Term
| What are the 6 types of hemorrhages? |
|
Definition
Vitreal
Pre-retinal
Flame
Dot/blot
Subretinal
Roth spots |
|
|
Term
| Where are pre-retinal hemorrhages? |
|
Definition
|
|
Term
| Where are subretinal hemorrhages? |
|
Definition
|
|
Term
| What are the two colors seen in subretinal hemorrhages? |
|
Definition
red--> subretinal
Gray-green --> Sub-RPE |
|
|
Term
| What type of vitreal hemorrhage readily shifts with eye movement? |
|
Definition
|
|
Term
| What type of vitreal hemorrhage settles into lacunae? |
|
Definition
|
|
Term
| What is the typical size of a pre-retinal hemorrhage? |
|
Definition
|
|
Term
| What color progression do pre-retinal hemorrhages follow as they heal? |
|
Definition
|
|
Term
| How do flame hemorrhages resolve? |
|
Definition
| dull red color --> fragment --> absorbed |
|
|
Term
| What layers are dot/blots found in? |
|
Definition
|
|
Term
| When does a dot/blot hemorrhage require FANG? |
|
Definition
|
|
Term
| When does a subretinal hemorrhage require FANG? |
|
Definition
| Required every time to determine tx |
|
|
Term
| What are the white spots in Roth spots made of? |
|
Definition
WBC
CWS
Leukemic cell foci
fibrin |
|
|
Term
| What conditions are associated w/ Roth spots? |
|
Definition
DM
pernicious anemia
bacterial endocarditis
leukemia |
|
|
Term
| Where are microaneurysms found, and what is their size? |
|
Definition
| 50-100 um, found in inner retinal capillaries/INL |
|
|
Term
| How big are macroaneurysms and where do they most commonly appear? |
|
Definition
280um
superior temporal quadrant most common (inferior nasal VF) |
|
|
Term
| What is necessary for exudates to form? |
|
Definition
|
|
Term
| What layer are hard exudates found in? |
|
Definition
|
|
Term
| What is almost always seen near exudates? |
|
Definition
|
|
Term
| When is FA warranted for hard exudates? |
|
Definition
| If 1/3DD or less from macula |
|
|
Term
| What color do CWS' appear on FANG? |
|
Definition
|
|
Term
| How long does a CWS take to resolve once the cuase is controlled? |
|
Definition
|
|
Term
| What is the mechanism that causes CWS? |
|
Definition
|
|
Term
| How does NV cause retinal detachments? |
|
Definition
|
|
Term
|
Definition
| IntraRetinal Microvascular Anomalies; A shunting system formed to drain fluid or in an area of non-perfusion |
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|
Term
| Which is known to leak: IRMA or Neo? Which is a threat to vision? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What mechanism causes venous beading? |
|
Definition
|
|
Term
| What is the sequence of filling in FANG? What is the timing? |
|
Definition
choroidal flush --> A-V phase --> late phase
10-12s = choroidal flush; 10-15s A-V phase; late phase = 10 min |
|
|
Term
| In FANG, when is the best time to see perifoveal capillaries? |
|
Definition
|
|
Term
| What is a hamartoma? What is it comprised of? |
|
Definition
| benign nodule similar to a tumor. Composed of normal cells and tissue |
|
|
Term
|
Definition
|
|
Term
|
Definition
| epithelial cell malignancy that infiltrates tissue and causes metastatic lesions |
|
|
Term
|
Definition
| tumor of melanin pigmented cells |
|
|
Term
| What % of pts will have a choroidal nevus of some sort? |
|
Definition
|
|
Term
| When is the maximal growth of a nevus? |
|
Definition
|
|
Term
| What do feeder vessels on a nevus indicate? |
|
Definition
| High probability of malignancy. Refer immediately |
|
|
Term
| What % of uveal tumors are malignant melanoma? |
|
Definition
|
|
Term
| If a choroidal tumor is greater than 10DD, what is a common tx? |
|
Definition
|
|
Term
| What layers of the uvea are ciliary body tumors found in? |
|
Definition
| pigmented, non-pigmented, and stroma |
|
|
Term
| What does focal dilation of episcleral vessels often indicate? |
|
Definition
| Feeder or sentinenl vessels for a ciliary body malignant melanoma are underneath |
|
|
Term
|
Definition
|
|
Term
| What % of melanocytoma pts have vision loss? |
