vision abnormalities

Question 1

what is presbyopia

Answer 1

aging eyes
normal aging in middle age– usually by 45 or so

Question 2

what does presbyopia cause

Answer 2

refractive error for close vision (can’t see up close)
eye strain
headaches

Question 3

what happens to the lens in presbyopia

Answer 3

lens gets harder and less flexible with age and stops focusing light correctly onto the retina

Question 4

how to treat presbyopia

Answer 4

corrective lenses

Question 5

how to assess presbyopia

Answer 5

eye exam

Question 6

three types of glaucoma

Answer 6

acute angle closure
chronic angle closure
chronic open angle

Question 6

what is glaucoma

Answer 6

damage to the optic nerve from pressure inside the eye

Question 7

Glaucoma risk factors

Answer 7

individuals with first degree relative
DM
affected ethnic groups (shape of eye)
pts using long term steroid therapy

Question 8

form of glaucoma caused by rapid narrowing or closure of the anterior chamber angle
(sudden, matter of seconds)

Answer 8

acute angle closure glaucoma

Question 9

inadequate drainage of the aqueous humor leads to increased IOP and damage to the optic nerve

Answer 9

acute angle closure glaucoma

Question 10

acute angle closure glaucoma risk factors

Answer 10

shallow anterior chamber which is associated with far sightedness or small eyes
genetics/ancestry
elderly

Question 11

extreme pain and blurred vision (sudden although can be subacute headaches)
unilateral
halos around lights
headaches
nausea/ abdominal pain
red eye/cloudy cornea/dilated pupil
eye feels hard on palpation

Answer 11

acute angle closure glaucoma patient presentation

Question 11

acute angle closure glaucoma precipitated by

Answer 11

pupil dilation
(they went into dark room, pupils dilated, then vision loss)

Question 12

acute angle closure glaucoma pressure

Answer 12

well over 50
(normal IOP 10-21)

Question 13

acute angle closure glaucoma treatment

Answer 13

emergent referral to ophthalmology

reduce IOP:
- IV acetazolamide
- followed by oral acetazolamide
- plus topical medication (timolol maleate)
- topical pilocarpine (after IOP starts to fall)

cataract removal or laser peripheral iridotomy to follow

Question 13

chronic glaucoma symptoms

Answer 13

may be no symptoms (or not noticed) until disease has progressed for a long time

Question 14

progressive optic nerve damage
leads to visual field loss and ultimately, irreversible blindness if left untreated
gradual loss of peripheral vision “tunnel vision”

Answer 14

chronic glaucoma

Question 15

chronic glaucoma often suspected on

Answer 15

routine eye test

Question 16

optic nerve cupping: looks like a pale cup
nerves don’t connect

Answer 16

chronic glaucoma vision loss

Question 17

chronic glaucoma prevention
screen patients with IOP measurements and optic disk exam if

Answer 17

inuit or asian ancestry
affected 1st degree relative
DM
older people with African or hispanic ancestry
long term oral, intranasal, and inhaled corticosteroid use

Question 18

increased aqueous production and/or decreased outflow are possible mechanisms for elevated IOP
most common and usually bilateral

Answer 18

open angle chronic glaucoma

Question 19

chronic low vascular perfusion, Raynaud’s phenomenon, migraine, nocturnal systemic hypotension and over treated systemic hypertension

Answer 19

normal tension chronic glaucoma

Question 20

flow of aqueous humor is obstructed
similar to acute form, can have eye redness, discomfort, and headache
progression much slower
may have only mildly elevated IOP

Answer 20

angle closure chronic glaucoma

Question 21

the outer rim tends to be orange or pink in color and contains the nerve fibers

Answer 21

disc

Question 21

(in the center) is a pit where there are no nerve fibers -- this is where blood vessels enter the eye

Answer 21

cup

Question 22

the disc takes on a hollowed out appearance on fundoscopic exam from the death of smaller nerves around the optic nerve

Answer 22

cupping

Question 23

the cup should not make up more than _______ of the total area of the optic nerve

Answer 23

30%

Question 24

what happens to central vision in glaucoma

Answer 24

remains good until late in disease

Question 25

glaucoma diagnosis consistent and reproducible abnormalities in at least 2 of 3 parameters:

Answer 25

optic disk visual fields intraocular pressure

Question 26

chronic glaucoma treatment

Answer 26

- prostaglandin analog drops: reduce IOP (latanoprost, travoprost, latanoprostene bound) - topical beta blockers: reduce production of fluid - laser treatment or surgery if medication fails: open up space to improve flow of aqueous humor (trabeculoplasty, trabeculectomy, iridectomy)

