Refractive Errors, Glaucoma and Cataracts

Question 1

Refractive errors include

Answer 1

Myopia
Hyperopia
Astigmatism
Presbyopia

Question 2

Myopia is

Answer 2

near sightedness

Question 3

Hyperopia is

Answer 3

Farsightedness

Question 4

Astigmatism is

Answer 4

distorted vision at all distances

Question 5

Presbyopia is

Answer 5

loss of ability to focus up close (reading), usually 40-50 yo

Question 6

Point of focus is in front of retina: cornea too steeply curved, axial length of the eye too long or both
distant objects are blurred but near objects are seen clearly =

Answer 6

Myopia

Question 7

to correct myopia you need

Answer 7

a concave (minus) lens

Question 8

Point of focus is behind retina, cornea too flatly curved, axial length too short or both
in adults both near and distant objects are blurred

Answer 8

Hyperopia

Question 9

To correct hyperopia you will need

Answer 9

a convex (plus) lens

Question 10

non-spherical (variable) curvature of cornea or lens causes light rays of different orientations to focus at different points

Answer 10

astigmatism

Question 11

To correct astigmatism you need

Answer 11

a cylindrical lens

Question 12

Loss of the lens’ ability to change shape to focus on near objects due to aging
typically becomes noticeable upon reaching early-mid 40s

Answer 12

Presbyopia

Question 13

To correct Presbyopia you need

Answer 13

a convex (plus) lens used for correction when viewing near objects, lenses may be supplied as separate glasses or built into a lens as bifocals or variable focus lenses

Question 14

Treatment of refractive errors

Answer 14

eyeglasses
contact lenses
refractive surgery

Question 15

primary sx of refractive errors is

Answer 15

blurred vision for distant/ near or both objects
HA
excessive staring - eye irritation, itching, visual fatigue, FB sensation, redness
Perceived imbalance, dizziness, stumbling

Question 16

Amblyopia means

Answer 16

lazy eye

Question 17

functional reduction in visual acuity of an eye caused by disuse during visual development - development takes place in first 3yrs of life but not complete until 8 yo
severe loss of vision can occur in affected eye if not detected and treated before 8 yo

Answer 17

amblyopia

Question 18

Treatment of amblyopia

Answer 18

eyeglasses or contact lenses
cataract removal
patching
atropine drops
treatment of strabismus if present

Question 19

Strabismus is

Answer 19

misalignment of eyes resulting in different retinal images being sent to visual cortex

Question 20

most common cause of irreversible central vision loss in older pts

Answer 20

AMD - age-related macular degeneration

Question 21

Two different forms of AMD

Answer 21

dry (all AMD starts as dry form) - nonexudative or atrophic
wet - exudative or neovascular

Question 22

Treatment of AMD

Answer 22

dietary supplements, intravitreal injection of antivascular endothelial growth factor drugs, laser photocoagulation, photodynamic, low-vision devices

Question 23

causes changes of retinal pigment epithelium, typically visible as dark pinpoint areas
accumulation of waste products from rods and cones results in drusen, which appear as yellow spots
no elevated macular scar, edema, hemorrhage or exudation

Answer 23

Dry AMD

Question 24

new abnormal blood vessels develop under the reina, choroidal neovascularization
localized macular edema or hemorrhage may elevate an area of the macula or cause a localized retinal pigment epithelial detachment

Answer 24

Wet AMD

Question 25

Wet AMD - Untreated neovascularization will cause

Answer 25

a disciform scar under the macula

Question 26

________ usually occurs late and can become severe in Dry AMD

Answer 26

central blind spots (scotomas)

Question 27

Dry AMD sxs are usually

Answer 27

bilateral

Question 28

Wet AMD sxs are usually

Answer 28

unilateral - affects one eye at a time usually

Question 29

Exams for wet AMD

Answer 29

color fundus photography = wet AMD fluorescein angiography = wet AMD

Question 30

Fundoscopic exam will dx both

Answer 30

wet and dry AMD

Question 31

Treatment of dry AMD

Answer 31

no way to reverse damage reduce risk of wet AMD taking supplements, reduce CV risk factors (eat foods high in Omega 3 fatty acids and dark green leafy vegetables)

Question 32

Treatment of wet AMD

Answer 32

daily nutritional supplements as recommended for dry AMD intravitreal injection of anti-vascular endothelial growth factor thermal laser photocoagulation photodynamic therapy corticosteroids

