It contains Examination Protocol for Contact Lenses along with information about pre-requisites for fitting a Contact Lens. A helpful guide for all Students, Eye Care Practitioners (Optometrist, Ophthalmologist).
It contains Examination Protocol for Contact Lenses along with information about pre-requisites for fitting a Contact Lens. A helpful guide for all Students, Eye Care Practitioners (Optometrist, Ophthalmologist).
DIRECT DOWNLOAD LINK ❤❤https://healthkura.com/retinoscopy/❤❤
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Retinoscopy and Objective Refraction and Subjective Refraction in spherical ametropia and astigmatism
Retinoscopy (Principle & Techniques of Retinoscopy) and objective refraction, Subjective Refracition
Best presentation about retinoscopy and objective refraction techniques, and basis of subjective refraction. If you want to master the technique of retinoscopy, this presentation can be your guidance and partner in your journey to retinoscopy, objective refraction and subjective refraction.
Presentation Layout:
Retinoscope, types of retinoscope and uses of retinoscope
-Introduction to retinoscopy and objective refraction
-Retinoscopy
- In spherical ametropia
- In astigmatism
- Others: strabismus, amblyopia, pediatric pt.,
cycloplegic refraction
-Static and Dynamic Retinoscopy
-Problems seeing reflex during retinoscopy
-Errors in retinoscopy
Objective of retinoscopy and objective refraction
-To locate the far point of the eye conjugate to the retina
- Myopia or hyperopia
-Bring far point to the infinity by using appropriate lenses
- Determines amount of ametropia by retinoscopy and objective refraction
References:
-Clinical Procedures in Optometry by Eskridge, Amos and Bartlett ,
-Primary Care Optometry by Grosvenor T.,
-Borish’s Clinical Refraction by Benjamin W. J.,
-Theory And Practice Of Optics And Refraction by AK Khurana
-Retinoscopy-Student Manual by ICEE Refractive Error Training Package (2009)
-Clinical Optics and Refraction By Andrew Keirl, Caroline Christie
-Clinical Refraction Guide - A Kumar Bhootra
-Clinical Procedures in Primary Eye Care by David B. Elliott
-Internet
Follow me to get in touch with optometric and ophthalmic updates.
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. :)
DIRECT DOWNLOAD LINK ❤❤https://healthkura.com/retinoscopy/❤❤
Dear viewers Check Out my other piece of works at ❤❤❤ https://healthkura.com ❤❤❤
Retinoscopy and Objective Refraction and Subjective Refraction in spherical ametropia and astigmatism
Retinoscopy (Principle & Techniques of Retinoscopy) and objective refraction, Subjective Refracition
Best presentation about retinoscopy and objective refraction techniques, and basis of subjective refraction. If you want to master the technique of retinoscopy, this presentation can be your guidance and partner in your journey to retinoscopy, objective refraction and subjective refraction.
Presentation Layout:
Retinoscope, types of retinoscope and uses of retinoscope
-Introduction to retinoscopy and objective refraction
-Retinoscopy
- In spherical ametropia
- In astigmatism
- Others: strabismus, amblyopia, pediatric pt.,
cycloplegic refraction
-Static and Dynamic Retinoscopy
-Problems seeing reflex during retinoscopy
-Errors in retinoscopy
Objective of retinoscopy and objective refraction
-To locate the far point of the eye conjugate to the retina
- Myopia or hyperopia
-Bring far point to the infinity by using appropriate lenses
- Determines amount of ametropia by retinoscopy and objective refraction
References:
-Clinical Procedures in Optometry by Eskridge, Amos and Bartlett ,
-Primary Care Optometry by Grosvenor T.,
-Borish’s Clinical Refraction by Benjamin W. J.,
-Theory And Practice Of Optics And Refraction by AK Khurana
-Retinoscopy-Student Manual by ICEE Refractive Error Training Package (2009)
-Clinical Optics and Refraction By Andrew Keirl, Caroline Christie
-Clinical Refraction Guide - A Kumar Bhootra
-Clinical Procedures in Primary Eye Care by David B. Elliott
-Internet
Follow me to get in touch with optometric and ophthalmic updates.
