This document discusses various methods for assessing the anterior chamber angle, including subjective tests like the oblique flashlight test and Van Herrick's technique, as well as objective tests like gonioscopy, ultrasound biomicroscopy (UBM), and anterior segment optical coherence tomography (AS-OCT). Gonioscopy is considered the reference standard but can be subjective, while UBM and AS-OCT provide high resolution cross-sectional images of the angle but have limitations like requiring specialized equipment. No single test is perfect, and gonioscopy remains essential for glaucoma evaluation and management despite advances in imaging technology.
To know Humphrey visual field analyser
To know about various types of perimetry
To identify field defect
To recognize that field defect is due to glaucoma or neurological lesion
To know that field defect is progressive or not
Interpretation of HVFA
To know Humphrey visual field analyser
To know about various types of perimetry
To identify field defect
To recognize that field defect is due to glaucoma or neurological lesion
To know that field defect is progressive or not
Interpretation of HVFA
Detailed instumentaion and use of manual Lensometer and just a outline of automated lensometer.
I have used the picture of manual lensometer with out the parts describtion because i have explained orally by showing the picture..
Hope u all like it and may help you in learning better. :)
Detailed instumentaion and use of manual Lensometer and just a outline of automated lensometer.
I have used the picture of manual lensometer with out the parts describtion because i have explained orally by showing the picture..
Hope u all like it and may help you in learning better. :)
Gonioscopy and optic nerve head evaluationAhmedfaik
this is a simple presentation copy paste from kanski clinical ophthalmology about gonioscopy and optic nerve head changes in glaucoma... hope you get benefit
Recent advances in glaucoma includes all the newer trends in the fields of measurement of increased IOP, assessment of anterior chamber angle and depth assessment and lastly the assessment of changes in the optic nerve head and RNFL thickness.
Recent advances in diagnosis of glaucoma includes all the newer trends in the fields of measuring increased IOP, anterior chamber angle and depth assessment and optic nerve head assessment including RNFL thickness.
Ultrasonic Evaluation of Eyes With Blunt Trauma
Thesis
Submitted for partial fulfillment of the master degree in ophthalmology
By
Mohamed Ahmed El-Shafie
Resident in ophthalmology department
Mansoura University
Similar to Assessment of Anterior Chamber Angle (20)
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
7. GRADE I GRADE II GRADE III GRADE IV
< 1/3
illuminated
1/3-2/3
illuminated
>2/3
illuminated
Fully
illuminated
Oblique flashlight test
8. • Good inter-observer agreement (p = 0.04)
• Good reproducibility (weighted kappa value = 0.74)
• Sensitivity: 75-97%
• Specificity: 67-99.4%
• Gracitelli et al. Ability of non-ophthalmologist doctors to detect eyes with occludable angles using the
flashlight test. Int Ophthalmol. 2014 Jun;34(3):557-561
• Congdon NG et al. Screening techniques for angle-closure glaucoma in rural Taiwan. Acta Ophthalmol
Scand 1996;74:113–119
• He M et al. Angle-closure glaucoma in East Asian and European people. Different diseases? Eye
2006;20:3–12
• Thomas R et al. The flashlight test and van Herick’s test are poor predictors for occludable angles.
Aust N Z J Ophthalmol 1996;24:251–256
• Vargas E, Drance SM Anterior chamber depth in angle-closure glaucoma. Clinical methods of depth
determination in people with and without the disease. Arch Ophthalmol 1973;90:438–439
Oblique flashlight test
9. • Simple
• No sophisticated equipment required
Advantages
Oblique flashlight test
10. • Lack of standardization
• Arbitrary cut-offs
Limitations
Oblique flashlight test
12. 5% 15% 25%
40% 75% >100%
Limbal Chamber Depth as a Fraction of Corneal Thickness
LCD & VH
13. All Occludable Angles PAC PACG
LCD VH Sensitivity Specificity Sensitivity Specificity Sensitivity Specificity
0% NA 17.8% 99.6% 29.3% 99.2% 52.2% 98.9%
≥5% NA 60.5% 96.1% 70.7% 93.7% 91.3% 92.6%
≥15% 1 83.7% 85.7% 84.5% 82.4% 91.3% 81.1%
≥25% 2 99.2% 65.5% 100% 62.4% 100% 61.1%
≥40% 3 100% 40.3% 100% 38.3% 100% 37.5%
Performance Indices of Limbal Chamber Depth Estimation in
Detection of Gonioscopically Occludable Angles, PAC and PACG
Foster PJ et al. Detection of gonioscopically occludable angles and primary angle closure glaucoma by
estimation of limbal chamber depth in Asians: modified grading scheme. Br J Ophthalmol.
