Macular function test and clinical assessment bos 3 1- 2010

Macular Function Test and Clinical assessment
Dr. AnandSudhalkar
Baroda
1/2/2010
Sudhalkar Eye Hospital and Retinal Laser Centre
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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
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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
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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
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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
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How best to see?Binocular Indirect
1/2/2010
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Panoramic view, 4* mag. , 14 and 20D

Slit Lamp Biomicroscopy
1/2/2010
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Documentation, Comparison, progress/prognosis, Treatment monitoring patient education
Fundus Camera
FFA CSR
1/2/2010
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Macular (Foveal) acuity charts
Vryghem Macular
Function Test: The Parinaud chart
ETDRS Chart
1/2/2010
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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
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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
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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
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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
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Next is An ArcuateScotoma As Seen By An Advanced Glaucoma Patient.
1/2/2010
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Above A Positive Or Absolute ParacentralScotoma As Seen By The Patient That Might Be The Result Of A Healed Chorioretinal Scar.
1/2/2010
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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
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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
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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
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1/2/2010
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Macular Field of Vision

1/2/2010
20
Thank You

Special tests
Macular Field of vision
Bailliart (1954) photostress test
FFA
OCT
SLO microperimetry,
Preferential hyperacuity perimeter
1/2/2010
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Macular function test and clinical assessment bos 3 1- 2010

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