Retina/Choroid/ Vitreous

Question 1

RTC for CSR?

Answer 1

1 month then monitor on monthly basis until stable, longer than 3-6 months = chronic CSR

Question 2

CSR on FA shows what shape?

Answer 2

Smoke stack

Question 3

Which condition is leakage from choriocapillaris into sub-retina, causing serous detachment of neuro sensory retina of macula? And appears as a “smoke stack on FA”

Answer 3

Central serous chorioretinopathy

Question 4

Demographic for CSR?

Answer 4

Middle age men (30-50 y.o) with high anxiety, stress, type A personalities.
* on systemic steroids
* HTN
* lupus

Question 5

Criteria for CSME?

Answer 5

1. Retina thickening within 500 microns of center of fovea
2. Hard exudates within 500 microns of center of fovea, if associated with adjacent retinal thickening
3. Thick retina greater than 1 DD, within 1DD of center of fovea

Question 6

4-2-1 Rule?

Answer 6

Severe vs Very severe non-proliferative DR
4 quadrants of intra-retinal hemes
2 quadrants of venous beading
1 quadrant of IRMA (intraretinal microvascular abnormalities)

Question 7

What conditions can cause falsely LOW A1c?

Answer 7

Hemolytic anemia
CKD, liver disease
Vitamin C and E
Pregnancy
Rheumatoid arthritis
Hypertriglyceridemia
** conditions that shortens lifespan of RBCs

Question 8

Cotton wool spots will be hyper or hypo under FA?

Answer 8

Hypo fluorescent

Question 9

Areas of neovascularization will be hyper or hypo on FA?

Answer 9

Hyper fluorescent

Question 10

Microaneurysms and areas of retinal edema will be hyper or hypo on FA?

Answer 10

Hyper fluorescent

Question 11

Which layers of the retina are supplied by the choriocapillaris?

Answer 11

Outer retina
RPE
PR
ELM
ONL
OPL

Question 12

Layer of retina supplied by both choroid and central retinal artery

Answer 12

Outer plexiform layer

Question 13

CSR tends to be associated with Type-A personalities and stress but it can also occur in? (5)

Answer 13

• Pregnancy
• HTN
• Steroid use
• Cushing Syndrome
• Lupus

Question 14

Which condition is most frequently observed in chorioretinal coloboma?

Answer 14

Microphthalmia
* abnormal small eye

Question 15

Which condition is most frequently observed in chorioretinal coloboma?

Answer 15

Microphthalmia

Question 16

Why is plaquenil toxic to the eyes?

Answer 16

It is an anti-malaria drug (melatropic medication)

prolonged use can cause it to concentrate in melanin-containing structures like the choroid and RPE

Question 17

In order to be classified as having Charles Bonnet Syndrome, a patient must have?

Answer 17

Intact cognition with no history of psychiatric disorders, neurological abnormalities, drug abuse, toxic, metabolic or infectious etiologies or dementia

Question 18

True or False
Patients with Charles Bonnet syndrome do not experience hallucinations that involve hearing or smell

Answer 18

True

Question 19

What’s a major difference between Charles Bonnet Syndrome and senile dementia?

Answer 19

In CBS patients are aware of the unreal nature of the hallucinations

Question 20

What ocular condition has the HIGHEST association with Charles Bonnet Syndrome?

Answer 20

AMD

Question 21

What is the most common type of visual hallucination in Charles Bonnet Syndrome?

Answer 21

Faces

Question 22

Talc retinopathy affects what type of patients?

Answer 22

Long term intravenous drug users

Question 23

Toxocariasis is caused by what organism?

Answer 23

Parasitic nematode called Toxocara canis
** think Canis = canines 🐶
** parasite found in dog feces

Question 24

Hollenhorst plaques are commonly located where on a retinal artery?

Answer 24

At the bifurcation of a retinal artery

Question 25

The most common source of a retinal embolism is?

Answer 25

Ulceration and release of material from atheromatous plaque of the carotid bifurcation

Question 26

What does cholesterol emboli look like?

Answer 26

Appear as bright, refractive golden yellow orange crystals

Question 27

Why does cholesterol emboli cause amaurosis fugax?

Answer 27

Cholesterol plaques are malleable, allows blood to flow through but may result in fleeting vision loss that last seconds/minutes due to temporary blockage of retinal artery

Question 28

Calcific emboli originate from?

Answer 28

Atheromatous plaques in the ascending aorta, carotid arteries or from calcified heart valves

Question 29

Which type of emboli is most dangerous, because it can cause permanent occlusion?

Answer 29

Calcific emboli (Look like single white plugs of material close to optic disc)

Question 30

Patients with s/s of retinal embolus must undergo what investigations? (5)

Answer 30

1. Pulse (to detect atrial fibrillation) 2. Blood pressure 3. Carotid evaluation (to detect bruit) 4. Electrocardiogram (EKG) 5. Blood testing (CBC, FBG, lipids and ESR)

Question 31

Management for Hollenhorst plaque

Answer 31

1. Report findings to PCP 2. Refer patient for vascular work up within 48-72 hours

Question 32

Indications for anterior chamber paracentesis

Answer 32

CRAO Acute glaucoma Uveitis or endophthalmitis

Question 33

Paracentesis

Answer 33

Penetrate corneal near limbus with a needle to allow outflow of aqueous from globe to relieve high IOP in emergencies or to obtain fluid samples for diagnosis

Question 34

Attenuation of RPE leading to loss of melanin granulates allows for increased what?

Answer 34

Visibility of underlying choroid aka window defect

Question 35

Inheritance pattern of gyrate atrophy

Answer 35

Autosomal recessive

Question 36

Tx for RPE window defect

Answer 36

Monitor annually * may enlarge as patient gets older but no Tx because will not cause vision loss

Question 37

What are the 3 types of RD?

Answer 37

- Tractional - Rhegmatogenous - Exudative

Question 38

What is the most common systemic disease associated with angioid streaks?

Answer 38

Pseudoxanthom elasticum * connective tissue disorder, elastin affected

Question 39

Gronblad-Strindberg syndrome

Answer 39

Pseudoxanthoma elasticum and angioid streaks

Question 40

Pathophysiology of angioid streaks

Answer 40

Small dehiscences (small openings) in collagenous and elastic portions of Bruch’s membrane

Question 41

2 fundus findings associated with angioid streaks

Answer 41

1. Peau d’orange 2. optic disc drusen *1. mottled fundus appearance, yellow, speckled pinpoint areas that look like a leopard skin-spotting

Question 42

6 conditions that can cause CNVM

Answer 42

CHBALA Choridal rupture Histoplasmosis Best disease AMD Lacquer cracks Angioid streaks

Question 43

Angioid streaks are associated with what systemic conditions (5)

Answer 43

PEPSI Pseudoxanthoma elasticum Ehler’s Danlos syndrome Paget’s Sickle cell Idiopathic

Question 44

Tx & management of Angioid streaks

Answer 44

Perform FA to check for CNVM If clear, close monitoring If CNVM present Tx with anti-VEGF if subfoveal

Question 45

CME formation following cataract surgery

Answer 45

Irvine Gass Syndrome * 6 weeks to 3 months post op

Question 46

Fluid accumulates in which layers of the retina in cystoid macular edema?

Answer 46

Outer plexiform layer and inner nuclear layer

Question 47

Chronic longstanding CME can lead to?

Answer 47

Lamellar macular hole (partial, hole doesn’t go through all layers of retina) * cystic spaces coalesce and progress to form macular hole

Question 48

On FA: small hyperfluorescent spots in early phase with flower-petal pattern of hyperfluorescence in late stage

Answer 48

cystoid macular edema

Question 49

On FA: well demarcated lacy hyperfluorescence in early phase with increasing leakage in late phase

Answer 49

Choroidal neovascular membrane

Question 50

On FA: smoke-stake appearance

Answer 50

Central serous retinopathy

Question 51

Which hereditary retinal disease is most commonly associated with CME?

Answer 51

Retinitis pigmentosa

Question 52

Tx of CME secondary to YAG cap following CE

Answer 52

* topical NSAID and topical steroids Example: 1 gtts ketorolac QID 1 gtts prednisolone acetate QID

Question 53

Detachment of neurosensory retina from RPE secondary to full thickness retinal break

Answer 53

RRD

Question 54

Detached retina will appear concave with a smooth surface

Answer 54

Tractional RD

Question 55

Tobacco dust seen in anterior vitreous is a sign for?

Answer 55

Rhegmatogenous retinal detachment

Question 56

IOP is lower in affected eye by 5mmHg compared to fellow eye in which type of RD?

Answer 56

RRD * if IOP extremely low, an associated choroidal detachment is suspected

Question 57

Talc can deposit in small blood vessels of which organs?

Answer 57

Lungs Liver Spleen Kidneys Lymph nodes * talc retinopathy in long term IV drug abuse with cocaine and heroin

Question 58

What additional tests should be ordered in a patient with talc retinopathy?

Answer 58

- Chest X-ray (pulmonary complications) - fluorescein angiography (evaluate for possible vasculature leakage or non-perfusion

Question 59

What retinal complications can arise from talc deposits?

Answer 59

Retinal ischemia * develop hemorrhages, CWS, peripheral neovascularization, vitreous hemorrhages and tractional RD

Question 60

Degenerative retinoschisis is between which layers of the retina?

Answer 60

outer plexiform layer and inner nuclear layer

Question 61

What is the visual prognosis of choroideremia?

Answer 61

Visual acuity will remain stable until later in life when it is expected to become significantly affected

Question 62

What is the most common initial symptom of patients with choroideremia?

Answer 62

Nyctalopia or night blindness

Question 63

Snail track degeneration is commonly located in which retinal quadrants?

Answer 63

ST and SN peripheral quadrants of myopic eyes

Question 64

What is the 2nd most common ocular opportunistic infection of AIDS patients?

Answer 64

PORN: progressive outer retinal necrosis * varicella zoster variant, very aggressive

Question 65

White without pressure is most commonly seen in which areas of the retina?

Answer 65

Inferior and temporal * located at the vitreous and ora serrata

Question 66

What is Central Serous Chorioretinopathy (CSR)?

Answer 66

CSR occurs as a result of fluid leaking from the choriocapillaris into the subretinal area, causing a serous detachment of the neurosensory retina. ## Footnote Occasionally, a detachment of the retinal pigment epithelium may also develop.

Question 67

What are the common demographics associated with CSR?

Answer 67

CSR typically occurs in middle-aged males with a type 'A' personality, experiencing high levels of emotional stress, increased cortisol levels, hypertension, or systemic lupus erythematosus. ## Footnote This condition is generally unilateral in presentation.

Question 68

List the symptoms of Central Serous Chorioretinopathy.

Answer 68

* Reduced visual acuity * Metamorphopsia (distortion of objects) * Abnormal color vision * Patients may be asymptomatic if the macular region is not involved.

Question 69

What clinical signs may indicate CSR? (Name at least 3)

Answer 69

* Loss of foveal reflex * Hyperopic shift * Potential relative scotoma * Distortion on Amsler grid testing * Hyperfluorescence in fluorescein angiography (smoke stack appearance) * Blister-like elevation of the neurosensory retina in posterior pole evaluation.

Question 70

True or False: CSR frequently requires intervention.

Answer 70

False ## Footnote CSR frequently spontaneously regresses within 6 months, and intervention is rarely required.

Question 71

What treatments are available for CSR?

Answer 71

* Photocoagulation * Photodynamic therapy ## Footnote These treatments are performed for patients experiencing profound levels of decreased acuity or blurred vision for prolonged periods of time, as long as the area is not within the foveal avascular zone.

Question 72

Fill in the blank: Argon laser photocoagulation or photodynamic therapy will decrease the _______ of CSR but will not alter the resultant visual outcome.

Answer 72

[recovery time]

Question 73

What is a potential result of fluorescein angiography in CSR?

