What is a serous detachment usually from in younger patients?
central serous (type A) and usually transient that resolves on own`
What is the stepwise process of a exudative/serous detachment occurring because of a choroidal nevus?
- RPE leaks out fluid
- fluid leaks in between RPE and sensory retina
- fluid pushes up, away from the RPE
What is drusen a result of inside of a choroidal nevus? 1. Is this a good or bad prognostic sign? 2
- poor vascular supply from the choriocapillaris created by physical barrier
- good sign because won’t convert to malignancy
What are the three classifications and treatments by the optometrist of a choroidal nevus (with the size of each)?
- benign, none (0.5-2 DD)
- suspicious, recall 6 months (2-5 DD)
- malignant, refer (5DD or larger)
How is the size of a malignant melanoma measured?
- ophthalmoscopy
- ultrasound
- FANG
What is the best way to confirm that a spot is a choroidal nevi? 1. What should be done to monitor the nevi? 2
- red free filter (will disappear)
2. take a photo
What is the appearance of a serous RPE detachment?
elevated retina and smooth surface
If their are none of the 8 factors that are more characteristic of a melanoma than a nevus than what is the probability of growth of the nevi in 5 years?
3%
What is the term for a multi-colored nevi?
mottling
What is a serous detachment usually from in older patients?
- macular degeneration
- cancer
- central serous possible (not type A)
What are the things to differentiate a nevus from a melanoma?
- Thickness > 2mm
- subretinal fluid
- symptoms (flashes mostly and sometimes floaters)
- orange pigment (lipofuscin)
- margin within 3mm of optic disc (2DD)
- ultrasonographic hollowness
- absence of halo
- absence of drusen
What are the things to look for with any choroidal nevus?
- how large?
- is it changing (border, elevation, color)?
- is it elevated
- what color is it and how many colors involved?
If their is one of the 8 factors that are more characteristic of a melanoma than a nevus than what is the probability of growth of the nevi in 5 years?
38%
If their are three or more of the 8 factors that are more characteristic of a melanoma than a nevus than what is the probability of growth of the nevi in 5 years?
50%, probably a melanoma
What is the outer 1/3 of the retina supplied by?
choroidal and choriocapillaris system
What is the inner 2/3 of the retina supplied by?
branches of the central retinal artery
Are arteries or veins more likely to break in vitreous detachment? 1. Why? 2
- arteries
2. closer to vitreous b/c sit on top of veins
What is the basement membrane of the RPE?
Bruch’s membrane
Where is the choriocapillaris the densest?
at the fovea
What is it called when the choroidal BV’s fill with fluid slightly earlier than the retinal circulation?
choroidal flush
What are the phases of FANG?
- choroidal flush
- arterial phase
- arteriovenous capillary phase
- early venous phase
- mid-venous phase
- late venous phase
Where is the blood located in dot-blot hemes?
- inner nuclear layer
- outer plexiform layer
- outer nuclear layer`
What layer are hard exudates usually found?
outer plexiform layer
What are artery-to-vein collaterals that do not have capillary bed obstructions called?
shunts
