This document provides an overview of myopia, including its classification and associated pathological conditions. It discusses the different types of myopia such as axial myopia, refractive myopia, pathological myopia. It also classifies myopia based on factors like rate of progression, anatomical features, age of onset and degree. Several ocular disorders and systemic conditions associated with myopia are described. Pathological changes in highly myopic eyes are outlined along with tools to monitor for complications. Key fundus signs of degenerative myopia are highlighted.
The term ‘‘aniseikonia” comes from the Greek words ‘‘an” (not) ‘‘is” (equal) & ‘‘eikon” (icon or image) so aniseikonia is a binocular condition in which the apparent sizes of the images seen with the two eyes are unequal.
Whenever refractive ametropias in the two eyes of a person are different (i.e., when there is an anisometropia), the corrected retinal images of the two eyes, and consequently the two visual images, differ in size.
This condition has been termed aniseikonia
Optical aniseikonia
Retinal aniseikonia
Cortical aniseikonia
Pediatric Ophthalmic dispensing in different visual problemsRaju Kaiti
Pediatric dispensing, introduction, different from adult dispensing, frame selection, lens selection, special case fitting, Do's and Dont's, Measurements, Down's syndrome, albinism, aphakia, strabismus, syndromes
The term ‘‘aniseikonia” comes from the Greek words ‘‘an” (not) ‘‘is” (equal) & ‘‘eikon” (icon or image) so aniseikonia is a binocular condition in which the apparent sizes of the images seen with the two eyes are unequal.
Whenever refractive ametropias in the two eyes of a person are different (i.e., when there is an anisometropia), the corrected retinal images of the two eyes, and consequently the two visual images, differ in size.
This condition has been termed aniseikonia
Optical aniseikonia
Retinal aniseikonia
Cortical aniseikonia
Pediatric Ophthalmic dispensing in different visual problemsRaju Kaiti
Pediatric dispensing, introduction, different from adult dispensing, frame selection, lens selection, special case fitting, Do's and Dont's, Measurements, Down's syndrome, albinism, aphakia, strabismus, syndromes
The eye is a mirror which reflect the health of other systems in the human body.
The human eye, as an organ, can offer critical clues to the diagnosis of various systemic illnesses.
Ocular changes are common in various endocrine disorders such as diabetes mellitus and Graves’ disease.
Awareness of the associations between the ocular manifestations and endocrine disorders is the first step in the diagnosis and management of these complex patients.
Nearsightedness (myopia) is a common vision condition in which near objects appear clear, but objects farther away look blurry. It occurs when the shape of the eye — or the shape of certain parts of the eye — causes light rays to bend (refract) inaccurately. Light rays that should be focused on nerve tissues at the back of the eye (retina) are focused in front of the retina.
Nearsightedness usually develops during childhood and adolescence, and it usually becomes more stable between the ages of 20 and 40. Myopia tends to run in families.
A basic eye exam can confirm nearsightedness. You can compensate for the blurry vision with eyeglasses, contact lenses or refractive surgery.
a detailed informative compilation on everything related to hypermetropia or hyperopia required in ophthalmic or optometric clinical practice and education
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.
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.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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.
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.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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
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
3. MYOPIA
eye having excessive refractive power for its axial length.
(borish)
This may be due either to the eye having
1-a relatively long axial length
2-increased dioptric power of one or more of the refractive elements.
7. • Axial myopia
• if the total refractive power of an eye remains constant but the
axial length (i.e., the distance from the anterior corneal surface to
the retina measured along the visual axis) increases, a myopic
shift in refractive error will result
• Refractive myopia
•
if the axial length of an eye remains constant but the
refractive power of one or more of its optical elements
increases, a myopic shift in refractive status will occur.
8. MYOPIA: REFRACTIVE vs AXIAL
Refractive Myopia
Axial Myopia
(Eye too long)
(Optics of the eye too strong)
9. • The proposed classifications may be grouped
under the following broad headings:
• 1-Rate of myopic progression
• 2-Anatomical features of myopia
• 3-Degree of myopia
• 4-Physiological and pathological myopia
• 5-Hereditary and environmentally induced myopia
• 6-Theory of myopic development
• 7-Age of myopia onset
10. • Classification by Rate of Myopic Progression
• 1-Stationary myopia
• 2-temporarily progressive
• 3-permanently progressive.
