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C-52683

Macular cases

This feature presents a series of macular-themed images to test the practitioner’s recognition and clinical management skill.

Image A

Image A

A 78-year-old woman presents complaining of unilateral distorted central vision.

01 Which non-invasive diagnostic technique is being utilised in the image above?

a) Fluorescein angiography (FA)
b) Optical coherence tomography angiography (OCTA)
c) Indocyanine green angiography (ICG)
d) Fundus autofluorescence (FAF)

02 What is the most likely diagnosis?

a) Non-exudative age-related macular degeneration
b) Exudative age-related macular degeneration
c) Central serous chorioretinopathy
d) Central retinal artery occlusion

03 What is the appropriate management of this patient?

a) Urgent same day referral to ophthalmology
b) Fast-track referral to ophthalmology within two weeks
c) Monitor at three-monthly intervals as the condition is self-limiting
d) No referral. Review patient in 12 months

Image B

Image B

An 82-year-old man with a history of dry macular disease presents with an acute reduction in visual acuity.

04 Which diagnostic imaging technique is being utilised in the image above?

a) Fluorescein angiography (FA)
b) Optical coherence angiography (OCTA)
c) Indocyanine green angiography (ICG)
d) Fundus autofluorescence (FAF)

05 Which of the following statements is true?

a) This technique carries a risk of life-threatening reactions such as anaphylaxis, cardiac arrest and bronchospasm
b) This technique can be produced using a modifiedbfundus camera or confocal scanning laser ophthalmoscope (cSLO)
c) This technique is the gold standard in imaging of the retinal vasculature
d) None of these

06 Which of the following statements is true?

a) Monitoring the metabolic integrity of the RPE with this imaging technique is useful in monitoring disease progression
b) This technique is useful in the diagnosis of retinal artery occlusion
c) This technique is helpful in confirming multifocal choroiditis and punctate inner choroidopathy
d) All of these

Image C

Image C

A 42-year-old man attends reporting a change in his vision over the last two weeks.

07 What is the most likely diagnosis?

a) Central serous chorioretinopathy
b) Polypoidal choroidal vasculopathy
c) Rhegmatogenous retinal detachment
d) Peripapillary choroidal neovascular membrane

08 Which of the following statements regarding this condition is true?

a) Patients require acute referral to ophthalmology as the condition is sight-threatening and time sensitive
b) Same day referral to local stroke clinic is required due to potential secondary vascular event
c) Rwoutine referral to ophthalmology for a vitreo-retinal opinion on prophylactic vitrectomy is required
d) The condition is likely to spontaneously resolve within three to six months

09 Which of the following statements is false?

a) This condition is a sporadic disorder of the outer blood retinal barrier typically affecting young to middle-aged men with Type A personality
b) Vitreo-retinal traction is usually responsible for this condition
c) The condition is aggravated by corticosteroid use, high alcohol intake, untreated hypertension and stress
d) Symptoms often include metamorphopsia, blurred vision and relative positive scotoma

Image D

Image D

A 48-year-old woman attends reporting a gradual deterioration in her visual acuity.

10 What is the most likely diagnosis?

a) Adult-onset foveomacular vitelliform dystrophy
b) Exudative age-related macular degeneration
c) Central serous chorioretinopathy
d) Vogt-Koyanagi-Harada syndrome

11 Which of the following statements is false?

a) Age of onset is typically between 30 and 50 years
b) The condition is associated with mutations in the peripherin 2 (PRPH2) gene
c) When detected in younger patients an autosomal dominant dystrophy associated with a mutation in bestrophin 1 (BEST1) gene should be suspected
d) Presentation of the condition is typically unilateral

12 Which of the following statements is true?

a) Prognosis is poor and the patient is likely to be registered as visually impaired within 12 months
b) The prognosis is generally good with this condition although may progress to become visually debilitating
c) The condition is always asymptomatic and no referral is required
d) Fast-track referral to ophthalmology for anti-VEGF injections is required

About the author

Craig McArthur MCOptom is an optometrist working within independent practice. He is a visiting lecturer and clinical tutor to undergraduates at Glasgow Caledonian University where he also teaches the glaucoma module for the independent prescribing course. 

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