Ocular Disease II: Acquired Maculopathies, Retinal Vascular

*BRVO can occurs at any grade, but is most likely to occurs at grade 4

Drusen, which are collections of hyaline deposits between the retinal pigment epithelium (RPE) and Bruch's membrane, are indeed considered the number one sign for age-related macular degeneration (ARMD). These deposits can be seen during an eye examination and are associated with the degeneration of the macula, leading to vision loss. Therefore, the statement "Drusen is the #1 sign for ARMD" is true.

CSR are the #1 MOST ACQUIRED Maculopathy

Arteriosclerotic retinopathy, also known as "hardening of the arteries," refers to the narrowing and hardening of the blood vessels in the retina. While it does not indicate the severity of hypertension (high blood pressure), it does suggest that systemic hypertension has been present for many years. This is because the chronic high blood pressure can cause damage to the blood vessels in the retina over time, leading to arteriosclerotic retinopathy. Therefore, the statement that arteriosclerotic retinopathy alone does not indicate the severity of hypertension but does show that systemic hypertension has been present for many years is true.

Photodynamic Therapy (PDT) "cold laser" can only be used in conjunction with Anti-VEGF injection.

The given description of the central yellow dot, loss of foveal reflex, and OCT findings of a small elevated space suggests that the correct answer is Stage 1A: Macular Cyst. In this stage, there is a collection of fluid within the macula, causing a cyst-like appearance. This stage is characterized by partial thickness involvement and is the earliest stage of macular hole formation.

The statement is true because according to the SCORE study, a 1 mg injection of steroid will improve visual acuity, decrease vascular permeability, and decrease inflammation. This study specifically focused on the treatment of central retinal vein occlusion (CRVO) and found that steroid injections had a positive overall effect in improving the condition.

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Prior to cataract surgery, caution is needed with glaucoma patients because discontinuing glaucoma medications for approximately one month may facilitate cystoid macular edema (CME). CME is a potential complication of cataract surgery, and glaucoma medications can help manage intraocular pressure and reduce the risk of CME. Therefore, stopping these medications prior to surgery may increase the likelihood of CME occurring.

If a hypertensive retinopathy patient presents with a FLAME heme (which refers to a flame-shaped hemorrhage), it is necessary to check their blood pressure because it can potentially lead to branch retinal vein occlusion (BRVO) or branch retinal artery occlusion (BRAO). High blood pressure can cause damage to the blood vessels in the retina, leading to bleeding and blockages in the retinal veins or arteries. Therefore, monitoring and controlling blood pressure is crucial in managing hypertensive retinopathy and preventing further complications.

The given description of the stage includes reduced VA, a slight reddish hole, no edema around the hole, and OCT showing a depressed area. Based on these characteristics, the correct answer is Stage 2: Lamellar Hole (partial Thickness). This stage is characterized by a partially-thickness hole in the macula, which can cause reduced visual acuity. The absence of edema around the hole suggests that it is not a full-thickness hole.

Overall defect in Bruch's membrane in wet AMD, there anti-VEGF injections will be helpful.
-eg) presumed ocular Hist, high myopia, angoid streaks, traumatic chorodial rupture

TRUE, because there is no traction in that area

Laser is effective but WILL NOT IMPROVE vision outcome. ALSO NOT used as an initial treatment

-If present after 4months, usually indicate tissue having irreversible damage.

HYPEROPIA (>0.75) is 25x higher risk due to less pigment

Inferior BRVO usually go away in 1 month f/up, bc it isn't affecting macula or vision, if good systemic dz control.

The patient is experiencing symptoms of Thoridazine (Mellaril) Retinopathy. Thoridazine is an anti-psychotic medication known to cause retinal toxicity. The symptoms of blurred vision, central vision loss, and brown discolored vision are consistent with this condition. Plaquenil Retinopathy is not the correct answer as it is associated with the use of a different medication called Plaquenil, which is used to treat autoimmune conditions.

According to the CRVO study, Pan-retinal photocoagulation (PRP) should only be reserved if NEO (neovascularization of the optic disc) is present. The study also shows that PRP is effective in reducing edema, but it does not lead to any improvement in visual outcome. Therefore, the statement that PRP should only be used if NEO is present and that it is effective in reducing edema but does not improve visual outcome is true.

Stage 3: Full thickness
-PARTIAL vitreomacular separation (>400um)
-Edges are NOT elevated around hole

Weiss Ring is seen in the stage 4 of macular hole (full thickness)

If you were to look in the back of the eye for Thoridazine Ret, you would see salt and pepper. This could be referring to a specific pattern or appearance in the retina that is characteristic of Thoridazine Ret. Without further context, it is difficult to determine the exact meaning of "salt and pepper" in this context.

If BRVO (Branch Retinal Vein Occlusion) is not in a significant visual area, it is recommended to refer the patient to their primary care physician (PCP) and follow up in one month. However, if BRVO is in a significant visual area, it is advised to refer the patient to a retinal specialist. Therefore, the statement "True" indicates that the given explanation accurately reflects the correct answer.

