Common retinal disease
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This document summarizes several common retinal conditions including retinal detachment, central retinal artery occlusion, branch retinal artery occlusion, hypertensive retinopathy, central retinal vein obstruction, branch retinal vein obstruction, diabetic retinopathy, age-related macular degeneration, retinitis pigmentosa, papilledema, optic neuritis, and optic atrophy. For each condition, it describes the clinical features and treatments. It also discusses intravitreal injections including common indications, medications used, and the preferred injection site.
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This document describes an orthoptic instrument called a haploscope. A haploscope is an optical device that presents different images to each eye, allowing examination of binocular vision. The haploscope described has adjustable components to measure fusion, stereopsis, deviations in different gazes, and more. It can be used for both diagnostic and therapeutic purposes in orthoptic treatment and management of conditions like strabismus and amblyopia.
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Keratoconus is a degenerative eye condition where the cornea thins and changes shape, causing vision problems. The cause is unknown but risk factors include eye rubbing and genetics. Symptoms include progressively worsening vision not fully corrected by glasses. Diagnosis involves examining the cornea shape using keratometry and topography to detect thinning, steepening, and irregular astigmatism. Mild cases may need no treatment, while progressive cases can be managed with contact lenses or corneal cross-linking depending on severity.
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Subjective refraction is used to find the best corrective lenses for a patient and requires their cooperation. It involves monocular refraction of each eye separately to determine the cylindrical lens power and axis as well as best spherical lens. This is followed by binocular balancing to ensure clear vision with both eyes open. Techniques like fogging, cross-cylinders, and Maddox rods are used in monocular refraction while techniques like fogging with occlusion, duochrome testing, and prism dissociation are used for binocular balancing. Determining the near vision correction involves estimating accommodation amplitude and adding readers if needed for presbyopia.
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This document discusses accommodative facility testing, which measures the eye's ability to rapidly change focus between near and far distances. The standard test uses +/- 2.0 diopter lenses mounted in a flipper frame, with the subject alternating focus between a near and far target at 40 cm. The number of complete focus changes made within one minute is recorded as the accommodative facility score. Studies show scores are typically highest between ages 18-30 years and lower in young children under 18, possibly due to differences in eye structure and time needed to focus clearly. A score below 3 cycles/minute may warrant further testing for accurate diagnosis.
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- Key features of progressive lenses, including having multiple focal points that change continuously across the lens rather than distinct segments.
- Important temporary and permanent markings on progressive lenses used in fitting, including the fitting cross, distance reference circle, and lateral locator lines.
- The process of accurately relocating the fitting cross from temporary to permanent markings to ensure proper positioning over the pupil.
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Binocular Single Vision Tests
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Vergence and its anomalies
Vergence refers to the simultaneous movement of the eyes in opposite directions to maintain binocular vision. There are different types of vergence including fusional vergence, proximal vergence, tonic vergence, and accommodative vergence. Vergence is measured through tests such as near point of convergence and AC/A ratio. Common vergence anomalies include convergence insufficiency, convergence excess, divergence insufficiency, and divergence excess, each characterized by specific symptoms and treatments.
Special purpose frames
This document discusses different types of special purpose frames. It describes frames that hold supplementary lenses outside the main frame, frames that contain cells to hold additional lenses behind the prescription, and folding frames with hinges at the bridge and temples to reduce the frame size. It also covers frames with extensions to support the lower eyelid, trial frames without temples, monocular frames that allow viewing through one lens at a time, and frames with flip-down lenses for reading or sunglasses.
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Contact lens for congenital aphakia and other eye conditions for infants and toddlers. The slide presentation encompasses indications for CL fitting in paediatric, contact lens options, fitting techniques, challenges and contact lens as myopia control.
