Lecture XI

Question 1

Pupil sparing CN III defect is more concerning for what type of problem? Why?

Answer 1

Systemic disease, since the nerve carries the parasympathetic fibers in the outer ring of the nerve.

Question 2

Bilateral disc edema, with good vision, and no RAPD = ?

Answer 2

Papilledema

Question 3

DM is the leading cause of blindness, specifically in what age group?

Answer 3

20-74

Question 4

What are the three major ophthalmologic changes that occur with DM?

Answer 4

• Refractive error changes
• Cataracts
• Retinopathy

Question 5

What are the small organs that are affected with small vessel dz 2/2 DM? (3)

Answer 5

• Eyes
• Kidneys
• Peripheral nerves

Question 6

What is the chemical mediator of increased capillary permeability/abnormal vasoproliferative due to increase BG?

Answer 6

VEGF

Question 7

What are the two forms of diabetic retinopathy?

Answer 7

Proliferative retinopathy

Non-proliferative form

Question 8

What is the non-proliferative form of DM retinopathy?

Answer 8

Retinal blood vessels are leaky, which causes leakage into the macula which reduces vision

Question 9

What is the progression of problems that occurs with non-proliferative DM? (4)

Answer 9

• Microaneurysm
• Leakage of intravascular fluid (hard exudates)
• Intraretinal hemorrhages
• Retinal ischemia (cotton wool spots)

Question 10

What is the treatment for nonproliferative DM retinopathy?

Answer 10

No immediate treatment

Question 11

What determines a high risk of imminent PDR?

Answer 11

• Cotton wool spots
• Capillary dropout
• Venous bleeding

Question 12

What causes the neovascularization with proliferative form of DM retinopathy?

Answer 12

Tissue hypoxia causes proliferation

Question 13

True or false: pts with proliferative retinopathy can also have all the s/sx of NPDR

Answer 13

True

Question 14

What are the fundoscopic findings of PDR?

Answer 14

• Neovascularization
• Vitreous hemorrhages
• Fibrous proliferation

Question 15

What eventually happens to the new blood vessels with PDR?

Answer 15

Vitreous hemorrhage

Question 16

What are the s/sx of vitreous hemorrhage?

Answer 16

• Floaters/cobwebs

- Sudden loss of vision

Question 17

What should be done with vitreous hemorrhages?

Answer 17

Refer to ophthalmologist

Question 18

What happens with scar formation in the eye?

Answer 18

Scar will cause traction on the retina–may lead to retinal detachment

Question 19

How do people lose vision with diabetic retinopathy?

Answer 19

Several causes-but macular edema or vitreous hemorrhage and traction RD

Question 20

What are the two basic causes of vision loss with NPDR? Which is treatable?

Answer 20

• Ischemic maculopathy

- Macular edema (generally treatable)

Question 21

What are the goals of photocoagulation with PDR?

Answer 21

• Involute neovascular tissue
• Prevents further neovascularization
• Reduces risk of vitreous hemorrhage, and reduce traction retinal detachment

Question 22

What is the general idea with photocoagulation with PDR?

Answer 22

Kill off peripheral vision (Retina) to maintain central vision (blood flow to the macula)

Question 23

When is vitrectomy indicated?

Answer 23

If vitreous hemorrhage or retinal detachment

Question 24

What is a vitrectomy?

Answer 24

Suction out the hemorrhages

Question 25

True or false: proteinuria is a risk factor for macular edema

Answer 25

True

Question 26

What is the role of diuresis and BP control with macular edema in DM?

Answer 26

Improves--ACEI/ARBs particularly

Question 27

True or false: PDR is a risk factor for MI, stroke, amputation, and death

Answer 27

True

Question 28

What happens to the risk of nephropathy with the advent of PDR?

Answer 28

Increases the risk

Question 29

What is the problem with dyslipidemia in the development of DM retinopathy?

Answer 29

Increases the chances of hard exudate formations

Question 30

What are the DM screening guidelines for DM pts?

Answer 30

-Annual ophthalmologic exams

Question 31

What are the two forms of laser photocoagulation treatment options?

Answer 31

- Focal macular laser for macular edema | - Panretinal photocoagulation for PDR

Question 32

What are the findings of HTN retinopathy?

Answer 32

- Arteriolar sclerotic changes | - HTN changes

Question 33

What is the major challenge with identifying HTN retinopathy?

Answer 33

Appears very similar to natural age changes

Question 34

What are the characteristics findings on fundoscopy with arteriolar sclerosis?

Answer 34

- Less transparent vessels | - Copper/silver wiring light reflex broadens d/t the thickening and fibrosis of the vascular wall

Question 35

What causes A/V nicking?

Answer 35

At the arterioles and veins share a common adventitial sheath at crossing sites causing A/V nicking

Question 36

What is the normal artery:vein ratio (size)?

Answer 36

2:3

Question 37

What is the pathogenesis of HTN causing retinopathy?

Answer 37

moderate elevation causes constriction of arterioles

Question 38

Severe acute BP rises over what mmHg causes fibrinoid necrosis of the vessels, and exudates?

Answer 38

More than 200 / 120

Question 39

What is the ophthalmologic consequence of malignant HTN?

Answer 39

Optic nerve edema and fibrinoid necrosis

Question 40

What are the three most sensitive ophthalmoscopic indications of HTN? (in order)

Answer 40

1. attenuation of arterioles 2. Focal narrowing 3. A/V changes

Question 41

True or false: it may be difficult to differentiate chronic HTN from normal involutional changes

Answer 41

True

Question 42

What are venous beading seen in?

Answer 42

Advanced NPDR

Question 43

What are copper wiring of vessels seen in? Why?

Answer 43

HTN retinopathy--increased arteriole pressure

Question 44

What are the two major consequences of the neovascularization of PDR?

Answer 44

- vitreous hemorrhage | - Fibrous proliferation

Question 45

What is the worst prognostic sign of hypertensive retinopathy?

Answer 45

Disc edema