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AGE-RELATED MACULAR DEGENERATION

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AGE-RELATED MACULAR DEGENERATION Damage of the central retina, or macula Two types Nonexudative (DRY ) - drusen (hyaline deposits) and areas of alternating bands of ... – PowerPoint PPT presentation

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Title: AGE-RELATED MACULAR DEGENERATION


1
AGE-RELATED MACULAR DEGENERATION
  • Damage of the central retina, or macula
  • Two types
  • Nonexudative (DRY ) - drusen (hyaline deposits)
    and areas of alternating bands of
    depigmentation/ hyperpigmentation in the retinal
    pigmented epithelium
  • Exudative (WET) - neovascularization

2
AMD
  • Symptoms
  • Asymptomatic initially
  • Loss of central vision (reduced visual acuity
    causing difficulties with detail discrimination)
  • Metamorphopsia (i.e., distortion of objects)
  • Central scotomas
  • Increased glare sensitivity
  • Contrast sensitivity
  • Decreased color vision.
  • Peripheral vision remains intact, and the patient
    does not progress to total blindness

Amsler grid
3
Etiology of AMD
  • Unclear, but known contributing factors include
  • Older age
  • Smoking
  • Hypertension
  • Hyperlipidemia
  • Vascular insufficiency to the retina and the
    choroids
  • History of ultraviolet (UV) light exposure
  • FHx of AMD (which increases risk three- to
    fourfold)

4
Prevention and Treatment
  • High-dose regimen of vitamin C, vitamin E, beta
    carotene, and zinc shown to decrease risk of
    developing vision loss caused by advanced AMD in
    patients with intermediate AMD or advanced AMD in
    one eye.
  • Patients without AMD and those with early AMD did
    not benefit from supplementation.
  • Control of vascular disease risk factors,
    exercise to increase circulation, and sunglasses
    for UV light protection.
  • Photodynamic therapy and intravitreal injections
    of antivascular endothelial growth factor and
    corticosteroids have shown promise in treating
    subsets of patients with macular degeneration.

5
GLAUCOMA
  • Increased ocular pressure that can damage the
    ganglion cell layer of the retina
  • Symptoms loss of peripheral vision that can lead
    to decreased central acuity, difficulty
    functioning in dim light, decreased contrast
    sensitivity, glare disability, and decreased
    dark/light adaptation.
  • Risk factors Age gt 40, Hispanic, African
    American, Family history, diabetes, HTN, eye
    injury, myopia, chronic steroids
  • Treatment topical prostaglandins, beta blockers,
    adrenergics, carbonic anhydrase inhibitors, and
    oral medications, laser therapy, and filtering
    surgery.

6
CATARACTS
  • Opacifications of the crystalline lens of the eye
  • Risk factors Age, female sex, corticosteroid
    use, diabetes, smoking, ocular UV-B light
    exposure
  • Symptoms decreased visual acuity, decreased
    color perception, decreased contrast sensitivity,
    and glare disability
  • Treatment alter prescriptions for eyeglasses or
    contacts, tobacco cessation, UV protection,
    surgical extraction.

7
DIABETIC RETINOPATHY
  • Nonproliferative - dilated retinal veins,
    intraretinal hemorrhages, microaneurysms, cotton
    wool spots, hard exudates, and macular edema
  • Proliferative - neovascularization, vascular
    fibrosis, and preretinal and vitreous hemorrhages

8
DIABETIC RETINOPATHY
  • Symptoms
  • decreased visual acuity, contrast sensitivity,
    color perception, and dark/light adaptation,
    glare disability, distortion, and scotomas
  • Treatment
  • Photocoagulation

9
Screening
  • ADA recommends that children with diabetes have
    an initial eye examination after 10 years of age
    if they have had diabetes for three to five
    years, followed by annual examinations thereafter
  • AAO recommended eye exam schedule
  • Normal examination or minimal nonproliferative
    retinopathy annually
  • Mild to moderate nonproliferative retinopathy
    without macular edema - every 6 to 12 months
  • Severe nonproliferative diabetic retinopathy
    every 2 to 4 months

10
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11
Quiz
  • Which one of the following is an adverse effect
    of alpha blockers?
  • A. Increased incidence of prostate cancer.
  • B. Increased incidence of high-grade prostate
    cancer.
  • C. Orthostatic hypotension.
  • D. Ejaculatory dysfunction.