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This document discusses diabetic retinopathy and its management. It begins by stating that diabetic retinopathy is the leading cause of vision impairment worldwide. It then describes the clinical presentation and stages of diabetic retinopathy from mild non-proliferative to proliferative, as well as diabetic macular edema. The management section discusses preventing and treating diabetic retinopathy through controlling blood sugar and blood pressure systematically, as well as local treatments like pan-retinal photocoagulation laser, anti-VEGF injections, and vitrectomy surgery. It emphasizes that timely screening and treatment according to guidelines can reduce the risk of severe vision loss to less than 5%.
Diabetic Retinopathy
Diabetic retinopathy is a disease of the retina caused by damage to blood vessels due to long-term effects of diabetes, and is a leading cause of vision loss. It can cause microaneurysms, hemorrhages, cotton wool spots, hard exudates, and the growth of new abnormal blood vessels. Prolonged poor blood sugar control, hypertension, and other factors increase the risk. Treatment involves laser therapy such as focal laser treatment for macular edema or pan-retinal photocoagulation for proliferative retinopathy. Anti-VEGF injections are also used to treat macular edema and neovascularization by inhibiting vascular leakage and growth of abnormal vessels. Regular screening is important
aion.pptx
This document discusses various types of ischemic optic neuropathies including anterior ischemic optic neuropathy (AION) and posterior ischemic optic neuropathy (PION). It describes the differences between arteritic AION (caused by giant cell arteritis) and non-arteritic AION, with the former affecting older patients and often causing bilateral simultaneous vision loss. Risk factors for NAION include hypertension, diabetes, and sleep apnea. The document provides details on clinical evaluation, imaging, and management of these vision-threatening conditions.
RETINA LECTURE2.ppt
This document discusses diabetic retinopathy and hypertensive retinopathy. It covers the pathogenesis, clinical features, investigation and treatment of diabetic retinopathy. It also discusses the diagnosis and management of hypertensive retinopathy and how hypertension can affect the eye and vision. Key points include how hyperglycemia leads to microvascular changes in the retina, the classification systems for grading diabetic and hypertensive retinopathy severity, and the use of laser therapy and anti-VEGF drugs to treat proliferative retinopathy.
Introduction to Glaucoma by Dr. Iddi.pptx
This document provides an outline and overview of a presentation on glaucoma for 4th year medical students. The presentation covers the anatomy of the anterior chamber angle, formation and drainage of aqueous humor, classification of glaucomas including open angle glaucoma and angle closure glaucoma. Medical, laser and surgical treatment options for glaucoma are also discussed. Key points like risk factors, clinical features and investigation methods for primary open angle and primary angle closure glaucoma are explained in detail.
Retinal detachment
This document discusses retinal detachment, including the different types (rhegmatogenous, tractional, exudative), symptoms, risk factors, examination findings, diagnosis, treatment options including pneumatic retinopexy, scleral buckling, vitrectomy, and prevention techniques. It also covers traction retinal detachment and exudative retinal detachment, their causes, presentations, signs, and management approaches.
Diabetic retinopathy
This document provides an overview of diabetic eye disease and its treatment. It begins with an introduction and discusses pathogenesis, classification, signs, and advanced complications such as retinopathy and macular edema. Risk factors for progression are described, including duration of diabetes, glycemic control, hypertension, and nephropathy. Treatment focuses on glycemic and blood pressure control as well as laser photocoagulation, intravitreal anti-VEGF agents, and steroids to treat macular edema. Several major clinical trials are summarized that demonstrate the benefits of tighter glucose and blood pressure control, as well as anti-VEGF therapies, on slowing progression of diabetic retinopathy and vision outcomes.
Ocular emergencies
This document summarizes various ocular emergencies and their management. It categorizes emergencies as immediate (within hours), or non-immediate (within a day). Immediate emergencies include chemical burns, central retinal artery occlusion, and orbital hemorrhage. Non-immediate issues include orbital cellulitis, corneal ulcer, hyphema, and retinal detachment. The document provides details on examining, diagnosing, and treating numerous conditions like acute angle closure glaucoma, corneal abrasion, endophthalmitis, penetrating globe injuries, and more. Management approaches focus on stabilizing the patient, identifying the issue, and initiating appropriate treatment to prevent vision loss and complications.