11. • 1-Stationary myopia Stationary myopia
•
(Donders )
•
is generally of low degree (-1.50 to -2.00 D) and arises "in
the years of development."
• The degree of myopia remains stationary during adulthood
and may occasionally diminish with the approach of old age.
12. • 2-temporarily progressive
• Temporarily progressive myopia generally arises in the early
teens and progresses until the late 20s.
•
After this age, the rate of myopia progression approaches
zero. Interestingly, Donders reported that it was rare for
myopia to develop after 15 years of age in previously normal
eyes and, falsely, that it never developed after the 20th year
of life
13. • 3-permanently progressive
• Permanently progressive myopia ascends rapidly until around 25
to 35 years of age, and there afteradvances more slowly.
• Subsequent increases in myopia are said to occur in jumps,
rather than in a smooth progression.
• Donders observed that because of pathological condi-tions such
as retinal detachment and macular degener-ation, in these cases
it was rare at 60 years of age "to find a tolerably useful eye."
14. • Classification by the Anatomical Features of Myopia
• 1-Axial
•
whereby the eye is too long for its refractive power
• 2-Refractive
•
whereby the refractive system is too powerful for the axial length of the eye.An increase in axial
length may occur in the anterior or posterior portions of the globe individually, or may occur
throughout the eye.
•
The site of elongation may have implications for determining the etiology. For example, it has
been suggested that expansion of the posterior portion of the globe may be related to the
actions of the superior and inferior oblique muscles during vergence
15. • Borish further divided refractive myopia into
1-Index myopia
• in which one or more of the refractive indices of the media are anomalous.
• 2-Curvature myopia,
•
in which the reduced radius of curvature of one or more refractive surfaces produces increased dioptric power.
• 3-Anterior chamber myopia
in which a decrease in anterior chamber depth increases the refractive power of the eye.
16. •
Hirsch examined the refractive error of 562 eyes having myopia in
patients between 18 and 60 years of age. He divided the population into
three groups on the basis of the degree of myopia,
• 1-alpha
•
Using inferential statistics, he determined that the alpha group followed a
normal distribution curve, with a theoretically assumed peak of -0.50 D.
17. • 2-beta groups
• The beta group was represented by a second normal
distribution curve, with its peak around -4 D.
•
Hirsch suggested that the myopia in this group may be hereditary in
origin
18. • 3-gamma groups
• The gamma group ranged from -9 to -15 D, and this degree
was described by Hirsch as malignant, pathological,
degenerative, or congenital.
• Sorsby et al in an investigation of 341 eyes between 20 and 60
years of age, concluded that 95% of refractive errors fell
within ±4 D. They also suggested that the etiology of myopia
of less than 4 D differed from that myopia exceeding 4 D,
19. • Classification Based on Age of Onset
• 1-Congenital myopia:
• Myopia is present at birth and persists through infancy .although many children are born with myopia (low birth
weight) lose their myopia during first year of life this classification includes only children whose myopia persist
in infancy and present when entering school. prevalence is about 2%.
• 2-Youth-onset myopia:
• The onset of myopia occurs between 6 years of age and the early teens .from 2% at 6 years to 20% at 20 years.
• 3-Early adult-onset myopia:
• The onset of myopia occurs between 20 and 40 years of age.
• 4-Late adult-onset myopia:
• Myopia onset occurs after 40 years of age.
20. • Physiological (correlation ) myopia
• All of the component of refraction are within normal limits .but lack of correlation.(0.50D) per years.
• intermediate myopia
• Similar to Physiological myopia but
• 1-age is slightly younger.
• 2-amount of myopia tends to be higher.
• 3-axial length is longer.
• Pathologic myopia
• Highly myopic refractive error is present from early childhood
and is progressive. prognosis is poor with legal blindness
21. • Other Myopias
• Night Myopia
• The phenomenon of increased myopia under low luminance
conditions was first reported in 1789 by the Revere and Nevil
Maskelyne
•
More recent evidence has demonstrated that night myopia is
produced by an increased accommodative response (typically
on the order of 0.50 to 1.00 D) under degraded stimulus
conditions changes in chromatic aberration may also be
involved in this myopic shift.
22. • Pseudomyopia
• Pseudomyopia has been defined as a reversible form of
myopia that results from a spasm of the ciliary muscle.