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. :)
optical coherence tomography is a new tool that makes retinal diagnosis easier. the above ppt includes a detailed and precise notes on OCT and its interpretation.
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
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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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.
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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. OUTLINE OF THE PRESENTATION
INTRODUCTION
ANATOMY OF OPTIC NERVE HEAD
BLOOD CIRCULATION
METHODS OF EVALUATION
EXAMINATION OF OPTIC NERVE HEAD
APPEARANCE OF OPTIC NERVE HEAD IN
SUMMARY
GLAUCOMA
CONGENITAL ANOMALIES OF OPTIC DISC
PAPILLEDEMA
INFLAMMATORY OPTIC NEUROPATHIES
ISCHEMIC OPTIC NEUROPATHIES
TRAUMATIC OPTIC NEUROPATHIES
OPTIC ATROPHY
3. INTRODUCTION
The optic nerve head is composed of axons from RGCs, as well as blood vessels and astroglial and collagen support.
The optic nerve head can be evaluated by various clinical methods as well as imaging techniques.
The evaluation of optic nerve head is central to the diagnosis and management of a lot of conditions.
With proper documentation, it helps in quantifying the amount of damage in the ONH and also monitor the change.
Technological advancements help in detection of early optic nerve head damage.
The optic nerve head evaluation has got considerable significance in the diagnosis and follow-up of glaucoma.
4. ANATOMY
Optic nerve head is the distal portion of the optic nerve.
Optic disc and papilla are referred to the portion of the optic nerve
head clinically visible by direct ophthalmoscope.
Extends from retinal surface to the myelinated part posterior to the
lamina cribrosa.
Composed of nerve fibres originated in ganglion cell layer,
converges upon ONH as neuroretinal rim (NRR) and exits the
globe.
Optic disc
5. ANATOMY…
1.5 mm in length
May be arbitrarily divided into :
1. Surface Nerve Fibre Layer
2. Prelaminar Region
3. Lamina Cribrosa Region
4. Retrolaminar Region
Parts of Optic nerve head
6. ORGANISATION OF NERVE FIBRES IN
OPTIC NERVE HEAD
Fibres from central region pass straight to form the
papillomacular bundle.
Fibres from nasal half come directly as superior and
inferior radial fibres.
Fibres from temporal region arches over the the pmb
forming the superior and inferior radial fibres.
Axons from peripheral retina takes a peripheral position
in the optic nerve head.
Figure : Distribution of retinal nerve fibers
7. BLOOD SUPPLY
Central Retinal artery
Short posterior ciliary artery –
Circle of Zinn / Haller
Pial vasculature
Figure : Blood supply optic nerve head
9. BLOOD SUPPLY…
ARTERIAL SUPPLY :
• Surface nerve fibre layer : central retinal artery, cilioretinal artery (occasionally)
• Prelaminar region : short posterior ciliary arteries
• Lamina cribrosa region : short posterior ciliary arteries, arterial circle of Zinn-Haller
• Retrolaminar region : pial vessels, short posterior ciliary vessels , central retinal artery
VENOUS DRAINAGE :
• mainly by central retinal veins , small portion by choroidal system.
11. METHODS OF EVALUATION OF
OPTIC NERVE HEAD
CLINICAL EXAMINATION :
a. Visual Acuity
b. Pupil Examination
c. Colour Vision
d. Spatial Contrast Sensitivity
12. STRUCTURAL ANALYSIS:
Direct Ophthalmoscopy
Indirect Ophthalmoscopy
Slit Lamp Biomicroscopy
HRT
Scanning Laser Polarimerty
OCT
METHODS OF EVALUATION OF
OPTIC NERVE HEAD
FUNCTIONALANALYSIS
Visual Field Analysis
ANCILLARY TESTS
• Ultrasound
• MRI
• CT Scan
• FFA
13. DIRECT OPHTHALMOSCOPY
Simplest and commonest method of disc evaluation.
The basic principle of direct ophthalmoscopy
Disadvantage: Lack of stereopsis
14. INDIRECT OPHTHALMOSCOPY
3 D Visualization
The basic principle of indirect ophthalmoscopy
Disadvantage: poor magnification
15. SLIT LAMP BIOMICROSCOPY
Current gold standard.