Primary open angle glaucoma
1) Glaucoma is defined as optic nerve damage caused by elevated intraocular pressure that is not due to other ocular or neurological causes.
2) Risk factors for glaucoma include older age, family history, higher eye pressure, and African or Hispanic descent.
3) Treatment involves medications, laser treatment, or surgery to lower intraocular pressure and slow progression of vision loss.
Glaucoma (opthalmology)
Glaucoma is a group of eye conditions that damage the optic nerve, often caused by an increase in intraocular pressure. The aqueous humour maintains pressure in the eye and normally flows through the anterior chamber, draining out of the eye. In glaucoma, the drainage pathways become blocked, increasing pressure and damaging the optic nerve. There are several types of glaucoma including open-angle glaucoma, the most common type caused by slow drainage blockage, and closed-angle glaucoma caused by physical blockage of drainage canals. Treatment aims to lower pressure through eye drops or surgery and slow progression of vision loss.
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Structural and oct changes in diabetic retinopathy1
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The document contains 6 sections describing different clinical cases involving retinal imaging with AngioPlex. Each section includes AngioPlex maps of the superficial retina, deeper retina, avascular retina, and in some cases choroid, along with B-scan flow images. The cases include wet AMD with CNV, DR, BRVO, and MacTel and provide AngioPlex imaging data for patients ranging in age from 48-76 years old, examining both right and left eyes.
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Post-operative endophthalmitis (POE) is an inflammatory response in the eye following surgery that can lead to vision loss. It is most commonly caused by bacteria entering through surgical wounds. POE presents with pain, redness, decreased vision and occurs usually 1-7 days after surgery. Treatment involves intravenous and intravitreal antibiotics based on culture and vitrectomy in severe cases. Proper pre-operative cleaning and use of prophylactic antibiotics can help prevent POE. A case of retained intraocular foreign body following a work injury is also discussed, demonstrating the importance of safety equipment and need for thorough examination and removal of any objects in such cases.
Oct updateS -AJAY DUDANI
Recent advances in OCT technology were discussed. New features of Cirrus HD-OCT include enhanced imaging capabilities like OCT angiography, improved anterior segment imaging, swept source technology, and enhanced visualization tools. Clinical cases were also presented to demonstrate the utility of these new technologies in evaluating and managing various retinal diseases.
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The document shares the author's personal story of losing his father during medical school, completing his training, and eventually opening his own eye centers in Mumbai. It then offers guidance for physicians starting private practices, including the benefits of being your own boss, building a patient base through strategic location and care, finding a niche, and prioritizing patient satisfaction over profits. The author believes reports of private practice being dead are exaggerated and that it can allow a good work-life balance if done correctly.
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This document discusses idiopathic juxtafoveolar telangiectasia (IJFT), including its classification and stages. It describes IJFT types 1 and 2, with type 1 being congenital and aneurysmal and type 2 being acquired and perifoveal. Type 2 is further classified into 5 stages based on angiographic and imaging findings. The document also presents three case studies where anti-VEGF therapy with ranibizumab was used to treat neovascularization associated with types 1 and 2 IJFT, showing improvements in leakage and vision. While anti-VEGF therapy may help reduce leakage, preexisting photoreceptor damage from IJFT may limit improvements in visual acuity.
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This document discusses diabetic macular edema (DME), its causes and prevalence, current treatments, and evidence for the use of ranibizumab (Lucentis) in the treatment of DME. Some key points:
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This document discusses retinal complications that can occur after LASIK surgery, particularly retinal detachment. It notes that while the incidence of retinal detachment after LASIK is low (around 0.05-0.08%), it is more common in highly myopic eyes. Lattice degeneration and atrophic retinal holes are identified as risk factors. The document debates whether prophylactic treatment of asymptomatic retinal lesions before LASIK is necessary or effective, as studies have found similar rates of retinal detachment in treated and untreated groups. Overall it emphasizes the need for counseling highly myopic patients with lattice degeneration undergoing LASIK, but cautions against overtreating asymptomatic lesions.