Answer 73

hyperfluorescence in a smoke-stack formation. ## Footnote This finding is characteristic of CSR.

Question 74

RTC for CSR

Answer 74

Monthly until resolution

Question 75

What is the choroid?

Answer 75

A heavily pigmented and highly vascularized layer of the eye positioned interior to the sclera and exterior to the retinal tissue ## Footnote It is part of the uveal tract, which includes the iris, ciliary body, and choroid.

Question 76

What are the four layers of the choroid, listed from most external to most internal?

Answer 76

* Suprachoroid * Stroma (vessel layer) divided into Haller’s layer and then Sattler’s layer * Choriocapillaris * Bruch's membrane ## Footnote These layers play distinct roles in the structure and function of the choroid.

Question 77

What is the function of the suprachoroid?

Answer 77

Serves as a transition junction between the sclera and the choroid ## Footnote Comprised of 10-15 layers of collagen binding to the lamina fusca of the sclera.

Question 78

What types of cells are found in the suprachoroid?

Answer 78

* Melanocytes (produce melanin, pigment) * Fibroblasts (connective tissue) ## Footnote These cells contribute to the structure and pigmentation of the choroid.

Question 79

What constitutes the vessel layer of the choroid?

Answer 79

Haller's layer and Sattler's layer ## Footnote This layer primarily consists of blood vessels.

Question 80

What is Haller's layer?

Answer 80

The layer external to Sattler's layer containing larger blood vessels ## Footnote It plays a role in the vascular supply of the choroid. *part of the stroma of the choroid

Question 81

What is Sattler's layer?

Answer 81

The layer possessing smaller blood vessels in the choroid ## Footnote The diameter of the blood vessels decreases from the outer to the inner edge of the stroma in choroidal

Question 82

What causes the brown appearance of the stroma in the choroid?

Answer 82

Melanocytes present in the stroma ## Footnote These cells contribute to the pigmentation of this layer.

Question 83

What is the choriocapillaris?

Answer 83

A network of capillaries that maintain the outer retina ## Footnote The capillaries in this layer are larger than those in the rest of the body.

Question 84

What is unique about the capillaries in the choriocapillaris?

Answer 84

They allow the passage of several blood cells simultaneously ## Footnote This feature is important for the metabolic needs of the outer retina.

Question 85

True or False: The choriocapillaris contains melanocytes.

Answer 85

False ## Footnote The choriocapillaris does not contain melanocytes.

Question 86

Fill in the blank: The choroid is a common site for ocular _______ that may develop into melanomas.

Answer 86

nevi ## Footnote Routine examination of the choroid is warranted due to this risk.

Question 87

What is Bruch's membrane?

Answer 87

A thin, complex membrane located between the choriocapillaris of the choroid and the retinal pigment epithelium of the retina ## Footnote It is about 2 microns thick.

Question 88

List the five components of Bruch's membrane from outermost to innermost.

Answer 88

* Basement membrane of the choriocapillaris * Outer collagenous zone * Elastic layer * Inner collagenous zone * Basement membrane of the retinal pigment epithelium ## Footnote These layers play a role in the structural support of the retina.

Question 89

What is the thickness of Bruch's membrane?

Answer 89

About 2 microns thick ## Footnote This thinness is significant for its function and structure.

Question 90

True or False: Bruch's membrane is located between the sclera and the choroid.

Answer 90

False ## Footnote Bruch's membrane is located between the choriocapillaris of the choroid and the retinal pigment epithelium.

Question 91

What is the function of the outer collagenous zone in Bruch's membrane?

Answer 91

Provides structural support ## Footnote It is one of the five layers that contribute to the integrity of the membrane.

Question 92

Fill in the blank: The _______ is the layer of Bruch's membrane that is elastic.

Answer 92

[Elastic layer] ## Footnote This layer is important for the flexibility of Bruch's membrane.

Question 93

What layers are found in the choroid alongside Bruch's membrane?

Answer 93

* Haller's layer * Sattler's layer ## Footnote These layers are part of the vascular structure of the choroid.

Question 94

What is Leber congenital amaurosis?

Answer 94

A rod-cone disorder characterized by vision loss ## Footnote It may initially show a normal-appearing fundus.

Question 95

What ocular findings are associated with Leber congenital amaurosis by childhood?

Answer 95

* Narrowing of retinal blood vessels * optic disc pallor * pigmentary changes ## Footnote These findings can be observed during an ocular examination. * congenital retinal dystrophy, affects rods and cones, severe impairment in ability to convert light into electrical signals * ERG abnormal The Visual Cycle is a series of enzymatic reactions between the retinal pigment epithelium (RPE) and the neurosensory retina to metabolize dietary vitamin A into 11-cis retinal to generate photopigment. Without 11-cis retinal, the phototransduction cascade cannot be initialized; thus, visual neuronal signals are not propagated to the visual cortex. A dysfunctional mutation of any of the genes encoding for proteins that catalyze any of the series of enzymatic reactions to generate 11-cis retinal can block the Visual Cycle and lead to symptoms of LCA.

Question 96

What does ERG reveal in cases of Leber congenital amaurosis?

Answer 96

ERG is markedly abnormal or flat ## Footnote *reduced or absent electrical response from retina when stimulated by light. Reflecting impaired photoreceptor function

Question 97

What is the inheritance pattern of Leber congenital amaurosis?

Answer 97

Autosomal recessive ## Footnote This means that the disorder typically requires two copies of the mutated gene for manifestation.

Question 98

Which layer of the retina are flame-shaped hemorrhages?

Answer 98

Nerve fiber layer * seen in HTN retinopathy, CRVO

Question 99

What is disc edema?

Answer 99

Swelling of the optic disc often associated with retinal conditions ## Footnote It is frequently present in cases of non-ischemic central retinal vein occlusion.

Question 100

What is the most common cause of non-ischemic central retinal vein occlusion? (Pathophysiology)

Answer 100

Formation of a thrombus near or at the lamina cribrosa ## Footnote This thrombus compresses the central retinal vein, impeding blood flow return. Associated with HTN, coronary artery disease, diabetes, hyperlipidemia, POAG, smoking

Question 101

What symptoms do patients with non-ischemic CRVO typically report?

Answer 101

Acute, painless, unilateral loss of vision ## Footnote This symptom is a key indicator of the condition.

Question 102

What clinical signs are associated with non-ischemic CRVO?

Answer 102

1. Decreased VA > 20/200 2. Neovasc rare 3. Dot-blot hemorrhages 4. Flame-shaped hemorrhages 5. Disc and macular edema 6. Dilated and tortuous vessels * no APD * CWS rare * better prognosis than ischemic CRVO * lower risk for neovasc

Question 103

What is the visual acuity level typically seen in non-ischemic CRVO?

Answer 103

Generally better than 20/400 ## Footnote This indicates that while vision is impaired, it is not as severely affected as in ischemic cases.

Question 104

What is the typical age demographic for individuals affected by non-ischemic CRVO?

Answer 104

Majority are 65 years of age or older ## Footnote Age is a significant risk factor for this condition.

Question 105

What are common symptoms reported by patients with a full thickness macular hole?

Answer 105

Decreased vision centrally, possible scotoma, or metamorphopsia on the Amsler grid ## Footnote Flashes of light may also be experienced due to possible vitreo-retinal traction.

Question 106

At what age group are idiopathic macular holes most commonly observed?

Answer 106

Women aged between 60-80 years

Question 107

What is postulated to cause idiopathic macular holes?

Answer 107

Traction on the macular region by the vitreous

Question 108

What classification system describes idiopathic macular holes by clinical findings?

Answer 108

Gass classification system

Question 109

Describe Stage 1A of the Gass classification for idiopathic macular holes.

Answer 109

Difficult to detect clinically, marked by an intraretinal cyst, may appear as a small yellow spot in the center of the fovea, best observed with OCT

Question 110

What characterizes Stage 1B of idiopathic macular holes?

Answer 110

Appearance of a yellow ring along with a foveal detachment

Question 111

What defines Stage 2 of idiopathic macular holes?

Answer 111

Small foveal defects measuring less than 400 um in diameter * stage 2 always progresses to stage 3 * VA varies 20/50 to 20/400

Question 112

What is noted in Stage 3 of idiopathic macular holes?

Answer 112

Defects greater than 400 um with posterior vitreous still attached, holes surrounded by a cuff of edema, yellow deposits at the level of the RPE may be observed in the center of the hole

Question 113

What are the characteristics of Stage 4 idiopathic macular holes?

Answer 113

- Macular defects larger than 400 um - complete PVD - yellow deposits at the level of the RPE may be observed in the center of the hole - border of the hole may appear elevated

Question 114

What protozoa causes Toxoplasmosis?

Answer 114

Toxoplasma gondii ## Footnote T. gondii is commonly associated with improper handling of raw meat or cat fecal matter

Question 115

Who is particularly at risk for Toxoplasmosis and why?

Answer 115

Pregnant mothers ## Footnote An infection in the mother can potentially harm the unborn fetus

Question 116

What serious consequence can Toxoplasmosis lead to if enough retinal damage occurs?

Answer 116

Blindness ## Footnote Retinal damage can result from the infection

Question 117

What clinical appearance do old lesions of Toxoplasmosis have?

Answer 117

Circular areas of chorioretinal atrophy surrounded by pigmentation ## Footnote Areas of atrophy are generally stable

Question 118

What symptoms may patients with active retinitis from Toxoplasmosis report?

Answer 118

Floaters, blurry vision, photophobia ## Footnote Patients typically do not experience pain

Question 119

What is a characteristic observation in cases of active retinal Toxoplasmosis?

Answer 119

A yellow-white lesion next to an old chorioretinal scar ## Footnote This is typically associated with vitritis

Question 120

What may happen to the anterior chamber in active retinal Toxoplasmosis?

Answer 120

Vitritis may spill over into the anterior chamber ## Footnote Vitritis is inflammation of the vitreous body

Question 121

What additional problems may immunocompromised persons experience with Toxoplasmosis?

Answer 121

Encephalitis and chorioretinitis ## Footnote These patients may not display vitritis

Question 122

True or False: Healthy individuals are likely to become seriously ill from Toxoplasmosis.

Answer 122

False ## Footnote Toxoplasmosis rarely leads to illness in healthy individuals

Question 123

Fill in the blank: Toxoplasmosis is primarily associated with improper handling of _______ or _______.

Answer 123

raw meat or cat fecal matter ## Footnote These are common sources of T. gondii infection

Question 124

What organism causes presumed ocular histoplasmosis?

Answer 124

Histoplasma capsulatum ## Footnote This organism typically enters the body via inhalation into the lungs. * associated with bats * fungus

Question 125

In which geographical areas is presumed ocular histoplasmosis most prominent?

Answer 125

Ohio-Mississippi River valley region and southern United States ## Footnote These regions have higher incidences of the disease.

Question 126

What are the three ocular findings associated with retinitis from presumed ocular histoplasmosis?

Answer 126

* Histo spots * Peripapillary atrophy * Choroidal neovascular membrane ## Footnote Two of these findings must be present for diagnosis.

Question 127

What is required for a diagnosis of presumed ocular histoplasmosis?

Answer 127

Two of the three ocular findings must be present ## Footnote The findings include histo spots, peripapillary atrophy, and choroidal neovascular membrane.

Question 128

Do patients suffering from histoplasmosis manifest vitritis?

Answer 128

No ## Footnote Patients with histoplasmosis will never show signs of vitritis.

Question 129

What is the most frequently occurring intraocular tumor in children?

Answer 129

Retinoblastoma ## Footnote This condition is critical for early detection due to its high mortality rate.

Question 130

Are most cases of retinoblastoma sporadic or familial?

Answer 130

Most cases are sporadic ## Footnote Occasionally, the malignancy may be familial in origin.

Question 131

What percentage of retinoblastoma cases may be observed bilaterally?

Answer 131

30% ## Footnote The majority of cases present unilaterally.