To visualize - Optic nerve head , peri papillary changes
- Nerve fibre layer thickness [red free filter]
Non-contact lenses
(+60D, +78D, +90D)
Contact lenses
16. SLIT LAMP BIOMICROSCOPY…
• The slit lamp viewing piece and the light column are kept coaxial.
• Intensity of the beam is kept brightest.
• Magnification preferably set at 10× initially.
• The slit beam is set around 1.5–2.5mm wide and 5–10mm long.
• Beam is focused at around 5 to 10 mm from thepatient’s eye.
• Increase the width of the beam to obtain larger field of view.
• Increase the magnification for greater details as necessary.
• Appropriate positions of gaze allows visualisation of
peripheral retina
17. 1. Excellent stereoscopic and magnified view of the optic disc.
2. Better image achieved when viewing through media opacities -
Cataract.
3. Allows for manipulation of image- Slit lamp magnification and
filters.
4. Image size less affected by patient refractive status.
5. Quick and inexpensive method.
SLIT LAMP BIOMICROSCOPY
ONH viewed with 90D
Non Contact Lens in Slit Lamp
18. HRT
(HEIDELBERG RETINAL TOMOGRAPH)
Precise observation and documentation of optic nerve head.
Based on confocal scanning laser ophthalmoscopy principle.
Non-contact, non-invasive method.
Uses 670nm He-Ne diode laser to take 3D pictures of optic nerve head.
Essential for diagnosis and management of Glaucoma.
20. Confocal scanning laser ophthalmoscope with integrated
polarimeter
Uses a near-infrared laser beam (780 nm) to scan the retina
The retardation of the reflected light is then measured for an
estimation of RNFL thickness.
Painless, less time consuming, pupils need not be dilated.
GDx VCC
(GLAUCOMA DETECTION WITH VARIABLE CORNEAL COMPENSATION)
22. OCT
(OPTICAL COHERENCE TOMOGRAPHY)
Scans the ONH, peripapillary retina and macular region.
Non-contact, non-invasive imaging technique.
Near-infrared light beam is used.
The intensity of light signal reflecting from retinal structures
is used to create a tomographic image.
The combined use of low-coherence light and an
interferometer provides high depth resolution.
24. OCT ANGIOGRAPHY
Functional extension of OCT.
Newer, non-invasive diagnostic technique.
Allows visualisation of blood flow in the retina and
choroid without injection of contrast medium.
Based on the detection of red blood cell movement
within the microvasculature of the eye.
Uses series of OCT B-scans.
25. VISUAL FIELD ANALYSIS
Perimetry is used for systematic measurement of visual
field function.
Useful in:
Optic disc lesion
Detection of glaucoma, progression
Chorioretinal lesions
26. FFA
(FUNDUS FLOURESCEIN ANGIOGRAPHY)
Adjunctive diagnostic tool aids the diagnosis of retinal vascular and macular diseases.
Useful in :
• Papilledema
• Anterior Ischemic optic neuropathy
• Optic Nerve Head Drusen
• Optic nerve coloboma
• Diabetic Retinopathy
27. 1. DISC
2. NEURORETINAL RIM
3. CUP
4. VESSELS
5. OPTIC NERVE HEAD HAEMORRHAGES
6. PERIPAPILLARY AREA
7. RETINAL NERVE FIBRE LAYER
EXAMINATION OF OPTIC
NERVE HEAD
31. OPTIC DISC
Shape: The normal shape of the optic disc is slightly vertically oval.
Size: There is wide variation in the size of the discs.
i. Small discs: <1.50 mm
ii. Medium discs: 1.50–2.50 mm
iii. Large discs: >2.50 mm
32. MEASUREMENT OF
OPTIC DISC SIZE
SLIT LAMP BIOMICROSCOPY:
DIRECT OPHTHALMOSCOPE
Small aperture (5 degree) of Welch –Allen
direct ophthalmoscope has a diameter of
1.5 mm and an area of 1.77 mm2.
Size of light spot ~ size of average optic disc Area= Π/4 x vertical diameter x horizontal diameter
33. PAPILLARY CHANGES IN GLAUCOMA
SIZE:
o Overdiagnosing large CDRs in large discs
-not glaucoma if NRR,RNFL etc normal.
o Underdiagnosing average CDR in small discs
with or without ocular hypertension.
o Early or moderate GON may be overlooked in
small discs because of “pseudo-normal”
appearance.
