Flashcards in Final Deck (57):
What are the possible mechanisms to treat the hypoxia of Bruch's/RPE in macular degeneration?
1. lose weight
2. eat healthy
What is an iris tuft capable of producing?
a hyphema if pops
What is the size of small drusen? 1. Medium drusen? 2. Large drusen? 3
1. less than 63 microns (1/2 retinal vein)
2. between 63 and 125 microns
3. more than 125 microns
What is the study that showed that grid laser has a modest effect on macular edema in BRVO?
What is the temporary loss of vision in one eye during a TIA called? 1. What other condition can lead to this? 2
1. amaurosis fugax (transient monocular blindness)
2. migrane headaches
What are the microvascular problems associated with diabetes (with examples)?
1. kidney (nephropathy)
2. nerves (neuropathy)
3. ocular involvement (retinopathy)
What are the more advanced changes in the retina due to chronic hypertension?
1. cotton wool spots
2. flame hemorrhages
3. intraretinal macular edema, optic disc edema
4. macular star hard exudates
What is the study that showed that patients with clinically significant macular edema from NPDR usually benefit from laser photocoagulation?
For a BRAO, what do the emboli consist of?
3. crystals of drug
What is the study that showed the significance of PRP for neovascularization in diabetic retinopathy?
diabetic retinopathy study (DRS)
What is the study that showed that anti-VEGF intravitreal injections may help with macular edema in BRVO, making it the standard of care?
What is the study that showed that intravitreal steroids can help with macular edema for CRVO?
What is different about the appearance and presentation of CRAO compared to BRAO?
1. complete loss of vision
2. retina is completely white except for a cherry red spot over fovea (diff blood supply)
3. veins distended and segmented (boxcarring)
What are the possible mechanisms to treat the choroidal neovascularization in macular degeneration?
2. PDT (with kenalog)
3. intra-vitreal anti-VEGF meds
What is the type of diabetes that is not due to insulin resistance and can initially be controlled with meal planning but insulin dependency gradually occurs?
latent autoimmune diabetes in adults (LADA)
What are the signs and symptoms of a transient ischemic attack?
1. sudden numbness or weakness of face, arm, or leg on one side of the body
2. temporary difficulty understanding speech
3. temporary (up to 2 hours) loss of vision in one eye
How long until permanent damage is done to the retinal following a BRAO? 1. What layers of the retina does the anoxia affect?
1. 105 min
2. nerve fiber layer
3. ganglion cell layer
4. inner plexiform layer
5. inner nuclear layer
What is the idea that over the first 18 months there may be worsening of the diabetic retinopathy with controlling of HbA1C compared to non-intensive/conventional control?
normal glycemic re-entry
What are the common signs and symptoms of diabetes mellitus?
1. refractive changes
2. mild weight loss, fatigue, weakness
3. the triad: polyuria, polydipsia, polyphagia
What is the type of choroidal neovascular membrane that has poorly demarcated hyperfluorescence on FANG and is sub-RPE? 1. Is it more or less common than the other kind? 2
1. occult CNVM
2. more common
What are the treatments in order from best to worst according to the DRCR study used for DME?
1. anti-VEGF meds
2. intravitreal tiamcinolone acetonide
3. focal or grid laser photocoagulation
What were the supplements used for the AREDS study?
1. vitamin C
2. vitamin E
What are the top reasons in order for iris neovascularization?
1. diabetic retinopathy
3. carotid occlusive disease
What is the best way to detect macular edema besides OCT and FANG?
Volk area centalis (non-mirrored portion)
What is the study that showed that intensive blood sugar control slows diabetic retinopathy progression?
diabetes control and complications trial (DCCT)
Is soft drusen or hard drusen a bad prognostic sign?
What is it called when a blood vessel to the brain is compromised by hemorrhage, clot or embolus?
Where is most of the blood located during a BRVO?
nerve fiber layer or below
What are the possible mechanisms to treat the inflammation and free radical formation in macular degeneration?
2. UV protection
What is the vein occlusion that has only one hemisphere affected called? 1. What is the treatment similar to? 2
1. hemicentral retinal vein occlusion
2. CRVO (refer)
What percentage of CRVO's develop neovascular glaucoma? 1. What percentage of ischemic CRVO's? 2
What is the function of insulin in the body?
key allowing glucose to get into cells for energy
What were the conclusions from the central vein occlusion study (CVOS)?
1. grid laser not helpful for macular edema
2. PRP for nonischemic CRVO should wait until NVI develops before performing
3. eyes with extensive hemes = ischemic
What are the anti-VEGF meds used for the management of BRVO?
What percentage of strokes are preceded by transient ischemic attacks? 1. How long do these usually last? 2
2. usually under 5 min but can be longer
What is the study that showed that anti-VEGF intravitreal injections may help with macular edema in CRVO, making it the standard of care?
If you are ever unsure changes in the macula (from clinical examination and/or reduced VA) what must you do?
1. run OCT and/or
2. refer to ophthalmology
Where in the retina are the veins most often associated with BRVO? 1. Why? 2
1. superior temporal
2. more AV crossings
What is the leading cause of new blindness in the U.S. for people between 20 and 74?
What are the differences between neo and IRMA?
2. blurrier edges
3. burgundy (not as red)
4. not at disk
5. shorter period of DM or poor control
What are the blood work tests that need to be performed for someone that has a BRVO?
1. blood pressure
2. fasting blood sugar or HbA1C
3. lipid profile
4. platelet count
5. CBC with differential
6. ESR or C-reactive protein
What disease of the eye is commonly associated with CRVO?
primary open angle glaucoma
What stage does arteriosclerotic retinopathy not get to?
leakage or occlusion (stay within mild hypertensive retinopathy)
What are the two reasons for loss of vision in diabetic retinopathy?
1. macular edema
2. retinal hypoxia with neovascular nets
What is the genesis of diabetic retinopathy?
1. losses of pericytes in BV walls especially during fluctuations in blood sugar
2. changes in capillary walls lead to focal development of microaneurysms, vascular loops, and dilated capillaries
Are collaterals crossing the horizontal raphe a good or bad sign for a BRVO?
good sign because old BRVO
What are the top reasons in order for retinal neovascularization?
1. diabetic retinopathy
What is the study that showed the significance of vitrectomy for vitreous involvement in diabetic retinopathy?
diabetic retinopathy vitrectomy study (DRVS)
What is the type of choroidal neovascular membrane that has well demarcated hyperfluorescence on FANG and is subretinal? 1. Is it more or less common than the other kind? 2
1. classic CNVM
2. less common
What are the macrovascular problems associated with diabetes (with examples)?
1. coronary artery disease (angina, MI, heart failure)
2. peripheral vascular disease (gangrene and non-healing foot wounds)
3. cerebro-vascular disease (stroke, TIA's)
What are BRAO often associated with that may have happened in the past to the patient?
1. amaurosis fugax
What quadrant of the retina is usually affected by a BRAO?
What are the conditions in which you should always check a persons blood sugar?
1. DM symptoms
2. refractive error or visual changes suggestive of DM
4. obesity and strong family Hx
5. Hx of DM
What should smokers avoid because of the increased risk of lung cancer?
What can cause complete vision loss in a CRVO?
1. retinal neovascularization
2. neovascular glaucoma secondary to iris and angle neo (90-day or 100-day glaucoma)
What is the study that confirmed that grid laser is still the standard of care for BRVO over steroids?