Common+eye+problems+in+children AJAY DUDANI
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The CATT trial compared the efficacy and safety of monthly ranibizumab, monthly bevacizumab, PRN ranibizumab, and PRN bevacizumab for wet AMD over 1 year. At 1 year, both monthly bevacizumab and PRN bevacizumab were found to be non-inferior to their ranibizumab counterparts in mean change in visual acuity from baseline. PRN bevacizumab resulted in more injections on average compared to PRN ranibizumab. Ranibizumab monthly resulted in a greater mean decrease in total retinal thickness compared to other groups. There were no significant differences in serious systemic adverse events between drugs, though bevacizumab patients had
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This document summarizes a study on the outcomes of scleral buckling surgery for rhegmatogenous retinal detachment. The study included 50 patients who underwent scleral buckling with cryotherapy, encirclage, and a localized buckle. Immediately after surgery, the retina was reattached in 45 patients, for a success rate of 90%. Complications included recurrent detachment in 5 patients who required vitrectomy, and epiretinal membrane or macular pucker in 2 patients. The document argues that while scleral buckling is less commonly performed now than vitrectomy, it remains an effective technique for uncomplicated retinal detachment, especially in younger patients, with advantages of lower cost
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This document discusses diabetic macular edema (DME), its causes and prevalence, current treatments, and evidence for the use of ranibizumab (Lucentis) in the treatment of DME. Some key points:
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Common retinal disease
- 1. COMMON RETINA CONDITIONS DR. AJAY DUDANI, MUMBAI RETINA CENTRE, SANTA CRUZ, MUMBAI.
- 2. RETINAL DETACHMENT Separation of the neural retina from the underlying retinal pigment epithelium. • Types: Rhegmatogenous. Tractional. Exudative.
- 4. TREATMENT • Vitrectomy with silicon oil. • Band buckling surgery.
- 5. CENTRAL RETINAL ARTERY OCCLUSION An abrupt diminution of blood flow through the central retinal artery serve enough to cause ischemia of the inner retina.
- 6. FFA
- 7. CLINICAL FEATURES • Abrupt, painless, severe loss of vision. • Cherry-red spot. • Box-carring of blood flow in the retinal vessels. • Ischemic retinal whitening of the posterior pole.
- 8. TREATMENT • Carbogen Inhalation (95% Oxygen + 5% CO2) • Ocular massage, paracentesis and administration of ocular hypertensive medications • Anti coagulants and fibrinolytic medications
- 9. BRANCH RETINAL ARTERY OCCLUSION An abrupt diminution of blood flow through a branch of central retinal artery severe enough to cause ischemia of inner retina in the territory of the affected vessel.
- 10. FFA
- 11. CLINICAL FEATURES • Retinal whitening in the territory of the obstructed vessel. • Embolus(66%) • Visual field defect that correspond to the territory of the obstructed vessels.
- 12. TREATMENT • Ocular massage, paracentesis and administration of ocular hypertensive medications • Laser Photocoagulation to melt embolus
- 13. HYPERTENSIVE RETINOPATHY Retinal vascular changes occurring from chronically elevated systemic arterial hypertension.
- 15. CLINICAL FEATURES • Narrowing and irregularity of retinal arteries. • Arteriovenous nicking (narrowing of retinal veins at arteriovenous crossing sites.) • Blot retinal haemorrhages. • Microaneurysms. • Cotton-wool spots.
- 16. TREATMENT • Treatment of Underlying Systemic condition can halt the progress of retinal condition
- 17. CENTRAL RETINAL VEIN OBSTRUCTION Obstruction of the central retinal vein at the lamina cribrosa.
- 18. CLINICAL FEATURES • Retinal haemorrhages in all four quadrants. • Dilated, tortuous veins in all four quadrants. • Optic disc oedema. • Macular oedema. • Cotton wool spots. • Neovascularisation of the iris, retina or optic disc.