34. • The tissue between the cup and the disc margins is referred
as the neural rim.
• Uniformly orange red in colour.
• The neuroretinal rim is the most important parameter of the
optic disc evaluation.
• For every 1 mm2 increase in disc area, the rim area increased
by 0.5 mm2
NEURORETINAL RIM
35. ISNT RULE
• It is broadest in inferior quadrant, followed by superior and then nasal, temporal being the thinnest (ISNT RULE)
Inferior > Superior > Nasal > Temporal rim
36. NORMAL VARIATIONS OF NRR
Slate gray crescent
• Variation of the normal anatomy
• Located in the temporal or
inferotemporal periphery
Oblique insertion of nerve in myopic
• Obfuscate the interpretation of the NRR
• Distortion of temporal rim
37. Loss Of NRR - Generalized Or Focal
ABNORMALITIES IN NRR
Notch is defined as localized defect in the NRR
on the cup side of the rim
39. The cup is the central portion of disc, which represents a partial or
complete absence of axons, with exposure of lamina cribrosa .
Size : Mean cup area is 0.72 mm2
Shape: Shape of the optic cup is horizontally oval
Depth: cup depth is somewhat proportional to the cup area
Cup to disc ratio: Ratio of cup and disc with measured in same meridian.
As the disc is vertically-oval and cup is horizontally-oval,
vertical C/D < horizontal C/D
OPTIC CUP
44. • DEEPENING OF THE CUP
• It is the predominant pattern of early glaucomatous
optic atrophy.
• Exposure of lamina cribrosa by the deepening cup
shown by gray fenestra of lamina: laminar dot sign.
• Seen ophthalmoscopically as dotlike or striate
appearance.
OPTIC CUP CHANGES IN GLAUCOMA…
45. OPTIC CUP CHANGES IN GLAUCOMA…
• In late glaucoma loss of all neural rim tissue occurs leading to
total cupping.
• Clinically : white disc with total loss of NRR and bending of
all vessels at margin of disc.
• Extreme posterior displacement of lamina cribrosa and
undermining of disc margin is seen on cross section.
• Known as Bean potting/‘shelving’
46. OTHER PAPILLARY CHANGES
IN GLAUCOMA
Saucerizatio
n
SAUCERIZATION:
When diffuse shallow cupping extends to the disc margin with retention of a central pale cup
47. TINTED HOLLOW:
The retention of normal neural rim color in the area of focal saucerization is called the Tinted hollow
OTHER PAPILLARY CHANGES
IN GLAUCOMA
48. Pallor-cup discrepancy : Important marker to differentiate between GOA and Non -GOA
In GOA,
Area of cup> area of pallor
In non-GOA,
Area of pallor >area of cup
OTHER PAPILLARY CHANGES
IN GLAUCOMA
49. • The retinal vessels emerge on the medial side of the cup.
• CRA divides dichotomously into 4 branches.
• The course of the veins and arteries is similar but not identical
• Cilioretinal artery is present in 40% population.
RETINAL VESSELS
50. EXAMINATION OF VESSELS
Origin : CRA enters globe through the cup.
Branching : Divides dichotomously within cup and surface of disc.
Course: Veins lie temporal to arteries.
Diameter: Arterioles: Venules = 2:3
Colour: Veins/venules are purplish red while artery/arterioles are
bright light red
Pulsation: Venous pulsation is noted at the sharp bend around the
optic nerve head.
51. VASCULAR CHANGES IN GLAUCOMA
DISC HAEMORRHAGES :
• Also known as Splinter/Drance haemorrhages
• More common in NTG
• Most common location – inferior quadrant
• May reappear at the same or different site.
• Not pathognomonic, but may be the first sign of glaucoma.
• Localised on or within 2 clock hours of an RNFL defect.
52. VASCULAR CHANGES IN GLAUCOMA…
BARING OF CIRCUMLINEAR VESSELS :
• Normally, circumlinear blood vessels rest on NRR tissue.
• Occurs in areas of focal NRR loss or notching.
