Glaucoma Flashcards
(116 cards)
1
Q
What happens when light hits the retina
A
photoreceptors turn the light into electrical signals
2
Q
What does the top number on the snelling chart refer to
A
the distance in feet you stand to the chart
3
Q
What does the bottom number on the snelling chart refer to
A
the distance in which a person with normal eyesight can read the same line
4
Q
What type of equipment is used for refractive testing
A
phoropter
5
Q
What equipment is used for glaucoma evaluation
A
gonioscopy
6
Q
What is the normal eye pressure range
A
10-21 mmHg
7
Q
What is the leading cause of blindness / low vision in the US due to
A
aging
8
Q
What are some age related vision changes
A
cataracts
diabetic retinopathy
glaucoma
macular degeneration
9
Q
What is the most frequent eye problem in the US
A
Refractive errors
10
Q
What are refractive errors
A
myopia
hyperopia
astigmatism
presbyopia
11
Q
What is near sightedness known as
A
myopia
12
Q
What is farsightedness
A
hyperopia
13
Q
What causes distorted vision at all distances
A
astigmatism
14
Q
What is the loss of ability to focus up close and when does it generally occur
A
presbyopia
40-50y/o
15
Q
What is the cause of myopia
A
cornea is too steeply curved
axial eye length too long
*point of focus is in front of retina
16
Q
How do you correct myopia
A
concave lens
17
Q
What causes hyperopia
A
cornea too flat
axial length too short
*point of focus is behind retina
18
Q
How do you correct hyperopia
A
convex lens
19
Q
What causes astigmatism
A
variable curve of the cornea / lens causing light to focus at different points
20
Q
hat type of lens is used to correct astigmatism
A
cylindrical lens
21
Q
What causes presbyopia
A
loss of the lens’ ability to change shape to focus on near objects from aging
22
Q
What is anisometropia
A
Significant difference between refractive errors of the 2 eyes
*>3 diopters
23
Q
What is aniseikonia
A
Different image sizes
24
Q
What are common s/sx of refractive errors in patients
A
blurred vision
headaches
perceived imbalance
Ocular surface desiccation
25
What do refractive errors cause headaches
excessive colliery muscle tone
Prolonged squinting/frowning
26
What are the signs of ocular surface desiccation from excessive staring
eye irritation
itching
visual fatigue
foreign body sensation
redness
27
What are symptoms of refractive errors in children
frowning / squinting when reading
excessive blinking
rubbing of eyes
28
How do you workup refractive errors
visual acuity testing
refraction
comprehensive eye exam
29
How often should visual acuity and refraction testing be done
every 1-2 years
30
Who preforms comprehensive eye exams
ophthalmologists
optometrist
31
How can you treat refractive errors
glasses
contacts
surgery
32
What are the three numbers that are included with corrective lens prescriptions
spherical correction
cylindrical correction
axis
33
What is the power of spherical corrections used for
- (myopia)
+ (Hyperopia)
34
What is amblyopia
lazy eye
35
When can severe loss of vision occur with amblyopia
if the affected eye is not detected and treated before 8 years old
36
What occurs amblyopia
visual cortex suppress image from affected eye
if suppression persists long enough - vision loss can be permanent
37
What is strabismus
misalignment of the eye resulting in different retinal images being sent to visual cortex
38
What is anisometropia
different focus of retinal images with image from eye with greater refractive error being less well focused
39
What causes obstruction of the visual axis
some point between surface of eye and retina, something interferes with or completely prevents formation of retinal image of affected eye
40
How can strabismus be confirmed
with alternate cover test or cover to uncover test
41
How can anisometropia be confirmed
refraction of each eye
42
How can obstruction of visual axis be confirmed
ophthalmoscope or sit-lamp exam
43
How do you treat amblyopia
glasses / contacts
patching (Common in kids)
Atropine drops
tx of strabismus if present
44
What is the most common cause of IRREVERSIBLE central vision loss in older patients
AMD (macular degeneration)
45
What is the diagnostic test for AMD
Dilated fundoycopic findings
46
What tests can be done for AMD
Color photographs
fluorescein angiography
