ABO Retina and Vitreous Disorders 5 — Questions and Answers
Question 1: Why did the AREDS2 formulation replace beta-carotene with lutein and zeaxanthin?
- Beta-carotene raised the risk of lung cancer in smokers (Correct answer)
- Beta-carotene caused copper deficiency anemia
- Beta-carotene raised the risk of geographic atrophy
- Beta-carotene interacted with anti-VEGF agents
Correct answer: Beta-carotene raised the risk of lung cancer in smokers
Beta-carotene was linked to higher lung cancer risk in current and former smokers, and lutein/zeaxanthin was a safe, effective substitute.
Question 2: Which imaging test is the gold standard for diagnosing polypoidal choroidal vasculopathy?
- Fluorescein angiography
- Fundus autofluorescence
- B-scan ultrasonography
- Indocyanine green angiography (Correct answer)
Correct answer: Indocyanine green angiography
ICGA shows the hyperfluorescent polyps and branching vascular network that define PCV.
Question 3: For hydroxychloroquine screening in an Asian patient, which visual field protocol is recommended in addition to 10-2 testing?
- Goldmann kinetic perimetry only
- 24-2 or 30-2 visual field (Correct answer)
- Amsler grid only
- FDT screening
Correct answer: 24-2 or 30-2 visual field
Asian patients often show pericentral toxicity outside the central 10 degrees, so wider-field testing is advised.
Question 4: Per the Branch Vein Occlusion Study, when is scatter laser photocoagulation indicated in BRVO?
- Prophylactically for any ischemia over 5 disc diameters
- For all BRVOs at diagnosis
- Once retinal or disc neovascularization develops (Correct answer)
- Only when visual acuity is worse than 20/200
Correct answer: Once retinal or disc neovascularization develops
BVOS supported scatter laser after neovascularization develops rather than prophylactically in nonperfused eyes.
Question 5: Per the Central Vein Occlusion Study, what is the recommended management for an ischemic CRVO without neovascularization?
- Close follow-up with PRP once iris or angle neovascularization appears (Correct answer)
- Immediate prophylactic panretinal photocoagulation
- Grid laser for macular edema to improve vision
- Radial optic neurotomy
Correct answer: Close follow-up with PRP once iris or angle neovascularization appears
CVOS found no significant benefit to prophylactic PRP and recommended prompt PRP when anterior segment neovascularization develops, with frequent gonioscopy.
Question 6: The COMS medium tumor trial compared iodine-125 brachytherapy with enucleation for choroidal melanoma. What was the main result?
- Enucleation improved 5-year survival
- Brachytherapy improved 5-year survival
- Pre-enucleation radiation improved survival
- There was no significant difference in all-cause mortality (Correct answer)
Correct answer: There was no significant difference in all-cause mortality
COMS showed similar 12-year all-cause mortality between brachytherapy and enucleation for medium choroidal melanomas.
Question 7: A 6-year-old boy has unilateral retinal telangiectasia with extensive yellow subretinal exudation and no calcification on imaging. What is the most likely diagnosis?
- Retinoblastoma
- Coats disease (Correct answer)
- Familial exudative vitreoretinopathy
- Toxocariasis
Correct answer: Coats disease
Coats disease typically affects young males unilaterally with telangiectatic vessels and exudation, and it lacks the calcification seen in retinoblastoma.
ABO Retina and Vitreous Disorders 5
Why did the AREDS2 formulation replace beta-carotene with lutein and zeaxanthin?