2000;84:186-192.
LCD & VH
14. • Good interobserver agreement (weighted kappa value = 0.73-0.76)
• High intraobserver repeatability
• Sensitivity = 99%
• Thomas R et al. The flashlight test and van Herick’s test are poor predictors for occludable angles.
Aust N Z J Ophthalmol 1996;24:251–256
• Foster PJ et al. Detection of gonioscopically occludable angles and primary angle closure glaucoma
by estimation of limbal chamber depth in Asians: modified grading scheme. Br J Ophthalmol
2000;84:186–192
• Cockburn DM. Slitlamp estimate of anterior chamber depth as a predictor of the gonioscopic
visibility of angle structures. Am J Optom Physiol Opt 1982;59:904–908
LCD & VH
16. • Subjective
• Overestimation of angle depth (if slit beam moved too far on to
the cornea, nasal limbus)
• Little or no information regarding angle morphology
• Affected by corneal degenerations such as arcus senilis
• Horizontal quadrants only
Limitations
LCD & VH
18. High interobserver agreement (kappa value = 0.62-0.82)
• Foster PJ et al. Detection of gonioscopically occludable angles and primary angle closure glaucoma by
estimation of limbal chamber depth in Asians: modified grading scheme. Br J Ophthalmol
2000;84:186–192
• Jacob JT et al. Evaluation of interobserver agreement in gonioscopy. Kerala J Ophthalmol.
2008;XX:253–255
• Lavanya R et al. Screening for narrow angles in the Singapore population: evaluation of new
noncontact screening methods. Ophthalmology 2008:115:1720–1727
• Thomas R et al. The flashlight test and van Herick’s test are poor predictors for occludable angles. Aust
N Z J Ophthalmol. 1996;24:251–256
Gonioscopy
20. • Invasive
• Subjective, requires skill and experience
• Variables – inadvertent pressure on cornea, light exposure onto
pupil, patient cooperation, type of lens used, direction of gaze
• Does not provide quantitative evaluation of the angle
• Can not visualize structures posterior to iris
Limitations
Gonioscopy
23. • Two-dimensional high-resolution gray-scale images of ocular
structures anterior to pars plana
• Quantitative and qualitative evaluation
• Principle similar to that of B-scan (10 MHz)
• Frequency – 50 MHz – More frequency – less penetration (5 mm)
and more resolution
UBM
24. Interpretation of anterior chamber angle configuration is
dependent on determining the location of scleral spur (inward
protrusion of sclera)
UBM
25. Kong X, Foster PJ, Huang Q et al. Appositional Closure Identified by Ultrasound Biomicroscopy in
Population-Based Primary Angle-Closure Glaucoma Suspects: The Liwan Eye Study. Glaucoma.
2011;52:7.
No ITC
High ITC
(S type)
High ITC
(B type)
Low ITC
UBM
26. • Angle opening distance (AOD500): Length of a perpendicular
from TM to iris at a point 500 µm from SS
• Trabecular-iris angle (Ø1): Apex in the iris sulcus and arms
passing through the point 500 µm from SS and the point
perpendicularly opposite on the iris
UBM
27. AOD500 :
• Sensitivity = 82%
• Specificity = 96%
Trabecular iris angle:
• Sensitivity = 83%
• Specificity = 93%
Henzan, IM et al. Comparison of Ultrasound Biomicroscopic Configurations Among Primary Angle
Closure, Its Suspects, and Nonoccludable Angles: The Kumejima Study. Am J Ophthalmol.
