Understanding Central Vision Loss in Older Adults – A UKMLA/PLAB Question Analysis

 

Decode Complex Exam Questions for UKMLA and PLAB Success

This article dissects a tricky question from the August 2024 PLAB 1 exam, focusing on a common yet challenging condition: age-related macular degeneration (AMD). As the leading cause of central vision loss in older adults, AMD tests clinical reasoning and diagnostic skills, making it a crucial topic for medical exams like the UKMLA, PLAB, and USMLE.

PLAB Exam Case Scenario: A 75-year-old man presents with difficulty recognizing faces and reading, which has gradually worsened over the past year. He reports that straight lines appear wavy. On examination, there is a loss of central vision in both eyes.

What is the most likely diagnosis?

- A) Glaucoma

- B) Diabetic retinopathy

- C) Age-related macular degeneration

- D) Cataracts

- E) Retinal detachment

Answer with an explanation is provided below.


Our content is updated to align with the MLA content map

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Our content is updated to align with the MLA content map 〰️


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Explanation of the above PLAB / UKMLA exam question

Correct Answer: C) Age-Related Macular Degeneration (AMD)

Why Age-Related Macular Degeneration (AMD) is the Most Likely Diagnosis

  1. Symptoms Match AMD: AMD is the leading cause of central vision loss in older adults and is associated with difficulty reading and recognising faces due to the involvement of the macula.

  2. Metamorphopsia: The symptom of wavy lines is characteristic of wet AMD, where fluid or blood accumulates under the retina, distorting vision.

  3. Bilateral Presentation: AMD typically affects both eyes, though not necessarily symmetrically, which fits this patient’s findings.

Why Other Options are Less Likely:

  • A) Glaucoma: Glaucoma primarily causes peripheral vision loss, not central vision loss. It progresses silently and does not typically cause metamorphopsia or distorted vision.

  • B) Diabetic Retinopathy: Diabetic retinopathy causes vision loss due to retinal haemorrhages, macular oedema, or detachment, but it is usually associated with a history of diabetes. This is not mentioned in the scenario.

  • D) Cataracts: Cataracts cause blurred vision, glare, and difficulty seeing at night. However, they do not typically cause wavy lines or central vision loss, as seen in this case.

  • E) Retinal Detachment: Retinal detachment presents acutely with symptoms like a sudden curtain-like shadow, flashes of light, and floaters, which are not present here. It does not typically cause progressive central vision loss over a year.

Management and Follow-Up:

  1. Confirm Diagnosis: Refer the patient to an ophthalmologist for further evaluation, including optical coherence tomography (OCT) and fundoscopy to confirm AMD and differentiate between the dry and wet types.

  2. Treatment:

    • Dry AMD: Focuses on lifestyle modifications, such as smoking cessation, dietary supplements (e.g., antioxidants), and vision aids.

    • Wet AMD: Requires treatment with intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections (e.g., ranibizumab or aflibercept) to reduce fluid accumulation and slow progression.

  3. Monitoring: Regular follow-up with an ophthalmologist is necessary to monitor disease progression and response to treatment.

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Reference:

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