Question 132

What clinical features are commonly observed in patients with retinoblastoma?

Answer 132

* Leukocoria * Strabismus * White retinal lesion * Iris neovascularization (in ~20% of cases) These features are crucial for clinical recognition

Question 133

Why is early detection and prompt treatment vital for retinoblastoma?

Answer 133

Due to the high mortality rate associated with this tumor ## Footnote Timely intervention can significantly impact patient outcomes.

Question 134

What additional testing should be included for patient taking plaquenil?

Answer 134

1. 10-2 VF (if Asian 24-2 or 30-2) 2. Multifocal ERG 3. Mac OCT 4. Ishihara color vision

Question 135

What additional testing should be included for patient taking plaquenil? (4)

Answer 135

1. 10-2 VF 2. Multifocal ERG 3. Mac OCT 4. Ishihara color vision *multifocal ERG is a diagnostic test that measures electrical activity in retina cells

Question 136

Ocular complications of lupus include?

Answer 136

CRVO BRVO CRAO BRAO Exudative retinal detachments Toxic maculopathies (secondary to plaquenil) * retinal diseases associated with lupus mimic T2DM and HTN

Question 137

What are the greatest risk factors for transformation of a choroidal nevus to a malignant choroidal nevus?

Answer 137

Thickness >2mm Fluid subretinal Orange pigment (lipofuscin) Symptoms (reduced VA) Location in posterior pole = proximity to optic disc * remember mnemonic: To Find Small Ocular Melanoma Do Imaging

Question 138

Are choroidal nevi acquired or congenital?

Answer 138

Congenital

Question 139

At what age does choroidal nevi usually become clinically apparent?

Answer 139

Puberty

Question 140

What are the characteristics of choroidal nevi?

Answer 140

Flat or minimally elevated, pigmented or amelanotic ## Footnote They usually measure between 1.5 to 5mm in diameter and less than 2mm thick.

Question 141

What may develop over time on choroidal nevi?

Answer 141

Overlying drusen

Question 142

What is the histopathological composition of a choroidal nevus?

Answer 142

Low-grade, spindle-shaped, ovoid or round melanocytes ## Footnote These melanocytes have varying amounts of cytoplasmic pigmentation.

Question 143

What is a statistical risk factor for the transformation of a choroidal nevus into a melanoma?

Answer 143

Tumor thickness greater than 2 mm ## Footnote Other factors include the presence of subretinal fluid, orange pigmentation, proximity to the optic disc, and the presence of symptoms.

Question 144

What percentage of nevi measuring 2.5 mm in thickness become melanomas per month?

Answer 144

Approximately 1%

Question 145

What increases the chance of transformation from choroidal nevus to melanoma?

Answer 145

Development of orange pigment on the surface of nevi

Question 146

Where on the retina are nevi more likely to become melanomas?

Answer 146

Towards the posterior portion of the eye (closer to the optic disc)

Question 147

What additional indicators may suggest a nevus is more likely to transform into melanoma? (FA, symptoms, visual field)

Answer 147

Hot spots on fluorescein angiography, decreased vision, or a visual field defect

Question 148

What do drusen indicate regarding choroidal nevi?

Answer 148

Chronicity and benignity ## Footnote Lesions with drusen rarely transform into melanomas.

Question 149

What occurs during the pre-maculopathy stage of hydroxychloroquine toxicity?

Answer 149

Visual acuities remain unaffected, but there is a noticeable loss of the foveal reflex. Granular changes within the macula may result in color vision changes and Amsler grid abnormalities. ## Footnote If the medication is discontinued at this time, the associated retinal changes are reversible.

Question 150

What happens if hydroxychloroquine is continued during the pre-maculopathy stage?

Answer 150

Early maculopathy occurs, linked to a decrease in visual acuity and RPE atrophy surrounding the fovea. ## Footnote Fluorescein angiography at this stage will reveal a window defect.

Question 151

What is the consequence of reaching the early maculopathy stage in hydroxychloroquine toxicity?

Answer 151

Retinal damage is not reversible upon cessation of the medication. ## Footnote This stage is marked by a decrease in visual acuity.

Question 152

What visual changes are noted as hydroxychloroquine toxicity progresses?

Answer 152

Moderate decrease in vision and a 'bull's eye' macular lesion is visible on fundus examination. ## Footnote This indicates progression to severe maculopathy.

Question 153

What characterizes the severe maculopathy stage in hydroxychloroquine toxicity?

Answer 153

Significant reduction in visual acuity and RPE atrophy adjacent to the fovea. ## Footnote This stage leads to more severe visual impairment.

Question 154

What are the features of end-stage maculopathy in hydroxychloroquine toxicity?

Answer 154

Very poor visual acuity, attenuation of arterioles, increased choroidal visibility due to RPE atrophy, and clumping of pigment in the retinal periphery. ## Footnote This stage represents the most advanced form of retinal damage.

Question 155

True or False: The retinal changes associated with hydroxychloroquine toxicity are always reversible.

Answer 155

False. ## Footnote Changes are reversible only if the medication is discontinued during the pre-maculopathy stage.

Question 156

Fill in the blank: Granular changes within the macula during the pre-maculopathy stage of plaquenil toxicity may result in _______.

Answer 156

color vision changes and Amsler grid abnormalities.

Question 157

What type of visual field defect frequently manifests in early stages of plaquenil toxicity?

Answer 157

Paracentral scotoma

Question 158

Which tests are MOST useful in the diagnosis and management of hydroxychloroquine retinopathy? (Select 2)

Answer 158

* Optical coherence tomography (OCT) * Multifocal electroretinogram (mERG) ## Footnote These tests help detect early signs of retinal damage, allowing for timely intervention.

Question 159

What is the key to maintaining visual integrity in patients with hydroxychloroquine retinopathy?

Answer 159

Early detection ## Footnote Early detection alerts clinicians to discontinue the medication before permanent retinal damage occurs.

Question 160

In later stages of hydroxychloroquine retinopathy, which retinal layers may show abnormalities?

Answer 160

* Parafoveal outer nuclear layer * Inner plexiform layer * External limiting membrane ## Footnote These layers can exhibit structural changes as the disease progresses.

Question 161

What sign associated with hydroxychloroquine toxicity can be observed on OCT?

Answer 161

Flying saucer sign ## Footnote This sign indicates preservation of outer retinal layers subfoveally with perifoveal loss.

Question 162

What is the purpose of the multifocal electroretinogram (mERG) in the context of retinal health?

Answer 162

To detect paracentral retinal damage ## Footnote mERG provides an objective measure of retinal function.

Question 163

What does fundus autofluorescence (FAF) identify in patients with hydroxychloroquine retinopathy?

Answer 163

Areas of retinal pigment epithelium (RPE) dysfunction ## Footnote FAF is useful for visualizing RPE health.

Question 164

What is candidiasis caused by?

Answer 164

Candidiasis is caused by a yeast fungus, Candida albicans.

Question 165

Where is Candida albicans frequently encountered in humans?

Answer 165

On the skin and in the digestive tract, mouth, and vagina.

Question 166

In which patients might retinal involvement occur due to candidiasis?

Answer 166

Immunocompromised patients, IV drug users, or those with long-term indwelling catheters.

Question 167

What symptoms might patients with retinal involvement from candidiasis notice?

Answer 167

Floaters and blurred vision unilaterally.

Question 168

How do lesions from retinal candidiasis appear?

Answer 168

As areas of small, white, round lesions with indistinct borders.

Question 169

What serious conditions may ensue if candidiasis is left untreated?

Answer 169

Endophthalmitis, retinal necrosis, and detachment.

Question 170

True or False: Candidiasis can only affect the skin.

Answer 170

False

Question 171

What are the clinical signs of an ischemic Central Retinal Vein Occlusion (CRVO)?

Answer 171

Multiple cotton wool spots, widespread retinal hemorrhages, dilated tortuous vessels, optic disc edema, macular and retinal edema, a relative afferent pupillary defect (APD), and poor visual acuity (usually 20/400 or worse) ## Footnote Ischemic CRVO indicates a more severe form of vein occlusion and often results in significant visual impairment.

Question 172

Signs for non-ischemic Central Retinal Vein Occlusion (CRVO)? List at least 2

Answer 172

- Dot-blot hemes and flame-shaped hemorrhages in all four quadrants - dilated and tortuous vessels - optic disc and macular edema *typically absent APD and cotton wool spots *generally better visual acuity than 20/400 ## Footnote Non-ischemic CRVO is usually less severe and may have a better prognosis than ischemic CRVO.

Question 173

What is the typical age demographic for individuals suffering from a CRVO?

Answer 173

65 years or older ## Footnote Age is a significant risk factor for CRVO, with older adults being more susceptible.

Question 174

Pathophysiology of arteritic anterior ischemic optic neuropathy (AION)?

Answer 174

Infarction of the prelaminar and laminar segment of the optic nerve ## Footnote AION is often associated with conditions like giant cell arteritis.

Question 175

What does CRAO stand for?

Answer 175

Central retinal artery occlusion

Question 176

What are the symptoms of central retinal artery occlusion?

Answer 176

Acute, painless vision loss

Question 177

What percentage of CRAO cases present unilaterally?

Answer 177

99%

Question 178

What type of pupillary defect is observed in CRAO?

Answer 178

Afferent pupillary defect

Question 179

How does the retina appear in cases of CRAO?

Answer 179

More pale/white superficially with cherry red spot macula

Question 180

What is the pronounced appearance of the fovea in CRAO known as?

Answer 180

Cherry red spot

Question 181

Is CRAO typically associated with retinal hemorrhages?

Answer 181

No

Question 182

Fill in the blank: CRAO is an obstruction of the _______.

Answer 182

central retinal artery

Question 183

Potential complications of CRVO

Answer 183

- persistent Mac edema - NVD - NVE - NVI *therefore monitor for “90 day glaucoma” from NVI which may occur 2-4 months after initial CRVO * neovascularization can cause recurrent pre-retinal and vitreous hemes, RD and open angle or closed angle glaucoma

Question 184

RTC for pt’s with CRVO and have a VA 20/40 or better

Answer 184

1-2 months for 6 months

Question 185

RTC for CRVO if VA is worse than 20/200

Answer 185

monthly for the next 6 months

Question 186

What is a sub-Tenon's injection?

Answer 186

An injection using a long needle where the tip is obscured from view.

Question 187

What happens if a needle bends during a tangential injection?

Answer 187

It will enter tissue away from the bevel and may penetrate further into the tissue.

Question 188

How should the bevel of the needle be positioned during a sub-Tenon's injection?

Answer 188

Toward the globe.

Question 189

What conditions is a sub-Tenon's injection typically reserved for?

Answer 189

* Vitritis * Posterior uveitis * Cystoid macular edema

Question 190

Where should the needle be placed for a sub-Tenon's injection?

Answer 190

2 to 3 mm from the inferotemporal fornix.

Question 191

What should be avoided when penetrating the bulbar conjunctiva?

Answer 191

Nick any of the subconjunctival vessels.

Question 192

Complete the sentence: A sub-Tenon's injection uses a long needle in which the tip, when properly inserted, is _______.

Answer 192

[obscured from view]

Question 193

Watzke-Allen sign

Answer 193

Patient sees a “break” in a Thin slit-beam shone over macula * positive test for full thickness macular hole

Question 194

Shafer sign

Answer 194

Release of pigment into vitreous chamber from a retinal tear, a break in retina releases retinal pigment epithelial cells * patient cues them as sudden increase in floaters

Question 195

What are the two forms of macular drusen associated with dry AMD?

Answer 195

Hard or soft drusen

Question 196

What is a common observation in the outer retina of patients with dry AMD?

Answer 196

Areas of pigment clumping

Question 197

What occurs in RPE atrophy related to dry AMD?

Answer 197

Underlying choroidal vessels may appear more visible

Question 198

What is geographic atrophy in the context of dry AMD?