Question 33

clouding of the lens (looking through a steamed window) - leading cause of blindness worldwide, leading cause of vision loss in US

Answer 33

Cataracts

Question 34

Main sx of Cataracts

Answer 34

gradual, painless vision blurring

Question 35

Treatment of Cataracts

Answer 35

surgical removal and placement of an intraocular lens

Question 36

_____ use by women after menopause may be protective but should not be used solely for this purpose

Answer 36

estrogen

Question 37

early sx of cataracts

Answer 37

loss of contrast, glare (halos and starburst around lights), needing more light to see well, problems distinguishing dark blue from black

Question 38

Treatment of Cataracts

Answer 38

frequent refractions and corrective lens prescription changes may help maintain useful vision during cataract development surgical removal of the cataract placement of intraocular lens - if lens is not implanted, contact lenses or thick glasses are needed to correct

Question 39

Cataracts - indications for surgery include

Answer 39

best vision with glasses is worse than 20-40 pt reports that vision is limiting (preventing ADLs) there is no advantage to removing a cataract early

Question 40

Cataracts - Post-op treatment

Answer 40

tapering schedule of topical abx and topical steroids for up to 4 wks abx may instead be injected into eye at end of surgery pts wear eye shield while sleeping and should avoid valsalva maneuver, heavy lifting, excessive forward bending, eye rubbing for several wks

Question 41

2nd most common cause of blindness worldwide and 2nd most common cause of blindness in US

Answer 41

Glaucoma

Question 42

Most common type of glaucoma in the US is

Answer 42

primary, open-angle glaucoma

Question 43

an acquired loss of retinal ganglion cells and axons within the optic nerve (optic neuropathy), that results in a characteristic optic nerve head appearance and corresponding progressive loss of vision increase in IOP

Answer 43

Glaucoma

Question 44

associated with physically obstructed anterior chamber angle, chronic or acute sx - severe ocular pain and redness, decreased vision, colored halos around lights, HA, nausea, vomiting IOP is elevated

Answer 44

angle - closure glaucoma

Question 45

Angle - closure glaucoma pathophysiology

Answer 45

pressure from continued secretion of aqueous into posterior chamber by ciliary body pushes peripheral iris anteriorly closure blocks aqueous outflow, resulting in rapid and severe elevation of intraocular pressure

Question 46

What are the 5 supplements recommended for AMD treatment

Answer 46

Zinc Copper Vit C Vit E Lutein/zeaxanthin (or beta carotene or vit a)

Question 47

acute angle - closure glaucoma treatment

Answer 47

homatropine or systemic meds with potential to dilate pupils

Question 48

if episode of pupillary block resolves spontaneously after several hours, usually after sleeping supine

Answer 48

intermittent angle - closure glaucoma

Question 49

if angle narrows slowly, allowing scarring between peripheral iris and trabecular meshwork, IOP elevation is slow

Answer 49

chronic angle-closure glaucoma

Question 50

mechanical obstruction due to coexisting condition, contraction of neovascular membrane or inflammatory scarring can pull iris into angle

Answer 50

secondary angle - closure

Question 51

Severe ocular pain and redness, decreased vision, colored halos around lights, HA, nausea, vomiting systemic complaints may be so severe that misdiagnosed as neurologic or gastrointestinal problem

Answer 51

acute angle - closure glaucoma

Question 52

acute angle - closure treatment

Answer 52

laser peripheral iridotomy (LPI) opens another path to pass fluid from posterior to anterior chamber

Question 53

chronic angle - closure treatment

Answer 53

LPI

Question 54

syndrome of optic nerve damage associated with open anterior chamber angle and elevated or sometimes average IOP

Answer 54

primary open-angle glaucoma

Question 55

Treatment for primary open-angle glaucoma

Answer 55

topical drugs (prostaglandin analogs, beta blockers) open requires laser or incisional surgery to increase aqueous drainage

Question 56

Sx of open-angle glaucoma

Answer 56

result of visual field loss, both eyes usually affected but not usually equally

Question 57

Open-angle glaucoma pathophysiology

Answer 57

aqueous humor drainage in inadequate but production by ciliary body is normal

Question 58

Open-angle treatment

Answer 58

drug therapy, then laser therapy, then incisional surgery if target IOP is not/ cannot be met