W9 - Macula & Choroid

symptoms of all maculopathies

reduced vision esp at near

scotomas

distortion / metamporphopsia

rare symtpoms of all maculopathies

micropsia

macropsia

what is micropsia

increased spacing of foveal cones

what is macropsia

reduced spacing of foveal cones

how to investigate

BCVA

use amsler grid

pipil light reactions

dilated fundus exam

OCT

fundus autofluorescence

what is central serous retinopathy (CSR)

exudative detachment of the sensory retina in the macula area

what is CSR aka

central serous choroidal retinopathy

what is the cause of CSR

multiple leaks in the RPE

shows up as a 'ink blot' appearance

choroidal leakage

risk factors of CSR

type A personality

elevated testosterone levels

systemic steroid use

symptoms of CSR

sudden onset reduced

VA blurred 6/9 - 6/18

possible hyperopic shift due to elevation of the retina

positive scotoma

metamorphopsia

micropsia

what is the clinical presentation of acute CSCR

detachment of sensory retina with serous fluid between the RPE and photoreceptor outer segs

absent foveal reflex

pigment changes

PED

clinical presentation of chronic CSCR

RPE atrophy

risk of CNV

how to differentiate between wet AMD and CSR

CSR = younger and resolves on its own

AMD = older px, progressively worse

optometric management of CSR

reassure px

resolves spontaneously within 2-3 months

subtle metamorphopsia --> can refer

ophthalmological management of CSR

confirm diagnosis

observation

Anti -VEGF injections

where does a full macular hole extend from

ILM to the RPE

signs of a full macular hole

edge of hole should be thicker and have pseudocysts

pigment changes at base of hole

edges may appear slightly raised

describe the lamellar macular hole

partial

photoreceptors are still intact

has an irregular foveal contour --> operculum

caaues of macular hole

traction

what is traction

retina is lifted from RPE pump

which can cause macular oedema

retina pulled away

what is an operculum

some retinal cells are still attached to posterior vitreous face

symptoms of a macular hole

painless loss of vision

VA at 6/60

positive scotoma

metamorphopsia

treatment for macular hole

self resolving - no treatment needed

surgery if fresh hole / full thickness

refer, not urgent, as routine referral

what is cystoid macula oedema (CMO)

result of fluid accumulation (cysts) at the OPL and INL of the fovea

what causes CMO

breakdown of the blood retinal barrier

symptoms of CMO

painless loss of central vision

loss of foveal depression

cysts appear in OCT as hyporeflective spaces (dark)

a flower petal of hyperfluorescence (light)

other causes of CMO

post surgery

diabetes

wet AMD

retinal vein occlusion

posterior uveitis

what is Irvine-Gass syndrome

cystic spaces in the retina post cataract surgery

when can Irvine-Gass syndrome occur

1-3 months post op

treatment for Irvine-Gass syndrome

topical NSAIDS

topical corticosteroids

Anti-VEGF

what is myopic maculopathy

degenerative changes in the sclera, choroid and RPE due to pathological / degenerative myopia

systemic associations of high myopia

down syndrome

marfan syndrome

prematurity

features of the myopic fundus (myopic maculopathy)

pale tesselated fundus (increased appearance of choroid)

focal chorioretinal atrophy (patchy areas of sclera and choroid)

anomalous ONH (small, large, tilted)

peripapillary chorioretinal atrophy (small yellow area inferior to disc)

acquired optic disc pit

lacquer cracks

subretinal haemorrhages

choroidal neovascularisation

Fuch's spot

how are lacquer cracks presented

linear breaks in RPE-Bruch's membrane complex

fine yellow lines which criss-cross

treatment for myopic maculopathy

anti-VEGEF

other complications related to myopic maculopathy

staphyloma

lattice degeneration

retinal tears and breaks

retinal detachment

macular hole

lens dislocation

primary CAG

what is the Fuch's spot

raised lesions due to the reabsorption of subretinal bleed

macular scar with pigment clumping