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Refracting Skills 2 > unit 3 > Flashcards

unit 3 Flashcards

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1
Q

Corneal Inlays

A

-INTACTS
-KARMA

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2
Q

Types of refractive surgery

A

-LASIK
-PRK
-RK
-LRI
-CRI

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3
Q

Corneal procedures

A

-PK
-CXL

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4
Q

Lens based correction

A

-RLE
-IOLS (standard, toric, presbyopic, phakic, piggyback)

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5
Q

4 surgical alternatives to eyelgasses

A

-refractive sx
-corneal procedures
-corneal inlays
-lens based correction

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6
Q

4 non surgical alternatives to eyeglasses

A

-contact lenses
-low vision aids
-occlusion therapy
-pharmacological

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7
Q

occlusion therapy

A

-patching
-atropine penalization

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8
Q

low vision aids

A

-hand held magnifiers
-telescopes
-tech based magnifiers

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9
Q

-pharmacological

A

-botox for strabismus
-low dose atropine for myopia control

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10
Q

basic types of corneal refractive surgery

A
  1. laser based surgeries
  2. blade-based surgeries
  3. corneal inlay
  4. other corneal procedures
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11
Q

laser based sx

A

-use a laser to adjust the corneal shape by removing tissue or creating incisions
(photoablate or photodisrupt the corneal tissue)
-can be preformed for all types of refractive errors

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12
Q

how LASIK works

A

-local anesthetic is used
-treatment is done by sculpting the corneal stroma
-a thin anterior corneal flap is created with a femtosecond laser or mechanical keratome (blade)
-the flap (epithelium and bowmans) remains attached by a hinge of tissue and is lifted to expose the stroma layer
-the intrastromal tissue is respahed using the excimer laser

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13
Q

what is LASIK done for

A

treat myopia, hyperopia and astigmatism (+4.00 to -12.00)
cyl - -0.5 to -4.00

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14
Q

how long does it take for the acuity and comfort to be better after LASIK

A

first few days after sx

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15
Q

SBK (Sub-bowmans keratectomy)

A

-similar to LASIK
-a femtosecond laser creates a VERY THIN anterior corneal flao. (blade less lasik)
-desired power treatment is applied to the exposed corneal bed
-sometimes know as “FS-assisted) LASIK

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16
Q

complications with LASIK

A

-dry eyes
-glare/halos
-double vision
-over or under-correction or regression
-vision loss or change
-quality of vision decrease
-corneal neuralgia
-epithelilal ingrowth
-diffuse lamellar keratits

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17
Q

flap complications with LASIK

A

-microstriae
-debris
-taco flap
-incomplete flap
-buttonhole
-flap displacement
-decentered flap
-free cap

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18
Q

corneal neuralgia

A

-neuropathic corneal pain / damage to corneal nerves
-causes your eyes, face or head to be “over sensitive”
-doctors dont know the exact cause of the neuropathic corneal pain
-pxs are typically referred to a pain management clinic
-condition where corneal pain is seen in response to normally non-painful stimuli

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19
Q

DLK

A

diffuse lamellar keratitis
-non infectious inflammatory infiltrates
-treated with a steroid drop such as predforte or maxidex

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20
Q

PRK (photorefractive keratectomy)

A

-Similar to LASIK, but no corneal flap
-epithelium is removed and excrimer laser treatment is done on the anterior stromal surface

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21
Q

people who do combat / competitive sports , is it recommended to get LASIK or PRK

A

PRK - for the reason being that their is no flap

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22
Q

does PRK or LASIK take longer to recover?

A

PRK

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23
Q

how long till your VA gets better with PRK

A

5 to 7 days

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24
Q

what does PRK treat

A

myopia and astigmatism
-can treat hyperopia but not ideal as its less predictable

