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OPTO3003 > Management > Flashcards

Management Flashcards

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1
Q

Environmental Risk factors for myopia:

A

Low light exposure (dopamine theory)
Low outdoor time <2h/d
Increased near work >45min at 20cm
Urbanisation vs Rural
Increased educational activity

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2
Q

Hx poor distance vision:

A

Onset: acute indicates inflammation
Describe symptoms: headaches/squinting/glare
Medical history: LEE / medications
Family history: myopia
Ocular discomfort: uveitis/ciliary spasm

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2
Q

Preliminary/screening tests:

A

D/N VA
Cover test
NPC
Accommodative amplitude (if needed)
Stereoacuity (if needed)
Amsler grid (if needed)
Color vision (young males)
Confrontation of VF (dim/light)
Pupil testing
Motility

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2
Q

Myopia visual impairment risks:

A

Greater risk with high myopia (>6D)
Retinal detachment/hole/tear
Peripapillary atrophy (atrophy near ON)
Lattice degeneration (pigmented retinal thinning)
Tilted insertion of OD
Tigroid fundus (tessellated colouration from RPE thinning)
Lacquer cracks (break in bruchs membrane)
Fuchs’ spot at macula
Pavingstone degeneration (chorioretinal atrophy)
Posterior staphyloma (scleral stretching)
Loss of choroidal circulation > CNV

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2
Q

Assessing presbyopia:

A

VA w/pinhole
Near add determined via:
Fused cross-cyl
Push up / Push down
Age expected/Hofstetter’s formula:
18-0.3(age) = expected amplitude

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2
Q

Hyperopia management:

A

Delay treatment: educate young asymptomatic adults
Partial correction: young Px with symptoms
Full correction w/cycloplegic refraction: child with strabismus

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2
Q

MF soft CLs on myopia control:

A

Plus power on periphery corrects hyperopic defocus
Misight lenses have 55% reduction in myopia progression
(greater add power > better reduction / worse vision)

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2
Q

Assessing myopia:

A

VA w/pinhole (expect refractive correction)
NPC / near VA (greater)
Auto-refraction
Refraction/subjective
Fundoscopy w/OCT (myopic retinopathies)

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2
Q

Assessing Hyperopia:

A

VA w/pinhole (expect refractive correction)
NPC / Near VA (lesser)
Auto-refraction
Cycloplegic subjective/refraction
Fundoscopy w/OCT (crowded ON)

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2
Q

Assessing astigmatism:

A

VA w/pinhole (expect refractive correction)
Auto-refraction
Refraction/subjective (dots/clock dial)
Keratectomy/Topography

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2
Q

OrthoK:

A

Hard lens forming neg-pressure on cornea overnight > thickens epithelium in mid periphery (vise-versa central epith) > myopic correction at macula / hyperopic correction at periphery
ROMEO / HM-PRO studies > 50% myopic reduction

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2
Q

Stable Myopia correction:

A

SV specs/CLs
OrthoK
Surgical correction (flatten cornea):
PRK/LASIK/LASEK/SMILE
Clear lens extraction / replacement

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2
Q

Stellest/DIMS/myosmart:

A

Lenslets in peripheral lens (<>9mm optical zone) reduces hyperopic defocus
Reduces myopic progression (in dioptres) by 50%
May be combined with atropine if significant progression

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2
Q

Required HT for cataracts:

A

Onset of vision change: sudden (trauma), range from 4 weeks (PSC), gradual (nuc.)
Ocular hist. (refractive/disease/amblyopia/surj./trauma)
Systemic health: (coronary art./cerebrovascular disease / hypertension / diabetes m. / dementia/arrhythmias/ chronic obstructive pulmonary disease) *conditions on supine position difficulty
Medications: a-antagonists (tamsulosin hydrochloride) lead to surj. Complications (floppy iris syndrome)
Allergies: anaesthetics/anti-inflammatories/antibiotics

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3
Q

HT for visual effect of cataracts:

A

Reading/distance
Facial recognition
TV watching
Bright/dark
Glare
Day/night driving
Moving in unfamiliar places
Using steps
Employment/housework
Hobbies

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3
Q

Myopia management stats:

A

4 main options with ~40% myopia slowing
Atropine 0.05%
OrthoK
MF soft CLs
DIMS/Stellest lenses

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3
Q

Atropine:

A

Muscarinic antagonist for M4 scleral receptor
Causes photophobia, accomodation loss, and rebound on cessation

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3
Q

Cataract general health risk factors:

A

DM, HT, coronary disease
Smoking, alcohol, obesity, poor nutrition
Corticosteroids, alpha-antagonists (tamsulosin hydrochloride)
Uveitis, eye trauma

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3
Q

Cataract comorbidities:

A

AMD/diabetic retinopathy: lesser VA improvement, Sx increases disease progression from inflammation
Fuch’s endothelial dystrophy: Sx progresses endo loss
Marfan’s syndrome: Sx may damage weakened zonules

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3
Q

Visual assessment in cataracts:

A

VA 1/pinhole: dist/near
Contrast sensitivity
Contrast sensitivity under glare (^loss of 0.35 logCS units is significant)
Colour vision (^3.0 LOCS III causes tritan)
Slit lamp: retroillumination LOSCI3, comorbidities (glauc)
Tonometry > DFE: comorbidities (AMD)
Pupils: RAPD / compare post-op

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3
Q

LOSC III grading:

A

Lens opacities classification system
NO: opalescence 0-6
NC: brunescence 0-6
C: cortical 0-5
P: posterior 0-6

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3
Q

Pelli-Robson contrast sensitivity chart:

A

Most common contrast test:
16 letter triplets (4.9cm high) in decreasing contrast by 0.15 Log CS units (first triplet of 0 Log CS)
0.05 Log CS score for each letter after first triplet
Px 20-50y should have 1.80 Log CS with each eye, older Px should have min 1.65 Log CS (Binocular score should be 0.15 greater)

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3
Q

Cataract PC:

A

Dist/near vision loss
Hazy/cloudy
Glare
Poor night vision
Contrast loss
Monocular diplopia
Shadowing

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4
Q

Clinical response to cataract:

A
  1. Establish visual disability (effect on life)
    1. Determine effect (glare/blur/colour)
    2. Diagnose LOSCI3
    3. Consider comobities (degree of disability attributed to cataract)
    4. Assess Sx benefit
    5. Obtain informed consent
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4
Causes of EDE:
MGD Infrequent blink Environment Ectropion / lagopthalmos CLs via lipid layer loss Mass lesions Vit A def. Defective mucins (infection)
4
Complications of cat. Sx:
1/200 VA loss 50% PSO by 3y (epith. Lens reminants) Dislocated IOL Rupture of capsule Dislocation of capsule (weak zonules) Suprachoroidal hemorrhage ^IOP Cystoid macular oedema (^prostaglandins > vessel leak) Retinal detachment (^with myopia) Endophthalmitis (+/- infectious) > blindness 0.04-0.4% by 6w
4
Cataracts review:
PSC review 6mo Nuclear review 12mo Return if notable change Refer to wait list if severe cataract or Px need to drive
5
Education on cataracts:
Sx. Improves QoL Cat will progress Nothing is lost from defferal Specs needed after (6 weeks) Opthal initial and 2 follow-up appt. Sx. Needs 2 operations on 2 days Anti inflammatory/microbial drops Public is free (1-2years) 20min surgery under local anasthesia (blurred) Unlikely complications
5
Causes of ADDE:
Sjrogren's syndrome (autoimmune against exocrine glands) Lacrimal gland dysfunction: Primary (age/genetics) or secondary (AIDS/Lymphoma) Lacrimal gland duct obstruction Alteration in stimulation (reflex block)
6
Types of MGD:
Primary (age/acne): increased bacterial lipases > meibum cleavage > fatty acid formation > increased melting point > hardening Secondary: diseases Cicatrical: hyposecretion from damage / steven-johnson syndrome / allergies
6
HT for presenting with dry eye:
Onset/duration: acute/chronic Symptom description: itch/FBS Triggering factors: AC/stimulants Medications: anti-histamines Medical conditions: Sjrogrens CLs/screen use
6
Diagnostic tests for DED
Tear stability (TBUT / osmolarity) Tear production (Schirmers / meniscus) Ocular surface (staining / ocular surface index) DED questionaire Osmolarity (>317mOsm/L) Phenol red (pH dye on string like schirmers) Lactoferrin test (lacrimal Gland production) Meibometry Impression cytology (goblet population)
7
Schirmer test:
5mm fold in Whatman filter inserted under lower lid (temporal side), don’t touch cornea/lash Px closes eyes over filter Remove paper after 5min <10mm without anesthesia / <6 with ana. Indicates abnormal
7
TFBUT:
NaFl instilled with Wratten #12 cobalt filter lens Px blinks before holding eyes open Timed appearance of black spots <10s abnormal, repeated breakup in given area indicates localized surface abnormality
7
Sodium Fluroescein function:
NaFl peak absorption at 493nm (blue), emits 520(green), instilled via strip (1% drop), viewed via wratten #12 (yellow-green) filter Hydrophilic (doesn't pass lipid bilayer epithelium or tight junctions), pools in corneal/conj. Areas of cell loss
7
Goals of DED management:
Eliminate exacerbating factors Lubricate ocular surface Minimize exposure Restore normal osmolarity Prevent inflammatory mediator/enzyme production Improve film stability
8
Step 3 DEWS management:
Autologous serum drops Therapeutus CLs (bandage)
8
Step 1 DEWS management:
Education Environment change Modification of topical medications Ocular lubricants Lid hygiene / warm compress
9
Step 2 DEWS management:
Non-pres lubricants Tea tree oil(Demodex) Punctal occlusion/moisture chamber Overnight ointment Lipiflow Short term FML
10
Blepharitis management:
Ant. > lid scrubs decrease bac. Load or 1/3 shampoo Pos. > warm compress + massage > melts meibum caps and expresses
10
Punctal occlusion:
Temporary plugs: dissolve in 2w Prolonged: removed in 6m (risks granuloma) Permenant occlusion: opthal for cautery
11
Anti-inflammatory treatment of DED:
Fluromethalone alcohol/acetate (FML/Flarex): 0.1% qid > 1week with lubricants Topical ciclosporin (cequa/ikervis): 0.05% bid for ADDE, reduces T-cell inflammation (requires oxford grading scale = 4) Topical lifitegrast (Xiidra 5%): lymphocyte function-associated antigen (LFA-1) antagonist, blocks LFA-1 on lymphocytes from intercellular adhesion molecule-1 (ICAM-1) on epith.
12
Uncommon DED treatments:
Manuka honey Systemic tetracyclines: alters meibum for rosacea/bleph. Omega 3 fatty acid supp.: decreases inflammation systematically CLs: occlusive GP scleral CLs provide saline reservoir Lacrisert: plastic insert placed in lower lid to hold artificial tears Palpebral tarsorrhaphy: stich lids closer together
12
Anisocoria Hx:
Symptoms: droopy lids, double vision, headache Onset: acute/traumatic General health: DM/HT Medications: tamulosin / apraclonidine (glauc)