12
  • Which one of the following statements about the
    surgical treatment of benign prostatic
    hypertrophy is correct?
  • A. Laser prostatectomy is associated with
    decreased libido.
  • B. Transurethral incision of the prostate is more
    likely to cause retrograde ejaculation than
    transurethral resection of the prostate (TURP).
  • C. Transurethral needle ablation is recommended
    only for men with severe symptoms who are not
    surgical candidates.
  • D. Retreatment rates are higher with
    transurethral microwave therapy than with TURP.

13
  • Which one of the following medications is
    recommended for the treatment of tinea capitis in
    children?
  • A. Oral terbinafine (Lamisil).
  • B. Oral ketoconazole (Nizoral).
  • C. Topical ketoconazole.
  • D. Oral itraconazole (Sporanox).

14
  • Which one of the following is the recommended
    initial test for the diagnosis of tinea unguium
    (onychomycosis)?
  • A. Histologic analysis.
  • B. Potassium hydroxide microscopy.
  • C. Fungal culture.
  • D. Wood's lamp examination.

15
  • Which one of the following statements about
    seizures in patients with primary brain tumors is
    correct?
  • A. Patients who present with seizure have a
    worse prognosis than those who do not present
    with seizure.
  • B. Patients who present with seizure have a
    better prognosis than those who do not present
    with seizure.
  • C. Seizures are more common in patients with
    high-grade gliomas.
  • D. Long-term seizure prophylaxis is recommended
    for all patients after surgery.

16
  • Which one of the following imaging studies is
    preferred for the initial anatomic evaluation of
    brain tumors?
  • A. Functional magnetic resonance imaging (MRI).
  • B. Computed tomography.
  • C. Gadolinium-enhanced cranial MRI.
  • D. Positron emission tomography.

17
  • A patient has dilated retinal veins, intraretinal
    hemorrhages, microaneurysms, cotton wool spots,
    and hard exudates. There is no macular edema.
    Which one of the following diagnoses is the most
    likely?
  • A. Age-related macular degeneration.
  • B. Nonspecific changes of aging.
  • C. Diabetic retinopathy.
  • D. Cataracts.
  • E. Open-angle glaucoma.

18
  • Which one of the following treatments represents
    optimal management of diabetic retinopathy
    without macular edema?
  • A. Intraocular vitamins.
  • B. Tight control of blood glucose.
  • C. Laser photocoagulation.
  • D. Oral corticosteroids.

19
X-Type
  • The initial evaluation of patients with symptoms
    of benign prostatic hyperplasia typically
    includes which of the following? A. Digital
    rectal examination.
  • B. Urinalysis.
  • C. Prostate-specific antigen measurement.
  • D. Serum creatinine measurement.

20
  • Which of the following statements about the
    management of tinea corporis is/are correct?
  • A. Culture confirmation of the diagnosis is
    recommended.
  • B. Diagnosis is usually clinical or based on
    potassium hydroxide microscopy findings.
  • C. Most patients require oral therapy.
  • D. Topical antifungals are usually sufficient
    for treatment.

21
  • Which of the following signs and symptoms is/are
    seen at presentation in one third or more of
    patients with primary brain tumors?
  • A. Nausea or vomiting.
  • B. Headache.
  • C. Papilledema.
  • D. Memory loss.

22
  • A 54-year-old patient with 20/70 vision has had a
    recent worsening of a physiologic tremor. Which
    of the following statements is/are correct?
  • A. He is legally blind.
  • B. A stand magnifier is an appropriate
    low-vision aid for this patient.
  • C. He should be examined by an ophthalmologist
    or optometrist every two to four months.
  • D. He is at risk for falls.

23
References
  • EDWARDS J. Diagnosis and Management of Benign
    Prostatic Hyperplasia. American Family Physician.
    May 15, 2008
  • ANDREWS M, BURNS M. Common Tinea Infections in
    Children. American Family Physician. May 15, 2008
  • CHANDANA S, MOVVA S, ARORA M. Primary Brain
    Tumors in Adults. American Family Physician. May
    15, 2008
  • ROSENBERG E, SPERAZZA L. The Visually Impaired
    Patient. American Family Physician. May 15, 2008
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