|
Definition
|
|
Term
| How often are metastatic carcinomas bilateral? |
|
Definition
|
|
Term
| In a metastatic carcinoma, where is the primary tumor usually located? |
|
Definition
| lung and breast most common. Also kidneys, testis, GI |
|
|
Term
| What kind lesions are visible in the posterior pole when a metastatic carcinoma is present? |
|
Definition
| creamy-white or yellow oval placoid lesions with slight elevation |
|
|
Term
| What grows faster: mal. melanoma or metastatic carcinoma? |
|
Definition
|
|
Term
| What has a worse prognosis: Met. Carc. of the choroid or ON? |
|
Definition
| Both are poor. However, ON is worse. Mean survival 10 mo. |
|
|
Term
| What late stage leukemia sx are found in the eyes? |
|
Definition
| infiltration of leukemic cells in the optic nerve displace normal neurons casuing vision loss |
|
|
Term
| How often are retinoblastoma's bilateral? |
|
Definition
|
|
Term
| What is the mean age for retinoblastoma dx? |
|
Definition
|
|
Term
| What are the avg number of tumors associated w/ retinoblastoma? |
|
Definition
|
|
Term
| What is the mortality rate of retinoblastomas? |
|
Definition
|
|
Term
| What % of retinoblastomas show AD inheritance pattern? |
|
Definition
|
|
Term
| What is the prevalence of retinoblastoma in the children of pt's who had one themselves? |
|
Definition
|
|
Term
| What is reflective in an ultrasound of retinoblastoma? |
|
Definition
|
|
Term
| Does a retinoblastoma hyper or hypofluoresce in FA? |
|
Definition
|
|
Term
| What is central serous chorioretinopathy? |
|
Definition
| small break in RPE --> serous retinal detachment |
|
|
Term
| Who are most at risk for central serous CR? |
|
Definition
typa A
men
stress
idiopathic |
|
|
Term
| What is the name of the AMD genetic test? |
|
Definition
|
|
Term
| What are prophylactic for AMD? |
|
Definition
| lutein, zeaxanthin, omega-3's, vitamins |
|
|
Term
| How much reduction of AMD was seen in AREDS studies? |
|
Definition
| Roughly 20-25% reduction in occurrence |
|
|
Term
|
Definition
| blood filtration to help microcirculatory dz (AMD) |
|
|
Term
| What is possible AMD oral drug tx? |
|
Definition
| fenretinide (currently in study) |
|
|
Term
| What are the two main types of exudative AMD tx? |
|
Definition
| destructive and pathway-based therapies |
|
|
Term
| What area is extrafoveal CNV in? |
|
Definition
|
|
Term
| What area is juxtafoveal CNV in? |
|
Definition
|
|
Term
| What area is subfoveal CNV in? |
|
Definition
|
|
Term
| After laser tx for CNV, what is the VA loss equal to if untreated (time wise)? |
|
Definition
| Laser pt's had same VA's as untreated at 12 mo |
|
|
Term
| What kind of CNV responds best to laser tx? |
|
Definition
| smaller lesions and worse initial VA's |
|
|
Term
| What wavelength of light is used to activate verteporfin? |
|
Definition
|
|
Term
|
Definition
| Determined effectiveness of photodynamic therapy (PDT/verteporfin) |
|
|
Term
| How much VA loss was prevented by PDT in the TAP study? |
|
Definition
| 2.2 lines better at 2 yrs than control |
|
|
Term
|
Definition
| Verteporfin tx reduces severe VA loss over 24 mo |
|
|
Term
|
Definition
pain
VA reduction
photosensitivity
1-5% 4 line VA drop w/in 7 days |
|
|
Term
| What was the FOCUS study? |
|
Definition
|
|
Term
| Why is celecoxib used in PDT? |
|
Definition
| Reduce inflammation response to PDT tx? |
|
|
Term
|
Definition
| Sent out by hypoxic cells |
|
|
Term
| What receptors are targeted by VEGF? |
|
Definition
| choroidal endothelial cells |
|
|
Term
|
Definition
Macugen
Lucentis
Avastin
Regeneron |
|
|
Term
|
Definition
| VEGF 165, 206, and 189 isoforms (binds to the hormone) |
|
|
Term
| Does macugen have any systemic SE? |
|
Definition
|
|
Term
| What does Lucentis target? |
|
Definition
| ALL forms of VEGF hormone |
|
|
Term
|
Definition
|
|
Term
| What is lucentis made of? |
|
Definition
|
|
Term
| What lucentis' generic name? |
|
Definition
|
|
Term