Answer 198

Regions of confluent retinal and choriocapillaris atrophy

Question 199

How does visual acuity in dry AMD compare to wet AMD?

Answer 199

Typically less affected

Question 200

What is a classic OCT finding in dry AMD?

Answer 200

Ripples formed under the RPE due to drusen

Question 201

What is the appearance of cystoid macular edema on fundus evaluation?

Answer 201

Irregular, blunted foveal light reflex and thickening in the central macular region

Question 202

What additional signs may be observed in severe cases of cystoid macular edema?

Answer 202

- Vitreous cells - swelling of the optic nerve - hemorrhages - lamellar macular holes

Question 203

What ocular conditions can lead to cystoid macular edema? (6)

Answer 203

* Diabetic retinopathy * BRVO and CRVO * Uveitis * Retinitis pigmentosa * Retinal vasculitis * Certain medications (ex: prostaglandins)

Question 204

What OCT finding is characteristic of cystoid macular edema?

Answer 204

Loss of foveal contour due to cystic spaces within the retina

Question 205

What is the typical presentation of central serous retinopathy?

Answer 205

Localized serous detachment of the neurosensory retina in the macula

Question 206

What visual acuity range is common in patients with central serous retinopathy?

Answer 206

20/20 to 20/80

Question 207

What may Amsler grid testing reveal in central serous retinopathy?

Answer 207

Distortion of straight lines and a possible central scotoma

Question 208

What are the clinical signs of idiopathic polypoidal choroidal vasculopathy? (Name at least 3)

Answer 208

* Subretinal red-orange polyp-like lesions * Circinate subretinal exudates * Choroidal neovascular membrane * Subretinal or sub-RPE blood * Vitreous hemorrhages * Subretinal fibrosis * Subretinal fluid * Multiple serous pigment epithelial detachments

Question 209

How can idiopathic polypoidal choroidal vasculopathy be distinguished from AMD?

Answer 209

Occurs at a younger age without significant drusen or geographic atrophy

Question 210

In which races is polypoidal choroidal vasculopathy more commonly observed?

Answer 210

Asians and African Americans

Question 211

In which demographic is choroidal melanoma most commonly found?

Answer 211

Occurs most commonly in Caucasians with a median age of 55

Question 212

What are some risk factors for developing choroidal melanoma?

Answer 212

Risk factors include: * Sun exposure (or arc welding) * Fair skin with inability to tan * Pre-existing choroidal nevi * Ocular or oculodermal melanocytosis

Question 213

True or False: Genetic factors may predispose patients to choroidal melanoma.

Answer 213

True

Question 214

What symptoms may indicate the presence of choroidal melanoma?

Answer 214

Symptoms include: * Decreased visual acuity * Metamorphopsia * Flashing lights (photopsia) * Scotomas

Question 215

What can cause decreased visual acuity in patients with choroidal melanoma?

Answer 215

Causes include: * Involvement in the macular area * Subretinal fluid * Media opacities (hemorrhage, vitreal tumor seeding, cataract, corneal pacification from secondary glaucoma)

Question 216

What characteristics are typical of melanomas observed in the fundus?

Answer 216

Melanomas are typically: * Elevated * Subretinal mass lesions * Color can vary from amelanotic to very darkly pigmented

Question 217

What shape is associated with choroidal melanoma due to a rupture in Bruch's membrane?

Answer 217

Collar-button or mushroom shape

Question 218

What is the differential diagnosis for choroidal melanoma?

Answer 218

Differential diagnosis includes: * Choroidal nevus * Congenital hypertrophy of the retinal pigment epithelium (CHRPE) * Melanocytoma * Disciform scar * Subretinal or subRPE hamartoma * Choroidal hemangioma * Posterior scleritis * Retinal gliosis * Ocular melanocytosis

Question 219

What characteristics of a lesion suggest it is a choroidal melanoma?

Answer 219

Suggestive characteristics include: * Thickness of >2 mm * Presence of subretinal fluid * Orange surface pigmentation * Visual symptoms * Proximity to the optic disc or macula **Documented history of growth**

Question 220

What procedure would be most helpful in diagnosis and evaluation of melanocytic choroidal nevus?

Answer 220

B-scan Characteristics: * dome or mushroom-shaped tumor * steep angle kappa * attenuation of signals * choroidal excavation * orbital shadowing

Question 221

What are the most common risk factors for development of choroidal melanoma?

Answer 221

* increased sun exposure * oculodermal melanocytosis * pre-existing uveal nevus

Question 222

What are adverse prognostic factors in patients diagnosed with choroidal melanomas?

Answer 222

Histological features, chromosomal abnormalities, appearance of tumor, local tumor recurrence ## Footnote These factors are critical for assessing the prognosis of patients with choroidal melanomas.

Question 223

What histological feature indicates a poor prognosis in choroidal melanoma?

Answer 223

Large number of epithelioid cells ## Footnote Epithelioid cells are more associated with aggressive tumor behavior compared to spindle cells.

Question 224

What tumor appearance factors contribute to poor prognosis in choroidal melanoma?

Answer 224

Larger size of tumor, extrascleral extension, growth through Bruch's membrane, optic nerve extension, lack of pigmentation, more anterior location ## Footnote These factors often correlate with advanced disease at the time of diagnosis.

Question 225

True or False: Lymphocytic infiltration is a favorable histological feature in choroidal melanoma.

Answer 225

False ## Footnote Lymphocytic infiltration is typically associated with a worse prognosis.

Question 226

Fill in the blank: A large number of _______ cells in choroidal melanoma is a poor prognostic factor.

Answer 226

epithelioid ## Footnote Epithelioid cells are more aggressive compared to spindle cells.

Question 227

What is the significance of local tumor recurrence in choroidal melanoma?

Answer 227

It indicates a poorer prognosis ## Footnote Local recurrence suggests that the disease is more aggressive and difficult to manage.

Question 228

What does the appearance of closed vascular loops within the tumor indicate?

Answer 228

Poor prognosis ## Footnote Closed vascular loops are a histological feature that correlates with aggressive tumor behavior.

Question 229

What is the implication of a tumor's anterior location in choroidal melanoma?

Answer 229

It is associated with larger tumor size at diagnosis ## Footnote Tumors located more anteriorly, especially involving the ciliary body, are often larger due to lead time before diagnosis.

Question 230

Once diagnosis of choroidal melanoma has been made what’s the next series of systemic tests to rule out possible metastasis? (3)

Answer 230

- Blood testing - chest x-ray - abdominal CT scan

Question 231

CSME criteria

Answer 231

1. Retinal edema within 500 microns of fovea 2. Hard exudates within 500 microns of fovea 3. Retinal edema within an area of at least 1500 microns within 1DD of the fovea * 1/3DD = 500 um * 1 DD = 1500 um

Question 232

4-2-1 rule

Answer 232

4 quadrants of hemorrhages 2 quadrants of venous beading 1 quadrant of IRMA (intraretinal microvascular abnormalities) * meet at least 1 criteria = severe NPDR * meet 2 criteria = very severe NPDR

Question 233

RTC for NPDR

Answer 233

Every 6 months

Question 234

RTC for PDR

Answer 234

Every 3 months

Question 235

Hemorrhages in patients with Valsalva retinopathy are located where?

Answer 235

Between the retina and posterior vitreous face * subhyaloid And/or sub-internal limiting membrane (between ILM and NFL) * mostly occur in macular area

Question 236

What is the pathophysiology of Valsalva maneuver?

Answer 236

Elevation of intra-abdominal pressure leads to increase in ocular venous pressure, resulting in ruptures of superficial retinal capillaries

Question 237

What is a Valsalva maneuver?

Answer 237

A forcible exhalation against a closed glottis that increases intrathoracic or intra-abdominal pressure ## Footnote This maneuver can interfere with venous return to the heart.

Question 238

What behaviors are typically associated with the Valsalva maneuver?

Answer 238

Strenuous exertion from behaviors such as: * Emesis (vomiting) * Violent coughing * Constipation * Labor * Heavy lifting * Blowing musical instruments * Crush or compression injuries ## Footnote These activities can lead to the forcible exhalation characteristic of the Valsalva maneuver.

Question 239

What happens to ocular venous pressure during a Valsalva maneuver?

Answer 239

There is a rapid rise in ocular venous pressure ## Footnote This can lead to rupture of superficial retinal capillaries.

Question 240

What is a possible consequence of elevated ocular venous pressure?

Answer 240

Rupture of superficial retinal capillaries leading to hemorrhaging into the subhyaloid space ## Footnote This can cause sudden and painless disruption of vision.

Question 241

What are some differential diagnoses for Valsalva retinopathy?

Answer 241

Differential diagnoses include: * Posterior vitreous detachment * Purtscher retinopathy * Hypertensive retinopathy * Diabetic retinopathy * Terson retinopathy ## Footnote Each of these conditions has distinct mechanisms that can lead to retinal hemorrhaging.

Question 242

What causes posterior vitreous detachment?

Answer 242

Mechanical traction due to compression and detachment of the vitreous body ## Footnote This can lead to damage of retinal vasculature and subsequent hemorrhaging.

Question 243

What is Purtscher retinopathy?

Answer 243

Multiple patches of retinal whitening, large cotton wool spots and hemorrhages that surround optic disc after multiple long-bone fractures with fat emboli or severe compressive injuries to trunk or head *due to occlusion of small arterioles by intravascular microemboli from a compression injury ## Footnote This condition is associated with trauma.

Question 244

What causes hypertensive retinopathy?

Answer 244

Chronic elevation in retinal arteriolar pressure ## Footnote This results in damage to the capillary wall endothelium and leakage of blood and fluid.

Question 245

What is diabetic retinopathy characterized by?

Answer 245

Increased vascular permeability due to changes in microvasculature structure ## Footnote This leads to leakage of blood and fluid into the retina.

Question 246

What triggers Terson retinopathy?

Answer 246

Increase in intracranial pressure leading to elevation in intraocular pressure ## Footnote This results in compression of the central retinal vein and can cause hemorrhaging.

Question 247

If pre-retinal hemorrhage from Valsalva maneuver does not spontaneously resolve over several weeks, what treatment would be indicated?

Answer 247

Nd:YAG laser disruption of posterior hyaloid face

Question 248

What is cobblestone degeneration?

Answer 248

A benign thinning/atrophy of the peripheral retina, retinal pigment epithelium, and choriocapillaris

Question 249

In which individuals is cobblestone degeneration more frequently seen?

Answer 249

Myopic individuals

Question 250

How is cobblestone degeneration commonly observed in terms of laterality?

Answer 250

It commonly occurs bilaterally

Question 251

Which part of the retina is most frequently involved in cobblestone degeneration?

Answer 251

Inferior temporal aspect

Question 252

What symptoms are associated with cobblestone degeneration?

Answer 252

Asymptomatic condition

Question 253

What clinical signs are observed during the evaluation of the fundus in cobblestone degeneration?

Answer 253

White/yellow circular areas of atrophy; halo of pigment surrounding lesions

Question 254

What may happen to regions of degeneration in cobblestone degeneration?

Answer 254

They may coalesce together to form a large band of atrophy

Question 255

Is cobblestone degeneration associated with ocular complications?

Answer 255

No, it is not associated with ocular complications

Question 256

What is the recommended follow-up for patients with cobblestone degeneration?

Answer 256

Annual evaluation

Question 257

What is another name for macular epiretinal membrane (ERM) when the membrane is slight?

Answer 257

Cellophane maculopathy

Question 258

What does the term 'macular pucker' refer to?

Answer 258

A denser ERM that results in diminished acuity

Question 259

What causes the formation of epiretinal membranes (ERMs)?

Answer 259

Disruption of the internal limiting membrane (ILM)

Question 260

What type of cells proliferate to form the membrane in ERM?

Answer 260

Glial cells

Question 261

What is the appearance of the membrane in the early stage of ERM?

