An 80-year-old woman presents with 'funny spots' affecting her vision. Over the past week she has noticed a number of flashes and floaters in the visual field of the right eye.
What is the most likely diagnosis?
Correct Answer B: Posterior vitreous detachment is thought to occur in up to 50-75% of the population over 65 years and is the most likely diagnosis here. Such patients are normally reviewed by an ophthalmologist to assess the risk of progressing to retinal detachment.
Sudden painless loss of vision:
The most common causes of a sudden painless loss of vision are as follows:
Ischaemic optic neuropathy:
Central retinal vein occlusion:
Central retinal artery occlusion:
Vitreous haemorrhage:
Retinal detachment:
Differentiating posterior vitreous detachment, retinal detachment and vitreous haemorrhage:
A 71-year-old female with dry age-related macular degeneration is reviewed. Unfortunately her eyesight has deteriorated over the past six months. She has never smoked and is taking antioxidant supplements.
What is the most appropriate next step?
Correct Answer C:
Age related macular degeneration: Age related macular degeneration is the most common cause of blindness in the UK. Degeneration of the central retina (macula) is the key feature with changes usually bilateral.
Traditionally two forms of macular degeneration are seen:
prognosis: Recently there has been a move to a more updated classification:
Risk factors:
Features:
Investigation and diagnosis:
General management:
Dry macular degeneration - no current medical treatments.
Wet macular degeneration:
Which one of the following statements regarding the Holmes-Adie pupil is incorrect?
Correct Answer B: The Holmes-Adie pupil is unilateral, rather than bilateral, in 80% of patients.
Holmes-Adie pupil:
Holmes-Adie pupil is a benign condition most commonly seen in women. It is one of the differentials of a dilated pupil.
Overview:
Holmes-Adie syndrome:
Which one of the following features is not characteristic of optic neuritis?
Correct Answer D: Visual loss typically occurs over days rather than hours. Sudden visual loss due to optic neuritis is very unusual.
Optic neuritis:
Causes:
Management:
Prognosis:
A 69-year-old man presents to the Emergency Department with blurred vision. The examining doctor suspects a diagnosis of primary open-angle glaucoma (POAG).
Which one of the following features would be most consistent with a diagnosis of POAG?
Correct Answer D: The other listed symptoms are seen with acute angle closure glaucoma.
Primary open-angle glaucoma:
Glaucoma is a group disorders characterized by optic neuropathy due, in the majority of patients, to raised intraocular pressure (IOP). It is now recognized that a minority of patients with raised IOP do not have glaucoma and vice versa.
Primary open-angle glaucoma (POAG, also referred to as chronic simple glaucoma) is present in around 2% of people older than 40 years. Other than age, risk factors include:
POAG may present insidiously and for this reason is often detected during routine optometry appointments.
Features may include:
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