| Are there systemic SE of lucentis? |
|
Definition
| Maybe CVA, but exceedingly small % |
|
|
Term
| The anchor study determined what regarding PDT and Lucentis? |
|
Definition
| Lucentis was more effective |
|
|
Term
| What was the PRONTO study? |
|
Definition
| Lucentis study where OCT was used to alter tx |
|
|
Term
| What is the SAILOR study? |
|
Definition
| Determine overall safety of Lucentis (stroke, etc) |
|
|
Term
| What is Avastin's generic name? |
|
Definition
|
|
Term
| What is Bevacizumab (Avastin) made of? |
|
Definition
| full length monoclonal Ab's |
|
|
Term
| What AMD drug tx is used off label? |
|
Definition
| Avastin; it is a colon cancer drug |
|
|
Term
| What kind of VEGF does avastin target? |
|
Definition
|
|
Term
| What has a longer 1/2 life: lucentis or avastin? |
|
Definition
|
|
Term
|
Definition
| Avastin effectiveness study |
|
|
Term
|
Definition
| lucentis vs avastin effectiveness, also called CATT |
|
|
Term
| According t the NEI/CATT study, what has higher systemic SE? What worked better for MD tx? |
|
Definition
| Avastin --> high SE; Both equally efficaceous at MD tx |
|
|
Term
| How much is Avastin/Lucentis monthly? |
|
Definition
| $24k/mo for lucentis; $600/mo for Avastin |
|
|
Term
| What is VEGF Trap-Eye Eylea? |
|
Definition
| AMD drug; recombinant fusion protein |
|
|
Term
|
Definition
| tested VEGF Trap-Eye Eylea effectiveness |
|
|
Term
| When is triamcinolone used in MD tx? |
|
Definition
| In combination with other tx's to decrease vascular permeability and decrease VEGF |
|
|
Term
| Should steroid implants be used for MD tx? |
|
Definition
|
|
Term
| When could stem cell therapy be available for MD tx? |
|
Definition
|
|
Term
| What are sustained delivery tx's for MD? |
|
Definition
|
|
Term
|
Definition
| modified steroid for MD tx, inhibits angiogenesis, does NOT stop inflammation or suppress immune system |
|
|
Term
|
Definition
| AMD potential drug that targets mRNA of VEGF? |
|
|
Term
| What is Complement Factor H? |
|
Definition
| AMD genetic risk loci --> chronic macular inflammation if abnormal |
|
|
Term
|
Definition
| Pigment Epithelial Derived Factor |
|
|
Term
| What is macular translocation? |
|
Definition
| Surgery to move the macula to intact RPE to prevent MD |
|
|
Term
| Has radiation therapy shown any promise for MD tx? |
|
Definition
| No conclusive evidence that it does |
|
|
Term
| What are signs in the retina associated with central serous retinopathy? |
|
Definition
Shallow round or oval elevation around fovea
drusen underlying CSR
borders contain glistening reflex |
|
|
Term
| What are sx of central serous retinopathy? |
|
Definition
moderate hyperopic shift
metamorphopsia
micropsia |
|
|
Term
| What do hyperfluorescent spots in CSR indicate? |
|
Definition
| small RPE detachment, is pathognomonic for CSR |
|
|
Term
| What FA patterns are seen in CSR? |
|
Definition
Smokestack
mushrooming
small focal RPE detachments |
|
|
Term
| How often does CSR recur? |
|
Definition
|
|
Term
| What sx remains the longest after CSR resolution? |
|
Definition
|
|
Term
| What often does CSR spontaneously resolve? |
|
Definition
|
|
Term
|
Definition
| nothing unless recurrent or chronic (4-6mo) |
|
|
Term
| What are the demographics of macular holes? |
|
Definition
|
|
Term
| What is the mechanism of a macular hole? |
|
Definition
| Vitreous detaches and traction rips out fovea |
|
|
Term
|
Definition
| The retinal tissue pulled free in a macular hole |
|
|
Term
|
Definition
| interruption of slit beam during SL exam |
|
|
Term
| What are the 4 stages (grades) of macular holes |
|
Definition
1. elevation of macular
2. Full thickness hole
3. Full thickness hole with operculum?
4. Full thickness hole, operculum, and PVD |
|
|
Term
| What are tx for macular holes? |
|
Definition
None for stg 1
vitrectomy, membrane peel, and gas/fluid exchange |
|
|
Term
| What is the prognosis for macular holes? |
|
Definition
If under 1 year, good.