Answer 261

A glistening area of transparent tissue

Question 262

What symptoms are commonly associated with macular epiretinal membranes?

Answer 262

Decreased and/or distorted vision

Question 263

What percentage of ERM cases may be bilateral?

Answer 263

Up to 20%

Question 264

What clinical signs indicate the presence of mild epiretinal membranes?

Answer 264

Glistening tissue overlying or next to the macula

Question 265

What are the sequelae of a severe macular pucker?

Answer 265

Cystoid macular edema or a tractional retinal detachment

Question 266

True or false The majority of patients with ERM are asymptomatic

Answer 266

True

Question 267

What are some causes of ERM formation? List at least three.

Answer 267

* Idiopathic origin * Posterior vitreous detachment * Uveitis * Trauma, intraocular surgery, or laser treatment * Diabetic retinopathy * Retinal breaks * Retinal vascular diseases

Question 268

What visual disturbances can be caused by a mature ERM?

Answer 268

Metamorphopsia and reduced visual acuity

Question 269

What is another name for Epiretinal Membrane?

Answer 269

Cellophane Maculopathy ## Footnote This term describes the appearance of the membrane on the retina.

Question 270

When is treatment recommended for patients with Epiretinal Membrane?

Answer 270

If the patient is symptomatic and suffers from reduced visual acuity or experiences a large amount of metamorphopsia ## Footnote Treatment is not recommended for asymptomatic patients with visual acuity of 20/40 or better.

Question 271

What surgical procedure is warranted for symptomatic patients with Epiretinal Membrane?

Answer 271

Pars plana vitrectomy followed by a membrane peel ## Footnote This procedure helps alleviate symptoms related to the membrane.

Question 272

What is the expected outcome of surgery for patients with Epiretinal Membrane?

Answer 272

Patients will typically experience an improvement in their postoperative acuity ## Footnote However, acuity is not expected to fully return to pre-membrane levels, especially in chronic cases.

Question 273

What tool may be given to patients for monitoring distortion after treatment?

Answer 273

Amsler grid ## Footnote This grid helps patients detect changes in their vision.

Question 274

OCT of patient with familiar drusen would show?

Answer 274

Thickening of RPE-Bruch’s membrane complex with an intact photoreceptors layer

Question 275

Tx for CME secondary to YAG cap following CE

Answer 275

Topical NSAID Topical steroid Oral CAI Example: 1 gtt ketorolac QID and 1 gtt prednisolone acetate QID

Question 276

Tx for CME in patients with retinitis pigmentosa

Answer 276

Oral CAI

Question 277

What does CME look like on FA in early and late stages?

Answer 277

Small hyper fluorescent spots in early stages 'flower-petal' pattern in the late stage. ## Footnote This pattern is indicative of cystoid macular edema (CME) observed during FA.

Question 278

Which imaging techniques are valuable for identifying patients with CME?

Answer 278

Fluorescein angiography (FA) and optical coherence tomography (OCT). ## Footnote These techniques are particularly useful when the diagnosis is uncertain.

Question 279

What does the early arteriovenous phase of FA show in patients with CME?

Answer 279

Capillary dilation and leakage of fluid. ## Footnote This leads to the visibility of small hyperfluorescent spots.

Question 280

What occurs in the later phase of FA for patients with CME?

Answer 280

Fluorescein dye accumulates within the microcystic spaces in the outer plexiform layer of the retina. ## Footnote This accumulation results in characteristic staining petalloid patterns

Question 281

What is the classic perifoveal staining pattern observed in CME during the late phase of FA?

Answer 281

'Petaloid' or 'spoke-wheel' staining pattern. ## Footnote This pattern is a key diagnostic feature of CME.

Question 282

In cases of CME, what additional leakage may be observed?

Answer 282

Optic nerve head leakage. ## Footnote This is most commonly associated with Irvine-Gass syndrome.

Question 283

What appearance do outer cystoid spaces show in severe cases of CME?

Answer 283

'Honeycomb' appearance. ## Footnote This is due to larger fused cystoid spaces extending outside the perifoveal region.

Question 284

What is the appearance of a classic choroidal neovascular membrane (CNVM) in the early phase of angiography?

Answer 284

Clearly visible and well-demarcated 'lacy' hyperfluorescence. ## Footnote This feature helps differentiate CNVM from other conditions.

Question 285

What is the appearance of fluorescein angiography in central serous retinopathy?

Answer 285

Smoke-stack appearance. ## Footnote This distinct appearance helps in the diagnosis of central serous retinopathy.

Question 286

What is the most common ocular complication of Behcet disease?

Answer 286

Uveitis * bilateral, non-granulomatous uveitis

Question 287

ERG and EOG in best disease

Answer 287

Normal ERG Abnormal EOG

Question 288

ERG and EOG in stargardt

Answer 288

Normal ERG Normal EOG

Question 289

ERG and EOG in familial drusen * familial drusen is autosomal dominant

Answer 289

Normal ERG Abnormal EOG (in advanced familial drusen)

Question 290

ERG and EOG in choroideremia

Answer 290

Abnormal ERG abnormal EOG

Question 291

What is choroideremia?

Answer 291

An X-linked recessive condition that leads to degeneration of the retina, specifically the choriocapillaris and retinal pigment epithelium (RPE).

Question 292

Who typically presents with choroideremia?

Answer 292

Typically presents in males in the 1st to 2nd decade of life.

Question 293

What is the most common entering complaint of choroideremia?

Answer 293

Nyctalopia, or night blindness.

Question 294

What are early signs of choroideremia?

Answer 294

Typically occur in the first or second decade of life.

Question 295

What visual symptoms progress throughout the patient's life in choroideremia?

Answer 295

Restriction of peripheral vision.

Question 296

When does visual acuity typically remain favorable in choroideremia?

Answer 296

Until late in the disease when macular involvement can occur.

Question 297

What is the characteristic appearance of the fundus early in choroideremia?

Answer 297

Pigment granules scattered throughout the fundus, sparing the macular region (salt-and-pepper fundus).

Question 298

What happens to the RPE as choroideremia progresses?

Answer 298

Patches of RPE atrophy in the mid-peripheral retina become confluent and progressive.

Question 299

Choroideremia is a degeneration of what structures?

Answer 299

choriocapillaris and RPE * diffuse progressive degeneration

Question 300

In end-stage choroideremia, what can be seen extending from the posterior pole to the periphery?

Answer 300

Visibility of the sclera.

Question 301

What visual function do patients commonly maintain until later in the disease?

Answer 301

Central vision.

Question 302

What is a common finding in female carriers of choroideremia?

Answer 302

Mid-peripheral mottling of the RPE that tends to be static.

Question 303

What is the 'moth-eaten' appearance associated with in choroideremia?

Answer 303

The RPE, along with RPE pigment clumping and degeneration.

Question 304

What is observed in late-stage ERG for choroideremia?

Answer 304

No recordable scotopic function and a greatly reduced photopic response.

Question 305

Fill in the blank: Choroideremia is an _______ condition.

Answer 305

X-linked recessive

Question 306

True or false A successful treatment for choroideremia does not currently exist

Answer 306

True

Question 307

What is Leber's Congenital Amaurosis?

Answer 307

A progressive autosomal recessive rod-cone dystrophy and the most common congenital cause of blindness in children ## Footnote It involves the loss of retinal photoreceptors, outer segments, and outer nuclear layers.

Question 308

What are the early symptoms of Leber's Congenital Amaurosis?

Answer 308

- Roving eye within the first few months of life - reduced acuity and color perception - nyctalopia - photophobia ## Footnote Nyctalopia refers to difficulty seeing in low light conditions. *group of hereditary disorders, onset birth or early childhood * severe visual impairment (20/40 to NLP) * vascular attenuation, salt and pepper fundus, RP appearance

Question 309

What range of visual acuity is typically seen in patients with Leber's Congenital Amaurosis?

Answer 309

From 20/40 to no light perception (NLP), with the average being 20/200 ## Footnote Visual acuity is a measure of the eye's ability to resolve detail.

Question 310

What are some ocular signs associated with Leber's Congenital Amaurosis?

Answer 310

* Attenuated vessels * Chorioretinal atrophy * Significant macular pigmentation * Pigmentary retinopathy * Yellow flecks * Tapetal metallic sheen * Sluggish pupils * Nystagmus * Constricted visual fields * High hyperopia * Keratoconus * Keratoglobus * Posterior subcapsular cataracts * Oculo-digital sign (eye rubbing) ## Footnote The oculo-digital sign may lead to atrophy of orbital fat and enophthalmos.

Question 311

What systemic findings can occur with Leber's Congenital Amaurosis?

Answer 311

* Deafness * Skeletal and muscular anomalies * Renal/kidney abnormalities * Endocrine dysfunction * Mental handicap * Epilepsy ## Footnote These systemic issues may vary in severity and presentation.

Question 312

What is the prognosis for patients with Leber's Congenital Amaurosis?

Answer 312

Poor, with no treatment available ## Footnote Management typically involves referral to a low vision specialist.

Question 313

ERG in Leber’s congenital amaurosis

Answer 313

Abnormal *severely reduced * loss of retinal photoreceptors, outer segments and outer nuclear layers

Question 314

FA on stargardt disease

Answer 314

“Silent choroid” * choroidal hypo-fluorescence with prominent retinal vasculature * dark choroid

Question 315

Tx for stargardt

Answer 315

Prescribe low vision aids * with daily Amsler, RTC ASAP if changes

Question 316

Macular disease may cause what color vision deficiency?

Answer 316

Blue-yellow

Question 317

WWOP is mostly seen in which area of the retina?

Answer 317

Inferior and temporally

Question 318

4 bright bands on OCT Mac

Answer 318

1. ELM 2. PIL (photoreceptor integrity line) 3. Interdigitation zone (RPE complex) 4. RPE (interacts with Burch’s membrane)

Question 319

Paving stone degeneration most commonly seen in which areas of the retina?

Answer 319

Inferior and temporal

Question 320

RP triad

Answer 320

1. Attenuation of arterioles 2. Bone-spicule pigmentation of retina 3. Waxy pallor of optic nerve *subcapsular cataract common in RP

Question 321

What type of cataract commonly develops in RP?

Answer 321

Subcapsular cataract

Question 322

How many layers compose the retina?

Answer 322

10 layers ## Footnote The layers include the retinal pigment epithelium, photoreceptors, and others.

Question 323

What is the first outermost layer of the retina?

Answer 323

Retinal pigment epithelium (RPE) ## Footnote This is the outermost layer of the retina.

Question 324

List the layers of the retina from outermost to innermost.

Answer 324

* Retinal pigment epithelium (RPE) * Photoreceptors * External limiting membrane (ELM) * Outer nuclear layer (ONL) * Outer plexiform layer (OPL) * Inner nuclear layer (INL) * Inner plexiform layer (IPL) * Ganglion cell layer (GCL) * Nerve fiber layer (NFL) * Internal limiting membrane (ILM) ## Footnote These layers play various roles in processing visual input.

Question 325

What is the role of the retinal pigment epithelium (RPE)?

Answer 325

Forms part of the blood-retinal barrier, phagocytosis of fragments from shed photoreceptor discs, metabolizes and stores vitamin A ## Footnote Vitamin A is crucial for the formation of rhodopsin photopigment.

Question 326

What happens due to vitamin A deficiency?

Answer 326

Prolonged dark adaptation ## Footnote Vitamin A is essential for converting light into electrical signals. *pts with retinitis pigmentosa supplement vitamin A to help with dark adaptation because pts are symptomatic for nyctalopia

Question 327

What does the photoreceptor cell layer contain?

Answer 327

Outer and inner segments of rods and cones ## Footnote These segments are characterized by high levels of metabolic activity.

Question 328

Fill in the blank: The _______ converts radiant energy into electrical energy.

Answer 328

photoreceptor cell layer ## Footnote This conversion is essential for visual processing.

