ESSAM OSMAN Associate Professor Chief Glaucoma unit Email:[email protected] .
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Transcript of ESSAM OSMAN Associate Professor Chief Glaucoma unit Email:[email protected] .
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CHRONIC VISUAL LOSSESSAM OSMANAssociate ProfessorChief Glaucoma unitEmail:[email protected]/68905
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CHRONIC VISUAL LOSSCauses of slowly progressive visual loss in an adult patient
1. Glaucoma.2. Cataract.3. Macular degeneration.4. Diabetic retinopathy .
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CHRONIC VISUAL LOSS1. Measure intraocular pressure with
a tonometer2. Evaluate the nerve head, classifying
it as normal, or abnormal3. Evaluate the clarity of the lens4. Evaluate the function and
appearance of the macula.
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The Visual PathwayCornea
Anterior Chamber
Lens
Vitreous
Retina
Iris
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The Visual Pathway
*Phototransduction:By photoreceptors (rods and cones)
*Image processing:By horizontal, bipolar, amacrine and RGCs
*Output to optic nerve:Via RGCs andnerve fiber layer
RGCs
Nerve Fibers
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The Visual PathwayRetina
Optic Nerve
Optic Chiasm
Visual Pathway
Lateral GeniculateNucleus
Primary Visual Cortex
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GLAUCOMA*A major cause of blindness.
*Often A symptomatic; in early stage.
*Damage is irreversible.
*Effective treatment is available.
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TYPES OF GLAUCOMAAcute glaucoma
Chronic glaucoma
Congenital glaucoma
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GLAUCOMARisk factorFamily historyBlackAgeMyopia DMHTN
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GLAUCOMADiagnosis 2 of 3IOPDisc Visual field defect(respect horizontal midline)
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GLAUCOMAPainless Gradual increase in IOP Central vision is affected late
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GLAUCOMANormal IOP10mmHg -2121-31 ocular hypertension
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GLAUCOMADisc Normally cupping 0.3 to 0.4
More than 2 of population C/D ratio more than 0.6
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GLAUCOMAIOP measurementSchiotz ApplanationTonopenPulsairAir puffpaskal
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GLAUCOMAPrimary or secondaryPrimary by exclusionPseudoexfoliationPigmentarySteriod inducedUveitic
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GLAUCOMAManagementMedical schoolSurgical school
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CATARACT
Opacity of the lens
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CATARACT
CausesAge related subcapsular Nuclear corticalTraumatic
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CATARACTMetabolic diabetic galactosemiaGlacokinase defiencyMannosidosisFabrys diseaseLowes syndromeHypocacemic syndrome
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CATARACT
Cataratogenic drugsChlorpromazineMioticsMyleranAmiodaronegold
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CATARACTComplicated cataractUveitisRetinal dystrophy,retinitis pigmentosaHigh myopiaAcute glaucomaIntrauterine causesrubellatoxo,cmvSyndromsdowen syndrome,wernerrothmanHeredetary 1/3
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CATARACTClassification1-morphologicnuclear,subcapsular,cortical2-maturityimmature,mature,itumescent,hypermature3-age of onsetcong,infantile,presenile.senile
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CATARACTManagementCongenital lens aspiration±IOLAquiredICCEECCEECCE IOLPHACO IOL
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Macular Degeneration
RELEVANCE In the United States, age-related macular degeneration is
the leading cause of irreversible central visual loss (20/200 or worse) among people aged 52 or older.
Because certain types of macular degeneration are treated effectively with laser, it is important to recognize this entity and to refer for appropriate care.
It is important to distinguish between the possible causes of visual loss, whether cataract (surgically correctable), glaucoma (medically or surgically treatable), or macular
degeneration (potentially laser treatable).
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Macular degenerationMacular AnatomyThe macula is an oval area situated about 2 disc
diameters temporal to the optic disc. The macula is composed of both rods and cones and is the area responsible for detailed, fine central vision.
The central macula is a vascular and appears darker than the surrounding retina. The fovea is an oval depression in the center of the macula.there is a high density of cones but no rods are present.
The central depressionof the fovea may act like a concave mirror during ophthalmoscopy, producing a light reflection (i.e., foveal reflex).
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Macular degenerationTest for macular functionV/APupillary light reactionColor visionOphthalmoscopyAmsilar gridPhtosterss testLaser inferometryFlourescine angiography
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Macular degenerationAge relatedSome degree of visual loss associated with drusen&atrophy of RPE subretinal neovascularizationTypes Dry type 90% slow progressive atrophy of RPE
and photoreceptorsWet type 10% RPE detachment and choroidal
neovas.
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Drusen are hyaline nodules (or colloid bodies) deposited in Bruch's membrane, whichseparates the inner choroidal vessels from the retinal pigment epithelium. Drusen maybe small and discrete or larger, with irregular shapes and indistinct edges. Patientswith drusen alone tend to have normal or near normal visualacuity ,with minimal metamorphopsa
Macular Degeneration
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Macular degenerationAs the most common cause of vision loss
among people over the age of 60, macular degeneration impacts millions of older adults every year. The disease affects central vision and can sometimes make it difficult to read, drive or perform other activities requiring fine, detailed vision.
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macular degeneration What Risk Factors You Can't ControlAgeRaceGenderGenetics
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Risk Factors You Can Control
SmokingHigh Blood PressureHigh CholesterolPoor NutritionUnprotected Exposure to SunlightUltraviolet (UV) light has been Excessive Sugar IntakeObesitySedentary Lifestyle
Macular Degeneration
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Diabetic retinopathy
Risk factorsDuration of the diseaseGood metamolic controllPregnancy,hypertemsion,renal disease,anaemia
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Diabetic retinopathyPathogenesisMicrovascular occlusionMicrovascular leakage
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Diabetic retinopathyMicrovascular occlusionThikened capillary basement membraneCapilary endothelial cell damageChanges in RBC
Retinal ischemia
AV SHUNTNEOVASCULARIZATIONJ
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Diabetic retinopathy Microvascular leakageLoss of pericyte cells between endothelial cellsLeakage of plasma conistitute in the
retina(exudate)
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Diabetic retinopathyTypesNon proliferativeProliferativeMacular oedema
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Diabetic retinopathyManagementNPDR OBSERVATION
PDR PRP
MACULAR OEDEMA FOCAL&GRID LASER