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Debilitating Eye DiseasesDebilitating Eye Diseases
ByByMa. Teresa G. Martinez, M.D.Ma. Teresa G. Martinez, M.D.
International Eye InstituteInternational Eye InstituteSt. Luke’s Medical CenterSt. Luke’s Medical Center
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Diabetes mellitusDiabetes mellitus HypertensionHypertension GlaucomaGlaucoma Age-Related Macular DegenerationAge-Related Macular Degeneration Retinal DetachmentRetinal Detachment UveitisUveitis
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Diabetic RetinopathyDiabetic Retinopathy
Non-ProliferativeNon-Proliferative mild, moderate, mild, moderate, severe, very severesevere, very severe
ProliferativeProliferative earlyearly high riskhigh risk
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S/SxS/Sx
painless blurring of vision (gradual or sudden)painless blurring of vision (gradual or sudden)
retinal changesretinal changes
TreatmentTreatment
blood sugar controlblood sugar control
panretinal photocoagulationpanretinal photocoagulation
pars plana vitrectomypars plana vitrectomy
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HPN RetinopathyHPN Retinopathy
Modified Scheie ClassificationModified Scheie ClassificationGrade 0 No changesGrade 0 No changesGrade 1 Barely detectable arterial narrowingGrade 1 Barely detectable arterial narrowingGrade 2 Obvious arterial narrowing withGrade 2 Obvious arterial narrowing with focal irregularitiesfocal irregularitiesGrade 3 Grade 2 plus retinal hges and/ orGrade 3 Grade 2 plus retinal hges and/ or exudateexudateGrade 4 Grade 3 plus disc swellingGrade 4 Grade 3 plus disc swelling
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S/SxS/Sx
blurring of visionblurring of vision
retinal changesretinal changes
TreatmentTreatment
Blood pressure controlBlood pressure control
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ComplicationsComplications
Central Retinal Artery OcclusionCentral Retinal Artery Occlusion Branch Retinal Artery OcclusionBranch Retinal Artery Occlusion Central Retinal Vein OcclusionCentral Retinal Vein Occlusion Branch Retinal Vein OcclusionBranch Retinal Vein Occlusion
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Central Retinal Artery OcclusionCentral Retinal Artery Occlusion Caused by atherosclerosis-related Caused by atherosclerosis-related
thrombosis (ophthalmic artery)thrombosis (ophthalmic artery) S/SxS/Sx
acute and profound loss of visionacute and profound loss of vision
pale retinapale retina
cherry red spotcherry red spot
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TreatmentTreatment
Immediate (within 90 mins)Immediate (within 90 mins)
↓ ↓ IOP by ocular massageIOP by ocular massage
Anterior Chamber Paracentesis orAnterior Chamber Paracentesis or
Retrobulbar AnesthesiaRetrobulbar Anesthesia
Inhalation Therapy (95% O2/ 5% CO2)Inhalation Therapy (95% O2/ 5% CO2)
Oral Acetazolamide & AspirinOral Acetazolamide & Aspirin
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Branch Retinal Artery OcclusionBranch Retinal Artery Occlusion
Most commonly caused by emboliMost commonly caused by emboli Cholesterol, Platelet-fibrin, CalcificCholesterol, Platelet-fibrin, Calcific Other associations:Other associations:
trauma, coagulation disorders, sickle cell trauma, coagulation disorders, sickle cell disease, oral contraceptives, mitral valve disease, oral contraceptives, mitral valve prolapse, inflammatory &/or infectious prolapse, inflammatory &/or infectious etiologies, connective tissue disordersetiologies, connective tissue disorders
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S/SxS/Sx Acute & severe altitudinal visual field defectAcute & severe altitudinal visual field defect Pale retina in the area supplied by the affected Pale retina in the area supplied by the affected
arteryartery TreatmentTreatment Mgt is directed toward determination of systemic Mgt is directed toward determination of systemic
etiologic factorsetiologic factors No specific ocular therapy proven to improve No specific ocular therapy proven to improve
visual prognosisvisual prognosis
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Central Retinal Vein OcclusionCentral Retinal Vein Occlusion Non-IschaemicNon-Ischaemic (most common) (most common)
moderate loss of visual acuitymoderate loss of visual acuity
FA shows venous stasis but good retinal FA shows venous stasis but good retinal capillary perfusioncapillary perfusion
50% - normal or near normal visual acuity50% - normal or near normal visual acuity
Chronic Cystoid macular edema – poor visual Chronic Cystoid macular edema – poor visual acuityacuity
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IschaemicIschaemic Severe loss of visual acuitySevere loss of visual acuity Marked tortuosity & engorgement of retinal veinsMarked tortuosity & engorgement of retinal veins Retinal hemorrhages, Cotton wool spotsRetinal hemorrhages, Cotton wool spots Severe optic disc edema & hyperemiaSevere optic disc edema & hyperemia Visual acuity is permanently impairedVisual acuity is permanently impaired Monthly follow-up for 6 monthsMonthly follow-up for 6 months (+) neovascularization – PRP treatment(+) neovascularization – PRP treatment Tx of associated medical Tx of associated medical conditioncondition
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Branch Retinal Vein OcclusionBranch Retinal Vein Occlusion Sudden blurring of visionSudden blurring of vision
