common and chronic conditions

Question 1

leading causes of vision loss

Answer 1

ARMD, refractive error, cataract, diabetic retinopathy

Question 2

myopia is when

Answer 2

Question 3

hypermetropia is when

Answer 3

Question 4

refractive error Hx

Answer 4

blurred vision at a distance (driving, TV), near (reading, screens) or both.
presbyopia: ~40yo, discomfort, headache, blurriness at work (eye strain)

Question 5

aetiology or refractive error

Answer 5

myopia and hypermetropia: axial length and/or corneal curvature
presbyopia: loss of accomodation
astigmatism: irregular corneal curvature

Question 6

examination of refractive error

Answer 6

improvement in VA with pin-hole occlusion (difficult in some patients)

Question 7

management of refractive error

Answer 7

glasses/contacts (optometry), refractive surgery (ophthalmology)
drivers advice
presbyopes: 20-20-20 rule. lubricating drops
children: 20-20-2 rule, low dose atropine (ophthalmology)

Question 8

a cataract is

Answer 8

an opacity of the natural lens
the lens should be transparent

Question 9

symptoms of cataract

Answer 9

blur
diminish in brightness
glare in some subtypes of cataract

Question 10

cataracts can be brought on my

Answer 10

systemic steroid use
diabetes
aging

Question 11

cataract surgery

Answer 11

removal of the natural lens under anaesthetised eye
ultrasonic probe used
laser can be used but often isn’t - primarily an ultrasound based surgery
artificial lens tailored to the patients eye replaces the natural lens

Question 12

Hx of cataract

Answer 12

> 60 year olds
gradual blurring of distance vision
‘glasses seem smudged’
‘second sight’ = myopic shift causes people to be able to read better than before
glare, monocular diplopia

Question 13

second sight

Answer 13

happens in cataract
caused by myopic shift
patient can paradoxically read/see close up better than they could before

Question 14

aetiology of cataracts

Answer 14

age- related opacification of the natural lens fibres (protein denaturation)
others: congenital, traumatic, iatrogenic (steroids), diabetes, UV radiation

Question 15

examination of cataract

Answer 15

progression of clear lens to yellow, brown, or white
slit lamp: nuclear, cortical or posterior sub capsular

Question 16

management of cataract

Answer 16

adress refractive error and dry eye first
cataract surgery: day surgery, LAS, painless, sequential; >90% success, recovery in days, dry eye symptoms post-op, may still need glasses

Question 17

glaucoma is

Answer 17

a group of conditions characterised by progressive optic neuropathy, often linked to increased intraoccqular pressure (but not all glaucoma has increased intraoccqular pressure)

Question 18

Hx of primary open angle glaucoma

Answer 18

usually asymptomatic, may present late with field constriction or blurred vision
+/- family history, age >40yo, obstructive sleep apnea, myopia, diabetes

Question 19

aetiology of primary open angle glaucoma

Answer 19

reduced aqueous outflow and raised IOP -> altered optic nerve head perfusion and progressive loss of retinal ganglion cells

Question 20

examination of primary open angle glaucoma

Answer 20

raised IOP (>21 mmHg), visual field loss, optic disc cupping or asymmetry
normal anterior chamber depth and appearance

Question 21

management of glaucoma

Answer 21

screening: 1-2 yearly with ophthalmology or optometry (at risk patients)
medical: b-blockers (e.g. timoptol), prostaglandin analogues, (Xalatan), alpha-agonsits (e.g. alphagan), carbonic anyhydrase inhibitors (e.g. Azopt)
surgical: SLT laser, trabeculectomy, glaucoma drainage devices

Question 22

drusen looks like

Answer 22

kinda looks like hard exudate but its not
this is age related macula degeneration
drusen - deposits of protein and fat at the back of the eye that are waste products not being adequately pumped out of the retina because the ability to pump waste product out of the retina reduces with age

Question 23

what is age related macula degeneration

Answer 23

progressive degeneration (wear and tear) of the macula, affecting central vision

Question 24

Hx of age related macula degernation

Answer 24

gradual central blurring, distortion (over months/years), prolonged dark adaptation
+/- smoking
family history, metabolic/cardiovascular disease
60-70+ yo

Question 25

what is prolonged dark adaptation

Answer 25

eyes take too long to acclimate to the dark

Question 26

examination of age related macula degeneration

Answer 26

macular drusen (yellow), pigment (black)
if you see red this is blood and this may be indicative of neo vascular age related macula degeneration which has a more subacute onset than ARMD

Question 27

management of ARMD

Answer 27

routine ophthalmology referral
conservative management to slow progression