Ophthalmology KFP 2.8 – Betty has painless bilateral vision loss

by | Jan 22, 2018

Betty, 70 presents with painless gradual onset distortion of vision over the past 6 months. She notes that straight lines seem wavy and objects seem distorted. She has difficulty in focussing on objects but no change in her peripheral vision. She is having difficulty in driving. On fundoscopy you note the following:

What are the abnormal features that you see on fundoscopy?

  1. Drusen

What are the causes of drusen?

  1. Age
  2. Macular degeneration
  3. Choroidal malignant melanoma
  4. Retinal detachment

What are common causes of visual failure in the elderly?

  1. Macular degeneration
  2. Cataracts
  3. Glaucoma
  4. Diabetic retinopathy
  5. Trauma

What are the complications of visual failure in the elderly?

  1. Increased falls risk
  2. Driving restrictions
  3. decreased ADLs
  4. Higher dependence on care

What is your main initial diagnosis?

  1. Dry Macular Degeneration

What are the strong risk factors for development of this condition?

  1. Age
  2. Smoking
  3. Previous cataract surgery
  4. Family history

What are the moderate risk factors for development of this condition?

  1. Higher BMI
  2. Cardiovascular disease history
  3. Hypertension
  4. High plasma fibrinogen

What are the key features of history in this presentation?

  1. Sudden fading of central vision
  2. Distortion of vision
  3. Straight lines seem wavy
  4. Objects seem distorted
  5. Periphery normal

What are the key features of examination in this condition?

  1. Amsler grid test – wavy
  2. Macular drusen
  3. Peripheral fields normal
  4. Central vision lost
  5. Red reflex normal
  6. Central scotoma
  7. Bilateral though one eye leads

What are the key features of management of this condition?

  1. Refer ophthalmology for management
  2. Vitamin A
  3. Vitamin C
  4. Vitamin E
  5. Beta carotene
  6. Zinc
  7. Manganese
  8. Copper
  9. CoQ
  10. Spectacles
  11. No smoking
  12. AMD support group
  13. Quality sunglasses

What is the role of the GP in providing ongoing management in this condition?

  1. Smoking cessation
  2. Vitamin supplementation
  3. Healthy varied diet
  4. Awareness of Charles Bonnet syndrome
  5. Awareness of post-injection Endopthalmitis
  6. Access to psychological services
  7. Assessing fitness to drive. N  = V/A of at least 6/12 in better eye or both eyes

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