Veterinary Veterinary OphthalmologyOphthalmology

MedVet/CVESMedVet/CVES

Worthington, OhioWorthington, Ohio

Amanda RogersAmanda Rogers

MedVet/CVES is a specialty and 24-hour MedVet/CVES is a specialty and 24-hour veterinary emergency care facilityveterinary emergency care facility

With a staff of over 25 veterinarians, With a staff of over 25 veterinarians, including over a dozen specialistsincluding over a dozen specialists

The largest private veterinary The largest private veterinary referral/emergency center in the referral/emergency center in the MidwestMidwest

CVES operates as an emergency CVES operates as an emergency practice onlypractice only

No routine veterinary preventative No routine veterinary preventative care is offeredcare is offered– VaccinesVaccines– Heartworm or flea preventativeHeartworm or flea preventative– Yearly wellness examsYearly wellness exams

MedVet operates on referrals onlyMedVet operates on referrals only– From your family veterinarianFrom your family veterinarian– From a CVES doctorFrom a CVES doctor

With difficult cases many private practice With difficult cases many private practice veterinarians refer their patients to a veterinarians refer their patients to a specialist for a more complete and specialist for a more complete and diagnostic workupdiagnostic workup

Veterinary SpecialistsVeterinary Specialists

CardiologyCardiology OphthalmologyOphthalmology Internal MedicineInternal Medicine SurgerySurgery RadiologyRadiology OncologyOncology NeurologyNeurology DermatologyDermatology DentistryDentistry

Specialists are required Specialists are required to complete internship to complete internship and residency programs and residency programs typically 3 to 5 years. typically 3 to 5 years.

Specialists receive Specialists receive board certification by board certification by fulfilling clinical fulfilling clinical training, research, training, research, scientific publications, scientific publications, and extensive and extensive examination. examination.

OphthalmologyOphthalmology

Entire focus is on Entire focus is on prevention and prevention and treatment of ocular treatment of ocular diseasesdiseases

Most patients Most patients referred by their referred by their regular regular veterinarianveterinarian

Initial EvaluationInitial Evaluation

Pertinent ocular and related health Pertinent ocular and related health historyhistory

■ ■ Duration of problemDuration of problem

■ ■ Medications presently, or recently, Medications presently, or recently, administeredadministered

■ ■ Previous related ocular or systemic Previous related ocular or systemic diseasesdiseases

■ ■ All pertinent information from your All pertinent information from your regular veterinarian is reviewed regular veterinarian is reviewed

Basic ExaminationBasic Examination■ ■ Evaluations of vision:Evaluations of vision:

             Menace              Menace              Pupillary Light              Pupillary Light Reflexes Reflexes

■  ■  Ability to navigate in a room Ability to navigate in a room

■ ■ Schirmer Tear TestsSchirmer Tear Tests

■ ■ Eye StainsEye Stains             Fluorescein              Fluorescein              Rose Bengal             Rose Bengal

■ ■ TonometryTonometry

■ ■ Slit Lamp ExaminationSlit Lamp Examination

■ ■ OphthalmoscopyOphthalmoscopy

Frequent CasesFrequent Cases

GlaucomaGlaucoma

CataractsCataracts

Cherry eyeCherry eye

UlcersUlcers

GlaucomaGlaucoma

Intraocular Intraocular pressures (IOP’s) pressures (IOP’s) are >20 mm Hgare >20 mm Hg

This is a blinding This is a blinding diseasedisease

Caused by trauma Caused by trauma or geneticsor genetics

Lifelong treatmentLifelong treatment

GlaucomaGlaucoma

Painful diseasePainful disease Even with Even with

treatment most treatment most cases eventually cases eventually result in the loss of result in the loss of one or both eyesone or both eyes– EnucleationEnucleation– ISP placementISP placement

EnucleationEnucleation

An eye is An eye is completely completely removed due to an removed due to an ocular disease or ocular disease or trauma to the eyetrauma to the eye

The lids are cut The lids are cut and sewn shut and and sewn shut and the pet looks like it the pet looks like it is “winking”is “winking”

ISPISP

An incision is made An incision is made in the eye and the in the eye and the inner contents inner contents removedremoved

A silicone ball is A silicone ball is placed inside and placed inside and the eye is sewn the eye is sewn shutshut

ISPISP

ISPs are placed for ISPs are placed for cosmetics onlycosmetics only

The pet has no The pet has no vision as a result vision as a result from the implantfrom the implant

The outside of the The outside of the eye is still subject eye is still subject to abrasion and to abrasion and diseasedisease

CataractsCataracts

The lens of one or The lens of one or both eyes becomes both eyes becomes dense and the dense and the animal’s vision is animal’s vision is restrictedrestricted

CausesCauses– DiabetesDiabetes– HeredityHeredity– TraumaTrauma– Retinal detachmentRetinal detachment

Cataract screeningCataract screening

Evaluation of Evaluation of candidacycandidacy

Ocular ultrasoundOcular ultrasound

Cataract screeningCataract screening

ERG tests for ERG tests for retinal functionretinal function

If the retina in not If the retina in not functioning the functioning the patient will not see, patient will not see, even with the even with the cataract removedcataract removed

Cataract surgeryCataract surgery

The patient’s lens The patient’s lens is removedis removed

An artificial lens is An artificial lens is placed for optimum placed for optimum visionvision

Patient is able to Patient is able to see immediately see immediately after surgeryafter surgery

““Cherry Eye”Cherry Eye”

Genetically causedGenetically caused Certain breeds Certain breeds

have a high have a high incidenceincidence– BulldogsBulldogs

Must be corrected Must be corrected surgicallysurgically

Predisposes the Predisposes the patient to “dry patient to “dry eye”eye”

UlcersUlcers

An abrasion to the An abrasion to the eyeeye

Many possible Many possible causescauses

The eye is stained The eye is stained to identify the to identify the extent of the ulcerextent of the ulcer

Most are treated Most are treated medically, but some medically, but some require surgeryrequire surgery

UlcersUlcers

With deep ulcers the With deep ulcers the eye may rupture eye may rupture without surgical without surgical correctioncorrection

Daily ActivitiesDaily Activities

Evaluate patients Evaluate patients during during appointmentsappointments

Prepare animals for Prepare animals for surgerysurgery

Monitor patients Monitor patients during proceduresduring procedures

Assist in surgical Assist in surgical proceduresprocedures– Cataract surgeryCataract surgery– ISP placementISP placement

ExperienceExperience Gained a tremendous Gained a tremendous

amount of knowledge amount of knowledge in veterinary in veterinary ophthalmologyophthalmology

Formed contactsFormed contacts Expanded veterinary Expanded veterinary

school applicationschool application Experiences that Experiences that

many veterinarians many veterinarians don’t havedon’t have