Ocular Disease II Mt 3

According to the OHTS (Ocular Hypertension Treatment Study), reducing intraocular pressure (IOP) by 1 mmHg will result in a 10% reduction in the risk of glaucoma progression. This suggests that even a small decrease in IOP can have a significant impact on preventing the progression of glaucoma.

CSR Prognosis:
- 80-90% spontaneously resolve w/in 1-6 mo (metamorphosias can remain up to 1 year after resolution)
- 40% have recurrence due to weaker bonds
-

Narrow angles are risk factor for ACG not POAG

Drusen: malfunctioning RPE deposits ECM; appear as small yellow/white lesions distributed across PP

BID dosing actually has less effect than q day dosing

Anti-VEGF: treats classic & occult CNVM (Macugen, Lucentis, Avastin)
Steroids: supportive tx for edema (Triamcinolone)
Photocoag & PDT: prior tx to destroy BVs & surrounding tissue / destroy only BVs that broke through Bruch's
Combo: PDT + VEGF

The statement is true because metallic taste and stinging upon instillation are indeed the most commonly associated signs/symptoms of Trusopt. Trusopt is a medication used to treat glaucoma and ocular hypertension, and these side effects are commonly reported by patients who use this medication. The metallic taste can occur after using Trusopt eye drops, while stinging upon instillation refers to the temporary discomfort or burning sensation that may be experienced when the eye drops are applied.

beta blockers have on effect at night, alpha-2 has some effect at night

Hollehorst: chl @ bifurcations; shiny/reflective --> rare risk for obstruction
Fibrinoplatelet: chl + platelet; whit plug --> greater risk for obstruction
Calcific: calcified emolus from heart/coronary arteries --> greatest risk for obstruction

BRVO, which stands for branch retinal vein occlusion, is indeed the most common type of retinal vascular occlusion. Retinal vascular occlusion refers to the blockage of blood vessels that supply the retina, leading to impaired blood flow and potentially causing vision loss. BRVO specifically occurs when a branch of the retinal vein becomes blocked, usually due to a blood clot. This condition can result in various symptoms, such as blurry vision, visual field loss, and in severe cases, permanent vision loss. Therefore, the statement that BRVO is the most common retinal vascular occlusion is true.

The signs and symptoms listed are commonly associated with Central Serous Retinopathy (CSR). CSR is a condition where fluid accumulates under the retina, causing a sudden reduction in vision. Scotoma refers to a blind spot in the visual field, metamorphopsia is the distortion of vision, afterimages are persistent images seen after the original stimulus is removed, hyperopic shift is a shift towards farsightedness, and prolonged photostress time refers to a delay in recovery from bright light exposure. These symptoms are all characteristic of CSR.

Hemorrhagic --> ischemic retinopathy

Ocupress advantages: does not lower HDLs (like timolol), less stinging, less CNS ADEs

anterior uveitis contras: miotics & prostaglandins (these increase inflammation)

Zioptan & Travatan Z don't have BAK

Although Travatan & Lumigan are both prostaglandins, pts have variations of PG receptors and Lumigan has a slightly different mechanism that might prove more effective. However, it would not be advised to substitute between Travatan and Xalantan.

PVD reduces the risk of a true macular hole since there will be no vitreal traction pulling on the macula

Ideally a pregnant woman would not be taking any medications, however if they need GLC meds to preserve vision, as in the case of advanced GLC, alphagan P 0.1% is the best option

Hard Drusen: small, well-defined yellow deposits deep in retina; overlying RPE appears depigmented
--> VA no reduced + Amsler normal
Soft Drusen: larger, fluffy, yellow deposits; localized zones of RPE detachment
--> VA reduced + Amsler abnormal

If a patient has unilateral wet age-related macular degeneration (ARMD), it means that only one eye is affected by this condition. The question asks about the chances of wet ARMD appearing in the other eye. Since wet ARMD can affect both eyes, the answer of 50% suggests that there is an equal likelihood of the condition appearing in the other eye. Therefore, there is a 50% chance of wet ARMD appearing in the other eye of a patient with unilateral wet ARMD.

Lumigan actually increases aq production by 14%
But it increase TM outflow by 30% and US OF by 50% so overall lowers IOP

CAI MOA: reduce aqueous production

Argon laser photocoag for tx of CSR:
- purpose to seal leak
- decreases time course of resolvement
- does NOT improve prognosis

Xalantan can cause pseudodendrites & reactivation of HSV keratitis

These AV crossing changes are associated with longstanding hypertension lead to arteriosclerotic retinopathy

Corneal endothelial dysfuncion --> avoid CAIs
CHF --> avoid beta blockers

Beta blockers and alpha-2 adrenergic agonists undergo systemic crossover. Systemic crossover refers to the ability of a drug to cross the blood-brain barrier and exert its effects centrally in the brain. Beta blockers are commonly used to treat cardiovascular conditions and they can also cross the blood-brain barrier, leading to central effects such as reducing anxiety and tremors. Alpha-2 adrenergic agonists, on the other hand, can also cross the blood-brain barrier and act centrally to reduce sympathetic outflow, resulting in sedation and analgesia. Prostaglandins and miotics do not typically undergo systemic crossover as they primarily act locally in specific tissues or organs.

Lumigan is the prostaglandin that has the fewest ocular and systemic side effects compared to the other options. This can be inferred from the question, which asks for the prostaglandin with the fewest side effects.

Beta blockers, Propine, and Epinephrine are medications that can dilate the pupils. Beta blockers work by blocking the effects of adrenaline, which causes the pupils to dilate. Propine is a medication used to treat glaucoma and can also cause pupil dilation. Epinephrine, also known as adrenaline, is a natural hormone that can dilate the pupils when administered as a medication. CAIs (carbonic anhydrase inhibitors) and Prostaglandins are not known to have a direct effect on pupil dilation.

Macular holes, CSR (central serous retinopathy), and CRVO (central retinal vein occlusion) are retinal diseases that commonly present as unilateral, at least initially. Macular holes are small breaks in the macula, the central part of the retina, which typically occur in one eye. CSR is characterized by fluid accumulation under the retina, causing vision loss in one eye. CRVO is a blockage of the central retinal vein, leading to sudden vision loss in one eye. These conditions usually affect only one eye initially, although they can progress to involve both eyes in some cases.

Beta blockers have many systemic ADEs, but ocular ADEs are relatively rare (dry eye, dec corneal sensitivity, burn/sting on instillation)