2011;151(6):1065-1073
UBM
28. Advantages
• High resolution of 50 µm at a frequency of 50 MHz
• Cross-sections of angle can be captured without lighting –
changes in iris shape with or without light can be ascertained
• Independent of corneal opacity
• Dynamic changes can be recorded
• Images can be automatically quantified
UBM
29. Assessment of areas not possible by gonioscopy:
• Ciliary body
• Inside the iris
• Posterior chamber
• Inside filtering blebs
• Outflow tract for aqueous humour inside sclera
UBM
30. Limitations
• Supine position – iris diaphragm falls back – angle opens
• Only 1 quadrant can be imaged at a time
• Angle region measured is located subjectively as superior, nasal,
inferior and temporal
• Skilled examiner
• Longer image acquisition time
• Use of anaesthesia
• Contact with the eye using a cup with a coupling medium or a
probe – corneal abrasion, infection
UBM
31. Can not detect:
• Pigmentation in the angle
• Inflammatory exudate in the angle
• Neovascularization in the angle
UBM
33. POSTERIOR SEGMENT OCT ANTERIOR SEGMENT OCT
830 nm 1310 nm
Unable to penetrate sclera Penetrates sclera and iris
More time for image acquisition Reduced time
Compromised image quality Reduced motion artefacts – better
image quality
AS-OCT
34. • Low coherence interferometry to obtain cross-sectional images of
the ocular structures
• Similar to UBM, interpretation of anterior chamber angle
configuration is dependent on determining the location of scleral
spur
AS-OCT
35. Angle closure in more than one quadrant was detected by:
• AS-OCT in 71% of patients
• Gonioscopy in 49.5% of patients
When performed in dark conditions,
AS-OCT identified angle closure in:
• 98% of subjects found to have angle closure on gonioscopy
• 44.6% of subjects found to have open angles on gonioscopy
Specificity of AS-OCT to detect angle closure: 55.4%
Nolan et al. Detection of primary angle closure using anterior segment optical coherence tomography in
Asian eyes. Ophthalmology. 2007 Jan;114(1):33-39.
AS-OCT
36. Intraobserver variability = 9.4% to 12.5%
Interobserver variability = 10.7%
High reproducibility: 0.875-0.942
Tan AN et al. Reproducibility of anterior chamber angle measurements with anterior segment optical
coherence tomography. Invest Ophthalmol Vis Sci, 52(5), 2095-2099
AS-OCT
37. AS-OCT scanning protocol Sensitivity Specificity
Nasal-temporal quadrants 47% 88%
Inferior quadrant 84% 69%
Superior-inferior quadrants 92% 54%
Khor WB et al. Evaluation of scanning protocols for imaging the anterior chamber angle with anterior
segment-optical coherence tomography. J Glaucoma. 2010 Aug;19(6):365-368.
AS-OCT
38. Advantages
• Higher resolution than UBM (18 µm vs 25 µm)
• Non-contact method
• All 4 quadrants are imaged at once
• Entire cross-section of anterior segment is imaged into one frame
– permits assessment and documentation of iris profile and its
relationship to other anatomical parameters of eye
• Patient in sitting position – no alteration in anterior chamber
depth
• Does not require a skilled operator
AS-OCT
39. Limitations
• Infrared light blocked by iris pigment – precludes assessment of
structures located behind iris
• Degradation of light by sclera – ciliary body not imaged fully
• Can not obtain clear images through opaque media
• Obstruction by eyelids – difficulty in imaging superior and
inferior angles
AS-OCT
40. OCT and UBM had similar
• mean values of angle opening distance, angle recess area and
trabecular-iris space area
• reproducibility, and
• sensitivity-specificity profiles
in identifying eyes with narrow angles
Radhakrishnan S et al. Comparision of optical coherence tomography and ultrasound biomicroscopy for
detection of narrow anterior chamber angles. Arch Ophthalmol. 2005 Aug:123(8):1053-1059.
AS-OCT
41. CONCLUSION
• UBM and AS-OCT provide real-time cross-sectional images of
anterior chamber angle – accuracy and reproducibility yet to be
proved
• Gonioscopy – continues to remain essential for glaucoma
evaluation and management
Editor's Notes
As many diagnoses are made only after angle assessment
Comparison of limbal AC depth & periph corneal thickness. Traditionally divided into 4 grades
Modified van Herick grade
Foster et al hv shown dt Sensitivity of limbal chamber depth measurement as a method for detecting occludable angle, PAC and PACG decreases with narrowing of angle. While specificity increases.
Plateau, Queer/concave peripherally, regular/straight, steep/convex. High insertion in dev gl.
B-type (closure starts from bottom of angle recess without aqueous filled space). S-type (closure occurs at level of Schwalbe's line with an aqueous filled space)
UBM compensates for shortcomings of gonioscopy but doesn’t replace it. Combination of the techniques maximizes the usefulness
Visante OCT, 200 Asian subjects (71% clinically diagnosed as PAC). Gonioscopy - Spaeth classification. ACA closed on gonioscopy – PTM not seen. AS-OCT – contact between iris and angle wall anterior to scleral spur