Chronic Ophthalmologic Disorders

Question 1

Refractory error

The lens of the eye loses the ability to focus due to loss of elasticity

Effects - Difficult to see objects up close

Answer 1

Presbyopia

Question 2

Most common age-related problem in ophthalmology

Answer 2

Presbyopia

Question 3

This disease is 50-100 different versions of an optic nerve disease
(neuropathy) with characteristic optic nerve head and visual field
changes

Answer 3

Glaucoma

Question 4

What are the types of glaucoma?

Answer 4

Primary Open-Angle (most common)

Angle Closure (emergency)

Childhood

Secondary (after trauma or disease)

Question 5

What is the most common type of glaucoma?

Answer 5

Primary Open-Angle

Question 6

What demographics/groups are at more risk for glaucoma?

Answer 6

Common in patients who may be least able to treat themselves or
gain access to care

Elderly

African Americans

Diabetics and CV disease

Individuals with elevated IOP

1st degree relatives with glaucoma

Question 7

Which type of glaucoma is described below?

High incident in AA population

Adult onset

More likely to go blind

Bilateral (but not always symmetric)

Usually takes years or even decades (can slowly result in complete
blindness)

Compliance an issue

Answer 7

Primary Open-Angle Glaucoma

Question 8

List some causes of secondary glaucoma

Answer 8

Trauma
Iritis
Chronic Steroid use
Diabetic Retinopathy
Ocular Vascular occlusion

Question 9

What is the most important testing in glaucoma?

Answer 9

Visual Field Testing

Question 10

What are the screening guidelines for a Type 1 diabetic?

Answer 10

Annual ophthalmologic exams starting 5 years after diagnosis

Question 11

What are the screening guidelines for a Type 2 diabetic?

Answer 11

Annual ophthalmologic exams starting at the time of diagnosis

Question 12

What are the two main glaucoma characteristics?

Answer 12

Optic Nerve Head Changes

Visual Field Changes

Question 13

In glaucoma, what are the goals of treatment?

Answer 13

Halt further vision loss (cannot regain what is lost)

Halt further optic nerve damage

Slow progression

Question 14

Vision loss in the center of the field of vision - Loss of central vision ONLY

Leading cause of permanent visual loss in older population

Caused by the deterioration in the central portion of the retina known as the macula

Answer 14

Macular Degeneration

Question 15

What is the leading cause of permanent visual loss in older population?

Answer 15

Macular Degeneration

Question 16

What is the macula responsible for?

Answer 16

responsible for focusing central vision in the eye, and it controls our ability to read, drive a car, recognize face/colors, and see objects in fine detail

Question 17

What are the two classifications of macular degeneration?

Answer 17

Atrophic
Neovascular

Question 18

What type of macular degeneration is described below?

Gradually progressive bilateral loss of vision due to atrophy and
degeneration of the outer retina and retinal pigment epithelium

Answer 18

Atrophic

Question 19

What type of macular degeneration is described below?

Choroidal new vessels grow between the retinal pigment epithelium and brunch membrane leading to accumulation of fluid, hemorrhage, and fibrosis

Onset of vision loss is more rapid and more severe

Answer 19

Neovascular

Question 20

Which type of macular degeneration accounts for 90% of all cases of
legal blindness d/t macular degeneration?

Answer 20

Neovascular

Question 21

List some risk factors for macular degeneration

Answer 21

Caucasian
Female > male
Family history
Cigarette smoking

Question 22

Which risk factor for macular degeneration doubles the risk?

Answer 22

Cigarette smoking

Question 23

What tool is used to assess for macular degeneration?

Answer 23

Amsler grid

Question 24

What does the Amsler grid assess?

Answer 24

Asses for acute vision changes in macular degeneration

Question 25

What is the cost common cause of vision loss after refractive error?

Answer 25

Cataract

Question 26

What is the most common cause of blindness worldwide?

