Old Midterm Review Sheet Material for the Final - Posterior Segment & Ocular Disease Spring 2026

-liquefaction

-condensation

-atrophy of the hyaloid

What are the age-related changes that occur in the vitreous?

-the slow development of floaters

-an occasional flash

Age related changes in the vitreous will lead to what?

true

True or False:

Age related changes to the vitreous can lead to a PVD?

flashes (or maybe floaters when the PVD nears completion)

As a PVD progresses, you can get an increase in ________

The vitreous begins to move more and because floaters previously near the retina become more visible

Why can a PVD lead to flashes and floaters?

an increase in floaters and/or possibly a complaint of one large floater

A complete PVD is often accompanied by what:?

Weiss (Vogt) ring

THE one large floater secondary to a PVD

true

True or False:

If you have a sudden increase in floaters, and it is a shower of floaters, it could be a vitreous heme or occasionally a vitritis

1) Get to ora in EVERY QUADRANT

2) If no break, re-examine by 1/1/6 rule

3) Warn the patient to return if the symptoms continue to increase over what is found that day

What is the management plan if flashes or floaters are seen regularly and/or increasing?

1) Get to ora in EVERY QUADRANT

2) If no break, re-examine by 1/1/6 rule

3) Warn the patient to return if the symptoms continue to increase over what is found that day

What is the management of a preretinal heme that is thought to be D/T TRACTION?

1) ERM

2) Preretinal Heme

3) Breaks (Holes and Tears)

4) Retinal Detachment

What are the conditions that can be caused by vitreoretinal traction?

Going to occur before a complete PVD or within 4-6 weeks after the complete PVD (posterior hyaloid will still be attached at the vitreous tails for a few weeks)

The disorders d/t vitreoretinal traction will usually occur when?

-MUST REFER IF flashes/floaters, OR a large edema ring >1DD, or encroachment 2DD past the equator towards the posterior pole

-Can monitor atrophic holes in 1 year unless referral criteria are met

-Monitor operculated holes in 6 months unless referral criteria are met

Management plan for retinal holes?

MUST REFER

Management plan for retinal tears?

rhegamatogenous RD

What is the most common form of retinal detachment?

from a tear or break in the retina

What is a rhegamatogenous retinal detachment d/t?

Imcomplete detachment of the hyaloid from the retina (hyaloid still attached at the macula) with no macular distortion

Describe Vitreomacular Adhesion (VMA)

Incomplete detachment of the hyaloid with distortion of the macula (potentially a macular cyst which is technically a localized retinoschisis)

Describe Vitreomacular Traction (VMT)

anterior-posterior separation of the inner and outer retina

With VMT, there is _____ separation of the retina, Where?

lateral break in the inner retina with an intact outer retina (may be a retinoschisis)

Describe Lamellar Hole

anterior-posterior separation of the inner and outer retina

With a lamellar hole, there is _____ separation of the retina, Where?

Lateral break in the outer retina with inner retina intact

Describe Stage 2- Macular Hole

Small (<400 micron) full thickness hole

Describe Stage 2 Macular Hole

Full thickness hole >400 microns; with vitreous still attached to the macula

Describe Stage 3 Macular Hole

Full thickness hole >400 microns AND the vitreous is detached from the macula (but can still be attached elsewhere)

Describe Stage 4 Macular Hole

usually in the periphery

Unifocal CHRPE Location in the Retina

Usually <2DD in size

Unifocal CHRPE Size

Dull yellow lacunae

What may appear with a Unifocal CHRPE?

<2DD

What is the typical size of a nevus?

Benign

Is a nevus benign or malignant?

5

A nevus of >_____DD is malignant until proven otherwise

TFSOM-UHHD

Look at the size, Look for changes in Color (orange = bad) Border, Elevation, Serous Detachment, Thickness >2mm

How to diagnose malignant melanoma?

toxoplasmosis infection

What is the #1 cause of a chorioretinal scar?

Ingested from cats, ingested from undercooked meats, or congenital

What is the etiology of a toxoplasmosis infection?

Chorioretinal Scar Pic

Chorioretinal Scar Pic

Cystoid Retinal Degeneration Pic

Cystoid Retinal Degeneration Pic

Snowflake Degeneration Pic

Snowflake Degeneration Pic

Snailtrack Degeneration Pic

Snailtrack Degeneration Pic

they all lead to shiny spots peripherally

Why are cystoid/snowflake/snailtrack all differentials?

Cystoid Degeneration Pic

Cystoid Degeneration Pic

White Without Pressure Pic

White Without Pressure Pic

Retinal Detachment Pic

Retinal Detachment Pic

Retinoschisis Pic

Retinoschisis Pic

all lead to blurry areas

Why are Peripheral Cystoid/WWOP/RD/Retinoschisis differentials for eachother?

Refer if outer layer hole, if there is a high water mark present, retinal detachment present, or if there is progression towards the posterior pole

What is the management plan for a retinoschisis?

-Refer if new symptoms

-Refer if there is a retinal tear within the lattice or on the border

-Refer id there is a retinal hole at the border of the degeneration

What is the management of lattice/snailtrack degeneration?

abnormal

Arterial pulsation is (normal/abnormal)

normal

Venous pulsation is (normal/abnormal)

because the venous perfusion pressure is similar to the intraocular pressure

Why does venous pulsation occur?

arteriosclerosis with occlusion of vein by an artery at AV crossing; or by a thombus

What is the etiology of BRVO?

