OPH: SAMPLEX BASED RATIO
CASE QUIZ
Case 5 and 6
QUESTION
1. Trauma is an important predisposing factor to
retinal detachment.
2. In rhegmatogenous retinal detachment, a retinal
tear is present, usually located in the retinal
periphery.
3. Screening for this condition entails an
examination of the retina using a direct
ophthalmoscope.
4. In retinal detachment, separation of the layers of
the retina occurs between the inner layers of the
retina and the retinal pigment epithelium.
A-TG5
OPHTHALMOLOGY
CASE QUIZ
NOV 25 2021
CASE QUIZ
ANSWER RATIONALE
True Retinal Detachment
● Risk Factors
→ Age
■ 45-65 years old age group (Number 1)
■ Cause is usually posterior vitreous detachment
→ Myopia
→ Cataract surgery
■ 1% risk, even if uncomplicated
■ Always disclose to patient
■ May develop earlier posterior vitreous detachment
→ Ocular trauma
→ Lifetime risk: 1:300
→ Incidence: 1:10,000/year
OPH.1.10.RETINA AND RETINAL DISORDERS
True Retinal detachment is classified under “Peripheral disorders of the retina”
• Rhegmatogenous Retinal Detachment: can still have 20/20 vision if it does not affect the visual axis,
since the detachment starts peripherally
Retinal detachment pathology is in the far periphery and requires indirect ophthalmoscopy or wide-field retinal
photography to visualize.
Arroyo, J.G. (2020). Retinal Detachment. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on November 26, 2021.)
False Retinal detachment pathology is in the far periphery, and requires indirect ophthalmoscopy or wide-field
retinal photography to visualize.
Arroyo, J.G. (2020). Retinal Detachment. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on November 2 6, 2021.)
Rhegmatogenous Retinal Detachment
● Binocular indirect ophthalmoscopy with scleral depression/slitlamp examination with a handheld contact
biomicroscopy lens
● Reveals elevation of the translucent detached sensory retina with one or more full-thickness sensory retinal
breaks
→ Horseshoe tear in the superotemporal quadrant
→ Holes in the temporal quadrant
→ Retinal dialysis in the inferotemporal quadrant
→ Scleral depression – allows us to examine the periphery
OPH.1.10.RETINA AND RETINAL DISORDERS
True ● Retinal pigment epithelium
→ Gives orange color of the retina
→ Area of RPE + rods & cones (photoreceptors) – where separation occurs in retinal detachment
● Retinal Detachment
→ Separation of neurosensory retina from underlying RPE
■ Sensory retina photoreceptors
OPH.1.10.RETINA AND RETINAL DISORDERS
5. Retinal detachment involving the macula should
be treated urgently.
6. The visual field exam in the case with retinal
detachment was normal.
7. There are no external eye signs in retinal
detachment.
8. A surgery for retinal detachment is scleral
buckling.
9. Central Visual Acuity may be unaffected in
peripheral retinal detachments.
10. Peripheral retinal detachments may be observed
only.
11. In our case, RAPD is detected in OS. This
signifies the presence of cataract in that eye
12. In optic neuritis, treatment is oral low dose
steroids
13. Observation is acceptable treatment for optic
neuritis
14. If there no pain in our patient, this is considered
unusual, atypical.
A-TG5
True The visual results of surgery for rhegmatogenous retinal detachment primarily depend on the preoperative
(Bonus) status of the macula. If the macula has been detached, recovery of central vision is usually incomplete. Thus,
surgery should be performed urgently if the macula is still attached. Once the macula is detached, delay in
surgery for up to 1 week does not adversely influence visual outcome.
Vaughan & Asbury’s General Ophthalmology p. 210
False In case discussion 6, the confrontational visual field exam was as follows:
● OD central, inferior, and nasal field deficits
● OS full to finger counting
True Regardless of the cause, patients with retinal detachments present with painless loss of vision in the affected
eye. In most cases, the patient will experience symptoms of posterior vitreous detachment as well, including
floaters and flashes of light. However, retinal detachments can occasionally be asymptomatic.
Arroyo, J.G. (2020). Retinal Detachment. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on November 26, 2021.)
True Scleral buckling
● Maintains the retina in position, while the chorioretinal adhesion forms, by indenting the sclera with a sutured
explant in the region of the retinal break
● Relieves vitreo-retinal traction and displaces the subretinal fluid away from the retinal break
● Success rate is 92-94%
OPH.1.10.RETINA AND RETINAL DISORDERS
True Symptoms of impending retinal detachment
● First symptom: floaters and flashes of light (signs of posterior segment problem)
● Sudden loss of vision (curtain vision)
OPH.1.10.RETINA AND RETINAL DISORDERS
False Treatment of Rhegmatogenous Retinal Detachment
● ALWAYS SURGICAL
● Examples are: Pneumatic retinopexy, laser cryotherapy, Scleral bucking, Pars plana vitrectomy
OPH.1.10.RETINA AND RETINAL DISORDERS
False In case discussion 5, (+) RAPD OS: This is indicative of asymmetric optic nerve disease or damage. It does
not signify cataract.
