Gradual Visual Loss

Question 1

how does dry ARMD present

Answer 1

gradual vision loss
bilateral central vision loss with maintenance of peripheral vision
o/e atrophic macula

Question 2

can dry ARMD be treated

Answer 2

no treatment only prevention helps

visual aids and register as blind

Question 3

what is a cataract

Answer 3

opacification of the lens

Question 4

state the causes of cataract

Answer 4

congenital - must be treated within 4 weeks of birth
age
metabolic - diabetes and hypertension
smoking and alcohol

Question 5

describe the vision loss seen in cataract

Answer 5

gradual vision loss - difficulty reading signs and recognising faces

Question 6

what is seen with a cataract on examination

Answer 6

loss of red reflex

opaque lens

Question 7

how is cataract treated

Answer 7

phaecoemulsification + intraocular lens implant

Question 8

what are the complications of cataract surgery

Answer 8

glaucoma
anterior uveitis
retinal detachment
endophthalmitis

Question 9

what is glaucoma

Answer 9

group of disorders leading to progressive optic nerve damage and visual loss
raised IOP is a feature but not diagnostic

Question 10

list the triad of changes that occur in glaucoma

Answer 10

visual field defect
raised IOP
optic disc cupping

Question 11

how does raised IOP arise

Answer 11

backflow of aqueous humour in the anterior chamber of the eye damaging retinal fibres in the optic disc

Question 12

what is the normal range for intraocular pressure

Answer 12

10-22mmHg

Question 13

what are the visual field defects seen in glaucoma

Answer 13

defect starts in the periphery causing crescent shape

central vision and acuity is maintained until late stages of disease

Question 14

what is optic disc cupping

Answer 14

optic disc is the pale part of disc where there are no neurones, the optic disc increases in size in glaucoma due to damage of the nerve fibres and the size of the cup increases

Question 15

what is the normal ratio of the optic disc

Answer 15

0.4-0.7

anything >0.7 is suggestive of glaucoma

Question 16

how does chronic closed angle glaucoma present

Answer 16

asymptomatic therefore needs picked up through screening

visual field defect, raised IOP and optic disc cupping are observed

Question 17

what is the outline of management of glaucoma

Answer 17

aim to reduce production of aqueous humour or increase the drainage of it

Question 18

what drugs are used to treat glaucoma

Answer 18

topical prostaglandins
topical beta-blockers and alpha agonists
carbonic anhydrase inhibitors such as acetazolamide

Question 19

acute angle closure glaucoma is an emergency true/false

Answer 19

true

Question 20

what is the pathophysiology of acute angle closure glaucoma

Answer 20

rapid build up of IOP, iris is pushed against the trabecular meshwork blocking AH flow out of the anterior chamber

Question 21

how does acute glaucoma present

Answer 21

sudden painful vision loss
blurred vision
haloes around light
headache, nausea and vomiting

Question 22

what are the examination findings of acute glaucoma

Answer 22

hazy cornea
hard tense eye
fix mid-dilated pupil

Question 23

how is glaucoma investigated

Answer 23

slit lamp

genioscopy to assess anterior chamber

Question 24

how is acute glaucoma treated

Answer 24

IV acetazolamide first line to reduce IOP

trabeculectomy can be carried out once IOP has reduced

Question 25

which factors within diabetes increase risk of developing diabetic retinopathy

Answer 25

pregnancy long duration of disease poor glycaemic control

Question 26

how does retinopathy develop within diabetes

Answer 26

glycosylation of proteins leads to formation of microaneurysms and reduces oxygen transport causing ischaemia ischaemia congests vessels causing neovascularisation leading to leakage and haemorrhage

Question 27

outline the retinal changes seen in diabetic retinopathy

Answer 27

hard exudates - lipoprotein cotton wool spots dot blot and flame haemorrhages

Question 28

what is the difference between non-proliferative and proliferative retinopathy

Answer 28

non-proliferative does not have neovascularisation of vessels yet, less severe forms

Question 29

what are the features of maculopathy seen in retinopathy

Answer 29

macular oedema blot haemorrhages hard exudates

Question 30

how is retinopathy managed

Answer 30

cannot reverse changes only prevent further damage through tighter glycaemic control

Question 31

outline the stage of retinopathy and the screening time for each

Answer 31

``` R0 no retinopathy - 12 month R1 mild - 12 months R2 background - 6 months R3 referable - refer to oph R4 proliferative - refer to oph ```