13
PERRLA examination (first test):
Pupils Equal Round Reactive to Light (direct/consensual) and Accommodative 1. Direct response: light activates ipsilateral EW > ipsilateral constriction 2. Consensual: light activates ipsilateral EW > contralateral EW activation > contraction Accommodative: Near response triad > visual cortex / pupillomotor Centre in midbrain response
14
RAPD examination (second test):
Swinging flash test for Relative Afferent Pupil Defect. No RAPD: equal constriction W/O radiation excluding Hippus Mild: affected pupil constricts and redilates Moderate: affected pupil does not change, then dilates Severe: immediate dilation of affected pupil Lack of consensual response is not RAPD, only examine pupil with light shown on it
15
Clinical tests for anisocoria:
VA w/pinhole IOP: ^AACG / low in horners Motility: CN3 Ptosis: horner/CN3 Slit lamp: adies/injury/AACG Fundoscopy: DM/HT > CN3 Pupil assessment
15
Assessing anisocoria greater in light:
Greater in light > parasym. Loss > CN3 palsy / adies 0.1% pilocarpine > great constriction of affect pupil in early adies (<2w) from Ach upregulation 1% pilocarpine > constriction of CN3 palsy Faliure to constrict > pharmacological/atrophic mydriasis
16
Assessing anisocoria greater in dark:
Greater in dark > sym. Loss > horners/aberrant regen (CN3/adies) 0.5% apreclonidine > pupil dilation of affected eye. Requires 1w post onset for a1 upregulation 1% hydroxyamphetamine > dilation of affected eye if 1/2 order neuron lesion (release of 3rd neuron noradrenaline)
16
Red eye Hx:
Onset: acute/chronic Uni/bilateral: allergic Constant/intermittant: causative Pain description: itch Vision affect: corneal Discharge type: water/mucoid Light sensitivity: corneal Previous episodes: viral Risk factors: CLs, allergies, trauma
17
Types of discharge in conjunctivitis:
Watery (viral/acute allergic): serous exudate / tears Mucoid (chronic allergic / DED): mucoid from inflamed goblet cell Mucopurulent (chlamydial / bacterial): mucoid and pus (leukocytes) Purulent (gonococcal): pus
18
Red eye clinical tests:
VA w/pinhole: Corneal involved Motility: orbital cellulitis Pupils: AACG/Uveitis (synechiae) Tonometry: AACG Slit lamp: - Lids: Bleph/Trachiasis - Conj: papillae/follicles, hyperemia, discharge, membranes - Cornea: infiltrates AC: flare cells/hypopyon
18
Fungal keratitis treatment:
Ophthal referal Topical natamycin 5% per 30min /24h > per hour / 24h > qid for months Paired BS antibiotics prevent co-infection Cycloplegics to reduce ciliary spasm Never steroids (increase fungal replication)
19
Chronic bacterial conjunctivitis management:
Lid hygiene regime Chloramphenicol .5% qid 1w
19
Acute bacterial conjuntivitis management:
Self limiting (3w) Chloramphenicol .5% qid 1w to slightly reduce symptoms
19
Hyperacute bacterial conjuntivitis management:
GP referral for systemic tetracycline/erythromycin Untreated > cornea ulceration > endophthalmitis
19
Trachoma treatment:
Initial infection > self limiting Recurrent > single dose of azithromycin 20mg/kg up to 1g
19
Management of CL hypoxia:
Discontinuation of CLs until corneal oedema/surface is healed Lubricating drops for symptoms / healing Refit with higher Dk/t lenses / change CL regieme
19
EKC management:
Self limiting 1-3w. Cold compress / lubricants (comfort) Topical cortico. (flarex 0.1% qid) for corneal subepithelial infiltrates
19
VKC management:
Topical lubricants w/systemic anti-histamines Topical anti-histamine Levocabastine 0.05% QID mast cell stabilliser Lodoxamide0.1% QID Cortico. If severe Usually resolves after 50 years of age
20
SAC/PAC management:
Topical lubricants w/systemic anti-histamines Topical anti-histamine/mast cell stabilliser (zaditen) if severe
20
GPC symptoms and management:
Itching, hyperemia, sup. And inf. Tarsal papillae, mucoid Secondary cases can have increased mucoid/debris on CL w/loss of CL tolerance (symptoms worse following removal) * Avoid allergen, topical anti histamines/mast cell stabilisers/steroids/NSAIDs Secondary > remove stimulus, change cleaning regime, topical treatment (no steroids)/
20
AKC management:
Topical lubricants w/systemic anti-histamines Topical anti-histamine/mast cell stabilliser (zaditen) Cortico. If severe
21
Signs of keratits:
Hyperemia: prostaglandins Corneal oedema: prostaglandin > endothelial pump dysf. Discharge: watery(CN 5)/mucoid(bacterial) Pain: severe/increasing (infection) Epithelial defect: immune infiltrate/epith. Apoptosis AC reaction: hypopyon(infective) / inflammatory mediators (sterile)
21
CL keratopathy staining:
Scattered dots: Dot toxicity Superior (epith. Arcuate) lesion: tight lid hyopxia (SEALs) Diffuse spread: CL overwear 3/9 'oclock: RGP poor size