Answer 26

Cataract

Question 27

A wing-like structure, typically found on the nasal side of cornea Fleshy and typically triangular A benign pathologic change in the bulbar conjunctiva at the palpebral fissure that develops in an eye exposed to drying elements such as sun, wind, and dust

Answer 27

Pterygium and Pinguecula

Question 28

What is the difference between Pterygium and Pinguecula?

Answer 28

Pinguecula - Does not involve the cornea Pterygium - Invades the cornea

Question 29

What are the indications for surgery in cases of Pterygium and Pinguecula?

Answer 29

Growth threatening vision by approaching the visual axis Marked induced astigmatism Severe ocular irritation

Question 30

What is the most common cause of blindness in working age Americans?

Answer 30

Diabetic Retinopathy

Question 31

What is the best predictor of diabetic retinopathy?

Answer 31

A1c

Question 32

At what A1c level needs to be achieved to help prevent diabetic retinopathy?

Answer 32

must keep below 7

Question 33

Defined as spontaneous, rhythmic, back-and-forth movement of one or both eyes Rhythmic “jumping”

Answer 33

Nystagmus

Question 34

What are the three most common types of nystagmus?

Answer 34

End gaze Jerk (drug induced) Pendular

Question 35

What type of nystagmus is described below? Attempt to maintain gaze in extreme lateral gaze Not unusual for eye to drift back slightly from the extreme horizontal gaze and then refixate with a small jerk movement Disappears as gaze is shifted

Answer 35

End gaze

Question 36

What type of nystagmus is described below? Drug induced Dilating, barbiturates, sedatives – jerk nystagmus in all positions of gaze

Answer 36

Jerk (drug induced)

Question 37

What type of nystagmus is described below? Searching commonly seen in individuals who are visually impaired from birth

Answer 37

Pendular

Question 38

What types of nystagmus should alert the provider to central lesion ideology?

Answer 38

Vertical, bidirectional, or unilateral

Question 39

Peripheral or central nystagmus? Horizontal nystagmus may be present Bilateral Unidirectional Rotary/horizontal NEVER vertical Improves with visual fixation

Answer 39

Peripheral (outside CNS)

Question 40

Peripheral or central nystagmus? Vertical nystagmus may be present Bilateral or unilateral Bidirectional or unidirectional Usually no change with fixation

Answer 40

Central (brainstem or cerebral dysfunction)

Question 41

Misalignment of visual axis, one or both eyes are divergent away from the midline Imbalance in ocular muscles

Answer 41

Strabismus

Question 42

20% of patients with retinoblastoma present with what symptom/sign?

Answer 42

strabismus

Question 43

What are the four types of strabismus?

Answer 43

Esotropia Exotropia Hypertropia Hypotropia

Question 44

What type of strabismus is described below? “in” or “cross-eyed” One or both eyes deviated towards the nose Age of onset: 2-5 years After age 5, suspect a CNS disease

Answer 44

Esotropia

Question 45

What type of strabismus is described below? “out” One or both eyes deviated outward

Answer 45

Exotropia

Question 46

What type of strabismus is described below? “up” Most often seen in adults after trauma or stroke, but do also occur in children

Answer 46

Hypertropia

Question 47

What type of strabismus is described below? “down” Most often seen in adults after trauma or stroke, but do also occur in children

Answer 47

Hypotropia

Question 48

What tests can be used to diagnose strabismus?

Answer 48

Cover/uncover test Corneal light reflex (Hirschberg test)

Question 49

Unilateral or bilateral decrease in visual acuity that occurs as a result of a lack of a clear image falling on the retina Asymptomatic – detected only by screening

Answer 49

Amblyopia

Question 50

This condition is why we screen for strabismus

Answer 50

Amblyopia

Question 51

This condition can only occur during the critical period of development Birth to 8-9 years

Answer 51

Amblyopia

Question 52

What is the treatment for Amblyopia?

Answer 52

Occlusion - Force the “lazy” (wandering) eye to work

Question 53

What is the concern and complication of Amblyopia?

Answer 53

loss may be permanent Once it’s turned off, you can’t turn it back on