Question 329

True or False: The inner layers of the retina absorb light before it reaches the photoreceptors.

Answer 329

False ## Footnote Light is refracted by the cornea and lens and passes through the inner layers before being absorbed by photoreceptors.

Question 330

What is the external limiting membrane?

Answer 330

Consists of intercellular junctions of the photoreceptor cells ## Footnote It delineates the inner segments of the photoreceptors and their respective nuclei.

Question 331

What cells does the outer nuclear layer contain?

Answer 331

The cell bodies and nuclei of the rods and cones

Question 332

What is the function of the outer plexiform (synaptic) layer?

Answer 332

Site where photoreceptor cells synapse with the dendrites of horizontal and bipolar cells from the inner nuclear layer

Question 333

What cell types are found in the inner nuclear layer?

Answer 333

Bipolar, horizontal, amacrine, and Muller cells

Question 334

What role do Muller cells play in the retina?

Answer 334

Create tight junctions and contribute to the formation of the external limiting membrane

Question 335

What does the inner plexiform (synaptic) layer encompass? (Which cells and which part of those cells?)

Answer 335

The synapses of bipolar, ganglion, and amacrine cells' axons

Question 336

What is contained within the ganglion cell layer?

Answer 336

Ganglion cell bodies

Question 337

What does the nerve fiber layer contain?

Answer 337

The axons of ganglion cells

Question 338

What forms the internal limiting membrane?

Answer 338

Radial feet processes of Muller cells and other glial cell constituents

Question 339

Where do Muller cells' processes extend in the retina?

Answer 339

Throughout the length of the retina except for the retinal pigment epithelium

Question 340

What types of cells do amacrine cells amalgamate information from?

Answer 340

Ganglion and bipolar cells

Question 341

Where are horizontal cell bodies located?

Answer 341

At the outer edge of the inner nuclear layer

Question 342

What information do horizontal cells combine?

Answer 342

Information obtained from rods and cones

Question 343

How many different types of horizontal cells are there?

Answer 343

At least two or three different types

Question 344

What is a potential complication of retinal laser photocoagulation treatment?

Answer 344

Choroidal detachment ## Footnote May lead to angle-closure glaucoma.

Question 345

What are the complications associated with retinal laser photocoagulation treatment? (Name 3)

Answer 345

* Choroidal detachment * Rhegmatogenous retinal detachment * Cystoid macular edema * Macular pucker * Exudative retinal detachment * Retinal hemorrhage (rare) ## Footnote Complications typically occur due to overtreatment of large regions of the retina.

Question 346

What complication of retinal laser treatment is rare?

Answer 346

Retinal hemorrhage ## Footnote Occurs in rare cases.

Question 347

What is a common complication of cryotherapy?

Answer 347

Eyelid edema ## Footnote Occurs almost 100% of the time.

Question 348

Which complication of cryotherapy occurs almost 100% of the time?

Answer 348

Chemosis ## Footnote This condition involves swelling of the conjunctiva.

Question 349

Fill in the blank: Transient diplopia may be caused by accidental treatment of an _______ muscle.

Answer 349

extracular ## Footnote This refers to muscles outside of the eye.

Question 350

List some complications of cryotherapy.

Answer 350

* Eyelid edema * Chemosis * Transient diplopia * Vitritis * Maculopathy (very rare) ## Footnote Maculopathy is considered very rare.

Question 351

What is vitritis?

Answer 351

Inflammation of the vitreous body ## Footnote It can occur as a complication of cryotherapy.

Question 352

True or False: Maculopathy is a common complication of cryotherapy.

Answer 352

False ## Footnote Maculopathy is described as very rare.

Question 353

stargardt on FA

Answer 353

Choroidal hypofl with prominent retinal vasculature “Silent choroid”

Question 354

What is Stargardt disease most commonly caused by?

Answer 354

Mutations in the ABCA4 gene ## Footnote ABCA4 gene mutations are primarily responsible for Stargardt disease.

Question 355

What type of protein does the ABCA4 gene encode?

Answer 355

ATP-binding cassette transmembrane protein ## Footnote This protein is specifically expressed by rod outer segments.

Question 356

What is the role of the ABCA4 gene in the retina?

Answer 356

Involved in the transport of all-trans-retinal ## Footnote This transport is crucial for proper photoreceptor function.

Question 357

What happens as a result of mutations in the ABCA4 gene?

Answer 357

Accumulation of all-trans-retinal in the photoreceptors and retinal pigment epithelium ## Footnote This accumulation leads to various retinal pathologies.

Question 358

What is lipofuscin and why is it significant in Stargardt disease?

Answer 358

A component that accumulates and is toxic to RPE and photoreceptors ## Footnote Lipofuscin accumulation leads to cellular damage and vision loss.

Question 359

Fill in the blank: The ABCA4 gene mutations lead to the _______ of lipofuscin.

Answer 359

accumulation ## Footnote This accumulation is detrimental to retinal health.

Question 360

What is Stargardt disease?

Answer 360

A genetic eye disorder that results in a decrease in visual acuity, typically presenting in the first to second decades of life. ## Footnote It is characterized by specific retinal changes and accumulation of lipofuscin-like material.

Question 361

What are the initial symptoms of Stargardt disease?

Answer 361

Decreased vision, which may be mistaken for malingering due to a normal appearing fundus. ## Footnote Children may report decreased vision before any noticeable retinal changes occur.

Question 362

What appearance does the macula take on as Stargardt disease progresses?

Answer 362

It may appear mottled and eventually develop a 'beaten-bronze' appearance, potentially surrounded by yellowish flecks. ## Footnote This progression indicates worsening of the disease.

Question 363

What is the characteristic pattern of geographic atrophy in Stargardt disease?

Answer 363

'Bull's eye' pattern. ## Footnote This pattern is associated with significant loss of visual acuity.

Question 364

What accumulates at the level of the retinal pigment epithelium in Stargardt disease?

Answer 364

Unusual lipofuscin-like material. ## Footnote This accumulation is a key feature of the disease.

Question 365

What is the typical finding in the electroretinogram (ERG) of patients with Stargardt disease?

Answer 365

Characteristically normal, but may be atypical in advanced cases. ## Footnote The ERG tests the electrical responses of the retina. Normal ERG and normal EOG until diseases advances

Question 366

How does the electro-oculogram (EOG) change as Stargardt disease progresses?

Answer 366

It is likely normal in early stages but becomes increasingly abnormal as the disease progresses. ## Footnote The EOG measures the electrical potential of the retina.

Question 367

What is Best disease also known as?

Answer 367

Vitelliform dystrophy. ## Footnote It is a rare retinal condition that affects the macular area.

Question 368

What occurs during the pre-vitelliform stage of Best disease?

Answer 368

The child is asymptomatic, the fundus appears normal, but the EOG reading is abnormal. ## Footnote This stage may be detected through testing even if no symptoms are present.

Question 369

Describe the vitelliform stage of Best disease.

Answer 369

Egg yolk stage! Occurs in the first or second decade of life with a small decrease in vision and a macular lesion resembling an egg yolk. **This stage is typically bilateral.

Question 370

What characterizes the pseudohypopyon stage in Best disease?

Answer 370

A blister-like lesion where lipofuscin may gravitate inferiorly, causing the appearance of a pseudohypopyon. ## Footnote This stage usually occurs in the second to third decades of life.

Question 371

What happens in the vitelliruptive stage of Best disease?

Answer 371

Scrambled eggs! The 'egg yolk' breaks apart, leading to a decrease in visual acuity. ** This stage indicates further progression of the disease.

Question 372

What defines the atrophic stage of Best disease? (End stage)

Answer 372

Macular scarring and potential formation of choroidal neovascular membranes (CNVM) and/or geographic atrophy. ## Footnote Visual acuity is typically very poor at this stage.

Question 373

What is fundus flavimaculatus?

Answer 373

A variant of Stargardt disease characterized by white-yellow flecks in the posterior pole instead of macular involvement. ## Footnote Visual acuity remains fairly good as long as the macula is clear.

Question 374

In fundus flavimaculatus, what happens to visual acuity?

Answer 374

It tends to remain fairly good as long as the macula remains clear and geographic atrophy is absent. ## Footnote This is in contrast to Stargardt disease where visual acuity decreases significantly.

Question 375

Tx for retinal detachment

Answer 375

Focal Laser photocoagulation * multiple rows of treatment burns to ensure longevity and stability

Question 376

Pneumatic retinopexy is used to treat?

Answer 376

Small retinal breaks associated with uncomplicated retinal detachment in upper 2/3rds of peripheral retina *procedure performed by injecting an expanding gas bubble into vitreous cavity * gas placed against break which seals it closed

Question 377

Tx for CRVO RTC after initiation of treatment

Answer 377

Refer for intravitreal anti-VEGF injection * treat macular edema * injections every 6 weeks RTC: if VA 20/40 or better 1-2 months for 6 months RTC if VA worse than 20/200 monthly for 6 months

Question 378

RTC for wet AMD with active CNVM

Answer 378

1-3 months until CNVM inactive (based on OCT and FA)

Question 379

What is Ocular Ischemic Syndrome (OIS) also known as?

Answer 379

Venous Stasis Retinopathy ## Footnote This term is considered outdated.

Question 380

What is the average age of patients affected by Ocular Ischemic Syndrome?

Answer 380

65 years ## Footnote Epidemiology shows >50 years as the demographic.

Question 381

What is the male to female ratio in cases of Ocular Ischemic Syndrome?

Answer 381

2:1 ## Footnote Males are affected more frequently than females.

Question 382

What is the 5-year mortality rate for patients with Ocular Ischemic Syndrome?

Answer 382

40% ## Footnote This indicates a significant risk associated with the syndrome.

Question 383

What are the common risk factors for developing Ocular Ischemic Syndrome?

Answer 383

* Hypertension * Hyperlipidemia * Diabetes Mellitus * Giant Cell Arteritis ## Footnote These conditions contribute to the development of OIS.

Question 384

What pathophysiological condition leads to Ocular Ischemic Syndrome?

Answer 384

Chronic ocular hypoperfusion due to severe internal carotid artery stenosis ## Footnote This can also involve insufficiency or thrombosis of the internal carotid artery.

Question 385

What percentage of internal carotid artery stenosis is associated with Ocular Ischemic Syndrome?

Answer 385

>70% ## Footnote Significant stenosis is critical for the development of OIS.

Question 386

What happens to the central retinal artery (CRA) perfusion pressure in Ocular Ischemic Syndrome?

Answer 386

It is reduced by 50% ## Footnote This reduction leads to ischemic conditions in the eye.

Question 387

What is a consequence of low perfusion pressure in OIS?

Answer 387

Induces oxidative stress damage ## Footnote This damage affects both the retina and choroid.

Question 388

What are the symptoms of Ocular Ischemic Syndrome?

Answer 388

* Gradual loss of vision over weeks or months * Decrease in visual acuity (VA) ranging from mild to severe * Asymptomatic cases are possible ## Footnote Visual acuity can vary significantly among patients.

Question 389

What defines 'mild' visual acuity loss in Ocular Ischemic Syndrome?

Answer 389

20/25 - 20/40 ## Footnote This indicates the range of mild loss in visual acuity.

Question 390

What defines 'severe' visual acuity loss in Ocular Ischemic Syndrome?

Answer 390

20/400 or worse ## Footnote Severe cases can lead to significant impairment in vision.

Question 391

What type of visual loss may occur in Ocular Ischemic Syndrome?

Answer 391

Transitory monocular visual loss ## Footnote This type of loss may recover over time.

Question 392

What percentage of OIS patients report transient monocular visual loss (TMVL)?

Answer 392

10-15% ## Footnote TMVL is a significant symptom in ocular ischemic syndrome (OIS) patients.

Question 393

What is the hallmark of carotid insufficiency?

Answer 393

Amaurosis fugax ## Footnote Amaurosis fugax is an older term for TMVL.