optical coherence tomography
47
How do you treat AMD
Dietary supplements
intra-vitreal injection
laser photocoagulation
low vision devices
photodynamic therapy
48
What are the different forms of AMD
Dry (all AMD starts here)
Wet
49
What does dry AMD do to the eye
Change in retinal pigment epithelium (dark pinpoint areas)
50
What occurs in the eye with dry AMD
Accumulation of waste products from rods and cones (drusen) will look like yellow spots
51
What causes dry AMD to turn wet
New abnormal blood vessels develop under the retina (choroidal neovascularization)
52
What is physically different with wet AMD compared to dry
Localized macular edema or hemorrhage may elevate an area of the macula or cause pigment epithelial detachment
53
What does untreated neovascularization cause
disciform scar under the macula
54
What is the clinical presentation of dry AMD
Loss of central vision that occurs over years and is generally painless
central blind spots (scotomas)
usually bilateral
Fundoscopic changes
55
What fundoycopic changes occur with dry AMD
Drusen
changes in retinal pigment epithelium
chorio-retinal atrophy
56
What is the clinical presentation of wet AMD
Rapid vision loss usually over days to weeks
legally blind in affected eye if not treated
often unilateral
57
What is the first sx of wet AMD
visual distortion (scotoma or metaporphopsia)
58
What is metaporphopsia
Curving of straight lines
59
What are some fundoscopic changes with wet AMD
Subretinal fluid (elevation)
Retinal edema
gray-green discoloration
exudates in/around macula
sub retinal hemorrhage
detachment of retinal epithelium
60
What test is better for wet AMD
color fundus photography
fluorescein angiography
61
What is optical coherence tomography help identify
Aids in identifying intraretinal / sub retinal fluid
assess response to treatment
62
What does Amsler grid help detect
visual changes
63
What supplements can help manage dry AMD
Zinc
Copper
Vitamin C/E
Lutein
64
What can help manage wet AMD
VEGF infections
thermal laser photocoagulation
Photodynamic therapy
injected corticosteroids
65
What supportive measures can be used for patient with lost central vision (AMD)
Low vision devices
large print on electronics
low vision counseling
66
if someone feels like they are looking through a steamed up window.. what do they most likely have
cataracts
67
What is the leading cause of blindness and vision loss in the US
Cataracts
68
Is cataracts age related
No, can be congenital or degenerative
69
Where in the eye can cataracts occur
central lens nucleus (nuclear)
beneath posterior lens capsule
On side of the lens (Cortical)
70
Which form of cataracts does not interfere with central vision
cortical
71
What are main symptoms of cataracts
painless vision blurring
gradual
72
How do you diagnose cataracts
ophthalmoscope and slit-lamp exam
73
How do you treat cataracts
surgical removal and placement of intraocular lens
74
What are early symptoms of cataracts
loss of contrast, glare, needing more light to see well, problems distinguishing dark blue from black
75
What are rare symptoms that can occur with cataracts
swelling pushing iris over trabecular drainage meshwork, causing occlusion and secondary closed angle glaucoma
76
What is nuclear cataract
Distance vision worsens, near vision may improve in early stages temporarily
presbyopic patients may be able to temporarily read without glasses (second sight)
77
What is posterior sub scapular cataracts
Reduced visual acuity when the pupil constricts
more likely to cause loss of contrast and glare
disproportionally affects vision because opacity is located at crossing point of incoming light rays
78
How do you workup cataracts
ophthalmoscope followed by slit-lamp
*best with pupils dilated
Exam of red reflex through dilated pupil (30cm away)
79
What will cataracts look like
gray/white/yellow-brown opacities in lens
80
What test is definitive for cataracts
slit-lamp because it provides more detail about character, location, and extent of opacity
81
How do you treat cataracts
frequent refractions and corrective lens prescription changes
long term pupillary dilation for small centrally located cataracts
Indirect lights while reading to minimize pupillary constriction
82
What are the indications for surgery with cataracts