•
The excessive accommodative response produces an apparent
myopic shift that will disappear when a cycloplegic agent is
administered to produce relaxation of accommodation
23. Ocular disorder Associated with Myopia
•
1-Retinopathy of prematurity
•
2-retinitis pigmentosa
•
3-Albinism
•
4-Congenital or juvenile glaucoma
•
5-keratoconus
•
6-isolated ectopic lentis
•
7-CSNB
•
8-subset of Lebers s Congenital amaurosis
•
(majority are hypropic)
•
9-Cone dystrophy
•
10-Interruption of light passing through ocular media
•
11-Genetics! autosomal dominant pathologic myopia to gene18p11.31
•
•
6-Cataract -Nuclear cataract causes a myopic shift
26. Albinism
Albinism, a group of inherited disorders, results in little or no production of the pigment
melanin
Foveal hypoplasia
Tyrosine negative –positive
28. • 4-Congenital or juvenile glaucoma
• 5-keratoconus
• 6-isolated ectopic lentis
• 7-CSNB
• 8-subset of Lebers s Congenital amaurosis
• (majority are hypropic)
• 9-Cone dystrophy
• 10-Interruption of light passing through ocular media
• 11-Genetics! autosomal dominant pathologic myopia to gene18p11.31
29. Marfan syndrome
most often affects the connective tissue of the heart and blood
vessels, eyes, bones, lungs, tall, thin build.
•
Long arms, legs, fingers, and toes and flexible joints.
•
A spine that curves to one side. This condition is called scoliosis .
•
A chest that sinks in or sticks out. These conditions are called pectus
excavatum and pectus carinatum respectively.
•
Teeth that are too crowded.
•
Flat feet.
30. Pathological Conditions Associated with Myopia
• Marfan’s syndrome
– Suspensory ligaments break
– dislocation of lens occurs superiorly and temporally and
results in a very high increase in myopia
Lens dislocation is common in Marfan's, affecting 50% to 80% of patients. The
dislocation is usually superior
31. • Marfan's syndrome is an autosomal dominant disorder
caused by mutations in the fibrillin gene on chromosome 15.
•
Fibrillin is a glycoprotein that is a major component in elastic
tissue and is important in lens zonules. 50-80 percent of
patients with Marfan’s syndrome have ectopia lentis.
33. homocysinuria
rare inherited metabolic disorder involving the amino acid methionine and resulting in a
harmful accumulation of homocysteine in the body.
Unlike Marfan syndrome, in which the joints tend to be "loose," in homocystinuria
the joints tend to be "tight."
Mental retardation
Skeletal abnormalities
Scoliosis Kyphosis
Chest abnormalities
34. Stickler syndrome
• Stickler syndrome is a
• connective tissue disorder
•
a genetic malfunction in the connective tissue
•
bones
• Eyes
• and ears
• flattened facial appearance.
• abnormal curvature of the spine (scoliosis or kyphosis)
38. Weill–Marchesani syndrome
short stature;
an unusually short, broad head (brachycephaly)
facial abnormalities;
hand defects,
including unusually short fingers (brachydactyly);
distinctive eye abnormalities.
A six year old female with Weill-Marchesani syndrome, which has caused a dislocated
lens.
42. Pathological Conditions Associated with Myopia
• Diabetes
– High blood glucose levels cause increased sorbital levels in
the lens
– Water rushes in and dilutes the sorbital in the lens
– Lens bulges and results in a myopic shift
44. • 1-Physiological myopia
•
was denned by Curtin as myopia in which each component of refraction
lies within the normal distribution for that population. Thus, the myopia
arises from a failure of correlation between the refractive components.
•
However, physiological myopia may be defined as normal as opposed to
pathologic myopia Therefore, physiological myopia might simply and
more accurately be defined as nonpathological myopia
45. • 2-Pathological Myopia(malignant or degenerative myopia)
•
Duke-Elder and Abrams defined pathological refractive errors as "those refractive
•
anomalies determined by the presence in the optical system of the eye of an
element which lies outside the limits of the normal biological variations.