It is still NOT safe to prescribe Beta-carotene to chronic smokers who just quit 2 years ago. Better to replace with a Lutein, according to AREDS forumation

The four types of retinal vascular occlusive diseases that were learned about are Central Retinal Venous Occlusion (CRVO), Hemi-Central Retinal Vein Occlusion (Hemi-CRVO), Branch Retinal Vein Obstruction (BRVO), and Central Retinal Artery Occlusion (CRAO).

The question asks for the wrong type of Central Retinal Vein Occlusion (CRVO). The correct answer is "Anticoagulant Retinopathy" because it is not a type of CRVO. CRVO is typically classified into two types: Incomplete CRVO, also known as Venous Stasis Retinopathy, and Ischemic CRVO, also known as Hemorrhagic Retinopathy.

Do an OCT or FA to rule out an CNVM!

Using your 90D and stereo to see if there is elevation. This is hard to detect with wet ARMD

Ozurdex (Dexametasone) implant will REDUCE risk of further vision loss. Similar effect as injections but with MUCH FEWER ADE

All the statements provided in the question are true. Hard drusen are small, well-defined yellow deposits deep in the retina, while soft drusen are larger and fluffy. Drusen will hyperfluoresce, compared to exudate which will hypofluoresce with red-free light, which can be used to differentiate between them. Hard drusen have a lower risk for neovascularization compared to soft drusen, which have a 7% risk. If it is just soft or hard drusen by itself and not true age-related macular degeneration (ARMD), visual acuity will still be 20/20 and the Amsler grid will be negative.

The explanation for the given correct answer is that the BRAVO study demonstrated that there is a significant improvement with LUCENTIS INJECTION (anti-VegF) compared to observation in treating BRVO (branch retinal vein occlusion). However, LASER treatment is still considered the most helpful approach in managing BRVO.

The given answer states that all the statements provided in the question are true. This means that all the mentioned conditions (bilateral drusen, AMD in one eye, confluent drusen in one eye, focal RPE changes in one eye and NEO in the other eye) put the patient at some level of risk for developing CNVM or macular degeneration in the good eye.

Vitrectomy is a surgical procedure that involves injecting a gas bubble into the eye to keep the macula in place and prevent the hole from getting larger. This procedure can improve visual acuity (VA) by 2x if the initial VA is poor. By keeping the macula in place, the gas bubble helps to stabilize the hole and promote healing, which can lead to an improvement in vision. Therefore, the statement is true.

-Calcific plaques are the LEAST common, while Hollenhorst plaques are the MOST
-We DO need to do carotid bruit assessment when we see plaques
-Due to its soft/mallable form, Hollenhorst plaques can LEAST cause occlusion
--blood can flow over and under the plaque :)

ADE of Triamcinolone/Kenalog injection is enhanced, compared to Oral Triamcinolone/Kenalog

Rubeosis iridis, which refers to the abnormal growth of blood vessels in the iris, is indeed a very rare complication in BRVO (Branch Retinal Vein Occlusion) compared to CRVO (Central Retinal Vein Occlusion). This is because in BRVO, only a smaller portion of the retina is affected by the occlusion of a branch retinal vein, while in CRVO, the occlusion occurs in the central retinal vein, affecting a larger area of the retina. Therefore, the likelihood of developing rubeosis iridis is higher in CRVO cases.

FA: HYPERfluorenscence in late stages (cyst)

Coalescing drusen DO indicate progression to WET ARMD (aka Disciform type)

KNOW! Swelling of optic disc is very serious because it is HALLMARK sign for MALIGNANT phase of HTN ret.

Anti-VegF injection are for WET ARMD

The explanation for the given correct answer is that the SCORE study, which is a research study, has found no difference in the effectiveness of laser treatment and steroid treatment for Retinal Vein occlusion. This means that both treatments have similar outcomes in treating this condition.

1) Prostaglandins Force= faclitates inflammation and CME if PG is around macula
2) Tractional Forces
3) Vascular= breakdown of capillaries

***KNOW That CME is when it is secondary to something that lead to a BREAKDOWN

5 Causes: MC-PIT
1)Idiopathic
2) CME= create a lamellar hole
3) Trauma= cause vitreous traction and, which can lead to lamellar hole
--Might need vitrectomy to collapse the hole
4) Myopia= subtretinal fluid leading to detachment
5) PVD

Photodynamic therapy is ONLY used in combo with:
1) VEGF injection
2) Steroid such as Triamcinolone

AREDS multi-vitamins are used to slow down progression of dry AMD

For Stage 3: Full thickness, the appropriate treatment option would be a retinal consult for vitrectomy. This procedure involves removing the vitreous gel from the eye and repairing any retinal tears or detachments. Monitoring alone would not be sufficient, and consulting with a retina specialist would not be enough to treat the condition. Therefore, the best course of action is to consult with a retinal specialist for a vitrectomy.

- You want to Run a VF CENTRAL theshold 10-2 to determine changes in sensitivity, with foveal sensitivity

**Stage 4: usually indicate poor prognosis and severe health issues

Cherry red spot at macula seen in FRESH CRAO

Hollenhorst plaques rarely cause CRAO because they are so soft! =)


Calcific plaques= MOST COMMON CAUSE

VA are BOTH reduced in Solar Ret and macular holes