-need systemic vascular workup

-BP check

What is the management plan for a patient with a BRVO?

Hypertension

___ is the most common association with BRVO

partial blockage with fewer hemes and cotton wool spots

What is non-ischemic BRVO?

nearly complete or complete blockage with more hemes and cotton wool spots

What is an ischemic BRVO?

true

True or False:

New venous occlusions usually have significant hemorrhage

-vascular sheathing

-tortuosity

-retinal collaterals

-hard exudates

What are the retinal signs post-BRVO?

-macular edema

-retinal neovasc

What are the major ocular concerns post-BRVO?

Anti-VEGF intravitreal injections may help with macular edema in BRVO; established anti-VEGF meds as the first line treatment for macular edema secondary to BRVO

What was the findings of the BRAVO, HORIZON, RETAIN Studies?

thrombus typically

What is the etiology of a CRVO?

-systemic vascular work up

-BP check

What is the management plan for patients with CRVO?

Hypertension

______ is the most common systemic association with CRVO

partial blockage with fewer hemes and cotton wool spots

What is non-ischemic CRVO?

nearly complete or complete blockage with more hemes and cotton wool spots

What is ischemic CRVO?

-vascular sheathing

-tortuosity

-retinal/optic nerve collaterals

-hard exudates

What are the retinal signs post-CRVO?

-macular edema

-Retinal neovasc

-iris neovasc

-neovascular glaucoma

What are the major concerns post-CRVO?

-grid laser WAS NOT helpful for macular edema

-Wait until NVI develops to perform PRP in non-ischemic CRVO

-Eyes with extensive hemes are often ischemic

What were the findings in the central vein occlusion study (CVOS)?

Anti-VEGF intravitreal injections may help with macular edema in CRVO; established anti-VEGF meds as the first line treatment for macular edema in CRVO

What were the findings of the CRUISE, HORIZON, RETAIN studies regarding CRVO?

-branch

-central

What are the forms of arterial occlusions?

embolus

What is the etiology of arterial occlusions?

retina appears white (giant cotton wool spots)

What is the appearance of the retina with an arterial occlusion?

painless loss of vision

What is the common symptom of arterial occlusion?

Yes

Is an arterial occlusion an ocular emergency?

hypertension

What is the #1 cause of venous occlusion and macroaneurysm?

mild to early moderate

Hypertensive retinopathy is usually ____ to _____

No

Do venous occlusions usually happen with mild to early moderate hypertensive retinopathy?

-generalized narrowing of the arteries

-AV crossing changes

-widening of the arterial light reflex (sheathing)

-tortuosity

What are the common retinal changes with mild hypertensive retinopathy?

-everything in the mild category can occur

- vascular leakage

- vascular occlusion

-microaneurysms (like diabetes)

What are the common retinal changes with moderate hypertensive retinopathy?

-may show everything in mild & moderate categories

-optic nerve head edema

What are the common retinal changes with malignant hypertensive retinopathy?

By controlling blood pressure w/ diet and exercise and/or medications

How is hypertensive retinopathy controlled?

No -- the mild changes will probably remain but will progress more slowly

Will all hypertensive retinal changes resolve with diet and exercise change to control BP?

Yes

Will moderate/malignant retinal changes d/t hypertension resolve with diet and exercise change to control BP?

Hypertension

What is the most common systemic association with vascular occlusion (BRVO/CRVO) and macroanuerysm?

No

Is arteriosclerotic retinopathy associated with any systemic disease?

age

Arteriosclerotic retinopathy is ____ related

mild changes of hypertensive retinopathy

What does arteriosclerotic retinopathy resemble?

vascular leakage or vascular occlusion

What does arteriosclerotic retinopathy NOT include?

exogenous insulin

Type 1 diabetics must get _____

endogenous insulin is made, but it does not work properly

Describe Type 2 diabetes

Type 2

Metabolic syndrome describes most (Type 1/Type 2) diabetics

Obesity with genetic insulin resistance will lead to hypertension, Type 2 diabetes, Lipid abnormalities (lower HDL, higher triglycerides), increased uric acid

Metabolic syndrome description

All of the above disorders (hypertension, Type 2 diabetes, Lipid abnormalities (lower HDL, higher triglycerides), increased uric acid) WILL occur together

What is the FOGT Conception that deals with Metabolic syndrome?

IF these disorders (hypertension, Type 2 diabetes, Lipid abnormalities (lower HDL, higher triglycerides), increased uric acid) occur together, then a patient is at risk for vascular disorders such as hypertension and diabetes

What is the NIH Conception that deals with Metabolic syndrome?

polyuria, polyphagia, polydipsia

Classic triad of symptoms in diabetes?

Yes -- transient (days) or more long-lasting changes in refractive error are possible

Can refractive error change d/t diabetes?

duration and control

What are the major determinants of diabetic retinopathy progression?

does not contain

Nonproliferative diabetic retinopathy (NPDR) (contains/does not contain) neovascularization

Proliferative = neovasc present (NVE, NVD, NVI)

What is the difference of PROLIFERATIVE diabetic retinopathy from NPDR?

microaneurysms

Usually ____ are the first retinal changes in NPDR

Yes -- hemes and hard exudate are common

Is vascular leakage commonly seen with NPDR?

1) Retinal thickening within 1/3 DD of the fovea

2) Hard exudate within 1/2DD of the fovea (with associated retinal thickening)

3) Retinal thickening at least 1DD within 1DD of the fovea

What are the 3 definitions of Clinically Significant Macular Edema from the ETDRS Study?