•
These authors adopted the term degenerative myopia to describe myopia that is
accompanied by degenerative changes, particularly in the posterior segment of the
globe. This is most frequently found in high (>6 D) degrees of myopia
46. Pathologic Myopia
Eyes with pathologic myopia have progressive elongation of the
eye, thus creating a propensity for thinning of the RPE and choroid
The spherical equivalents of an eye with high myopia are more
than -6.00 D, or an axial length greater than 26.5 mm, whereas
patients with pathologic myopia are more than —8.00 D, or an
axial length greater than 32.5 mm.
47. • Degenerative myopia is also known as other terminology
including:
• High Myopia
• Degenerative Myopia
• Pernicious Myopia
• Malignant Myopia
49. • TOOLS TO MONITOR
• Fundus photography
• A- and B-scan ultrasonography
• Visual fields
• OCT
• Monitor corneal health if CL wearer
• Fundus photos
50. • FUNDUS SIGNS
•
It is important as primary eye care providers to be cognizant of the signs of degenerative myopia
which commonly include:
• Tilting of the optic disc
• Peripapillary chorioretinal atrophy
• Lacquer cracks
• Round, subretinal hemorrhages that clear spontaneously
• Fuchs spots + CNV
• Posterior staphyloma
• Paving-stone degeneration
• lattice degeneration
• Hole formation in the peripheral retina
• Elongation and atrophy of the cilliary body
• POAG
51. TIGROID FUNDUS
• As the eye enlarges, the retinal pigment epithelium thins,
resulting in a tessellated (checkered) appearance of the
fundus and increased visibility of the choroidal vasculature.
52. TIGROID FUNDUS: As the eye enlarges, the retinal pigment epithelium thins, resulting in
a tessellated (checkered) appearance of the fundus and increased visibility of the
choroidal vasculature.
53. Myopic crescent
• a white or grayish white crescentic area in the fundus of the
eye located on the temporal side of the optic disc; caused by
atrophy of the choroid, permitting the sclera to become
visible.
54. Optic disc crescents are common in myopes. They can vary in size and location
but are typically situated at the temporal disc margin as in this three dioptre myope.
57. • Posterior Staphyloma
• The posterior staphyloma is a pathognomonic feature of eyes with pathologic myopia. It is a
localized
• ectasia of the sclera, choroids, and retinal pigment epithelium that can be of variable size and
involve different aspects of the posterior fundus.
• These staphylomas are best observed with indirect binocular ophthalmoscopy and B-scan
ultrasonography.
• The posterior staphylomas are usually present from a young age and
• may progress with age, particularly with high myopias and long axial
• lengths.
• Vision progressively deteriorates in eyes with staphylomas that amacula-centered because of
the progressive thinning of the choroids and
• retinal pigment epithelium in the macula.
58. POSTERIOR STAPHYLOMA: Staphylomas are localized ectasia (“enlargement”) of the
sclera, choroid, and RPE. It can be easily seen on B-scan or a CT Scan. Staphylomas can
eventually lead to atrophy and loss of vision.
59. The most common type 1 posterior staphyloma. The edge of thestaphylomatous region is
arrowed
60.
61. Lacquer Cracks
• With the thinning of the retinal pigment epithelium and
choroid,ruptures of Bruch’s membrane occurs in up to 4.2%.
•
These typically occur with a streak of retinal hemorrhage that is not
associated with any underlying choroidal neovascularization.
62. Lacquer Cracks
• The lacquer cracks are best defined as linear hyperfluorescence in the early
phase of fluorescein angiography and late hypofluorescence on indocyanine
angiography.
• Over time, the cracks may widen and join with areas of atrophy. Central vision
may be affected depending on the course of the lacquer crack, especially if
there is foveal involvement. It should be noted that the presence of lacquer
cracks does put the eye at risk of choroidal neovascularization.
• In our series of 28 Asian eyes with myopia of greater than –6.0 DS, sixeyes
(21.4%) were found to have lacquer cracks as the underlying cause.
63. LACQUER CRACKS: are spontaneous ruptures of the elastic lamina of Bruch’s membrane
that appear yellowish-white and are usually located in the posterior pole. They generally
have linear or stellate patters. IVFA will show hyperfluorescence, as the fluorescein leaks
through Bruch’s membrane, highlighting these cracks. These can lead to CNV in the 4th6th decade of life.
66. Myopic Foveoschisis
• As a consequence of the ectasia secondary to the posterior
staphyloma,highly myopic individuals can develop foveoschisis.
