halos around lights Blurred Vision Decreased Vision Ciliary Reddness Headache May have N/V Result: Emergency referral One attack can result in substantial permanent vision loss - d/t restricted blood flow to the optic nerve because of increased pressure
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What is treatment for Angle-Closure glaucoma? |
Emergent ophthalmologic exam Lower intraocular pressure Topical drops -pilocarpine -timolol -apraclonidine Systemic meds -oral acetazolamide (diuretic to lower pressure) -IV meds only after dx is confirmed -surgical iridectomy |
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What are treatments for Glaucoma? |
Laser trabeculoplasty Laser peripheral iridotomy Trabeculectomy surgery Tube shunt surgery -pts with narrow angles should not use over the counter medications that warn against use by glaucoma patients -restrictions do not apply to patients with open angle glaucoma |
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When do you refer a patient with glaucoma? |
CDR (cup to disc ratio) >= 0.7 IOP >= 25mm Hg on 2 or more meds Pts with split fixation on VF (visual field) Pts with VF loss above and below midline |
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How does congenital glaucoma present? |
Clouded over look in infants Not common |
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This is a benign melanocytic tumor of the choroid and is the most common intraocular tumor. How does it present? |
Choroidal nevus Typically unilateral Asymptomatic and usually found incidentally |
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This is the most common primary intraocular malignancy. How does it present? |
Choroidal melanoma - growing from choroid, pushing in on eye Unilateral No genetic pattern Typically after age of 30 May be Asymptomatic Decrease in vision or field loss Retinal detachment Elevated, dome-shaped, brown pigment or amelanotic Orange pigment clumps on surface Vitreous hemorrhage |
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How is choroidal melanoma tested for? |
Dx by clinical appearance Baseline fundus photo Fluorescein angiography B-scan ultrasound Systemic work-up for metastatic disease |
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How is choroidal melanoma Treated and what is the prognosis? |
Tx: observation local resection radioactive plaque brachytherapy proton beam irradiation gamma knife irradiation enucleation (removal of eye) Prognosis: -10 year 34% risk at metastasis -Recurrence is low if treated with plaque radiation or external beam radiation -Post treatment visual acuity depends on location of the tumor |
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This is a thrombosis of the central retinal vein occuring in the venule at the exit site from the eye within the optic nerve. Who is it common in? What systemic diseases is it associated with? Is it ischemic? |
Central Retinal Vein Occlusion (CRVO) Age 50+ Associate with HTN/Diabetes/ Glaucoma Can be ischemic or non-ischemic |
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What are the clinical findings of Central Retinal Vein Occlusion? (CRVO) |
-mild to severe, sudden, painless, visual loss -intraretinal hemorrhage in all four quadrants -optic disc swelling -macular edema -dilated and tortuous veins |
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What testing and treatment is done for Central Retinal Vein Occlusion? |
Testing Ophtalmologic evaluation Systemic hypertension work-up Possible thyroid eye disease and tumor work-up Treatment Treat underlying HTN/Diabetes Treat Glaucoma Panretinal photocoagulation Intravitreal injections |
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What is Branch Retinal Vein Occlusion? (BRVO) |
Thrombosis occurring in a branch of the central retinal vein - usually unilateral - usually occurs at the site of an arteriole-venue crossing - older adults - more common than central retinal vein occlusion |
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What is treatment for Branch retinal vein occlusion? |
Grid laser for macular edema Intravitreal injections |
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This presents as unilateral, acute, persistent, sudden, painless loss of vision from diminished blood flow through the central retinal artery. Who is it common in? What systemic diseases can cause it? |
Central Retinal Artery Occlusion (CRAO) Older adults in 7th decade Carotid atherosclerotic disease Cardiac valvular disease (clot breaks away and goes to retinal artery) |
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How is Central Retinal Artery Occlusion managed? |
**Emergency Referral** Carotid Ultrasound Labs specific to each patient If Duration of onset is < 24 hours: Treat as an emergency - ocular massage - hyperbaric oxygen - IV acetazolamide (usually vision is lost and anucleation is performed) |
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This results from demyelination of the optic nerve. What disease is it associated with? What can be another cause? What age group does it affect most? |
Optic Neuritis Multiple Sclerosis Viral Ages 15-45 |
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What are the signs/symptoms of optic neuritis? |
Signs: Visual field defect Central visual loss is common Initial normal appearing disc 1/3 develop disc edema Relative afferent pupillary defect in affected eye Symptoms: Unilateral vision loss occurring over several days Pain with eye movement History of transient neurological disturbance (halos) |
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What testing/treatment is done for optic neuritis? |