Question 394

How long does TMVL typically last? (Transient monocular visual loss)

Answer 394

5 minutes or less ## Footnote This duration is characteristic of transient monocular visual loss.

Question 395

What proportion of patients with amaurosis fugax have significant ipsilateral carotid artery obstruction?

Answer 395

1/3rd ## Footnote Specifically, these patients have an obstruction of ≥75%.

Question 396

What visual symptoms may patients with OIS complain of?

Answer 396

Blur, dimming, or darkened vision ## Footnote Patients may describe a curtain coming down over the eye.

Question 397

What is ocular angina?

Answer 397

Ocular and/or periocular pain ## Footnote This symptom occurs in approximately 40% of OIS patients.

Question 398

What visual phenomenon might patients experience after bright light exposure?

Answer 398

Slow adaptation ## Footnote This is a common symptom in OIS.

Question 399

What are the typical signs of OIS in the posterior segment?

Answer 399

1. Typically unilateral (80%) 2. Dilated retinal veins 3. Mid-peripheral hemorrhages (80% of cases) 4. Cherry-red spot (12% of eyes) ## Footnote Other signs may include narrowed arteries and rare cases of flame hemes, CWS, optic disc edema, and macular edema.

Question 400

What is a cherry-red spot associated with in OIS?

Answer 400

Embolic occlusion of the CRA or increased IOP *embolism causes a blockage in CRA ## Footnote It may occur in neovascular glaucoma.

Question 401

True or False: Retinal hemorrhages in OIS are usually in the posterior pole.

Answer 401

False ## Footnote Midperipheral hemorrhages are more common than those in the posterior pole.

Question 402

Fill in the blank: OIS symptoms may include _______ after bright light exposure.

Answer 402

Worsening of vision ## Footnote This worsening can also occur with postural changes.

Question 403

What is the most common sign of Ocular Ischemic Syndrome (OIS)?

Answer 403

NVI (iris rubeosis) is most common (65-85%) ## Footnote NVI stands for Neovascularization of the Iris.

Question 404

What is the order of anterior chamber reaction in OIS?

Answer 404

flare > cells > KPs (20%) ## Footnote KPs refer to Keratic Precipitates.

Question 405

What percentage of OIS cases may present with neovascular glaucoma?

Answer 405

50% of OIS cases ## Footnote Neovascular glaucoma may not have very high intraocular pressure due to poor ciliary body perfusion.

Question 406

What is a common IOP finding in unilateral OIS?

Answer 406

Unilateral low IOP (non-neovascular) ## Footnote This finding can help differentiate OIS from other conditions.

Question 407

What are some signs of Ocular Ischemic Syndrome (OIS) in the anterior segment? (List at least three)

Answer 407

* Diffuse episcleral injection * Corneal edema * Iris atrophy with poor reacting pupil (mid-dilated) ## Footnote These signs indicate ischemic changes in the eye.

Question 408

What is a differential diagnosis (DDx) for OIS?

Answer 408

* Central Retinal Vein Occlusion * Diabetic Retinopathy ## Footnote Both conditions can present with similar vascular disorders.

Question 409

What laboratory tests should be ordered for OIS evaluation?

Answer 409

* CBC * Fasting glucose * HbA1C * Fasting lipids * Sed Rate * C-reactive protein ## Footnote These tests help assess overall health and identify potential underlying causes.

Question 410

What diagnostic imaging study is recommended if the carotid ultrasound is inconclusive?

Answer 410

MRA ## Footnote MRA stands for Magnetic Resonance Angiography.

Question 411

What happens to the carotid arteries during a venous stasis evaluation?

Answer 411

Ask patient to hold breath ## Footnote This maneuver helps visualize blood flow and detect abnormalities.

Question 412

At what stenosis level can a bruit be heard during carotid auscultation?

Answer 412

50-60% stenosis ## Footnote A bruit may not be heard if stenosis is less than 50%.

Question 413

True or False: A bruit can be detected if stenosis is less than 50%.

Answer 413

False ## Footnote Bruits are typically not audible at less than 50% stenosis.

Question 414

What is the management strategy for inflammation in the anterior segment?

Answer 414

Treat inflammation with topical steroid QID and homatropine 5% BID (cycloplegic) ## Footnote QID means four times a day, and BID means twice a day.

Question 415

What should be done when neovascularization develops?

Answer 415

Refer to OMD for Panretinal Photocoagulation (PRP) 500um spots when neovascularization develops ## Footnote OMD refers to an ophthalmic medical doctor.

Question 416

What is the recommended treatment for macular edema?

Answer 416

Intravitreal anti-VEGF agents may be beneficial for macular edema ## Footnote Anti-VEGF agents are used to inhibit vascular endothelial growth factor.

Question 417

What is indicated for significant carotid blockage?

Answer 417

Carotid endarterectomy or stent surgery if significant blockage ## Footnote This is to restore normal blood flow in the carotid artery.

Question 418

When is Carotid Endarterectomy (CEA) indicated?

Answer 418

Symptomatic patients with 70-99% carotid stenosis, asymptomatic minimum of 60% stenosis ## Footnote CEA may be considered on a case-by-case basis for 50-69% stenosis.

Question 419

What is the perioperative risk of stroke or death for CEA?

Answer 419

<6% and 3% ## Footnote These percentages indicate a low risk for surgery.

Question 420

Why is endarterectomy not performed in cases of total (100%) obstruction?

Answer 420

Because it is dangerous due to collateral blood supply having occurred ## Footnote This means that alternative pathways for blood flow have developed, complicating surgery.

Question 421

What are the signs of Ocular Ischemic Syndrome (OIS)?

Answer 421

Mid-peripheral hemes Neovasc of the angle Flare in anterior chamber Corneal edema * Dilated non-tortuous veins * Arterial attenuation * Hemorrhages (midperipheral > PP) * Neovascularization (Iris > angle > NVD > NVE) * Mild anterior uveitis * Neovascular Glaucoma ## Footnote NVD refers to neovascularization of the disc, and NVE refers to neovascularization elsewhere.

Question 422

How is the diagnosis of OIS typically made?

Answer 422

Based on fundus appearance and history of systemic disease ## Footnote Fundus examination is key in identifying changes associated with OIS.

Question 423

True or False: TMVL and retinal artery occlusions are considered medical emergencies.

Answer 423

True ## Footnote They necessitate emergent vascular and brain imaging.

Question 424

True or False Pts with stargardt should avoid Vitamin A supplements

Answer 424

TRUE, Unable to process excess Vitamin A, causes accumulation of deposits in macula

Question 425

Mortality rate for OIS

Answer 425

After 5 years, mortality rate it 40%

Question 426

What is retinoschisis?

Answer 426

Retinoschisis is defined as splitting of the layers within the retina.

Question 427

How does retinoschisis differ from retinal detachment?

Answer 427

Retinal detachment is when the retina is split from the choroid, while retinoschisis involves splitting within the retina.

Question 428

What type of lesions does retinoschisis typically create?

Answer 428

Dome shaped lesions in the retinal periphery.

Question 429

What visual field defects are associated with retinoschisis?

Answer 429

Absolute visual field defects with sharp borders.

Question 430

What visual field defects are associated with retinal detachments?

Answer 430

Relative visual field defects.

Question 431

What testing/ imaging can help differentiate retinoschisis from retinal detachment?

Answer 431

* Threshold visual field * Scleral depression * OCT

Question 432

Can fluorescein angiography be used to differentiate retinoschisis from retinal detachment?

Answer 432

No, fluorescein angiography cannot be used for differentiation.

Question 433

What sign is absent in retinoschisis that may be seen in retinal detachment?

Answer 433

Tobacco dust/Shafer's sign.

Question 434

Can retinoschisis present with rhegmatogenous retinal detachments?

Answer 434

Yes, retinoschisis can rarely present with rhegmatogenous retinal detachments.

Question 435

What are the two types of retinoschisis?

Answer 435

* Acquired Age Related * Juvenile (X-linked recessive)

Question 436

What characterizes acquired age-related retinoschisis?

Answer 436

More common, presents bilaterally and symmetrically; splitting between inner nuclear and outer plexiform layers.

Question 437

What characterizes juvenile retinoschisis?

Answer 437

Less common, located in the nerve fiber layer; presents with progressively decreasing VA from 20/25 to 20/80.

Question 438

What conditions can juvenile retinoschisis cause? (3)

Answer 438

* Amblyopia * Nystagmus * Strabismus

Question 439

What does juvenile retinoschisis look like on OCT?

Answer 439

Stellate maculopathy (spoke-like foveal cysts).

Question 440

What may juvenile retinoschisis present with due to the longevity of the disease?

Answer 440

A pigment demarcation line.

Question 441

What symptoms may patients with retinoschisis report?

Answer 441

Patients may be asymptomatic or complain of blurry vision.

Question 442

What are the three categories of non-proliferative diabetic retinopathy (NPDR)?

Answer 442

Mild NPDR, moderate NPDR, severe NPDR

Question 443

What is mild NPDR associated with?

Answer 443

Hard exudates, microaneurysms, isolated dot/blot hemorrhages

Question 444

What characterizes moderate NPDR?

Answer 444

Greater degree of ischemia and vascular leakage, increased hemorrhages, venous beading/tortuosity, cotton wool spots, intraretinal microvascular abnormalities (IRMA)

Question 445

What are the features of severe NPDR?

Answer 445

Dot/blot hemorrhages and microaneurysms in all four quadrants, venous beading in at least two quadrants, IRMA in at least one quadrant

Question 446

What occurs in proliferative diabetic retinopathy (PDR)?

Answer 446

Development of new, abnormal, preretinal blood vessel growth and proliferation

Question 447

Where can neovascularization be observed in PDR?

Answer 447

At the optic nerve (neovascularization of the disc), greater than 1 disc diameter away (neovascularization elsewhere), new blood vessel growth at the iris (rubeosis iridis)

Question 448

What type of hemorrhages are associated with PDR?

Answer 448

Large preretinal hemorrhages (keel or boat-shaped)

Question 449

What complication may arise from the proliferation of fibrovascular tissue in PDR?

Answer 449

Tractional retinal detachment

Question 450

Fill in the blank: Mild NPDR is associated with what retinal findings? (3)

Answer 450

* isolated dot/blot hemorrhages * hard exudates * microaneurysms

Question 451

True or False: Severe NPDR includes venous beading in at least one quadrant.

Answer 451

False

Question 452

What are the three categories of non-proliferative diabetic retinopathy (NPDR)?

Answer 452

Mild NPDR, moderate NPDR, severe NPDR

Question 453

What is mild NPDR associated with?

Answer 453

Hard exudates, microaneurysms, isolated dot/blot hemorrhages

Question 454

What characterizes moderate NPDR?

Answer 454

Greater degree of ischemia and vascular leakage - increased hemorrhages - venous beading/tortuosity - cotton wool spots - intraretinal microvascular abnormalities (IRMA)

Question 455

What are the features of severe NPDR?

Answer 455

Dot/blot hemorrhages and microaneurysms in all four quadrants, venous beading in at least two quadrants, IRMA in at least one quadrant

Question 456

What occurs in proliferative diabetic retinopathy (PDR)?

Answer 456

Development of new, abnormal, preretinal blood vessel growth and proliferation

Question 457

Where can neovascularization be observed in PDR?

Answer 457

At the optic nerve (neovascularization of the disc), greater than 1 disc diameter away (neovascularization elsewhere), new blood vessel growth at the iris (rubeosis iridis) NVD NVE NVI

Question 458

What type of hemorrhages are associated with PDR?

Answer 458

Large preretinal hemorrhages (keel or boat-shaped)

Question 459

What complication may arise from the proliferation of fibrovascular tissue in PDR?

Answer 459

Tractional retinal detachment

Question 460

Fill in the blank: Mild NPDR is associated with _______.

