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CC March 2017 Cataracts

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echoecho's version from 2018-04-12 02:19

Section

Question Answer
Describe the crystalline lens of the eye?it is a transparent, biconcave disc located BEHIND the pupil that can change its shape and help to focus light on the retina
Do the epithelial cells of the lens shed?no
Define cataract?when opacification of the lens occurs, it is termed a cataract (from the Latin for "waterfall" describing how the opacification affects the patient's vision
There are more than ____ million pts in the US with cataracts, and the number is expected to surpass ____ million in the next 30 years?24; 50
In addition to the direct effects of visual loss, cataracts can do what 3 things?1) increase the risk of falls 2) increase social isolation 3) decrease quality of life
Changes in what 4 things can result in cataracts?changes in 1) lens thickness 2) water content 3) pigment 4) electrolytes
What is the most common type of cataract? What part of the lens does it affect? Do they progress fast or slowly? The affect _____ vision in more advanced stages?1) nuclear cataract 2) affects the central part of the lens 3) progress slowly 4) color
Which type of cataract causes opacification of the outer layers of the lens typically in a spoke-like pattern that initially spares central vision but often produces glare especially during night time driving?cortical cataracts
Which type of cataract forms at the back of the lens in a central area producing night time glare and loss of central vision and they occur in younger patients relative to other types of cataracts?posterior subcapsular cataracts
*** What is the major risk factor for developing cataracts?advancing age
List the risk factors for developing a nuclear cataract?1) family hx 2) tobacco use 3) DM 4) ultraviolet light exposure 5) myopia
List the risk factors for developing a cortical cataract?1) family hx 2) nonwhite race 3) DM, poor glycemic control 4) tobacco use 5) obesity 6) chronic systemic, inhaled or topical corticosteroid use 7) ultraviolet light exposure
List the risk factors for developing a posterior subcapsular cataract?1) DM 2) uncontrolled HTN 3) obesity 4) myopia 5) chronic systemic, inhaled or topical corticosteroid use 6) hx of ocular trauma
List the 3 things you can do to reduce the risk of cataract development?1) improved glycemic control 2) improved BP control 3) exercise
*** Have the use of supplements (vit C, vit E, beta carotene, zinc, lutein, zeaxanthin ) reduce the development of cataracts? no
List the symptoms of cataracts?1) blurry vision (particularly at night) 2) halos around lights 3) faded colors 4) decreased vision
What should the physical exam consist of?1) acuity testing for near and far vision 2) ophthalmoscopic exam
What will the opthalmoscopic exam of a cataract show?opacity of the lens (particularly in advanced stages of disease)
Patients experiencing visual _________ should be referred for further evaluation to a opthalmologist?impairment
Mild visual changes due to cataracts can often be treated with what?prescription glasses
Advanced disease, what treatment is recommended?surgery
What is the most common type of cataract surgery in the USA? Describe the procedure?1) phacoemulsification 2) ultrasound breaks up the hardened lens, that is then aspirated through a small incision then a posterior chamber intraocular lens is implanted
Does phacoemulsification have a high success rate and low complication rate?yes
Describe the extracapsular extraction?a larger incision is made and the nucleus is removed in a single piece; a posterior chamber intraocular lens is then inserted into the remaining posterior capsule.
Describe the intracapsular extraction?the entire cataract and capsule are removed through a large incision and either an anterior or posterior implant is sutured in place
Whichever surgery is performed, the implanted lens does not change _____ like a native lens, so either a near vision or distance vision lens is implanted, and corrective lenses are used for the other distance?shape
Is preoperative testing generally required prior to cataract surgery?no
In most cases, does anticoagulant medications need to be stopped?no
Men who take the alpha-blocker ______ are at higher risk for intraoperative floopy iris syndrome (IFIS)?Tamsulosin (Flomax)
Describe what IFIS is?it is progressive miosis, iris prolapse or billowing iris during any stage of cataract surgery resulting in difficulat managment and poorer outcomes. The effects of tamulosin can persist for months to years, to temporary discontination of the medication may not reduce the risk of IFIS
*** Exposure to tamsulosin within ____ days of cataract surgery was significantly associated with serious postoperative opthalmic adverse events and should be avoided in those who are considering cataract surgery?14
What other medications and conditions may also be potential risk factors for IFIS?1) Benzodiazepines 2) Quetiapine 3) Finasteride 4) HTN
*** SUMMARY = Age-related cataracts are a common cause of visual impairment, affecting more than ____ million Americans, a number that is expected to rise to ____ million by 2050?20; 50
*** SUMMARY = Risk fxs for cataract formation include what?1) age 2) ultrviolet light exposure 3) smoking 4) DM 5) HTN, 6) steroid use 7) family hx
*** SUMMARY = Is prophylaxis with vitamin supplements effective?no
*** SUMMARY = What is the most common treatment of cataracts?phacoemulsification and intraocular lens implantation
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