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Macular function test and clinical assessment bos 3 1- 2010
 

Macular function test and clinical assessment bos 3 1- 2010

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    Macular function test and clinical assessment bos 3 1- 2010 Macular function test and clinical assessment bos 3 1- 2010 Presentation Transcript

    • Macular Function Test and Clinical assessment
      Dr. AnandSudhalkar
      Baroda
      1/2/2010
      Sudhalkar Eye Hospital and Retinal Laser Centre
      1
    • Why look at Macula?
      Clinically compelling situations
      Pointing Symptoms
      Vision does not improve after cataract surgery
      After refraction
      Referred cases with unexplained vision loss
      Children with strabismus
      Inability to read fine prints
      Metamorphopsia
      Minification, magnification
      Obstruction: Positive/Negative scotomas
      Colour vision changes
      1/2/2010
      Sudhalkar Eye Hospital and Retinal Laser Centre
      2
    • What are we looking for?
      Known Macular Pathologies
      “Other” conditions
      CME, CSR
      Macular Hole
      Heredomacular degenerations
      Retinoblastoma
      Infective conditions
      Trauma, Eclipse burns
      ARMD
      Diabetic Maculopathy
      Retinal Vascular Diseases
      Vitreoretinal conditions
      Amblyopia
      Astigmatism
      Nystagmus
      Masquerades
      Neurological: Pituitary
      Hemianopia,
      Optic neuritis
      Toxic amblyopias
      Inferior RD
      Advanced glaucomatous damage
      Malingering
      1/2/2010
      Sudhalkar Eye Hospital and Retinal Laser Centre
      3
    • Multiple sclerosis
      UHTHOFF'S SIGN OR PHENOMENON: This is a temporary worsening of vision and other neurologic functions commonly seen in patients with multiple sclerosis just after exertion or in situations where they are exposed to heat. The condition is of importance because multiple sclerosis (a demyelinizing condition which can be related to optic neuropathy) may present with optic neuritis. Patients may report they notice their central vision becomes blurry and will show a positive defect when tested with an amsler grid. The condition is commonly reported after exercising or simply sitting in front of a fireplace, it is important if you suspect multiple sclerosis that you ask questions related to this phenomenon.
      PULFRICH PHENOMENON: There have been reported cases of patients with multiple sclerosis who experience this phenomenon. Using the test diagnostically is somewhat questionable, however, suspect patients should be questioned. It is the perception (a binocular stereo phenomenon) that objects they know are moving in a straight line appear to be moving in an elliptical pattern. These patients may suddenly start having motion sickness problems unrelated to an ear infection. They may also complain that things just look odd to them or they are having problems with depth perception.
      1/2/2010
      Sudhalkar Eye Hospital and Retinal Laser Centre
      4
    • Routine Examination: How to look?
      Inspection
      Common tests
      Eccentric viewing,
      Searching movements
      Pupillary reflex:
      Fixation Reflex
      Refraction
      Pinhole
      Ishihara Charts
      Macular Field of vision by: Amsler/ Auto perimeter
      1/2/2010
      Sudhalkar Eye Hospital and Retinal Laser Centre
      5
    • How best to see?Binocular Indirect
      1/2/2010
      Sudhalkar Eye Hospital and Retinal Laser Centre
      6
      Panoramic view, 4* mag. , 14 and 20D
    • Slit Lamp Biomicroscopy
      1/2/2010
      Sudhalkar Eye Hospital and Retinal Laser Centre
      7
    • Documentation, Comparison, progress/prognosis, Treatment monitoring patient education
      Fundus Camera
      FFA CSR
      1/2/2010
      Sudhalkar Eye Hospital and Retinal Laser Centre
      8
    • Macular (Foveal) acuity charts
      Vryghem Macular
      Function Test: The Parinaud chart
      ETDRS Chart
      1/2/2010
      Sudhalkar Eye Hospital and Retinal Laser Centre
      9
    • Amsler Grid: Each square measures 5 mm and when the grids are held at 30 cm from the patient each square subtends 1 degree on the retina.
      The First Grid Has White Lines On A Black Back Ground And Central White Dot On Which The Patient Is To Fixate.
      1/2/2010
      Sudhalkar Eye Hospital and Retinal Laser Centre
      10
    • If The Patient Reports On The First Chart They Cannot See The Central White Spot. This Would Indicate A Positive Scotoma. The Following Chart Should Be Used On Which Diagonal Lines Help Maintain Central Fixation. This Helps Them Point Out The Limits Of The Scotoma. This Chart Also Has White Lines On A Black Back Ground And Central White Fixation Dot.
      1/2/2010
      Sudhalkar Eye Hospital and Retinal Laser Centre
      11
    • The Third Chart Has Red Lines On A Black Back Ground And Is Very Helpful In Diagnosis Of Optic Nerve, Chiasmal, Or Toxic Amblyopia Related Problems.
      1/2/2010
      Sudhalkar Eye Hospital and Retinal Laser Centre
      12
    • Central Scotoma As Seen By A Patient With A Positive Or Absolute Scotoma. For Example This Might Be Secondary To Central AreolarChoroidal Dystrophy Or Congenital Toxoplasmosis .
      1/2/2010
      Sudhalkar Eye Hospital and Retinal Laser Centre
      13
    • Next is An ArcuateScotoma As Seen By An Advanced Glaucoma Patient.
      1/2/2010
      Sudhalkar Eye Hospital and Retinal Laser Centre
      14
    • Above A Positive Or Absolute ParacentralScotoma As Seen By The Patient That Might Be The Result Of A Healed Chorioretinal Scar.
      1/2/2010
      Sudhalkar Eye Hospital and Retinal Laser Centre
      15
    • A Space-Taking Pathology Such as A Tumor That Forces The Cones Closer Together Will Cause The Grid To Be Seen Distorted. The Retinal Image Will Fall On More Cones Than Normal And The Lines Of The Amsler Grid Will Be Seen As Larger And Bend Outward As In The Above. This Is Known As "Macropsia".
      1/2/2010
      Sudhalkar Eye Hospital and Retinal Laser Centre
      16
    • A Patient With Macular Edema Or Any Other Pathology That Forces The Cones Apart The Retinal Image Will Stimulate Fewer Cones Than Normal And The Lines Of The Amsler Grid Will Be Seen As Smaller And Tend To Bend Away From The Patient. This Condition Is Termed "Micropsia".
      1/2/2010
      Sudhalkar Eye Hospital and Retinal Laser Centre
      17
    • A Combination Of Squeezing And Spreading Of The Cones Causes An Overall Distortion Of The Image. The Lines Of The Amsler Grid Become Distorted And Non-Uniform. This Can Occur In A Number Of Macular And Retinal Conditions. This Condition Is Termed Metamorphopsia.
      1/2/2010
      Sudhalkar Eye Hospital and Retinal Laser Centre
      18
    • 1/2/2010
      Sudhalkar Eye Hospital and Retinal Laser Centre
      19
      Macular Field of Vision
    • 1/2/2010
      Sudhalkar Eye Hospital and Retinal Laser Centre
      20
      Thank You
    • Special tests
      Macular Field of vision
      Bailliart (1954) photostress test
      FFA
      OCT
      SLO microperimetry,
      Preferential hyperacuity perimeter
      1/2/2010
      Sudhalkar Eye Hospital and Retinal Laser Centre
      21