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25
who is PRK typically done on?
-pxs with thin corneas -abnormal corneal topographies (not kerataconus) -px into combat competitive sports
26
how to remove the tissue in PRK
-excimer laser -alchohal and saline then scrapped off
27
what is used after reshaping the cornea (PRK)
mitomycin-C which helps prevent scaring/haze -then a bandage contact lens is inserted for approx 5-7 days
28
complications with PRK
-delayed visual recovery -over or under correction -decentered treatment -haze or scaring -dry eyes -corneal ectasia -infection -corneal neuralgia
29
blade based surgeries
-a blade is used to 'relax" the cornea -now mostly used to correct astigmatism
30
radial keratotomy (RK)
was a blade based method used for spherical and astigmatic errors -results did not provide refractive stability -largely abandoned
31
SMILE: small incision lenticule extraction
-laser-based correction of refractive error -considered minimally invasive -involves a small incision and the creation of a lenticule (disc shaped piece of cornea)
32
Corneal Inlay procedures
-artificial material is involved -tissue is not removed -may have greater reversibility -plastic device is placed between the layers of the cornea to flatten or steepen it. -may be used for small amounts of myopia and astigmatism, to bolster a weak cornea or for correction of presbyopia
33
what is lenticule
disc shaped piece of cornea
34
INTACTS corneal inlay
-optically clear, arc-shaped devices -two separate effects: -to flatten the corneal surface in cases of mild myopia associated with keratoconous -to flatten certain meridians to help correct astigmatism associated with keratoconus
35
KARMA corneal inlay
-small opaque device implanted centrally -allows only central light through -increases depth of foucs (like a pinhole), with the intent to eliminate the need for reading gls -FDA restricts KARMA to one eye in pxs who have not had cataract sx
36
Penetrating keratoplasty
Corneal transplant - full thickness replacement from a donor cornea
37
Corneal cross-linking (CXL)
-a special concentration of sterile riboflavin (Vitamin B2) eye droped are applied at specific interals before stictly timed UV exposure -Strengthens the chemical bonds within the cornea to halt progressive and irregular changes in corneal shape due to conditions like keratoconus -refractive changes are mostly minor
38
pre-op evaluation
-a full EE is recommneded prior to referring the px -ocular and health history -refractive status -dilated ocular health exam this allows surgical team to pre screen and discuss any issues -px is required to discontiune soft CL wear for a min of 48 hours prior to testing and 2 weeks for RGPS
39
Contraindications for corneal refractive sx
-ocular pathology -corneal scar/disease -extreme dry eyes -systemic pathology (autoimmune disorders, rheumatoid arthritits, lupus) -medications (accutane)
40
post op evaluation
-after the 1 day follow up visit, the px is encouraged to return to the co-managing optometrist for their f/u care -f/u frequency and testing differs for each type of procedure -post op follow up referral form should be sent to the surgical centre for review -ensure we are monitoring infection and inflammatory response
41
LASIK post op care/medications
-steroid -antibiotic -AT - q15-30mins x 2day -eyesheilds 5-7 nightsf
42
follow up schedule for LASIK
day 1 week 1 month 1 yearly
43
PRK post op care/medication
-steroid -antibiotic -pain relief -AT - q15-30 mins until bandage CL removed -eye shield 5-7 nightsf
44
follow up schedule for PRK
day 1 day 3 week 1 month 1 yearly
45
POST OP PRESENTATION FOR LASIK
-VA 20/15 to 20/50 (may take 3-5 days to start improving) -Foreign Body Sensation (48 H) -Tearing/Photophobia (72 H) -Dry Eyes (up to 6M) -Sub-conjunctival hemorrhage (2-3W) -Ghosting/Halos/Glare (2-3M)
46
POST OP PRESENTATION FOR PRK
-VA 20/30 to 20/400 (up to 1W) -Mild to severe pain (48H) -Foreign body sensation (3-5D) -Tearing, Photophobia (3-5D) -Lid edema (3-5D) -Ghosting (2-4W) -Dry eyes (up to 3M) -Halo/Glare (2-3M) -Drop in VA/diplopia (occurs at day 3-5)
47
What NOT to do after sx
-No pets in the bed -No eye make-up -No swimming, hot tub, water sports -No dusty/smoky environments -No eye rubbing -UV protection -Safety glasses during appropriate activities
48
Non-surgical alternatives to eyewear
-orthokeratology -presbyopia eye drops -patching -atropine therapy
49
Presbyopic drops 2 methods
-Miotics -Lens softening
50
Miotics (presbyopic drops)
-Change the size of the pupil (Creates pinhole effect) -Pilocarpine drop -Daily rx eye drop that works in as little as 15 mins and lasts 6 hours -most common adverse effects were headaches and eye redness
51
Lens softening
-Softens the eyes aging lens (lens regains flexibility, the eye can better focus up close) -Cannot completely restore near vision -May work best for ppl w/o cataracts who are in the early stages of presbyopia
52
what age is treatment for amblyopia most successful?>
before the age of 7 -early detection is crucial
52
Treatment success for amblyopia depends on..
-the age of onset -cause -severity -duration of amblyopia -type of treatment -adherence to therapy
52
2 methods of treating amblyopia
-surgery -patching -penalization
53
surgery for amblyopia
strabismus sx is performed to align the eyes -involves loosening or tightening the muscles -goal is to include reduction/ellimination of diplopia, improvement of stereopsis and cosmesis -amblyopia is treated first so both eyes have the best VA before surgery
54
patching for amblyopia
-occlusion involves covering the stronger eye -continued until the VA becomes equal in each eye or until there is no improvement after 3 to 6 months
55
types of patches available
-sticky patches -cloth patches that fit over gls
56
Penalization
involves blurring the good eye through cycloplegic eye drops (atropine 1%) -decrease accommodation and the ability to focus
57
Manahement of strabismus
-spectacle correction -prism -botox -surgery
58
Spectacle correction for strabismus
-cycloplegic refraction -prescription - mainly based on objective findings until around age6 -bifocal - allows for sufficient relaxation of accomodation to allow for near fusion -sometimes prism is needed to help control diplopia (try w fresnel then u can prescribe it)
59
Fully accomodative esotropia may correct with a full time plus or minus rx?
PLUS
60
Botulinum Toxin
Injection of botulinum toxin type A into an EOM produces dose dependent paralysis -several days after the injection the chemical paralysis of the muscle allows the eye to be moved into the field of action -chemically paralyzed muscles it stretched / lengthend
61
Surgery for strabismus
-goal is to improve ocular alignment and help the eyes achieve binocular single vision -muscle weakening / strengthening -the muscle is detached from the eye and resewn to the eye at a measured distance -the muscle is detached, shortneed and then resewn -not performed on small deviations (<10D)

Refracting Skills 2 (5 decks)

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