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Macular function test before cataract surgery 4 9-10
Macular function test before cataract surgery 4 9-10
Macular function test before cataract surgery 4 9-10
Macular function test before cataract surgery 4 9-10
Macular function test before cataract surgery 4 9-10
Macular function test before cataract surgery 4 9-10
Macular function test before cataract surgery 4 9-10
Macular function test before cataract surgery 4 9-10
Macular function test before cataract surgery 4 9-10
Macular function test before cataract surgery 4 9-10
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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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  • 1. Macular Function test before cataract surgery Ophthaglance 2, Sept 4-5 2010
    Dr AnandSudhalkar, Vadodara
    1
    sudhalkareyehospital.health.officelive.com
  • 2. Expectations after cataract surgery
    Improvement in vision
    Achieve “Full” vision (6/6) ?
    Achieve “Better than normal” vision (6/5) ?
    sudhalkareyehospital.health.officelive.com
    2
  • 3. 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
  • 4. 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
  • 5. 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
  • 6. 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
  • 7. 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
  • 8. 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
  • 9. Preop Retinal ExaminationIndirect Ophthalmoscopy
    sudhalkareyehospital.health.officelive.com
    9
  • 10. 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

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