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Flashcards in Gradual Loss of Vision Deck (63)
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1

Questions

Same as sudden

2

What are common causes of loss of vision gradual

Macular degeneration
Diabetic retinopathy
Hypertensive retinopathy
Cataract
Open angle galucoa
Optic atrophy

3

What are less common causes

Coloboma
Retinal dystrophy
Drug induced
Retinitis pigments

4

What causes hypertensive retinopathy

Chronic hypertension
Malignant hypertension.

5

What does it lead too

Ischaemia
No risk of new vessel formation

6

What are 4 stages

1 = arteriolar narrow
2 = AV nipping
3 = cotton wool exudate + blot haemorrhage
4 = papilloedema

7

What is most common cause of blindness in 30-60

Diabetic retinopathy

8

How does DM lead to retinopathy

High BG causes endothelial dysfunction
Increased vascular permeability
- Exudates released
- Blot haemorrhage
Cotton wool spots due to ischaemia
Micro-aneurysm of capillary
Intra-retinal microvascular abnormality = dilated and torturous vessel
Neovascularisation due to release of VEGF in response to ischaemia

9

What is mild non-proliferative

1+ microaneurysm

10

What is moderate

Microaneurysm
Blot haemorrhage
Hard exudate
Cotton wool spot
venous bleed
IRMA less severe

11

What is severe

Blot haemorrhage
Aneurysm all 4 quadrant
Venous bleed 2+
IRMA 1+

12

What is proliferative

Retinal neovascularisation

13

What can it lead to

Vitreous haemorrhage + retinal detachment

14

What is maculopathy

Hard exudate causing changes to macula affecting visual acuity

15

When is it more common

Type II

16

How do you visualise changes

Fundoscopy

17

How do you Rx

DM Control
Regular screening
Lower BP

18

How do you treat proliferative

Laser photocoagulation
Anti-VEGF (Raibizumab)

19

What is most common cause of blindness worldwide

Macular degeneration
- Degeneration of photoreceptors in macula

20

What causes

Dry due to atrophy (Early age related)
Wet due to blood / fluid (Late age related)

21

What causes dry

Non-exudative
Alterations to retinal pigment epithelium
Atrophy of macula as photoreceptors die
Linked to oxidative stress / inflammation

22

What causes wet

Secondary to dry
Neovascularisation causes leakage of serous fluid into eye or bleeding
If bleed = catastrophic and leads to scarring
Often stimulated by VEGF
Cause scarring of macula = central visual loss
Sub-retinal haemorrhage
Can cause sensory detachment

23

What are symptoms

Progressive loss central vision
Particular near objects
Difficulty in dark adaption
Photopsia - flashing
Crooked or wavy appearance to straight lines

24

What may be present

Area of central field visual loss with normal surrounding Patient aware = +Ve scrotoma

25

What does distortion of vision / crooked lines suggest

Problem with macula
Known as metamorphosia
If patient complains of this = refer urgently

26

What is it till proven otherwise

Wet related macular degeneration

27

What are other causes

Macular hole if older
Myoptic degeneration / central serous retinopathy if younger

28

How does macular hole present

Central loss of vision
Distortion

29

What are RF for macular degeneration

Age
Smoking
CVS RF
FH - some form of genetics

30

What are ocular RF

Hypermetropia
Light iris