Answer 460

hard exudates, microaneurysms, isolated dot/blot hemorrhages

Question 461

True or False: Severe NPDR includes venous beading in at least one quadrant.

Answer 461

False

Question 462

What is the inheritance pattern of Juvenile retinoschisis?

Answer 462

X-linked recessive * affects males * females are carriers

Question 463

Tx/Mgmt of juvenile retinoschisis

Answer 463

Close monitoring + retina Patient education about avoiding head trauma and high impact sports because increased risk of RD If RD Tx with scleral buckling If vitreous heme Tx with vitrectomy

Question 464

What is preretinal hemorrhage?

Answer 464

Leakage of blood into either the subhyaloid space between the posterior vitreous face and retina, or beneath the internal limiting membrane ## Footnote Usually presents with a boat-shaped hemorrhage which obscures the underlying retina.

Question 465

What are the common findings in malignant hypertension related to the retina?

Answer 465

* Hard exudates in a macular star formation * optic nerve edema * flame-shaped retinal hemorrhages * retinal edema * cotton- wool spots ## Footnote Requires immediate medical treatment. Malignant HTN = systolic >180 And/or >120 diastolic

Question 466

Fundus evaluation of Valsalva retinopathy will show?

Answer 466

Single or multiple hemorrhages beneath the internal limiting membrane, most commonly noted in the area of the macula ## Footnote Usually associated with a history of heavy lifting, coughing, vomiting, or straining.

Question 467

What are the signs of ocular ischemic syndrome?

Answer 467

Mid-peripheral retinal hemorrhages with dilated and irregular retinal veins ## Footnote Disc neovascularization may be present.

Question 468

What symptoms are commonly associated with ocular ischemic syndrome?

Answer 468

History of transient visual loss, transient ischemic attacks, or orbital pain ## Footnote These symptoms indicate potential underlying vascular issues.

Question 469

What is preretinal hemorrhage?

Answer 469

Leakage of blood into either the subhyaloid space between the posterior vitreous face and retina, or beneath the internal limiting membrane ## Footnote Usually presents with a boat-shaped hemorrhage which obscures the underlying retina.

Question 470

What are the common findings in malignant hypertension related to the retina?

Answer 470

Hard exudates in a macular star formation, optic nerve edema, flame-shaped retinal hemorrhages, retinal edema, and cotton-wool spots ## Footnote Requires immediate medical treatment.

Question 471

What characterizes Valsalva retinopathy?

Answer 471

Single or multiple hemorrhages beneath the internal limiting membrane, most commonly noted in the area of the macula ## Footnote Usually associated with a history of heavy lifting, coughing, vomiting, or straining.

Question 472

What are the signs of ocular ischemic syndrome?

Answer 472

Mid-peripheral retinal hemorrhages with dilated and irregular retinal veins *flare in anterior chamber and corneal edema ## Footnote Disc neovascularization may be present.

Question 473

What symptoms are commonly associated with ocular ischemic syndrome?

Answer 473

History of transient visual loss transient ischemic attacks or orbital pain ## Footnote These symptoms indicate potential underlying vascular issues.

Question 474

What characterizes severe non-proliferative diabetic retinopathy?

Answer 474

*1 category from the 4-2-1 rule Any of the following in the absence of proliferative retinopathy: *intraretinal hemorrhages in all 4 quadrants * 2 quadrants of venous beading * 1 quadrant of prominent intraretinal microvascular abnormalities (IRMA) ## Footnote These criteria help in the diagnosis of severe non-proliferative diabetic retinopathy.

Question 475

What is defined as clinically significant macular edema?

Answer 475

Defined as any one of the following: * Retinal thickening within 500 microns (1/3 disc diameter) of the center of the fovea * Hard exudates within 500 microns of the center of the fovea, if associated with adjacent retinal thickening * Thickening of the retina with a size greater than 1 disc area, part of which is within 1 disc diameter of the foveal center ## Footnote Clinically significant macular edema can lead to vision impairment if not treated.

Question 476

What observations indicate high-risk proliferative diabetic retinopathy?

Answer 476

Includes one of the following observations: * NVD with a size greater than 1/4 to 1/3 of the optic disc * Any degree of NVD if an associated pre-retinal or vitreous hemorrhage is present * NVE greater than 1/2 the size of the optic disc when associated with a pre-retinal or vitreous hemorrhage ## Footnote These criteria are critical for determining treatment approaches such as parenteral laser photocoagulation.

Question 477

Fill in the blank: Severe non-proliferative diabetic retinopathy can involve _______ intraretinal hemorrhages in each quadrant.

Answer 477

>20 ## Footnote This specific number is part of the diagnostic criteria for severe non-proliferative diabetic retinopathy.

Question 478

True or False: Clinically significant macular edema can occur without retinal thickening.

Answer 478

False ## Footnote Retinal thickening is one of the key definitions of clinically significant macular edema.

Question 479

What is NVD in the context of diabetic retinopathy?

Answer 479

Neovascularization of the disc (NVD) ## Footnote NVD is a critical indicator of high-risk proliferative diabetic retinopathy.

Question 480

Fill in the blank: High-risk proliferative diabetic retinopathy includes NVE greater than _______ the size of the optic disc when associated with a pre-retinal or vitreous hemorrhage.

Answer 480

1/2 ## Footnote NVE stands for neovascularization elsewhere and is a significant factor in assessing the severity of diabetic retinopathy.

Question 481

What condition may occur even following uneventful cataract surgery?

Answer 481

Cystoid macular edema ## Footnote Cystoid macular edema is a condition characterized by fluid accumulation in the eye.

Question 482

What results in the formation of a small cyst in cystoid macular edema?

Answer 482

Buildup of fluid between the outer plexiform layer and the inner nuclear layer adjacent to the macula ## Footnote This fluid accumulation leads to the characteristic cyst formation seen in this condition.

Question 483

How long does cystoid macular edema commonly self-resolve?

Answer 483

Within six months ## Footnote Most cases of cystoid macular edema resolve spontaneously without treatment.

Question 484

What treatments may be prescribed if a patient with cystoid macular edema is symptomatic?

Answer 484

Topical NSAIDs or steroids ## Footnote Non-steroidal anti-inflammatory drugs (NSAIDs) and steroids are used to reduce inflammation and symptoms. If no response Tx with oral NSAIDs and/or oral acetazolamide

Question 485

What can happen if cystoid macular edema is longstanding?

Answer 485

Cysts may enlarge and coalesce, causing a lamellar macular hole ## Footnote Prolonged cystoid macular edema can lead to more serious complications affecting vision.

Question 486

What appearance does cystoid macular edema have on fluorescein angiography during the late phase?

Answer 486

Flower-like or clover-like appearance ## Footnote This distinctive appearance helps in the diagnosis of cystoid macular edema.

Question 487

What characteristic appearance is observed in fluorescein angiography for central serous maculopathy?

Answer 487

Smoke stack appearance ## Footnote The smoke stack appearance is a key diagnostic feature in central serous maculopathy.

Question 488

What factor influences the fluorescein angiography presentations in proliferative diabetic retinopathy?

Answer 488

Area(s) of leakage ## Footnote Different areas of leakage can result in varied fluorescein angiography findings in this condition.

Question 489

What does the fluorescein angiography for bull's eye maculopathy display?

Answer 489

RPE window defects surrounding the fovea in a ring-like fashion ## Footnote This ring-like pattern is characteristic of bull's eye maculopathy.

Question 490

What is AS sickle cell trait?

Answer 490

Found in 8% of the African-American population, requires extreme hypoxia to cause sickling.

Question 491

What is SS sickle cell anemia?

Answer 491

Found in 0.4% of the African-American population, associated with severe systemic complications but only mild ocular problems.

Question 492

What is SC sickle cell C disease?

Answer 492

Found in 0.2% of the African-American population.

Question 493

What is sickle cell thalassaemia (Sthal)?

Answer 493

Both SC and SThal result in mild systemic complications but are associated with advanced ocular conditions.

Question 494

How many stages are there in proliferative retinopathy associated with sickle cell disease?

Answer 494

5 stages.

Question 495

What occurs in Stage 2 of proliferative retinopathy?

Answer 495

Peripheral arteriovenous anastomoses.

Question 496

What is observed in Stage 3 of proliferative retinopathy?

Answer 496

Neovascularization of the anastomoses resulting in a 'sea-fan' appearance; 40-50% of 'sea-fans' will unexpectedly involute.

Question 497

What happens in Stage 4 of proliferative retinopathy?

Answer 497

Vitreous hemorrhage.

Question 498

What is the outcome in Stage 5 of proliferative retinopathy?

Answer 498

Proliferation of fibrovascular tissue and rhegmatogenous or tractional retinal detachment.

Question 499

What is AS sickle cell trait?

Answer 499

Found in 8% of the African-American population, requires extreme hypoxia to cause sickling.

Question 500

What is SS sickle cell anemia?

Answer 500

Found in 0.4% of the African-American population, associated with severe systemic complications but only mild ocular problems.

Question 501

What is SC sickle cell C disease?

Answer 501

Found in 0.2% of the African-American population.

Question 502

What is sickle cell thalassaemia (Sthal)?

Answer 502

Both SC and SThal result in mild systemic complications but are associated with advanced ocular conditions.

Question 503

How many stages are there in proliferative retinopathy associated with sickle cell disease?

Answer 503

5 stages.

Question 504

What occurs in Stage 1 of proliferative retinopathy?

Answer 504

Occlusion of the peripheral arterioles.

Question 505

What occurs in Stage 2 of proliferative retinopathy?

Answer 505

Peripheral arteriovenous anastomoses.

Question 506

What is observed in Stage 3 of proliferative retinopathy?

Answer 506

Neovascularization of the anastomoses resulting in a 'sea-fan' appearance; 40-50% of 'sea-fans' will unexpectedly involute.

Question 507

What happens in Stage 4 of proliferative retinopathy?

Answer 507

Vitreous hemorrhage.

Question 508

What is the outcome in Stage 5 of proliferative retinopathy?

Answer 508

Proliferation of fibrovascular tissue and rhegmatogenous or tractional retinal detachment.

Question 509

What are some toxic/metabolic disorders that may cause visual hallucinations?

Answer 509

• Drug and alcohol withdrawal syndromes • Medications with toxic side effects • Metabolic encephalopathies due to endocrine disturbances, vitamin deficiency, inflammatory and infectious diseases, cardiopulmonary insufficiency ## Footnote Toxic/metabolic disorders encompass a range of conditions affecting the body's metabolism and can lead to hallucinations.

Question 510

Name two psychiatric disorders that can cause visual hallucinations.

Answer 510

• Acute psychosis • Schizophrenia ## Footnote Psychiatric disorders often involve disturbances in perception, which can manifest as hallucinations.

Question 511

Fill in the blank: _______ is a condition that may lead to visual hallucinations and involves intense emotional states.

Answer 511

[Affective disorder]

Question 512

What neurologic disorder is associated with visual hallucinations?

Answer 512

• Parkinson disease • Migraine • Dementia • Epilepsy • Brain-stem lesions • Hemispheric lesions ## Footnote Neurologic disorders can disrupt normal brain function, leading to various perceptual disturbances, including hallucinations.

Question 513

True or False: Sensory deprivation can cause visual hallucinations.

Answer 513

True ## Footnote Sensory deprivation removes external stimuli, which can lead to the brain generating its own perceptions, including visual hallucinations.

Question 514

What is the condition characterized by visual hallucinations without any other sensory stimuli (hearing or smell)?

Answer 514

• Charles Bonnet syndrome ## Footnote Charles Bonnet syndrome typically affects individuals with significant vision loss and can lead to vivid visual hallucinations. *can be simple or complex *mostly faces not scary

Question 515

List some miscellaneous conditions that may cause visual hallucinations.

Answer 515

• Sensory and sleep deprivation • Intense emotional states (grief, stress) ## Footnote Miscellaneous conditions can be varied and often intersect with psychological and physiological factors.