Vision Loss - Retinal Detachment

Question 1

Retinal detachment occurs when the neurosensory layer of the retina becomes detached from the pigmented epithelium. What is the incidence of retinal detachment?

1 - 1000 cases per 100,000
2 - 100 cases per 100,000
3 - 10 cases per 100,000
4 - 1 cases per 100,000

Answer 1

3 - 10 cases per 100,000

Affects men and women equally

Question 2

What age does the incidence of retinal detachment peak at?

1 - 20-30
2 - 30-40
3 - 40-50
4 - 60-70

Answer 2

4 - 60-70

Question 3

Which of the following is NOT a risk factor fore developing retinal detachment?

1 - young age
2 - previous surgery for cataracts (accelerates posterior vitreous ageing, increasing risk)
3 - short sighted (Myopia)
4 - Eye trauma
5 - Family history
6 - Previous history of retinal break/detachment in either eye

Answer 3

1 - young age

Typically affects older patients

Question 4

Which 2 of the following are the most common causes of retinal detachment?

1 - head trauma
2 - vitreous ageing
3 - autoimmune
4 - infection

Answer 4

1 - head trauma
2 - vitreous ageing
- physiological change from thick gel to watery solution

Question 5

Patients with retinal detachment can describe the following, EXCEPT which one?

1 - floaters
2 - complete loss of vision in both eyes
3 - shadow
4 - photopsia (perceived flashes of light)

Answer 5

2 - complete loss of vision in both eyes

Can occur but far less likely and would occur later on

Question 6

If photopsia (perceived flashes of light) is bilateral, is this more likely to be retinal detachment of migraines?

Answer 6

• migraines

Question 7

In patients with retinal detachment, are the symptoms such as floaters, shadow and photopsia (perceived flashes of light) appear in both eyes?photopsia (perceived flashes of light)

Answer 7

• no

Typically occurs unilaterally

Question 8

Patients with a large retinal detachment can experience a Relative Afferent Pupillary Defect (RAPD). What is the RAPD?

1 - patient has no direct response in eye with lesion
2 - patient has no indirect response in eye with lesion
3 - swing test in affected eye causes pupil dilation
4 - swing test in affected eye causes pupil constriction

Answer 8

3 - swing test in affected eye causes pupil dilation
- lesion in eye that dilates as the lesion is impairing the afferent signal

direct = pupil dilates when light shone in that eye
in-direct/consensual = pupil dilates when light shone in opposite eye

Question 9

How is retinal detachment typically treated?

1 - wait and see
2 - analgesia and lubricating eye drops
3 - surgery to repair retina
4 - laser therapy

Answer 9

3 - surgery to repair retina

Question 10

Age-related macular degeneration is the most common cause of blindness in the UK. What is the incidence of this?

1 - 11000 cases per 100,000
2 - 1100 cases per 100,000
3 - 110 cases per 100,000
4 - 11 cases per 100,000

Answer 10

3 - 110 cases per 100,000

Equally likely in men and women

Question 11

What age does the incidence of age-related macular degeneration typically peak?

1 - >80
2 - >70
3 - >60
5 - >50

Answer 11

2 - >70

Question 12

Although the peak incidence of age-related macular degeneration typically peaks at 70 years old, what age can this occur from?

1 - >30
2 - >40
3 - >50
4 - >60

Answer 12

3 - >50

Question 13

Which of the following is NOT a typical risk factor for developing age-related macular degeneration?

1 - advancing age
2 - smoking
3 - thyroid dysfunction
4 - family history
5 - comorbidity associated with ischaemia (CVD, hypertension, diabetes and dyslipidaemia

Answer 13

3 - thyroid dysfunction

Advancing age is the biggest risk factor

Question 14

There are 2 types of age-related macular degeneration:

• dry macular degeneration
• wet macular degeneration

Which of these accounts for 90% of all age-related macular degeneration?

Answer 14

• dry macular degeneration

Question 15

Age related wet macular degeneration, more commonly known as exudative macular degeneration. What is the primary pathophysiology causing this?

1 - increased intraoccular pressure
2 - clumping of protein on the lens
3 - abnormal neovascularisation
4 - ischaemia

Answer 15

3 - abnormal neovascularisation

• abnormal blood vessels develop from the choroid, behind the retina. These vessels leak intravascular fluid or blood

Question 16

Which of the following is NOT a characteristic of age related wet macular degeneration?

1 - accounts for 90% of age related macular degeneration
2 - neovascular macular degeneration occurs
3 - characterised by choroidal neovascularisation
4 - leakage of serous fluid and blood 5 - can result in a rapid loss of vision
6 - worse prognosis between wet and dry age related macular degeneration

Answer 16

1 - accounts for 90% of age related macular degeneration

Accounts for only 10% of cases, BUT far more serious

Question 17

Does wet or dry age related macular degeneration have a more rapid onset of vision loss?

Answer 17

• wet

Typically causes rapid central vision loss over weeks to months

Question 18

Can patients with dry age-related macular degeneration (ARMD) develop wet ARMD?

Answer 18

• yes

Question 19

In wet age-related macular degeneration, which 2 of the following do patients typically complain of?

1 - blurry central vision
2 - central scotoma
3 - recognising faces
4 - distorted vision

Answer 19

6 - all of the above

Question 20

Do patients with wet age-related macular degeneration typically have a Relative Afferent Pupillary Defect (RAPD). What is the RAPD?

Answer 20

• no

Question 21

Are drusens common in wet age-related macular degeneration?

Answer 21

• no

Question 22

Which of the following imaging techniques is NOT typically used to diagnose and stage age related macular degeneration?

1 - slit-lamp microscopy
2 - ultrasound of the eye
3 - optical Coherence Tomography (OCT)
4 - fluorescein angiography

Answer 22

2 - ultrasound of the eye

Question 23

What is the treatment for patients with wet age-related macular degeneration?

1 - lubricating drops
2 - intravitreal anti-VEGF agents
3 - laser therapy
4 - surgery

Answer 23

2 - intravitreal anti-VEGF agents

Aim is to stabilise vision as cannot return to previous