22
Management of bacterial keratitis:
Fluoroquinolone mono w/ciprofloxacin ointment 0.3% Q10m for first hour > qhour for 24h > review > qhour for 24h > q2hour Unresponsive/complex > microbe culture > dual therapy
22
Clinical testing for keratitis:
VA w/pinhole Pupils: sluggish response Slit lamp: conj. Hyperemia/corneal defect/AC response Tonometry
23
Acanthamoeba treatment:
Cease CLs and see ophthal. Cocktail of polyhexamethylene biguanide (PHMB) 0.02% with brolene 0.15% tapered from hourly>quaterly from 2-6 months FML contradicted until infection is controlled
24
HSK treatment:
Self limiting in 3w Live virus (dendritic/geographic): Topical aciclovir 3% 5/d for 10d Assisted with topical lubricants AC reaction can be assisted with cycloplegics If corneal toxicity at risk > oral acyclovir 400mg 5/d for 10d w/specialist refferal Metaherpetic / neuroprophic: Topical lubricants per hour
25
HZO symptoms and treatment:
Punctate epith. Keratitis Skin rash (nose) Aciclovir 800mg 5/day for 10d
25
GPC management:
Removal of stimulus (CLs) for 1 month > monitor Severe cases > topical mast cell-stabiliasers/anti-histamines If returning to CLs change cleaning solution/regieme, decrease wear time
26
Management of CL related toxic/allergic conjuntivitis:
Immediate CL cessation Frequent non-preserved topical lubricants Refit with daily CLs and non-preservative cleaning agent (hydrogen peroxide)
26
Management of 3/9' staining:
Px education on correct wear and reducing forceful blinking Topical lubricants reduce peripheral desiccation Refit CLs with thinner edges / better diameter
26
CLPU/CNPU management:
Immediate cessation of CLs Sterile lesion doesnt need therapeutic management > 24h BS antibiotic (fluroquinolone Ciprofloxacin) if too similar to bac keratitis or disrupted epith. w/infiltrates
26
Management of CL associated dry eye:
Lubricants and DED management (MGD) Refit with higher Dk/t lenses / change CL regieme
26
Tight lens syndrome management:
Immediate cessation of CLs Topical lubricant aid healing Chlorsig if epithelium disturbed Refit CLs with RGP / change regieme Frequent lubricants when resuming CLs for hydration
26
CLARE management:
Immediate CL cessation > self resolves by 1w No therapeutic management required as is sterile inflammation > 48h BS antibiotic (fluroquinolone Ciprofloxacin) if too similar to bac keratits or disrupted epith. w/infiltrates
27
Viral keratits clinical testing:
VA w/pinhole Slit lamp: vessicles, corneal staining, infiltrates, AC Corneal sensitivity Pupils: sluggish Fundoscopy Tonometry Scrape: debribe/culture
27
HSK dendritic ulcer management:
Self limiting 3w Review daily Treatment initiated to minimise scarring 3% aciclovir ointment 5/d for 2w(or 3d post re-epithelialisation) Cycloplegic for pain relief / ciliary spasm (when AC related) Unresponsive > scrape/culture Lack of re-repithelisation > toxicity/neurotrophic keratophy Oral acyclovir 400mg 5/d for 10d to avoid epithelial toxicity (GP ref)
28
HSK geographic ulcer management:
Aciclovir 3% 5/d until re-epithelilised Monitor for toxicity /co-infection signs > oral aciclovir / opthal ref Lack of re-repithelisation > toxicity/neurotrophic keratophy Oral acyclovir 400mg 5/d for 10d to avoid epithelial toxicity (GP ref)
29
Metaherpectic / neurotrophic ulcer management:
Opthal refferal w/ scrape / culture Non-preservative lubricants every hour
30
HSK deeper infection management:
Opthal refferal Epith. > 3% acyclovir ointment 5/d Stromal/AC > prednisolone Forte 1% per 2/h (monitor rapid viral replication) Trabeculitis/steroid response > b-blocker/a-agonist glaucoma medication After resolution oral acyclovir 400mg 3/d reduces recurrence by 50% (HEDS)
30
VZV reactivation management:
GP referal Oral acyclovir 800mg 5/d for 10d Should initiate within 72h > later will still be benificial
31
Classifications of TED:
[NO SPECS] No symptoms Only signs (lid retraction) Soft tissue involved Proptosis EOM involvement Corneal involvement Sight loss
31
Management of HZO:
Epithelial: oral aciclovir 800mg 5/d for 10d w/pres-free lubricants Nummular stromal: FML qid, 400mg aciclovir 3/d Disciform stromal / keratouveitis: Predneferin forte 1% per 2h, 400mg aciclovir 3/d, anti-glaucoma, cycloplegics
31
Hx graves disease:
Vision loss: mono/binocular, intermittant? Diplopia Eye strain/uncomfortable Dry/sore/gritty eyes Soft tissue swelling around eyes? Systemic changes: energy, mood, heat intolerance, rashes, palpatations
32
Sjogrens syndrome diagnosis:
Unanesthetised schirmers <5mm Rose bengal score >4 Salivary flow <1.5ml by 15m Auto-antibodies anti-Ro(SSA) or anti-La (SSB) Histopathology > high lymphocytes in mucosa Oral symptoms Ocular symptoms Classification requires 3/4 objective or 4/6 total
