Retinal diseases

Question 1

What are the mild features of diabetic retinopathy?

Answer 1

Microaneurysms
Dot and blot haemorrhages
Exudates

Question 2

What are the features of preproliferative diabetic retinopathy?

Answer 2

Cotton wool spots

Venous bleeding

Question 3

What are the features of proliferative diabetic retinopathy?

Answer 3

New vessels present at disc or elsewhere

Question 4

What is the management of diabetic retinopathy?

Answer 4

Screening/prevention

Application of PRP laser

Question 5

What are the most common causes of painless monocular vision loss?

Answer 5

Retinal vein occlusion
Retinal artery occlusion
Macular haemorrhage
Optic neuritis
Retinal detachment
Ischaemic optic neuropathy (caused by GCA)

Question 6

How is retinal vein occlusion treated?

Answer 6

Laser treatment to reduce macular edema and neovascularisation

Question 7

Describe the fundus of a patient with retinal vein occlusion

Answer 7

Flame haemorrhages
Dot and blot haemorrhages
Macula oedema
Swollen optic disc

Question 8

Describe the fundus of a patient with retinal artery occlusion

Answer 8

Pale retina
Cherry red spot
Retinal emboli may be present

Question 9

How do we treat retinal artery occlusion?

Answer 9

There is no specific treatment available-but prompt referral important as giant cell arteritis is a differential which is treatable.
Prophylactic aspirin may be prescribed in high risk patients

Question 10

What are the clinical features of hypertensive retinopathy on fundoscopy?

Answer 10

Generalised arteriolar narrowing
Focal arteriolar narrowing
Flame haemorrhages
Cotton wool spots
Exudate
Optic disc swelling
Macroaneurysms
Microaneurysms

Question 11

Describe the 5 stages of retinopathy of prematurity

Answer 11

Stage 1: Demarcation between vascular and avascular retina
Stage 2: Elevated ridge on demarcated line
Stage 3 Fibrovascular proliferation from the ridge into vitreous cavity
Stage 4: Subtotal retinal detachment
Stage 5: Total retinal detachment

Question 12

How do we treat retinopathy of prematurity?

Answer 12

The avascular area is ablated using a laser to induce regression of abnormally growing blood vessels
Surgery for retinal detachment has very limited success

Question 13

What is the difference between dry/wet macular degeneration?

Answer 13

Dry: Slow progressive deterioration of vision
Wet: Growth of new abnormally located blood vessels (called choroidal neovascular membrane) underneath the retina causes a sudden loss of vision

Question 14

What are the fundal signs of macular degeneration?

Answer 14

Large numbers of drusen
Macula is mottled with atrophic pallor
Choroidal neovascular membrane looks like haemorrhage and exudate
Spontaneous involution can occur at a later stage-leaving a large pale scar

Question 15

How does prognosis differ between dry and wet macular degeneration?

Answer 15

Dry: progresses very slowly-requires routine referral
Wet: can cause sudden onset vision loss, most experience a significant loss of vision within 3 years

Question 16

What is the treatment for macular degeneration?

Answer 16

High dose antioxidants have shown small benefit in preventing progression in high risk patients
For wet mac deg: photodynamic therapy, IV injection of anti-VEG (ranibizumab), laser therapy.

Question 17

What is a key investigation into wet macular degeneration?

Answer 17

Fundus fluorescein angiography

Question 18

Where are dot and blot haemorrhages located?

Answer 18

Middle compact retinal layers

Question 19

Where are flame haemorrhages located?

Answer 19

Superficial ganglion nerve layer

Question 20

What are hard exudates?

Answer 20

Residual lipids from prior macular oedema

Question 21

Where are pre-retinal haemorrhages located?

Answer 21

Between posterior hyaloid face and retina

Question 22

What are cotton wool spots?

Answer 22

Ischaemia of superficial retinal nerves which look like small feathery white spots