OPH.2.10.CASE DISCUSSION 5
False Treatment of Optic Neuritis: Steroid Therapy
● IV methylprednisolone led to more rapid recovery of vision, but the final outcome was no better than
with oral prednisone alone or with placebo similar results is earlier and later studies that faster recovery is
the sole benefit of steroid treatment.
● Bioequivalence: 1250mg/kg prednisone
● Established role for high-dose IV corticosteroid therapy in the treatment of typical optic neuritis
● Low dose oral prednisone alone had higher rates of new attacks of optic neuritis (recurrence)
OPH.2.10.CASE DISCUSSION 5
True Optic neuritis (ON) is a self-limiting condition caused by inflammation-driven demyelination process affecting
the optic nerve. Main clinical features are sudden, unilateral worsening of visual acuity, colour vision
disturbance, visual field defects and motion-induced ocular pain. Spontaneous recovery appears usually
within up to 8 weeks.
Gryzbowski, A. and Pieniqzek, M. (2013). Treatment of Optic Neuritis. European Opthalmic Review,7(1):52-5
: http://doi.org/10.17925/EOR.2013.07.01.52
True Typical optic neuritis has pain, loses vision over 12 days then gets better, and is common in young patients so
if the pattern does not present like this, it’s atypical
OPH.2.06.NEURO-OPHTHALMOLOGY
15. Multiple sclerosis is very common in the
Philippines
16. Most adult cases of optic neuritis have swollen
disc.
17. In optic neuritis with hard exudates in macula,
this is most likely associated with multiple
sclerosis.
18. MRI is indicated in optic neuritis to determine
chance of developing multiple sclerosis.
19. MRI findings consistent with multiple sclerosis
are periventricular white matter lesions.
20. Optic neuritis symptoms include decreased color
vision.
A-TG5
False Epidemiology of multiple sclerosis:
● US: 100-200/100,000
● Asia: 1-5/100,000
OPH.2.06.NEURO-OPHTHALMOLOGY
False Profile of patients with optic neuritis
● 65% presents with a normal disc
● 35% presents with swollen disc which is more common in children
OPH.2.06.NEURO-OPHTHALMOLOGY
False Neuroretinitis, neuromyelitis optica, chronic recurrent immune optic neuropathy, and optic nerve involvement
in other autoimmune diseases are the most common atypical type of optic neuritis. Only neuroretinitis
can be diagnosed early on the basis of the macular findings.
In neuroretinitis, inflammation spreads from the optic nerve to the retina. This disc is very swollen, and, when
the symptoms are most severe, a stellate figure composed of hard exudates is seen in the macula.
Wilhelm, H., & Schabet, M. (2015). The Diagnosis and Treatment of Optic Neuritis. Deutsches Arzteblatt international, 112(37), 616–
626. https://doi.org/10.3238/arztebl.2015.0616
True Other ancillary tests for optic neuritis (irrespective of etiology):
● Magnetic Resonance Imaging (MRI)
→ Optic nerve MRI
■ Gadolinium enhancement, increased signal and occasionally, swelling of the affected nerve
→ Brain MRI
■ Cerebral brainstem and/or cerebellar white matter lesions
■ Periventricular white matter lesions → predisposition to multiple sclerosis
■ White matter abnormalities → most valuable predictor for the development of MS
● Visual Evoked Potential (VEP)
→ Assessment of the alteration in visual acuity due to demyelination
● Optical Coherence Tomography
→ Measures the thickness of the retinal nerve fiber layer and determine the extent of axonal atrophy
OPH.2.10.CASE DISCUSSION 5
True Brain MRI
● Cerebral brainstem and/or cerebellar white matter lesions
● Periventricular white matter lesions → predisposition to multiple sclerosis
● White matter abnormalities → most valuable predictor for the development of MS
OPH.2.10.CASE DISCUSSION 5
True Common clinical features of typical optic neuritis:
● Cardinal symptom: subacute loss of vision developing over 2-7 days
● Reduced visual acuity
→ (+) visual field defect
→ 1/3 better than 20/40
→ 1/3 worse than 20/200
● Reduced color vision
● Reduced papillary response to light shone (+ RAPD)
● No associated systemic illness
● Periocular pain in 90% exacerbated by eye movement in 50%
● Retina: edematous around the nerve head and vessels become engorged
● Prominent manifestation: pain on movement of the eye
OPH.2.10.CASE DISCUSSION 5
OPH.SBR1 Samplex Based Ratio – Quiz 1 4 of 4