Term
|
Definition
| A progressive optic neuropathy w/ associated visual field loss. |
|
|
Term
| What is intraocular pressure maintained by? What is considered normal IOP? |
|
Definition
| By amt. of fluid made by ciliary body. < or = 22mm Hg |
|
|
Term
| What does optical coherence tomography/RNL measure? |
|
Definition
| Concavity of optic nerve in glaucoma |
|
|
Term
| Name 4 treatment options for glaucoma? Which is the main tx? |
|
Definition
| 1) Topical meds* 2) Laser trabeculectomy 3) Shunt/valve surgery 4) Trabeculectomy |
|
|
Term
| Name 5 classes of meds used to tx glaucoma. |
|
Definition
| 1) Beta blockers 2) Alpha antagonists 3) Carbonic anhydrase inhibitors 4) Prostaglandin analogues 5) Miotics |
|
|
Term
| What do beta blockers, alpha antagonists, and carbonic anhydrase inhibitors do to tx glaucoma? |
|
Definition
| They decrease the amount of fluid made. |
|
|
Term
| What is the leading cause of central visiual acuity loss in people over 50 years of age in the US? |
|
Definition
| Age-related macular degeneration (AMD) |
|
|
Term
| Name the 3 greatest risk factors for AMD. |
|
Definition
| 1) Age >65 2) Family hx 3) Cigarette smoking |
|
|
Term
| What are other risk factors of AMD? |
|
Definition
| Hyperopia, light iris color, HTN, Hypercholesterolemia, CVD, female |
|
|
Term
|
Definition
| 1) Dry (non-exudative) 2) Wet (exudative) |
|
|
Term
| What are drusen and in what type of AMD are they found? |
|
Definition
| Small, round, yellowish lesions located at the RPE. Found in dry AMD. |
|
|
Term
| What is RPE? What happens to it in dry AMD? |
|
Definition
| Retinal pigment epithelial cells in the macula, thinned or broken down in dry AMD. |
|
|
Term
| How does dry AMD affect one's vision? |
|
Definition
| Reduces central vision and can affect color perception |
|
|
Term
| What can be done to tx dry AMD? |
|
Definition
| 1) Have pts check monocular vision 2) Antioxidant supplementation (VIT C, E, A and zinc) 3) Avoid UV light |
|
|
Term
| Which is the more severe form of AMD? |
|
Definition
|
|
Term
| The presence of what defines wet AMD? |
|
Definition
| Choroidal neovascular membrane (CNV) |
|
|
Term
|
Definition
| Ingrowth of new vessels from the choriocapillaries through a break in Bruch's membrane into the subpigment epithelial space. |
|
|
Term
| What happens when CNV occurs? |
|
Definition
| The abnormal vessel growth causes blood and protein to leak below the macula causing edema (exudate) resulting in central vision loss |
|
|
Term
| What is the goal of tx for wet AMD? Name 3 tx types. |
|
Definition
| To maintain vision. 1) Photodynamic therapy 2) Anti-VEGF 3) Focal laser |
|
|
Term
| What is the most common introcular malignancy in children? |
|
Definition
| Retinoblastoma (1 in 20,000) |
|
|
Term
| What is the clinical presentation of retinal blastoma? |
|
Definition
| 1) Leukocoria (50%) 2) Strabismus (22%) 3) Decreased vision (5%) |
|
|
Term
| What are differential dx of retinoblastoma? |
|
Definition
| Cataract, retrolental mass, tumor, change in retinal pigment, high myopia, infxns |
|
|
Term
| Name 2 tx for retinoblastoma. |
|
Definition
| 1) Episcleral plaque radiation 2) Photocoagulation/cryotherapy |
|
|
Term
| What occurs in branch retinal vein occlusion (BRVO)? |
|
Definition
| Superficial hemorrhages, retinal edema, cotton wool spots (nerve fiber layer infarcts) |
|
|
Term
| Where does BVO typically occur? |
|
Definition
| Where the artery and vein cross each layer (art hardens and compresses vein) |
|
|
Term
|
Definition
| >50 yo, M>F, HTN, CVD, Obese, h/o glaucoma |
|
|
Term
|
Definition
| 1) Angiogram to check for edema 2) Laser to reduce edema 3) Steroid injection (intravitreal triamcinolone) 4) Anti-VEGF |
|
|
Term
| What occurs in central retinal vein occlusion (CRVO)? |
|
Definition
| 1) Dilated, torutuous retinal veins 2) swollen optic disc 3) Intraretinal hemorrhage 4) Retinal edema |
|
|
Term
|
Definition
| >50 yo, M>F, HTN, glaucoma, DM, oral contraceptives, diuretics |
|
|
Term
| What condition can mimic CRVO, but is generally bilateral? |
|
Definition
| hyperviscosity retinopathy |
|
|
Term
|
Definition
| Angiography, glaucoma work-up, laser for macular edema, intravitreal triamcinolone |
|
|
Term
| What other considerations should be done for CRVO? |