if over 1 year, bad |
|
|
Term
| What is myopic degeneration? |
|
Definition
| High myopic axial length pulls retina away from ONH reveling sclera |
|
|
Term
|
Definition
| dark RPE hyperplasia in macula |
|
|
Term
| What is a posterior staphyloma? |
|
Definition
| IOP pushes thinned sclera outward --> traction on retinal vessels, straightening them out |
|
|
Term
| What are lacquer cracks, yellow streaks, and breaks in Bruch's associated with? |
|
Definition
|
|
Term
| What are angioid streaks? |
|
Definition
| Cracks in a calcified, thickened Bruch's membrane |
|
|
Term
| How often are angioid streaks associated with systemic dz? |
|
Definition
|
|
Term
| What signs are associated with angioid streaks? |
|
Definition
CNM
VA loss of macula involved |
|
|
Term
| How are angioid streaks treated? |
|
Definition
treat CNM/neo similar to ARMD
Safety eyewear to prevent trauma |
|
|
Term
| What is the prognosis for angioid streaks? |
|
Definition
|
|
Term
| What is Cystoid Macular Edema (CME)? |
|
Definition
| Fluid in the OPL of the Macula (Henle's fiber layer) --> cysts under macula |
|
|
Term
| What presents with a petaloid pattern in FANG? |
|
Definition
|
|
Term
| What is CME treated with? |
|
Definition
| NSAID drops or steroid drops for 1 mo |
|
|
Term
| When is a YAG laser used to treat CME? |
|
Definition
| If BCVA <20/80. Vitrectomy may also be considered. |
|
|
Term
| What is an epiretinal membrane? |
|
Definition
| ILM cellular proliferation --> retinal surface wrinkles (cellophane like) |
|
|
Term
| What causes an epiretinal membrane? |
|
Definition
| Generally prior trauma/inflammation of eye |
|
|
Term
| What is the demographics of epiretinal membranes? |
|
Definition
|
|
Term
| What are s/sx of epiretinal membrane? |
|
Definition
VA loss
vascular tortuosity
metamorphopsia
macropsia
monocular diplopia |
|
|
Term
| What is the px of an epiretinal membrane? |
|
Definition
| Good, 75% resolve after surgery |
|
|
Term
| What can cause toxic retinoptahy? |
|
Definition
chloroquine and hydroxychloroquine
tamoxifen (breast cancer med)
thioridazine (psychotic med) |
|
|
Term
| What are s/sx of toxic retinopathy? |
|
Definition
scotoma
EOG abnormal
photostress test (look into flashlight, test recovery)
Decreased color vision
VA affected later |
|
|
Term
| What is bulls eye retinopathy? |
|
Definition
| hyper/hypo pigmentation pattern associated with chloroquine retinopathy |
|
|
Term
| What causes toxic maculopathy at a lower level? |
|
Definition
| Chloroquine is 1/2 to 1/3 the dose as hydroxychloroquine to cause |
|
|
Term
| What can thioridazine retinopathy cause? |
|
Definition
decreased VA
night vision problem
ring/paracentral scotoma
brown discoloration of vision |
|
|
Term
| What can tamoxifen cause? |
|
Definition
decreased VA
yellow white refractile spots on posterior pole |
|
|
Term
| What are choroidal folds? |
|
Definition
| flattening of the posterior pole --> acquired hyperopia |
|
|
Term
| What are s/sx of choroidal folds? |
|
Definition
|
|
Term
| What do choroidal folds kind of look like? |
|
Definition
|
|
Term
| With FANG, what do choroidal folds look like? |
|
Definition
| contrast bands overlaid on posterior pole |
|
|
Term
| How are choroidal folds treated? |
|
Definition
| just diagnose via exclusion after r/o serious dz |
|
|
Term
| What is a C/I for zinc supplementation? |
|
Definition
|
|
Term
| What do the POLA and LAST studies focus on? |
|
Definition
| lutein and zeaxanthin hypopigment --> AMD |
|
|