- 19. BRANCH RETINAL VEIN OBSTRUCTION Obstruction of branch retinal vein.
- 20. FFA
- 21. CLINICAL FEATURES • Retinal haemorrhages in the distribution of the obstructed branch retinal vein.
- 22. TREATMENT • Intravitreal Anti VEGF • Intravitreal Steroid • Grid Photocoagulation
- 23. DIABETIC RETINOPATHY Progressive dysfunction of the retinal vasculature caused by chronic hyperglycemia.
- 25. CLINICAL FEATURES • Microaneurysm. • Retinal haemorrhages. • Cotton wool spots. • Macular oedema. • Neovascularization.
- 26. TREATMENT • Anti VEGF • Panretinal Photocoagulation • Peripheral retinal cryotherapy • Vitrectomy in diabetic patients
- 28. AGE RELATED MACULAR DEGENERATION • Age-related macular degeneration (AMD) is the leading cause of irreversible severe visual loss in patients over 50 years of age. • Types: Non exudative AMD Exudative AMD
- 29. WET AMD DRY AMD
- 30. FFA WET AMD DRY AMD
- 31. TREATMENT • Intravitreal anti-VEGF • Photodynamic Therapy • Transpupillary thermotherapy • Double frequency Nd YAG • Surgery
- 32. RETINITIS PIGMENTOSA • The term Retinitis pigmentosa encompasses a set of diverse hereditary disorders that affect the photoreceptors and retinal pigment epithelium.
- 34. CLINICAL FEATURES • Progressive photoreceptor dysfunction and death. • Intraneural retinal “bone spicule” pigment. • Gliotic “waxy pallor” of optic nerve head. • Visual field constriction. • Night blindness. • Loss of rod and cone electroretinography responses.
- 35. • Frequently, but not always, a family history.
- 36. PAPILLOEDEMA Optic disc oedema usually bilateral that results from increased intracranial pressure
- 37. CLINICAL FEATURES • Blurring of optic disc margins • Hyperaemia of optic nerve head • Venous Congestion of arcuate and peri-papillary vessels. • Engorged and dusty veins • Peri-papillary splinter haemorrhages
- 38. TREATMENT • Repeated lumbar puncture • Diuretics • Carbonic anhydrase inhibitors • Optic nerve Sheath decompression • Lumbar peritoneal Shunt
- 39. OPTIC NEURITIS • It refers to inflammation of the optic nerve. • Such inflammation my spare the optic disc (Retrobulbar Optic neuritis) or may cause optic disc swelling(papillitis)
- 40. CLINICAL FEATURES • Abrupt Vision loss. • Dyschromatopsia. • Afferent pupillary defect.
- 41. TREATMENT • IV Methylprednisolone for 3 days. • Followed by oral prednisolone tapered over 11 days.
- 42. OPTIC ATROPHY Refers to optic nerve shrinkage from any cause which produces degeneration of axons in the anterior visual system
- 43. INTRAVITREAL INJECTIONS • AMD • CSME/PDR • Retinal Vein Occlusions • Endophthalmitis • Uveitis • CME • CNVM secondary to multiple retinal diseases COMMON INDICATIONS
- 44. INTRAVITREAL MEDICATIONS In Retinal vein occlusion/ AMD: • Bevacizumab (Avastin) • Ranibizumab (Lucentis) • Triamcinolone acetonide (Kenalog) In CMV Retinitis: • Ganciclovir Intravitreal In Endophthalmitis: • Vancomycin 1mg/0.1ml • Ceftazidime 2.25mg/0.1ml • Amikacin 0.4mg/0.1ml • Amphotericin B 0.1ml of 5-10mcg/ml • Dexamethasone 0.4mg/0.1ml
- 45. INJECTION SITE • Usually inferotemporal for ease of access • Some Retina Specialists give the injection in the superotemporal quadrant, as they feel that should a complication such as a retinal detachment form, it can be easier treated with a pneumatic retinopexy.