Testing: Ophthalmic evaluation MRI of Brain/Orbits with contrast Labs Neuro consult (multiple sclerosis) Tx: Refer Steroids PPI or H2 Blockers Blood pressure and blood sugar monitoring |
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This is swelling of the optic nerve head due to increased intracranial pressure and almost always appears bilaterally. What procedure does this require? |
Papilledema Requires a lumbar puncture to measure an opening pressure to diagnose |
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What are the signs/symptoms of papilledema? |
Bilateral optic disc edema Unilateral or bilateral 6th cranial nerve paresis (may occur) Optic nerve hyperemia (red/swollen) Brief episodes of vision loss HA N/V Other neurologic deficits may be present with an intracranial mass |
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What is the etiology of papilledema? DD? |
Intracranial mass Idiopathic intracranial Hypertension (obesity) Impediment of CSF flow - dural sinus thrombosis - arteriovenous malformation - trauma DD? - bilateral optic neuritis - bilateral anterior ischemic optic neuropathy - hypertensive retinopathy |
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What is the work-up/treatment for papilledema? |
work-up -MRI -lumbar puncture -blood pressure -Ophthalmology and neurology consults tx -etiologic process determines treatment -idiopathic intracranial hypertension - weight loss and acetazolamide (diuretic) |
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This is progressive visual loss from photoreceptor death in which rod-cone dystrophy occurs with rods affected early and cones affected later. What is the etiology? |
Retinitis Pigmentosa - Genetic - Or sporadic without and inheritance patterns |
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What are the sign/symptoms of retinitis pigmentosa? |
Night blindness (nyctalopia) Photophobia Peripheral visual field loss Bilateral and symmetric Fundus may appear normal Pigment clumping Waxy pallor of Optic Nerve |
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What testing/treatment is done for retinitis pigmentosa? |
Testing - Electroretinography (ERG) - retinal response to light Visual field testing Color testing Genetic studies Tx: NO tx is effective in halting visual loss Tx is done to reduce inflammation |
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This primarily occurs in children b/w ages of 1-2 and presents as a white pupil (leukokoria) with proptosis. |
Retinoblastoma - chromosomal mutation Most common primary ocular malignancy of childhood |
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If a retinoblastoma invades the optic nerve and sclera, what can occur? |
Extension into the brain and metastasis |
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What testing/tx is done for retinoblastoma? |
Testing Systemic and genetic evaluation Ultrasound/CT/MRI Tx: REFER to PED OPTHALMOLOGIST Enucleation for all unilateral tumor or extensive bilateral disease Chemotheraphy Cryotherapy |
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This is the leading cause of childhood blindness in the US and is an abnormal proliferation of developing retinal blood vessels at the junction of the visualized and avascular retina in premature infants. |
Retinopathy of Prematurity (ROP) |
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What are the risk factors for retinopathy of prematurity (ROP)? |
Low birth weight Low gestational age |
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What is the treatment for Retinopathy of prematurity? |
All babies <33 wks gestation <1500g or have been on O2 >48 hours Should Be Screened 4-6 wks after birth REFER Laser photocoagulation Manage retinal detachments Followed by pediatric ophthalmologist |
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A copper/green ring around the iris of the eye is what? |
Kayser-Fleischer Ring Wilson's Disease |
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What eye conditions do we always REFER? |
Chemical Burn Corneal Ulcers Herpes Simplex Keratitis Herpes Zoster Ophthalmicus Hyphema Glaucoma Iritis Retinal Artery Occlusion Retinal Detachment |
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What are the risk factors for Cataracts? What can they be caused by? |
Age Diabetes Smoking Sun Exposure Alcohol Aging Trauma Radiation Exposure Congenital Surgery Medications |
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What are the risk factors for Macular Degeneration? |
Advanced Age Female Lighter Pigmentation Smoking Genetic Predisposition |
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What are the risk factors for Open-angle (chronic) Glaucoma? |
Age 70+
Race - African America and Hispanic Family History IntraOcular Pressure (IOP) Aqueous humor is able to reach drainage area angle but outflow channels are blocked |
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What are the risk factors for Closed-angle (acute) Glaucoma? |
Age 70+
Race - African America and Hispanic Family History IntraOcular Pressure (IOP) Rapid rise in pressure Iris is pushed forward and blocks the angle causing rapid increase in pressure |
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Clouding of the lens in the eye due to protein or pigmentation deposits in the lens decreasing vision. Tx? |
Cataract Surgery to remove and replace the lens |
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What are the symptoms of cataracts? |
faded colors blurry vision halos around lights trouble with bright lights trouble with night vision |
