Retinal Disorders

Question 1

How does fundus fluorescein angiography (FFA) show a defect/damage in the retina?

Answer 1

Inner and outer blood-retinal barriers are impermeable to fluorescein, and choriocapillaris is only permeable to free fluorescein (15%), therefore the majority is kept within the retina, so a leak is indicative of retinal defect/damage

Question 2

How does optical coherence tomography (OCT) work?

Answer 2

Uses light waves to take cross-section pictures of the retina, allowing each layer to be mapped and measured

Question 3

How does electroretinogram (ERG) work?

Answer 3

Measures retinal function by recording action potentials within the retina

Question 4

How does electro-oculogram (EOG) work?

Answer 4

Measures function of RPE and photoreceptors by measuring resting potential difference between RPE and photoreceptors

Question 5

How are visually evoked potentials (VEP) measures?

Answer 5

Records optic nerve function by measuring electrical activity in the visual cortex in response to a flashing light or a checker board patter

Question 6

What does reduced amplitude of VEP indicate?

Answer 6

Reduced cell number - ischamic/traumatic optic neuropathy

Question 7

What does latency in VEP indicate?

Answer 7

Reduced cell function - optic neuritis

Question 8

Causes of central retinal vein occlusion

Answer 8

Hypertension
Glaucoma
Hyperviscosity
Inflammation

Question 9

Presentation of central retinal vein occlusion

Answer 9

Macular oedema

Question 10

Causes of central retinal artery occlusion

Answer 10

Emboli

Inflamamtion

Question 11

Presentation of central retinal artery occlusion

Answer 11

Pale retina with cherry-red spots

Question 12

Types of ischaemic optic neuropathy

Answer 12

Arteritic (AION)

Non-arteritic (NAION)

Question 13

Cause and presentation of arteritic ischaemic optic neuropathy

Answer 13

Giant cell arteritis
Headaches, weight loss, lethargy
Sudden painless vision loss in one and then both eyes

Question 14

How do you differentiate between arteritic and non-arteritic ischaemic optic neuropathy?

Answer 14

Using blood tests for inflammatory markers, particularly ESR and CRP, as non-arteritic is not related to inflammation

Question 15

Sign of ischaemic optic neuropathy seen on examination of the eye

Answer 15

Swollen nerve
Indistinct margins
Pale if atrophy has occurred

Question 16

Presentation of giant cell arteritis

Answer 16

Headache 
Scalp tenderness 
Jaw claudication 
Neck pain 
Nausea
Anorexia 
Vision loss

Question 17

Treatment of giant cell arteritis

Answer 17

High dose oral steroids

Question 18

Presentation of optic neuritis

Answer 18

Pain on eye movements
Reduced vision
Central scotoma
Red desaturation

Question 19

Signs of optic neuritis on eye examination

Answer 19

Relative afferent pupil defect

Swollen optic disc

Question 20

Typical patient affected by optic neuritis

Answer 20

Middle-aged females

related to MS

Question 21

Painless causes of sudden vision loss

Answer 21

Stroke
Vitreous haemorrhage
Retinal detachment

Question 22

What is age-related macular degeneration?

Answer 22

Progressive loss of central vision

Question 23

Risk factors for age-related macular degeneration

Answer 23

Age
Smoking
Poor diet

Question 24

Typical presentation of age-related macular degeneration

Answer 24

People no longer able to read newspaper/computer screen

Question 25

Treatment of dry-type age-related macular degeneration

Answer 25

No treatment - vitamins can be given to slow onset/progression

Question 26

What happens in wet-type age-related macular degeneration?

Answer 26

Patients with dry-type will go on to develop blood or fluid in the retina, can lead to fibrous scarring

Question 27

Presentation of diabetic neuropathy

Answer 27

Exudates and haemorrhage from the eyes, cotton wool spots seen on examination

Question 28

Treatment of diabetic neuropathy

Answer 28

Controlling diabetes Manage symptomatic features Laser treatment to reduce vision loss

Question 29

Cause of hypertensive retinopathy

Answer 29

Poor control of hypertension

Question 30

Type of photoreceptor retinal dystrophies

Answer 30

Retinitis pigmnetosa Cone dystrophy Leber's congenital amaurosis

Question 31

Types of retinal pigment epithelium dystrophies

Answer 31

Best's vitelliform macular dystrophy Stargadt macular dystrophy Sorsby macular dystrophy North Carolina macular dystrophy

Question 32

Types of choiroidal dystrophies

Answer 32

Choroideraemia | Gyrate atrophy

Question 33

Types of vitreoretinal dystrophies

Answer 33

Stickler syndrome | Congenital retinoschisis

Question 34

What structures of the eye are predominantly affected by retinitis pigmentosa?

Answer 34

Rods

Question 35

Drug classes responsible for drug-induced retinopathy

Answer 35

Antimalarials Phenothiazines Tamoxifen TB medications

Question 36

Other causes of gradual painless loss of vision

Answer 36

Cataract Refractive error Open-angle glaucoma

Question 37

Other acquired maculopathies

Answer 37

``` Central serous retinopathy Idiopathic macular hole Epiretinal membrane Cystoid macular oedema Myopic maculopathy Choroidal folds Angioid streaks ```

Question 38

Method of gene therapy for retinal disease

Answer 38

Used to treat defective/missing gene | Use of a viral vector to insert replacement gene into host DNA