• This is the splitting of the retinal layers in the macula which can cause
blurring of vision and metamorphopsia.
• It can then progress on to a myopic macular hole formation that may be
associated with a retinal detachment
• .Surgical intervention may be necessary to restore the anatomy and
visual function. The surgical procedures that have been performed
include vitrectomy with gas tamponade and macular buckling.
67. • Postsurgical developments in a myopic macular hole with associated retinal detachment. (a) Posterior pole of the left eye shows a tilted optic disc with myopic
crescent, and a horizontally oval macular hole with extensive subretinal fluid, which masks the retinal pigment epithelial (RPE) atrophy around the hole. Subretinal
precipitates suggest chronicity of the retinal detachment. (b) Optical coherence tomogram (vertical 10 mm scan) shows the macular hole, the surrounding sensory
retinal detachment, and the posterior staphyloma. (c) One month after vitrectomy, the retina is reattached with closure of the macular hole. The central geographic
patch of RPE atrophy is now prominent. (d) Repeat OCT (10 mm horizontal scan) confirms the anatomical outcomes; and reveals the residual central defect between
the flattened edges of the macular hole ('flat open' configuration), as well as the presence of posterior staphyloma. Central sub-RPE hyperreflectivity is suggestive of
geographic atrophy. (e) A small blister is evident within the nasal edge of the closed hole as early as 4 months on repeat mode OCT, which, however, disappeared on
subsequent visits. (f) In a 4-year review, a full-blown foveoschisis has developed, with irregular but attached central edges. Status quo continued for 6 months.
69. Color fundus photo of a highly myopic patient who presented with progressive
reduction in vision. Notice the significant myopic degeneration in the posterior pole.
The patient was found to have myopic foveoschisis (MF) with foveal detachment.
70. • OCT AND MF
• The standard test to detect MF remains OCT
71. Clinical photographs of the fundus of the right (A) and (B) left eyes in a patient with MFS.
(c) Fluorescein angiogram of the right eye in the early (C) and late (D) phases,
demonstrating staining of the optic nerve crescents and small window defects along the
macular region.
72. On OCT scans
• eyes with MF exhibit a thickened retina in the posterior pole
and hyporeflective splitting between the less reflective outer
retina and the more reflective inner retina.
•
There is splitting of the retinal layers of the macula in the presence of myopic
foveoschisis as seen on this OCT scan.
73. SD-OCT image of a 60-year-old woman with high myopia and posterior staphyloma
demonstrating typical MF (large arrow), premacular structure (small arrow), and foveal
detachment (star).
74. •
Lattice degeneration
• Lattice degeneration is a peripheral vitreoretinal thinning that is clinically
• important because of the potential risk of developing retinal tears and
• detachments.
• Lattice lesions can vary in their appearance. They can be linear or oval
• lesions of retinal thinning that can be of various sizes and extents of pigmentation.
• They are usually anterior to the equator
• Some may have round atrophic holes within them.
•
• These are not considered to be major risk factors for retinal detachment, however,lattice
degeneration has been reported in up to 20% of all detachments,and Byer showed that the
risk of developing retinal detachment in the presence of lattice degeneration is about 0.3 to
0.5%.
75. LATTICE DEGENERATION: is a vitreo-retinal degeneration that causes retinal atrophy
(“thinning”). It can be classified as pigmented or non pigmented. It takes on a lattice
formation (“crisscrossing”) because the retinal vessels become sclerotic, and the
collagen is laid down in this crisscross pattern. Due to the retinal thinning, it is prone to
causing retinal breaks, tears, or holes, which of course might lead to retinal detachment.
However it is important to remember that retinal breaks due to lattice degeneration
rarely turn into retinal detachments.
82. Fuchs’ spot
•
The most serious outcome of myopic chorioretinal degeneration is the
presence of a Fuchs’ spot, which is a round or elliptical, circumscribed lesion
in the macular or perimacular area.
•
It occurs as a result of breaks in Bruch’s membrane and the development of
a neovascular membrane, giving rise to a hemorrhage that becomes
pigmented.
•
A Fuchs’ spot initially causes symptoms of metamorphopsia - as found on
the Amsler grid - and can eventually cause a partial or complete loss of
central vision.
