Important information related to ophthalmology and optometry is out lined in this preswntation

1. Content
• Eye examination
• Anatomy
• Inflammatory conditions
• Lens and iris
• Retina and choroid
• Vascular disease
• Glaucoma
• Infectious eye disease
• Trauma
• Pupillary and visual pathways
• Eye movement disorders

2. Examination of the eye

4. Retina and Choroid
Retinal disease
Macula Peripheral
•Blurred vision/ metamorphopsia
•Micropsia, macropsia
Field loss
RP
AMD
Dry Wet
Macular
oedema
Night blindness
Retinal
detachment

5. Macular disease
• Age related macular degeneration
Pathogenesis
Bruch’s
membrane
- Drusen
VEGF choroid angiogenesis  Subretinal neovascular membrane

6. Investigation of AMD
• Clinical
• Fluorescein angiography

10. Macular disease
• Age related macular degeneration
Pathogenesis
Bruch’s
membrane
- Drusen
VEGF choroid angiogenesis  Subretinal neovascular membrane

14. Treatment of AMD
• Dry
– ?high dose antioxidants
– Stop smoking
• Wet
– Anti-VEGF

15. Retina and Choroid
Retinal disease
Macula Peripheral
•Blurred vision/ metamorphopsia
•Micropsia, macropsia
Field loss
RP
AMD
Dry Wet
Macular
oedema
Night blindness
Retinal
detachment

16. Macular oedema
Intraocular surgery
Inflammation (uveitis)
Retinal vascular
disease
Retinitis pigmentosa
Cystoid macular oedema
Diabetic macular oedema
Rx NSAIDs, cortisone, Anti-VEGF

18. Retina and Choroid
Retinal disease
Macula Peripheral
•Blurred vision/ metamorphopsia
•Micropsia, macropsia
Field loss
RP
AMD
Dry Wet
Macular
oedema
Night blindness
Retinal
detachment

19. Retina and Choroid
Retinal disease
Macula Peripheral
•Blurred vision/ metamorphopsia
•Micropsia, macropsia
Field loss
RP
AMD
Dry Wet
Macular
oedema
Night blindness
Retinal
detachment

20. Retinitis Pigmentosa
• Genetic disorder
• XR/AR/AD - rhodopsin
• Photoreceptors

21. RP - symptoms
Night vision  tunnel vision  blurred
Cataracts
Macular oedema

22. RP - investigation
• Field mapping
• Electroretinography
• DNA testing

29. RP treatment
• Vitamin A
• Genetic therapy
• Mx of associated cataracts etc

30. Extra points
• ?Deaf  Usher
• ?Ophthalmoplegia  Kearns-Sayre

31. Retinal Vascular Disease
Vessel
Leak
Block Ischaemia
Lipid
Fluid
Blood
neoangiogenesis
Cotton wool spots

32. Retinal Vascular Disease
Retinopathy
Diabetic
Hypertensive
Occlusive
Arterial
Venous
CRAO
BRAO
CRVO
BRVO

33. Diabetic Retinopathy
• Commonest blindness of middle age
• Associated with cataracts, glaucoma, and
extraocular muscle palsy

34. Investigation
• Annual fundoscopy 5y after DM onset (DRP)

35. Classification
• NON-PROLIFERATIVE
• PROLIFERATIVE
Background, preproliferative,
maculopathy, proliferative

36. Non-proliferative
• Nerve-fiber layer infarcts (cotton wool spots)
• Intraretinal hemorrhages
• Hard exudates
• Microvascular abnormalities
• MACULAR OEDEMA

49. • New vessels lack pericytes
• Microaneurysms
• Disorganised blood supply

50. Treatment
• Maculopathy – circinate laser treatment
• Proliferative – Photocoagulation

51. Retinal Vascular Disease
Retinopathy
Diabetic
Hypertensive
Occlusive
Arterial
Venous
CRAO
BRAO
CRVO
BRVO

52. Hypertensive retinopathy
Keith Wagener Barker (KWB)
• Grade 1
– Generalised arteriolar constriction - seen as `silver wiring`
and vascular tortuosities. Copper wiring.
– Hard opaque vessel wall
• Grade 2
– Grade 1 + AV nipping
• Grade 3
– Grade 2 + with cotton wool spots and flame-hemorrhages
• Grade 4
– Grade 3 + papilledema

58. Retinal Vascular Disease
Retinopathy
Diabetic
Hypertensive
Occlusive
Arterial
Venous
CRAO
BRAO
CRVO
BRVO

59. Arterial Occlusion
• Transient – Amaurosis fugax
• Permanent – sudden painless loss of
vision
• Signs – atrophic retina – cherry red spot

63. Retinal vein occlusion