Question 27

what causes strabismus

Answer 27

problems with the eye muscles nerves that transmit information to the muscles control center in brain that directs eye movements

Question 28

misalignment of the eyes

Answer 28

strabismus

Question 29

strabismus usually presents in

Answer 29

children

Question 30

eye deviated inward

Answer 30

esotropia (strabismus)

Question 31

eye deviated outward

Answer 31

exotropia (strabismus)

Question 32

epicanthal skin folds cover the medial canthus lack of development of the bridge of the nose

Answer 32

pseudostrabismus

Question 33

what tests do you do for strabismus

Answer 33

Hirschberg test to see if white light is in same spot on pupil cover test to see if bad eye will move into place

Question 34

risk factors for amblyopia

Answer 34

prematurity small size for gestational age first degree relative with amblyopia neurodevelopmental delay

Question 35

functional reduction in visual acuity caused by abnormal visual development early in life most common cause of pediatric visual impairment unilateral often associated with impaired or absent fine depth perception

Answer 35

amblyopia

Question 36

abnormal binocular interaction and long term suppression of one eye

Answer 36

strabismic amblyopia

Question 37

appropriately focused visual stimuli are crucial to the development of

Answer 37

normal vision critical period of visual cortex neuroplasticity

Question 38

affected children are often diagnosed at the first vision screening when they are old enough to identify letters or figures (typically 4-5 years)

Answer 38

refractive amblyopia

Question 38

visual acuity typically reaches the adult level by

Answer 38

3-5 years of age

Question 39

growth on eyelid

Answer 39

deprivational amblyopia

Question 40

amblyopia diagnosis

Answer 40

complete eye exam by skilled eye care specialist defined as >2 line difference in visual acuity between eyes

Question 41

what does amblyopia screening include

Answer 41

vision risk assessment at all health maintenance visits and vision screening at 3,4, and 5

Question 42

objection to occlusion test (amblyopia: preverbal screening and referral)

Answer 42

monitoring Childs response to alternate occlusion of the eyes

Question 42

who should be screened for amblyopia

Answer 42

all children younger than five

Question 43

during objection to occlusion test what can you expect from children with moderate to severe visual impairment in one eye when the eye with better vision is occluded

Answer 43

become irritable

Question 44

children with suspected amblyopia should be referred to a

Answer 44

pediatric ophthalmologist or optometrist

Question 45

indications for amblyopia referral

Answer 45

- visual acuity worse than 20/40 in a child 3-5 or worse than 20/30 in a child 6 or older - visual acuity difference > 2 lines between eyes - strabismus -abnormal red reflex - asymmetry of vision - unilateral ptosis or other lesions that threaten the visual axis

Question 46

amblyopia treatment

Answer 46

occlusion therapy (patching better eye) atropine fix structural problems

Question 47

retinal tumor of childhood 67% diagnosed before the age of 2, rare after 6

Answer 47

retinoblastoma

Question 48

most common presenting symptoms of retinoblastoma

Answer 48

leukocoria (white reflex) or strabismus

Question 49

retinoblastoma diagnosis

Answer 49

fundoscopic exam under anesthesia with maximally dilated pupil imaging studies to confirm and evaluation for extension

Question 50

retinoblastoma management

Answer 50

ophthalmology and oncology

Question 51

transient emboli to a retinol artery carotid artery stenosis

Answer 51

amaurosis fugax

Question 51

this is a symptom sudden unilateral vision loss painless typically lasts a few minutes like a curtain going down and then up

Answer 51

amaurosis fugax

Question 52

how do patients present with amaurosis fugax

Answer 52

almost always present after transient visual loss episode has resolved - neurologic and ophthalmologic exam is usually normal

Question 53

Amaurosis fugax: differential diagnosis

Answer 53

carotid artery disease giant cell arteritis (swelling of the arteries of the head reduces blood supply) (usually with pain and headache)

Question 54

amaurosis fugax: evaluation > 45

Answer 54

ischemic cause likely

Question 55

amaurosis fugax: evaluation < 40

Answer 55

benign migrainous cause likely

Question 56

Amaurosis fugax: exam

Answer 56

visual acuity visual fields examination of optic fundus carotid artery

Question 57

Amaurosis fugax: evaluation

Answer 57

- ophthalmologic evaluation - erythrocyte sedimentation rate and C-reactive protein - carotid imaging

Question 58

what to do if initial testing for amaurosis fugax is normal

Answer 58

Cardiac evaluation brain MRI EEG hypercoagulable testing

Question 59

Amaurosis fugax treatment

Answer 59

depends on the cause treat like stroke until proven otherwise