1. Acute and Chronic Visual Loss continued Dr. G.M.Wise Senior Lecturer Ophthalmology Copyright G.Wise 2006 Session 10. Chronic visual loss

2. Chronic Visual Loss Many causes overlap with acute 3. NO OCULAR SIGNS = NEUROLOGIC CAUSE 4. Conditions CVA Aneurysm M.S. Tumour (pituitary in particular) 5. CHRONIC VISUAL LOSS Symptoms Unilateral Vs bilateral Age (young Vs old) Time frame of progression Worse at night ? corrected with glasses, can they read glare, other symptoms 6. Va with and without pinhole Pupils Red reflex - lens opacities IOP raised plus or minus Fields Special tests SIGNS 7. CHRONIC VISUAL LOSS ANTERIOR POSTERIOR 8. CHRONIC VISUAL ANTERIOR CORNEA . LENS 9. CHRONIC VISUAL LOSS POSTERIOR VITREOUS RETINA OPTIC NERVE NEUROLOGICAL 10. Posterior Subcapsular cataract 11. Nuclear Sclerosis 12. Cortical lens opacities 13. Posterior synechiae Mature Cataract 14. Hypermature Cataract 15. Retinal Level Macular Degeneration 25% greater 75 years 25% bilateral Va (Near) down 1st Dry Vs Wet 16. Subretinal (disciform) scarring Massive subretinal exudation Possible subsequent course of CNV Haemorrhagic sensory and RPE detachment Exudative retinal detachment 17. Diabetic Retinopathy Non-proliferative haemorrhage exudates aneurysms Proliferative New vessels 18. DIABETIC RETINOPATHY 1. Adverse risk factors 2. Pathogenesis 5. Clinically significant macular oedema 6. Preproliferative diabetic retinopathy 3. Background diabetic retinopathy 4. Diabetic maculopathies Focal Diffuse Ischaemic 7. Proliferative diabetic retinopathy 19. Diabetic Retinopathy Minimal Mild Moderat eSever e Grading is based on standard pho Depends on haems.exudates ,etc Non Proliferative 20. Focal diabetic maculopathy Circumscribed retinal thickening Associated complete or incomplete circinate hard exudates Focal leakage on FA Focal photocoagulation Good prognosis 21. Diffuse diabetic maculopathy Diffuse retinal thickening Generalized leakage on FA Guarded prognosis Grid photocoagulation Frequent cystoid macular oedema Variable impairment of visual acuity 22. Ischaemic diabetic maculopathy Macula appears relatively normal Capillary non-perfusion on FA Poor visual acuity Treatment not appropriate 23. Preproliferative diabetic retinopathy Treatment - not required but watch for proliferative disease Cotton-wool spots Venous irregularities Dark blot haemorrhages Intraretinal microvascular abnormalities (IRMA) Signs 24. Indications for vitreoretinal surgery Retinal detachment involving macula Severe persistent vitreous haemorrhage Dense, persistent premacular haemorrhage Progressive proliferation despite laser therapy 25. Retinal Dystrophies Multiple Types Rod dystrophies Cone dystrophies Commonest is Retinitis Pigmentosa 26. Classic bone corpuscle pigmentation