|
Definition
| 1) Tx any underlying cause (HTN, Hyperchol., Dm) 2) Consider aspirin 3) Watch for dev. of neovascular glaucoma |
|
|
Term
| What clinical presentation would result in immediate referral for CRVO? |
|
Definition
| Iris neovascularization (ischemia in retina causes the eye to redev. abnormal blood vessels esp. in the iris) |
|
|
Term
| WWhat occurs in branch retinal artery occlusion? |
|
Definition
| Edematous opacification of the retina caused by infarction in the distribution of the affected vessel |
|
|
Term
| What are the 3 most common causes of BRAO? |
|
Definition
| 1) DM retinopathy 2) HTN 3) Cardiac embolic dz |
|
|
Term
| What are other causes of BRAO? |
|
Definition
| Carotid artery obstructive dz, sickle cell retinopathy, XRT retinopathy, vasculitis, collagen vascular dz, leukemia, AIDS |
|
|
Term
| What are the 3 main varieties of emboli? |
|
Definition
| 1) Cholesterol (Hollenhorst plaques) in carotid art. 2) Platelet-fibrin 3) Calcific |
|
|
Term
| What are the sx of central retinal artery occlusion (CRAO)? |
|
Definition
| Sudden, severe, painless loss of vision (irreversible /p 90min) |
|
|
Term
| What is the etiology of CRAO? |
|
Definition
| Similar to BRAO, but giant cell arteritis accounts for ~1-2% of cases |
|
|
Term
|
Definition
| Transient loss of usually monocular vision |
|
|
Term
| IS there pain associated with amaurosis fugax? |
|
Definition
|
|
Term
| What is the most common cause of amaurosis fugax? |
|
Definition
| Embolic phenomena w/i the carotid distribution |
|
|
Term
| What is giant cell (temporal) arteritis? |
|
Definition
| Inflammation w/i med. and lg. arteries of the head and neck |
|
|
Term
| What are sx of temporal arteritis? |
|
Definition
| amaurosis fugax, temple pain or HA, jaw claudication*, fever, wt loss, malaise |
|
|
Term
| What tests are done to check for temporal arteritis? |
|
Definition
| 1) SED rate 2) CRP* 3) temporal artery bx |
|
|
Term
| What is the tx for temporal arteritis? |
|
Definition
| 1) HIgh-dose steroids (1-2yrs) 2) Serial SED rates |
|
|
Term
| What is leading cause of death in pts w/ retinal artery obstruction? |
|
Definition
|
|
Term
| What is the most common cause of blindness in pts 20-64yo? |
|
Definition
| DM retinopathy, prevalance increases w/ age and duration of dz |
|
|
Term
| Describe the pathogenesis of DM retinopathy. |
|
Definition
| Exposure to hyperglycemia results in biochemical and physiologic changes that result in vascular endothelial damage. |
|
|
Term
| What 3 conditions are associated w/ potential vision loss? |
|
Definition
| 1) Ischemia-related neovascularization 2) DM macular edema* 3) Ischemic macular changes |
|
|
Term
| What are the 2 stages of DM retinopathy? |
|
Definition
| 1) Non-proliferative (NPDR) 2) Proliferative (PDR) - blood vessels growing |
|
|
Term
|
Definition
| Microvascular changes limited to the confines of the retina. |
|
|
Term
| What are the microvascular changes that occur in NPDR? |
|
Definition
| Microaneurysms, dot-and-blot intraretinal hemorrhages, retinal edema, hard exudates, dilation and beading of retinal vessels, IRMA, NFL infarcts, arteriolar infarcts, and capillary non-perfusion |
|
|
Term
|
Definition
| Extraretinal fibrovascular proliferation extends |
|
|
Term
| What are the stages of the proliferation in PDR? |
|
Definition
| 1) Fine new vessels w/ minimal fibrous tissue appear 2) New vessels increase in size and extent with increased fibrous component 3) New vessels regress, leaving residual fibrovascular proliferation along the posterior hyaloid |
|
|
Term
| What are people w/ PDR at increased risk for? |
|
Definition
| MI, CVA, DM retinopathy, amputation, death |
|
|
Term
| What is an important visual consequence of abnormal vessel permeability in DM retinopathy? |
|
Definition
| Retinal edema threatening or involving the macula |
|
|
Term
| What does enlargement of the foveal avascular zone >1000mcm in diameter mean? |
|
Definition
|
|
Term
| What condition is associated with enlargement of the FAZ from retinal capillary non-perfusion? |
|
Definition
|
|
Term
| Name 3 tx for DM retinopathy. |
|
Definition
| 1) Laser photocoagulation (>1200 500mcm burns) 2) Intravitreal steroid injections 3) Vitrectomy |
|
|
