Diagnosis Tree (Posterior Segment)

Question 1

C: Optic Nerve
F: C:D Ratio > 0.4
60%

Answer 1

Glaucoma Suspect, Low

Plan: Regular Monitoring with:
OCTn (Optical Coherence Tomography) ,
DFE (Dilated Fundus Exam),
FP,
HVF (Humphrey Visual Field)

Question 2

C: Optic Nerve
F: C:D Ratio > 0.4
40%

Answer 2

Primary Open Angle Glaucoma, Mild/Mod/Severe

Plan: Monitoring as above, plus SLT vs. Medications

Question 3

C: Optic Nerve
F: Peripapillary Atrophy

Answer 3

Chorioretinal Scars

Question 4

C: Optic Nerve
F: Peripapillary SRH

Answer 4

Neovascular AMD (Age-related Macular Degeneration)

Question 5

C: Optic Nerve
F: Optic Nerve Noch

Answer 5

Glaucoma Suspect, Low

Question 6

C: Optic Nerve
F: Saucerized

Answer 6

Dry AMD

Question 7

C: Optic Nerve
F: Disc Hemorrhage

Answer 7

Disc Hemorrhage

Question 8

C: Optic Nerve
F: Disc Pallor

Answer 8

Glaucoma Suspect, Low;
Anatomic Narrrow Angles;
POAG

Question 9

C: Optic Nerve
F: Disc Edema

Answer 9

Central Retinal Vein Occlusion

Question 10

C: Optic Nerve
F: NVD

Answer 10

Proliferative Diabetic Retinopathy;
NPDR (Nonproliferative Diabetic Retinopathy);
Neovascular Glaucoma

Question 11

C: Vitreous
F: PVD

Answer 11

Posterior Vitreous Detachment

Plan: No RT/RD (Retinal Tear/ Retinal Detachment). RD precautions (Retinal Detachment)

Question 12

C: Vitreous
F: Vitreous Syneresis/ Vitreous Floaters

Answer 12

Vitreous Opacities;
Posterior Vitreous Detachment;
Vitreous Debris

Question 13

C: Vitreous
F: Asteroid Hyalosis

Answer 13

Asteroid Hyalosis

Question 14

C: Vessels
F: Attenuated Vessels

Answer 14

NPDR/PDR;
Retinal Vein Occlusion;
Neovascular Glaucoma;
Macular Edema

Question 15

C: Vessels
F: AV nicking

Answer 15

NPDR/PDR;
Retinal Vein Occlusion;
Macular Edema

Question 16

C: Macula
F: Drusen w/o Pigment Changes

Answer 16

Macular Drusen

Plan: Amsler, monitor

Question 17

C: Macula
F: Drusen w/ pigment changes

Answer 17

Macular Degeneration: Early/Int/Advanced

Plan: Amsler, AREDS, no neovascularization, monitor

Question 18

C: Macula
F: Nevus

Answer 18

Choroidal nevus

Plan: Monitoring with FP
May refer to oncologist for further evaluation

Question 19

NPDR

F: Microaneurysms

Answer 19

**Mild

Plan: D/w patient the importance of blood sugar control, routine f/u exam (DFE/FP/OCTm q1yr)

Question 20

NPDR

F: Hemorrhage or MA’s, and/or; retinal hemorrhages, hard exudates, cotton wool spots, venous beading

Answer 20

**Moderate

Plan: D/w patient the importance of blood sugar control, routine f/u exam (DFE/FP/OCTm), refer to retina specialist,

Question 21

NPDR

F: >20 intraretinal hemorrhages in each four quad, venous beading, IRMA

Answer 21

**Severe

Plan: F/u exam (OCTm, fluorescein angiography, DFE q3-4mos), referral to retinal specialist, importance of blood sugar control and close observation

Question 22

CSME

F: neovascularization, vitreous/preretinal hemorrhage

Answer 22

Immediate referral to retinal specialist, Peripheral neovascularization with photocoagulation treatment, anti-VEGF injections in conjuction with PRP.

Once stabilized, monitor by retinal specialist q6-12mos

Question 23

Dry AMD, (early-advanced)

F: numerous small soft drusen

Answer 23

**Early Dry

Plan: OCTm, FP, AREDS2, monitor

Question 24

Dry AMD, (early-advanced)

F: small or intermediate size of extensive drusen

Answer 24

**Intermediate Dry

Plan: OCTm, FP, AREDS2, monitor

Question 25

Dry AMD, (early-advanced) F: geographic atrophy or choroidal neovascularization, RPE hemorrhage, serous fluid, subretinal fibrosis

Answer 25

**Late/Advanced Dry or Wet Plan: Anti-VEGF injections, Photodynamic therapy (PDT), FFA, OCTm, FP, AREDS2

Question 26

Dry AMD, (early-advanced) F: intra/subretinal leakage, hemorrhage, RPE detachment

Answer 26

Neovascular AMD Plan: OCTm, FP

Question 27

Dry AMD, (early-advanced) C: Periphery F: Lattice Degeneration

Answer 27

Lattice Degeneration

Question 28

Dry AMD, (early-advanced) F: Horseshoe Tear

Answer 28

Horseshoe Tear

Question 29

Dry AMD, (early-advanced) F: Retinal Hemorrhage

Answer 29

NPDR/PDR; Retinal Vein Occlusion

Question 30

Dry AMD, (early-advanced) F: Peripheral RPE Changes

Answer 30

Dry AMD; Neovascular AMD

Question 31

Dry AMD, (early-advanced) F: Scleral Buckle

Answer 31

S/P Vitreo-Retinal Surgery; Retinal Detachment

Question 32

Dry AMD, (early-advanced) F: Choroidal Nevus

Answer 32

Choroidal Nevus

Question 33

Dry AMD, (early-advanced) F: Hard Exudates (Lipid)

Answer 33

Diabetes, Type I or II