83. FUCHS SPOTS: Fuch’s spots are dark spots due to RPE hyperplasia. They can involve
subretinal neovascular membrane with an overlying retinal pigment epithelial hyperplasia.
The CNV can eventually cause disciform scars on the macula in the 4th-6th decade of life.
84. A developing Fuchs’ spot together with haemorrhage and a serous detachment of
the macula. Vision was markedly reduced
85.
86. Paving Stone Degeneration
• well-delineated, flat yellow foci in the size
range of 0.5–2.0 disc diameters .
• Irregular black pigmentation frequently is
present on the margins of the lesions and red
lines, which correspond to choroidal blood
vessels
87. Pavingstone degeneration (also known ascobblestone) (Image courtesy
of Dr HD Riley andthe Indiana University School of Optometry, USA)
88. Myopic Chorioretinal Atrophy
• The areas of atrophy may be focal or diffused, defined or irregularly
• shaped, isolated or composed of multiple pale white areas in the posterior pole
• . There may be clumps of pigment within these areas.
• The choroidal vessels are usually easily seen beneath the thinned out retina.
Fundus fluorescein angiography would show staining of these atrophic areas
while they are hypofluorescent with indocyanine green angiography.
• The natural history of these areas of atrophy is gradual enlargement
• and coalescence. As the fovea becomes more extensively involved, centralvision
becomes progressively affected.
89. A myopic CNV which is seen as a greyish subfoveal membrane with surrounding
subretinal blood.
91. (a)
(b)
A 53-year-old female with myopia of –8.50 DS, presented with a subfoveal
hemorrhagein the right eye with visual acuity 6/15 (a).
The fluorescein anigoram showed the presenceof a myopic CNV involving the macula
(b).
92. (c)
(e)
(d)
The OCT scan showed the subretinal fluid space and the subretinal neovascular membrane (c).
(d) and (e) She received a singledose of intravitreal bevacizumab 1.25 mg/0.05 ml and the vision
improved to 6/9 after one month and this was maintained after 12 months. However there was
formation of chorioretinalatrophy around the involuted mCNV (black arrow).
93. Myopic macular hole detachments
• Macular holes can develop in highly myopic eyes. This usually
occurs as aconsequence of tractional forces from the
vitreoretinal interfaceOften, a localized detachment arises
within the macula, which over time,can extend peripherally
101. • Low myopia <1.00 has little significant in infant and preschool children and is not
usually corrected.
• Moderately low degrees of myopia (1- 3D) should be corrected in children who are 3
years of age or older.
• Moderately high degrees of myopia (3.00- 5.00D) should be corrected in children
who are 1 years of age .
• high degrees of myopia (- 5.00D) should be corrected in any age .
•
Bruce D.MOOR,OD. eye care for infants and young children.
106. Management
• Surgery
– Radial keratotomy (RK)
– Post-surgical complications
• Hyperopic shift
• Diurnal fluctuations of refractive error and visual acuity
• Glare
• Corneal scarring
107. Management
• Refractive surgery
– Photorefractive keratectomy (PRK)
– Technique
• High energy photons from an excimer laser are used to
photoablate a small amount of tissue from the anterior corneal
surface and sculpt the cornea
108. Management
• Refractive surgery
– Photorefractive keratectomy (PRK)
– Post-surgical complications
• Eye pain
• Corneal disruption
• Blurry vision
• Prolonged duration of drug use
• Greater time needed for eyesight recovery
109. Management
• Refractive surgery
– Laser in-situ keratomileusis (LASIK)
– Technique
• A microkeratome is used to cut a flap of superficial corneal tissue
• The flap is lifted back, exposing the underlying corneal stroma
• The excimer laser is used to perform tissue removal in the corneal
stroma
• The flap is repositioned in its original position and adheres to the
underlying corneal stroma without the need for sutures
Flap creation
Laser intervention
Flap repositioning
110. Management
• Refractive surgery
– Laser in-situ keratomileusis (LASIK)
– Post-surgical complications
• Severe dry eye syndrome
• Poor night vision
• Reduced contrast sensitivity
• Astigmatism
111. Management
• Refractive surgery
– Points to consider after the surgical procedure
– Use eyedrops, as prescribed by the ophthalmologist
– Wear sunglasses when outside to protect the eyes from sunlight
– Remember to go back to the hospital for regular follow up visits with
the ophthalmologist and to get eyedrops