The document provides a detailed clinical overview of a 76-year-old female patient with a history of progressive vision loss and underlying retinal dystrophy. It includes examination findings, visual acuity measurements, management plans, and recommendations for rehabilitative services. The patient's condition is diagnosed as atypical retinitis pigmentosa, and multiple assistive device trials are discussed.

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2. NAME: XYZ
AGE:76 years/ female
CHIEF COMPLAINT: C/o Decrease of vision in OD X 10 years
OCULAR HISTORY: H/o OS decreased vision X 50 years ( K/c/o Eales Disease)
H/o of using glasses X 10-15 years
SYSTEMIC ILLNESS: H/o HTN X 20 years
CURRENT MEDICATION: H/o using Beta Blockers
PRESENT GLASSES: OD: +1.00/-1.00 X 90
OS: Plano
2
CASE

3. VISION (aided): OD: 6/18P
OS: CF CF (Peripheral)
RETINOSCOPY: OD: +2.00/-2.00 X 90
OS: -----
SUBJECTIVE: OD: +1.50/-1.75 X 90---- 6/12P
OS: Plano ------ CF CF
SLIT LAMP EXAMINATION:
3
WNL Lids/ Lashes WNL
Clear Cornea Clear
RRR Pupil RRR
NCNP Iris NCNP
Deep Anterior Chamber Deep
NS - 2 Lens NS - 2
OD STRUCTURES OS
IOP: OD: 17
OS: 17
mmHg@9:55am
+3.00--- OD: N6
Add OS: N36

4. OD OS
Disc size- normal Disc size- normal
CDR- 0.6 CDR- 0.7
Mild cupping Cupping+
Sub retinal bleed Peripheral sclerosed
vessels
Gross arteriol
attenuation
Geographical trophy
4
ADVICE LVA TRIAL
DIAGNOSIS:
ATYPICAL
RETINITIS
PIGMENTOS
A

5. 5

6. 6
PERSONAL HISTORY
EDUCATION OCCUPATION MARITAL STATUS CO OPERATION FROM
WORK PLACE
MBBS, MS surgeon Retired Doctor Married Nil
ARE YOU
THE
BREAD
WINNER
OF THE
FAMILY?
SUPPORT DEPENDENTS LITERACY
STATUS OF
PARENTS/
GUARDIA
N
ECONOMIC
STATUS OF
FAMILY
OCCUPATIONAL
STATUS OF
GUARDIAN
FINANCIAL
SUPPORT
PROVIDED BY
No Independent
living
No Good Good Good Self

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FAMILY
HISTORY
No Significant
family history
ADDITIONAL
DISABILITIE
S
Hearing
Diability-2
years
PREVIOUS
USE OF
DEVICES
No
DISTANT
VISION TASKS
Recognizing faces
Reading bus
numbers
INTERMEDIATE
VISION TASKS:
No
NEAR
VISION
TASKS : Yes
Reading and
writing
Occupation
PREFERENCE OF
ILLUMINATION
Fluorescent light
Bright light
LIGHT
SENSITIVITY
No
MOBILITY
HISTORY
Yes
DAILY LIVING
SKILLS
No

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DISTANCE VA VA UNAIDED VAAIDED
Chart used logMAR chart under
room illumination @3mt
With present glasses
OD 0.8 logMAR 0.2 logMAR
OS 0.5 logMAR 0.5 logMAR
OU 0.4 logMAR 0.2 logMAR
BCVA SPHERE CYLINDER AXIS VISION Near vision
with +3.00Ds
OD +2.00DS -2.00DC 90 0.3 logMAR N6
OS Plano plano - CF CF N36

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NEAR
VISION with
+3.00Ds – OU
DISTANCE CHART ILLUMINATION
N8 40cm Reduced
snellen
Room illumination

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COLOR VISION:
OU: Not able to
appreciate demo plate
CONTRAST
SENSITIVITY:
OD:0.48 logCS
OS: 0.00 logCS
VISUAL FIELD:
OD:Normal
OS: Superior
peripheral vision
loss

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MAGNIFICATION REQUIRED
BCVA/TVA=8/4=2X
EVD=40/2=0.20m ; EVP=+5.00D
TRIAL 1
Hand magnifier – 1.5x, 3x ; VA:N6 ; with Reduced Snellen ; under room illumination
TRIAL 2
Cut away stand magnifier – 2.5x ; VA:N6 ; with reduced snellen ; under room
illumination

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TRIAL 3
Stand magnifier – 3x ; VA:N6 ; with Reduced Snellen ; under room
illumination
TRIAL 4
Higher add of +5.00Ds ; VA:N8 ; with Reduced Snellen ; under room
illumination
TRIAL 5
Spectacle magnifier +8.00Ds – pt was not comfortable

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MANAGEMENT PLAN
DISTANCE
DEVICE
NEAR
DEVICE

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TRAINING:
 Patient should be motivated
 Usage of Devices
 Explain about relative distance magnification and relative size magnification

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CERTIFICATE:
 The patient can even get a certificate regarding his condition and can avail the
Rehabilitation services, rights and many other services
SCHOOL:
 Advising parents about the advantages of Integrated schools
 Teachers must be made aware of the condition

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COUNSELLING:
 Guardians must be counselled and the prognosis must be explained.
 Patient should feel independent.
 Regular checkup
 The patient must be made aware of his condition

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18. It is a pigmentary retinal dystrophy
Bilateral, symmetrical, progressive degeneration of retinal
photoreceptors
Rods and cones dystrophy
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INTRODUCTION
TYPES
 TYPICAL RETINITIS PIGMENTOSA
 A TYPICAL RETINITIS PIGMENTOSA

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TYPICAL RP
A TYPICAL RP
SYMPTOMS SIGNS
o Nyctalopia
o Progressive loss of visual
field
o Light and glare problems
o Decrease of visual acuity
o Arteriolar attenuation
o Retinal bone spicule
pigmentation
o Choroidal vessels
visualization
o Macular atrophy
 Cone affected earlier and severely
 Central vision impairment with no nyctalopia
 Macular lesion with or without peripheral changes
 Involves inferior quadrant

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INVESTIGATIONS:
History
Visual acuity
Colour vision
Amsler grid
Anterior chamber depth
Gonioscopy
ERG
OCT
FFA
MANAGEMENT:
Refractive error
Cataract
Glaucoma
Vitreous surgery
Genetic
counselling
LVA & Rehab

21. [1] Jack J kanski, Clinical Ophthalmology : a systemic approach. (Sixth edition ed.)Elsevier
limited; 2007. pg: 491-494
21
REFERENCES

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