Metamorphopsia or relative visual field defectMetamorphopsia or relative visual field defect
Dilated & tortuous veins, hemorrhages, edema, Dilated & tortuous veins, hemorrhages, edema, cotton wool spotscotton wool spots
Complications- chronic macular edema & Complications- chronic macular edema & neovascularizationneovascularization
Within 6 mos 50% of eyesWithin 6 mos 50% of eyes
w/ collaterals will have w/ collaterals will have
better visual acuitybetter visual acuity
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GlaucomaGlaucoma
Increase in IOP, Optic Nerve changes, Increase in IOP, Optic Nerve changes, Visual Field defectsVisual Field defects
Types:Types: Congenital, Infantile, JuvenileCongenital, Infantile, Juvenile Open Angle (Primary, Secondary)Open Angle (Primary, Secondary) Closed Angle (Primary, Secondary)Closed Angle (Primary, Secondary)
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Early Disc ChangesEarly Disc Changes
Advanced Disc ChangesAdvanced Disc Changes
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S/SxS/Sx Decrease or loss in peripheral vision,Decrease or loss in peripheral vision, eye pain with or without headache, eye redness, eye pain with or without headache, eye redness,
haloes around light haloes around light Optic Nerve changesOptic Nerve changes
TreatmentTreatment Medical – oral, IV, eyedropsMedical – oral, IV, eyedrops SurgicalSurgical Laser or CryotherapyLaser or Cryotherapy
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Age-Related Macular DegenerationAge-Related Macular Degeneration
Severe central visual acuity loss in one or Severe central visual acuity loss in one or both eyesboth eyes
Types:Types:
NonneovascularNonneovascular
NeovascularNeovascular
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Nonneovascular Neovascular
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S/Sx :S/Sx : Decrease or loss in central visual acuityDecrease or loss in central visual acuity
TreatmentTreatment Education & follow upEducation & follow up MicronutrientsMicronutrients Laser treatment (PDT)Laser treatment (PDT) Intravitreal injection of steroidsIntravitreal injection of steroids Intravitreal injection of anti-VEGFIntravitreal injection of anti-VEGF
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Retinal DetachmentRetinal Detachment
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Types:Types:
RhegmatogenousRhegmatogenous – liquefied vitreous – liquefied vitreous
passing through a retinal break into the passing through a retinal break into the
potential space between the sensorypotential space between the sensory
retina and the RPEretina and the RPE
Tractional Tractional –caused by proliferative mem-–caused by proliferative mem-
branes that contract & elevate the retina branes that contract & elevate the retina
Exudative – caused by retinal or cho- – caused by retinal or cho-
roidal diseases in which leakage of fluidroidal diseases in which leakage of fluid
accumulates beneath the sensory retinaaccumulates beneath the sensory retina
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S/Sx:S/Sx:
light flashes, wavy or watery vision, veil or curtain light flashes, wavy or watery vision, veil or curtain obstructing vision, shower of floatersobstructing vision, shower of floaters
that resemble spots, bugs or spider webs &that resemble spots, bugs or spider webs &
sudden decrease of visionsudden decrease of vision TreatmentTreatment
Surgery : Scleral BucklingSurgery : Scleral Buckling
Pneumatic retinopexyPneumatic retinopexy
Cryotherapy, Laser or DiathermyCryotherapy, Laser or Diathermy
VitrectomyVitrectomy
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UveitisUveitis
Inflammation of the uveal tractInflammation of the uveal tract
Types:Types:
AnteriorAnterior
IntermediateIntermediate
PosteriorPosterior
PanuveitisPanuveitis
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Anterior UveitisAnterior Uveitis
Posterior UveitisPosterior Uveitis
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S/SxS/Sx floaters, blurring of vision, eye redness, eye pain, floaters, blurring of vision, eye redness, eye pain,
systemic manifestationssystemic manifestations anterior chamber findings, retinal changesanterior chamber findings, retinal changes
TreatmentTreatment steroidssteroids immunosuppressivesimmunosuppressives surgerysurgery
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Legal BlindnessLegal Blindness
Visual acuity of 20/200 or worse in the Visual acuity of 20/200 or worse in the better eye w/ corrective lenses better eye w/ corrective lenses (20/200(20/200 means that a person at 20 ft from an eye chart means that a person at 20 ft from an eye chart can see what a person w/ normal vision can see can see what a person w/ normal vision can see at 200 ft)at 200 ft)
OROR Visual field restriction to 20 degrees Visual field restriction to 20 degrees
diameter or less (tunnel vision) in the diameter or less (tunnel vision) in the better eye.better eye.
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Visual AcuityVisual Acuity
Snellen ChartSnellen Chart
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Visual Fields/ PerimetryVisual Fields/ Perimetry
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Fluorescein AngiographyFluorescein Angiography
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B-Scan UltrasoundB-Scan Ultrasound
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Optical Coherence TomographyOptical Coherence Tomography
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THANK YOUTHANK YOU