best vision obtained with glasses is worse that 20/40
bothersome halos or starburst
vision is limiting
83
What are the different types of cataracts surgery
intracapsular
extracapsular
phacoemulsification
84
What is intracapsular cataract extraction
cataract and lens are used in one piece
85
What is extra capsular cataract extraction
hard central nucleus is removed in one piece and then soft cortex is removed in multiple pieces
86
What is phacoemulsification
Type of extracapusular
**Gold standard cataract surgery
87
What do patients have to avoid for several weeks after cataracts surgery
valsalva maneuver
heavy lifting
excessive forward bending
eye rubbing
88
What is the second most common cause of blindness worldwide
Glaucoma
89
What is the leading cause of blindness for hispanics and African Americans in the US
glaucoma
90
What is the most common type of glaucoma in the US
primary open angle glaucoma
91
What causes glaucoma
progressive optic nerve damage with a relative increase in IOP
92
What is glaucoma
acquired loss of retinal ganglion cells and axons within the optic nerve that results in a characteristic optic nerve head appearance and peripheral vision loss
93
What occurs with open angle glaucoma
>98% of aqueous humor exits the eye via either trabecular meshwork and canal of schlemm
94
What are the divisions of glaucoma
primary (cause of outflow resistance or angle closure is unknown)
Secondary (outflow resistance results from a known disorder
95
What are symptoms of closed angle glaucoma
severe ocular pain and redness decreased vision
colored halos around lights
H/A
N/V
Increased IOP
96
What is definitive treatment of closed angle glaucoma
iridotomy
97
What are risk factors for closed angle glaucoma
Fhx
advanced age
ethnicity (asians at most risk)
98
What type of glaucoma is an ophthalmic emergency
primary acute closed angle
99
what IOP is indicative of closed angle glaucoma
>40mmHg
100
What is intermittent closed angle glaucoma
an episode of pupillary block that resolves spontaneously after several hours -> generally after sleeping supine
101
What is chronic closed angle glaucoma
angle narrows slowly, which allows for scarring between peripheral iris and trabecular meshwork
IOP elevation is slow
102
What can cause secondary closed angle glaucoma
proliferative diabetic retinopathy
ischemic central vein occlusion
uveitis epithelial down-growth
103
Why is acute closed angle glaucoma misdiagnosed
systemic complaints being so severe
104
What will be seen on exam with acute closed angle glaucoma
conjunctive hyperemia
hazy cornea
fixed mid-dilated pupil
anterior chamber inflammation
IOP 40-80
105
What is seen on exam with chronic closed angle glaucoma
gonioscopy showing peripheral anterior synechiae
optic nerve/visual field abnormalities
106
How do you treat acute closed angle glaucoma
Timolol
pilocarpine
Brinonidine
Acetazolamide
osmotic agent
107
What is definitely treatment of acute closed angle glaucoma
laser peripheral iridotomy
*done as soon as cornea is clear and inflammation has subsided
108
What are risk factors for open angle glaucoma
older age
positive family history
African Ethnicity
Hypertension
Diabetes
Myopia
109
What is occurring with open angle glaucoma
aqueous humor drainage is inadequate but production by ciliary body is normal
110
What is found on physical exam with open angle glaucoma in asians
IOP with average range but optic nerve damage and visual field loss typical of glaucoma are present
*Have higher risk of intravascular disease
111
How will the optic nerve look with open angle glaucoma
increased cup to disc ration
pitting / notching of rim
splinter hemorrhage
vertical cup elongation
bayoneting
112
What is bayoneting in the eye
quick angulations in course of exiting blood vessels
113
What is diagnostic of glaucoma regardless of IOP
thinning of neurosensory rim
Visual field change
114
What is the clinical presentation of open angle glaucoma
Visual field defects
arcuate scotoma extending nasally
temporal wedge defect
paracentral scotoma
115
What is the initial treatment for open angle glaucoma
drug therapy
then laser and last option is surgery
116
Which medications can be used to manage open angle glaucoma
prostaglandin analogs
beta blockers (timolol)
