Ohp II Mt 2 Cataracts

Infantile (congenital) catracts typically do NOT affect vision.

• True

• False

Indicate which conditions can result due to anterior/posterior polar cataracts.

• Uveitis

• Myopic shift

• Increased glare issues

• Capsular rupture

• Hyperopic shift

Zonular cataracts present as a region/zone of the lens that is opaque and is usually unilateral.

• True

• False

Which of the following is the most common type of congenital cataract?

• Fetal Nuclear

• Lamellar

• Blue Dot

• Coronary

Fetal Nuclear Cataracts are limited to what area of the nucleus?

• Embryonic nucleus

• Fetal nucleus

• Adult nucleus

Sutural cataracts can occur in both the anterior and posterior of the lens.  Anterior is more common.

• True

• False

For sutural (stellate) cataracts, anterior sutures are inverted 'Y'-shaped and posterior sutures are 'Y'-shaped

• True

• False

Coronary and Blue Dot cataracts occur in the lens nucleus.

• True

• False

Down's Syndrome and Myotonic Dystrophy are associated with what type of congenital cataract?

• Lamellar

• Sutural

• Coronary

• Blue Dot

What is the most common cause of Total Congenital cataract?

• Rubella

• Mumps

• Hepatitis

• Toxoplasmosis

Galactosemia causes what type of secondary cataract?

• Polychromatic

• Diabetic

• Anterior Subcapsular

• Oil Droplet

Indicate which type(s) of cataracts can cause a myopic shift.

• Oil Droplet

• Cortical

• Diabetic

• Traumatic

• Morganian

• NSC

Indicate the potential causes of Polychromatic (christmas tree) cataracts.

• Thermal radiation

• Wilson's Disease

• Myotonic dystrophy

• Trauma

• Cholesterol issues

A 'milky NSC' apperance is associated with what type of secondary cataract?

• Sunflower

• Diabetic

• Posterior Subcapsular

• Hypermature

Glassblower's cataract is also known as a pseudo-exfoliation cataract

• True

• False

Wilson's Disease involves copper accumulation from poor metabolism and is associated with a Keiser-Fleisher Ring

• True

• False

Drugs such as phenothiazines and miotics can cause what type of secondary cataract?

• Polychromatic

• Hypermature

• Anterior Subcapsular

• Mature

Posterior subcapsular is rarely visually devastating.

• True

• False

A 'rosette (star of david) or vossius ring is associted with which type of cataract?

• NSC

• Cortical

• Traumatic

• Morganian

A Mature cataract is one where there is liquefaction of lens contents and wrinkling of capsule; a Hypermature cataract is complete opacification of lens capsule, cortex and nucleus

• True

• False

If you see nuclear contents that have sunken inferiorly, what type of cataract would you consider?

• Diabetic

• Hypermature

• Morganian

• Total Congenital

What is the VA limit for Medicare to cover cataract extraction?

• 20/30

• 20/40

• 20/50

• 20/60

Phacolytic glaucoma and lens particle glaucoma are very similar in that they both involve lens proteins that go into the AC and clog the TM.  Describe the 2 main differences between these two.

Inflammation due to lens proteins can clog up the TM and is associated with what tyepe of lens-associated glaucoma condtiion?

• Lens particle

• Closed angle (phacomorphic)

• Phacoanaphylaxis

A phacomorphic lens can cause narrow angle glaucoma because with age the lens grows and can close off the angle.

• True

• False

A diabetic lens is easier to 'break up' during cataract surgery because the swelling and de-swelling that has occured has already damaged the lens in most cases.

• True

• False

Cataract surgery can proceed even if there is an active uveitis as long as necessary precaustions (antibiotics etc) are administered.

• True

• False

What aspect of the cataract surgery is particularly important for a pt with COPD & Parkinson's?

• Wide dilation

• Antibiotics

• Anesthesia

• Steroids

If a patient is on Warfarin, what test must be taken before cataract sx?

When would a B-Scan be important for pre-cataract sx testing?

When performing the Maddox Rod test, if the patient cannot see the line then that indicates poor macular function

• True

• False

Absence of scleral spikes during A Scan indicates that the probe is oriented toward the ONH

• True

• False

The anterior lens spike is slighly shorter than the posterior lens spike

• True

• False

Retinal spike sloping during A Scan will result in what? Choose all that apply.

• Falsely long axial length

• Falsely short axial length

• Weaker IOL

• Stronger IOL

• - SRx needed

• + SRx needed

The average AC depth is 3.24 mm.  0.1 mm error in measurement is equal to what dioptric error?

Indicate when an A Scan should be retaken.

• Axial length less than 22 mm

• Axial length greater than 23 mm

• Axial length greater than 25 mm

• Axial length difference of 0.4mm

Cataract sx can result in _____% loss of endothelial cells.

• 15%

• 25%

• 40%

• 60%

Which of the following endothelial cell counts should you NOT recommend for cataract sx?

• < 800 cells/mm2

• < 1200 cells/mm2

• < 1500 cells/mm2

RAM is the most commonly used potential acuity meter in the ECC.

• True

• False

The endpoint or Interferometry is when the pt can only read 1 out of 4 presentations.

• True

• False

Interferometry has a more optimistitic prediction than PAM

• True

• False

Indicate all of testing set-ups for interferometry.

• Undilated

• Moderate room illumination

• 8 deg field

• Moderate setting

• Dim room illumination

• Dilated

• 18 deg field

• High setting

• Start at 20/60

• Start at 20/80

• Start with worse eye

How would you interpret the results of a glare test if the VA improves?

• No significant glare problem

• Glare is a problem

• Pinhole effect

• Results cannot be determined

Glare testing is typically done with the patient dilated.

• True

• False

Topical NSAIDs are used pre-sx to maintain mydriasis and prevent post-op CME.  Choose the appropriate regimen.

• 1 gtt Acular q 30min, 2 hr before surgery

• 2 gtt Acular q 1 hr, 3 hr before surgery

• 1 gtt Acular q 30 min, 2 days before surgery

• 2 gtt Acular q 2 hr, 1 day before surgery

Oral glaucoma meds are used pre-sx to help control IOP.  It is best to switch the patient from using prostaglandins, however, in order to reduce the aggravation of inflammation.

• True

• False

Which anesthesia has the best pain control?

• Local

• Peribulbar

• Retrobulbar

• Intracameral

• More than one of the above

Peribulbar block is riskier than than retrobulbar block

• True

• False