A brand new title in the Rapid series, providing a concise, structured approach for students preparing for ophthalmology examinations
Presents a thorough foundation of ophthalmology knowledge, emphasising clinically relevant information, in the familiar 'Rapid' series format where diseases are presented in alphabetical order so aiding quick look-up of conditions
Ideal for use in busy clinical settings, such as clinics and hospital wards, while on rotation
Includes a companion website at www.wileyrapids.com/ophthalmology containing a range of clinical images in PowerPoint format This title is also available as a mobile App from MedHand Mobile Libraries. Buy it now from iTunes, Google Play or the MedHand Store.
Frequently asked questions
How do I cancel my subscription?
Simply head over to the account section in settings and click on “Cancel Subscription” - it’s as simple as that. After you cancel, your membership will stay active for the remainder of the time you’ve paid for. Learn more here.
Can/how do I download books?
At the moment all of our mobile-responsive ePub books are available to download via the app. Most of our PDFs are also available to download and we're working on making the final remaining ones downloadable now. Learn more here.
What is the difference between the pricing plans?
Both plans give you full access to the library and all of Perlego’s features. The only differences are the price and subscription period: With the annual plan you’ll save around 30% compared to 12 months on the monthly plan.
What is Perlego?
We are an online textbook subscription service, where you can get access to an entire online library for less than the price of a single book per month. With over 1 million books across 1000+ topics, we’ve got you covered! Learn more here.
Do you support text-to-speech?
Look out for the read-aloud symbol on your next book to see if you can listen to it. The read-aloud tool reads text aloud for you, highlighting the text as it is being read. You can pause it, speed it up and slow it down. Learn more here.
Is Rapid Ophthalmology an online PDF/ePUB?
Yes, you can access Rapid Ophthalmology by Zahir Mirza in PDF and/or ePUB format, as well as other popular books in Medicine & Opthalmology & Optometry. We have over one million books available in our catalogue for you to explore.
Blinding degeneration of the macula characterized by drusen and changes to the retinal pigment epithelium (RPE).
AETIOLOGY
Unknown, likely multifactorial. See Associations/risk factors.
ASSOCIATIONS/RISK FACTORS
Increased age, female gender (most likely due to increased ages of survival), smoking, hypermetropia, hypertension, race (greater in Caucasians than Blacks), excessive alcohol intake. Cumulative UV light exposure. Increased dietary fat intake. There is some evidence for an inherited predisposition. Variants in the complement factor H gene, located on chromosome 1, are associated with the development of AMD.
EPIDEMIOLOGY
AMD is the leading cause of blindness in the Western world amongst 50+ year-olds. Dry AMD accounts for 90% of cases of macular degeneration but can be less severe than wet AMD.
HISTORY
Reduced visual acuity – gradual deterioration in central vision leading to difficulty with reading, recognizing faces, seeing fine details. Vision is not significantly improved with glasses. Metamorphopisa. Reduced contrast and colour sensitivity.
EXAMINATION
Drusen, focal hyperpigmentation, RPE atrophy. Geograpic atrophy can be a sign of late stage AMD. Amsler-grid testing should be used to monitor for development of wet AMD.
PATHOLOGY/PATHOGENESIS
Drusen are abnormal yellow deposits located between the RPE and Bruch's membrane. These can become calcified. The overlying photoreceptors cease to function due to lack of the required support from the RPE. Geographic atrophy represents a large well demarcated area of RPE damage.
There is no treatment for established Dry AMD. Measures to consider to prevent progression are below.
LIFESTYLE
Smoking cessation. High dose prophylcatic vitamins; C, E, zinc and beta-carotene. (Beta carotene may increase the risk of lung cancer in smokers who require a formulation without its inclusion.)
SUPPORTIVE
Counselling, low vision aids, referral to support groups. Sight-impaired/severely sight-impaired registration as appropriate.
COMPLICATIONS
Choroidal neovascularization (wet AMD).
PROGNOSIS
The presence of large drusen and pigment abnormality in one eye is associated with a 50% risk of developing AMD in the fellow eye within 5 years.
Age related macular degeneration, wet
DEFINITION
Degeneration of the macula complicated by choroidal neovascularization.
AETIOLOGY
Unknown, likely multifactorial. Excessive secretion of vascular endothelial growth factor (VEGF) may be a cause.
ASSOCIATIONS/RISK FACTORS
Increased age, female gender, smoking, hypermetropia, hypertension, alcohol intake. UV light exposure. Increased dietary fat intake. Variants in the gene coding for complement factor H, a component of the alternative complement cascade pathway, predispose to AMD.
EPIDEMIOLOGY
Accounts for 10% of cases of macular degeneration, however, is responsible for most of the sight-impaired/severely sight-impaired registrations that are made in the UK.
HISTORY
Subacute onset of decrease/loss of central vison +/- associated metamorphopsia.
There is neovascularization that develops from the choroid and extends through the RPE and into the subretinal space. The vessels are fragile and susceptible to rupture with resulting haemorrhage and oedema. Fibrosis and collagen deposition occur eventually leading to further degeneration and predisposition to bleeding of the macula. Haemorrhage and macular scarring can cause profound central vision loss.
INVESTIGATIONS
Urgent fluorescein angiography – to identify choroidal neovascularization. Optical coherence topography – aids in the detection of macular oedema and has revolutionized diagnosis and monitoring of this condition.
MANAGEMENT
Referral to ophthalmology: for consideration of intravitreal anti-VEGF injections.
Amsler-grid self-monitoring (allowing patients to determine progression).
LIFESTYLE
Smoking cessation/vitamin supplementation (see age-related macular degeneration, dry).
SUPPORTIVE
Low-vision aids, registration as sight-impaired/severely sight-impaired, counselling, referral to support groups.
COMPLICATIONS
Without treatment permanent visual loss almost inevitable.
PROGNOSIS
Intravitreal anti-VEGF injections have revolutionized treatment of wet AMD; a course of injections can lead to partial restoration of normal anatomy and cessation of the neovascularization. The benefit can be persistent.
Note: intravitreal injections can be associated with serious complications including endophthalmitis and retinal detachment.
Amaurosis fugax
DEFINITION
Transient monocular loss of vision.
AETIOLOGY
There is transient interruption of the retinal blood supply. Causes of transient visual loss have been classified by the Amaurosis Fugax Study Group 1990:
Most cases are due to underlying intracranial carotid artery disease hence the need for investigation as below to prevent stroke.
HISTORY
Monocular blurring, dimming or loss of vision lasting only seconds to minutes. The classic description (which is not ubiquitous) is of a vertically descending, curtain-like loss of vision. History should include eliciting symptoms of associated pathology and risk factors in particular those of giant cell arteritis.
EXAMINATION
Ophthalmic examination, especially for optic disc pallor, disc swelling and retinal ischaemia, e.g. cotton wool spots. Cholesterol...