32
MG testing and management:
Unable to upgaze for 1min > EOM/LPS loss Ptosis improves after 2min icepack (acetylcholinesterase inhibition) Requires ophthal as is life threatening
33
TED clinical tests:
VA: DED/ON compression Pupils: RAPD ON compression Motility: limited / uncomfortable Red cap desaturation: ON compression Slit lamp: Blink/lagopthalmos, SLK, NaFl asses exposure keratopathy Exopthalmometry Fundoscopy: ON assessment VFT: ON compression
34
Quantifying proptosis:
Exophthalmometer measures ent. Protrusion from orbit Ruler placed on lateral orbit margin 21-23mm mild, 24-27 moderate, >28 severe
34
Sjogrens syndrome managment:
Follows DEWS2 Manage symptoms Lubricant gels/ointment, punctal plugs Therapeutic ciclosporin/liftegrast/steroids Immunosuppressive therapy
34
ERM management:
Mild (<6/12): monitor for spontaneous ERM seperation Symptomatic / (>6/12): epiretinal peel w/vitrectomy Trypan blue stain 0.15%, silicon oil/gas replacement 75% ^VA, 25% unchanged, 2% VA loss, 75% cataract in 2y ERM can regrow
35
TED management:
Opthal refferal AND PERSCRIBE PRISM LENSES Topical lubericants, anti-inflammatories Nocturnal lid taping (lagopthalmos) Systemic glucocorticoids 60mg/d (reduce ON compression) Surgical orbit decompression, correction of fibrotic muscles
35
CSR management:
Self resolves 95% in few months *rarely retains slight metamorphopsia Change lifestyle Chronic(5%)/recurrent(40%) require photodynamic therapy or anti-VEGF
36
AMD HT:
Onset: acute/chronic Location: central/peripheral Uni/Bilateral: asymmetrical Progression: worsening QOL impact: work/hobbies LEE Risk factors: FOH, Smoker, HT, Cholesterol Headaches, peripheral neuropathy (rule out other causes of sudden vision loss)
36
Managing macula hole:
VA Macula assessment on fundoscopy Amsler grid > enlarged central spot / central metamorphopsia/scotoma OCT Regular monitoring 3-12mo > vitrectomy
36
HT maculopathies:
Mono/binocular Duration/progression: ERM/mac hole slow (years), CSCR fast (days) Metamorphosia: describe wriggly/wine glass Change of colour in affected area: CSCR Impact/severity: near/far tasks Systemic health/medications: DM/HT POH: CSCR recurrance FOH: AMD/Bests disease
36
Clinical test for maculopathies:
VA: imapct? Record for future comparisons Refraction/near ADD: hyperopic shift CSCR Slit lamp: lenticular changes, angles IOP > DFE: extent of pathology Amsler grid: describe visual defect / monitor OCT
37
Amsler grid:
Qualitative 10(deg) in place of 10-2 Screens mac. Oedema, drusen, CNV, hole/traction Viewed 30cm, each 5mm square subtends 1(deg) Note missing area (scotoma), or warping
38
FFA tools:
Sodium fluroescein: water soluble dye, peak excitation 490nm (blue), emits 520nm (yellow/green) Yellow/green filter (530nm) blocks blue reflection 80% dye binds serum protein (unbound > renal/hepatic met. Removed by 36h)
39
AMD clinical tests:
VA: change/progression Refraction: can VA improve Pupils: severe asymmetrical > RAPD Slit lamp: Ant. Examination Tonometry > DFE: drusen size, RPE change, GA, CNV OCT/OCT-A: type/severity, progression
39
Dry AMD treatment:
Monitor early stages > OCT, amsler, follow-ups Px education AREDS based "macu-vision plus" supps. Cease smoking, HT/cholesterol control, BMI reduction Refer to royal society of the blind
40
AREDs supplements:
Vit C 500mg, Vit E 400UI, zinc 80mg, Lutin 10mg, zeaxanthin 2mg
40
Exudative AMD treatment:
Anti-VEGF is standard Photodynamic/photocoagulation damage retina even with laser activated drugs
41
Bevacizumab:
Monoclonal antibody against VEGF-A, originally systemic treatment No significant difference in clinical efficiancy Australia Lucentis is cheaper now (under PBS)
41
Electrophysiological testing:
Evaluate RPE / retina function International Society for Clinical Electrophysiology of Vision developed guide for: Full-field/Pattern/Multifocal electroretinogram (ERG/PERG/mfERG) Electrooculogram (EOG) Cortical-derived visual evoked potential (VEP)
42
RP clinical tests:
VA Refraction and BCVA Slit lamp: associated findings (cataracts) Tonometry > DFE OCT: macula structure VFT/Amsler: Macula assesment 30-2 VFT: peripheral assesment
42
RP management:
Ophthal reff. > electrophysiological/genetic testing Low Vision Service reff. > Royal society of the blind > visual aids (service dogs, counselling, employment)
43
Retinal dystrophy management:
Ophthal refferal > Electrooculography / Electroretinography / gene testing Genetic counselling (family) Low vision aids (dogs) Gene therapy for RPE65 can improve prognosis

OPTO3003 (18 decks)

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