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Macular function test before cataract surgery 4 9-10
 

Macular function test before cataract surgery 4 9-10

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Prediction of visual gain after cataract surgery depends on the assessment of retinal function.

Prediction of visual gain after cataract surgery depends on the assessment of retinal function.

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    Macular function test before cataract surgery 4 9-10 Macular function test before cataract surgery 4 9-10 Presentation Transcript

    • Macular Function test before cataract surgery Ophthaglance 2, Sept 4-5 2010
      Dr AnandSudhalkar, Vadodara
      1
      sudhalkareyehospital.health.officelive.com
    • Expectations after cataract surgery
      Improvement in vision
      Achieve “Full” vision (6/6) ?
      Achieve “Better than normal” vision (6/5) ?
      sudhalkareyehospital.health.officelive.com
      2
    • The answer depends on:
      Surgical success?
      Achieve the best “Optical Correction”
      Visual Success:
      Function of retina, visual pathway and occipital lobe, neuroadaptation and other “higher” functions.
      sudhalkareyehospital.health.officelive.com
      3
    • Macular Functions
      Fovea: Acuity of vision
      Colour vision
      Day time adaptation
      Peri and Paramacular region:
      Mesopic and night vision
      Refixation reflexes
      sudhalkareyehospital.health.officelive.com
      4
    • Macular Function tests
      Basic preop assessment
      Refraction: Snellen Acuity
      Amblyopia
      NEAR vision (Vryghem Macular Function Test charts)
      Pinhole vision,
      Ishihara charts
      Maddox rod Two point discrimination
      Photostress test
      Amsler grid
      Entoptic phenomenon
      Slit-Lamp: Post sub capsular
      Dilated fundus: Macular pathology
      Special tests for fovea
      Contrast sensitivity
      Glare disability
      Potential acuity meter
      Perimetry
      Optokineticnystagmus
      FFA
      B-scan
      OCT
      ERG
      VEP
      sudhalkareyehospital.health.officelive.com
      5
    • Maddox Rod test
      Simplest, most reliable test(opaque med).
      Rod consists of several cylinders of glass placed side by side in a frame.
      Pt is asked to fixate light at a distance of 1/3 m through M.R. with opposite eye occluded.
      Image formed is a straight line(vertical/horizontal streak) running perpendicular to the axis of rods.
      Any breaks/holes; discoloration/distortion indicates a macular lesion.
      RED: more sensitive, tells us about colour perception
      Rotate the rod to test different meridians.
      sudhalkareyehospital.health.officelive.com
      6
    • Two point discrimination test
      The ability to distinguish two illuminated points of light suggests good retinal function.
      •“Rule of 2” : Two illuminated points of 2 mm diameter size and 2 inches apart are placed 2feet away from the patient’s eye. The patient is then asked to indicate whether he canperceive the two points separately
      sudhalkareyehospital.health.officelive.com
      7
    • The blue field entoptic phenomenon or Scheerer's phenomenonBlue field entoptic phenomenon in cataract patients. Arch Ophthalmol. 1979 Jun;97(6):1092-5. Sinclair SH, Loebl M, Riva CE.
      In predicting normal macular function:
      87% for the two-light discrimination test
      94% for the BFE test.
      In pathological conditions:
      BFE test identified more than 75% of the poor maculae; the Purkinje vascular entoptic test and the two-light discrimination test, only 22%; and the colour perception test, 11%.
      A positive response to the BFE test indicated a .98 probability of good macular function; a negative response indicated a .82 probability of poor macular function, predictions that were better than the other three tests or their combination.
      sudhalkareyehospital.health.officelive.com
      8
    • Preop Retinal ExaminationIndirect Ophthalmoscopy
      sudhalkareyehospital.health.officelive.com
      9
    • Practical Pearls
      Awareness regarding macular Pathology
      Diagnose and Identify Treatable pathologies and give them the priority over the cataract surgical procedure
      Patient counseling and spending preop “Chair time”
      “Acceptable” visual gain and success in an otherwise perfectly executed cataract surgery.
      sudhalkareyehospital.health.officelive.com
      10