OCANZ Written September 2017/Q and A
A 75 y/o F comes in for her annual check complaining of reduced vision and
increased intolerance to glare. She has had a myopic shift and has cataracts.
a) What factors should you consider when referring for cataract surgery? - -
Cataract Cause of visual complaint
Compramising Lifestyle
Driver
Anisometropia
Visual Acuity
Other Ocular Pathology
General Health and Medications
Patient wants to have operation
-b) What type of cataract is most likely from the above description? - -
Nuclear Sclerotic
-c) Describe a cataract op in laymans terms - -Outpatient Basis
Before surgery seen by a specialist doctor
30-40 minutes on local anaesthetic
The Surgeon will make a tiny cut in your eye to get to the lens
High-frequency ultrasound device that breaks up the cloudy lens into small
pieces
Small pieces gently removed from the eye with suction.
Cloudly lenses replaced by a clear plastic one
-d) What are the post op drops (names and concentration) and common
post-op complications you would look out for weeks after? - -Postoperative
regimens of topically applied antibiotics, corticosteroids, NSAIDs, and oral
analgesic agents vary among practitioners.
From Incision - wound leak
Corneal Astigmatism
Keratopathy
IOP rise
Endopthalmitus
IOL disslocation
Sunset syndrome
Iris epithelial ingrowth
Pupil Capture
CMO
Retinal Detachment
-Signs of Glaucoma - -Disc Signs: Asymetric Cupping, Disc Haemorrhage ,
Increased cuppping, RNFL changes, PPA, NRR thining.
, Visual field loss characteristic to ONH changes, notching, superior arcuate
defect.
-How is glaucoma diagnosed. - -Progression analysis, visual fields and RNFL
scanning using OCT
-Medisoft plot, RE: false +ve 3% fixation losses 7/10 Le: false +ve 7%
fixation losses 2/10.
What is the reliability of the fields? - -Fixation loss higher than about 20% is
deemed unreliable.
A false positive rate around 20% or higher is considered to indicate low
patient reliability
-Medisoft plot showing a right homonymous hemianopia with macular
sparing.
What is the full name and classification of the condition?
Where in the visual pathway is the loss? - -Right homonymous hemianopia
with macular sparing indicating a legion in the posterior occipital lobe and
optic radiations or optic tracts
-Medisoft plot showing a right homonymous hemianopia with macular
sparing.
What is the likely cause? - -Vascular episode
Tumour
-Medisoft plot showing a right homonymous hemianopia with macular
sparing.
What is the appropriate management? - -Prisms (field expanders)
Managment of cause if possible and review.
-Patient with horizontal diplopia and a picture of a patient's eyes having
problems with right eye adduction but no problems converging to read.
What is the neurological lesion and syndrome shown? - -Internuclear
ophthalmoplegia is caused injury or dysfunction in the medial longitudinal
fasciculus (MLF)
-Patient with horizontal diplopia and a picture of a patient's eyes having
problems with right eye adduction but no problems converging to read.
A 75 y/o F comes in for her annual check complaining of reduced vision and
increased intolerance to glare. She has had a myopic shift and has cataracts.
a) What factors should you consider when referring for cataract surgery? - -
Cataract Cause of visual complaint
Compramising Lifestyle
Driver
Anisometropia
Visual Acuity
Other Ocular Pathology
General Health and Medications
Patient wants to have operation
-b) What type of cataract is most likely from the above description? - -
Nuclear Sclerotic
-c) Describe a cataract op in laymans terms - -Outpatient Basis
Before surgery seen by a specialist doctor
30-40 minutes on local anaesthetic
The Surgeon will make a tiny cut in your eye to get to the lens
High-frequency ultrasound device that breaks up the cloudy lens into small
pieces
Small pieces gently removed from the eye with suction.
Cloudly lenses replaced by a clear plastic one
-d) What are the post op drops (names and concentration) and common
post-op complications you would look out for weeks after? - -Postoperative
regimens of topically applied antibiotics, corticosteroids, NSAIDs, and oral
analgesic agents vary among practitioners.
From Incision - wound leak
Corneal Astigmatism
Keratopathy
IOP rise
Endopthalmitus
IOL disslocation
Sunset syndrome
Iris epithelial ingrowth
Pupil Capture
CMO
Retinal Detachment
-Signs of Glaucoma - -Disc Signs: Asymetric Cupping, Disc Haemorrhage ,
Increased cuppping, RNFL changes, PPA, NRR thining.
, Visual field loss characteristic to ONH changes, notching, superior arcuate
defect.
-How is glaucoma diagnosed. - -Progression analysis, visual fields and RNFL
scanning using OCT
-Medisoft plot, RE: false +ve 3% fixation losses 7/10 Le: false +ve 7%
fixation losses 2/10.
What is the reliability of the fields? - -Fixation loss higher than about 20% is
deemed unreliable.
A false positive rate around 20% or higher is considered to indicate low
patient reliability
-Medisoft plot showing a right homonymous hemianopia with macular
sparing.
What is the full name and classification of the condition?
Where in the visual pathway is the loss? - -Right homonymous hemianopia
with macular sparing indicating a legion in the posterior occipital lobe and
optic radiations or optic tracts
-Medisoft plot showing a right homonymous hemianopia with macular
sparing.
What is the likely cause? - -Vascular episode
Tumour
-Medisoft plot showing a right homonymous hemianopia with macular
sparing.
What is the appropriate management? - -Prisms (field expanders)
Managment of cause if possible and review.
-Patient with horizontal diplopia and a picture of a patient's eyes having
problems with right eye adduction but no problems converging to read.
What is the neurological lesion and syndrome shown? - -Internuclear
ophthalmoplegia is caused injury or dysfunction in the medial longitudinal
fasciculus (MLF)
-Patient with horizontal diplopia and a picture of a patient's eyes having
problems with right eye adduction but no problems converging to read.