• Often occurs normally and not pathognomonic of glaucoma.
• Characterized as unsupported appearance of ‘suspending’ or
‘hanging in mid-air’ of the vessels crossed over the optic cup.
53. VASCULAR CHANGES IN GLAUCOMA…
NASALIZATION OF BLOOD VESSELS IN ONH:
• Normally, blood vessels enter and leave the eye along nasal
border of cup.
• Nasalization of ONH vessels is a function of cup size- may be
physiological or as in advanced glaucomatous cupping.
• Due to loss of superior, inferior, and temporal NRR & presence
of structural support only in nasal NRR.
54. VASCULAR CHANGES IN GLAUCOMA…
OVERPASS CUPPING :
• Normally, vessels run over surface of disc and NRR and then
come out.
• Loss of NRR takes away the support.
• Vessels appear to hang over the disc , bridging the cup-
overpass cupping
55. VASCULAR CHANGES IN GLAUCOMA…
BAYONETING :
• When the local thinning of NRR reaches the disc margin, a
sharpened rim is produced.
• A retinal vessel crossing the sharpened rim bends sharply at
the edge of disc creating bayoneting at disc edge.
56. OPTIC NERVE HEAD
HAEMORRHAGES
Have relatively high specificity but relatively low sensitivity for glaucoma.
Predictor for visual field loss with a faster rate of visual field progression.
Other optic nerve diseases can have disc hemorrhages:
optic disc drusen, retinal vascular occlusive diseases, and systemic
conditions.
Can be located within the
Optic disc tissue ,
Neuroretinal rim, or
Parapapillary zone.
57. PERIPAPILLARY AREA
• Crescentic region of chorioretinal atrophy is a common finding at
the temporal margin of normal discs.
• Alpha Zone:
1. Hypo and Hyper pigmented areas
2. Present in glaucomatous as well as non-glaucomatous
• Beta Zone:
1. Large choroidal vessel become visible
2. More common in glaucomatous eyes
58. Retinal nerve fiber layer (RNFL) is seen as
striations in the light reflexes from bundles of nerve
fibers.
Can be best seen with green light or red free light.
Observe
1. Brightness,
2. Striations,
3. Visibility of peripapillary blood vessels,
4. Diffuse or localized nerve fiber loss.
RETINAL NERVE FIBER
LAYER
59. PATTERNS OF RNFL LOSS
Localised:
1. Slit like/Groove like defect
2. Wedge shaped defect
Localised wedge shaped RNFL defect
60. PATTERNS OF RNFL LOSS
Diffuse :
Diffuse/Generalised RNFL Loss
• Diffuse RNFL loss
• Diffuse loss of striate
pattern
• Increased visibilty of
retinal vessels
62. This includes asymmetry in:
• Size of the cup ( >0.2)
• Width of NRR.
• Vessel course.
• Peripapillary atrophy.
ONH ASYMMETRY IN GLAUCOMA
63. FIVE STEPS FOR ASSESSMENT OF THE OPTIC
NERVE HEAD IN GLAUCOMA
1. Observe the scleral Ring to identify the limits of the
optic disc and it’s size.
2. Identify the size of the Rim.
3. Examine the Retinal nerve fiberlayer
4. Examine the Region of parapapillary atrophy
5. Look for the Retinal and optic disc hemorrhages.
67. PAPILLEDEMA
Oedema of the Optic Nerve Head due to raised intracranial pressure.
Pathogenesis:
1. Blockage of axoplasmic transport
2. Compression of central retinal vein
Etiology:
• Intracranial Tumor
• Brain abscess
• Cavernous sinus thrombosis
• Pseudotumor cerebri
Blurred disc margins in Papilledema
70. OPTIC NEURITIS
Inflammation of the optic nerve
According to ophthalmoscopic appearance:
1. Retrobulbar neuritis
2. Papillitis
3. Neuroretinitis
According to etiology:
1. Demyelinating
2. Parainfectious
3. Infectious
4. Non-infectious
TREATMENT:
• Treat the underlying cause
• Use of steroids as per Optic neuritis treatment trial (ONTT) recommendations
76. Follows ocular, orbital or head trauma .
Presents with sudden visual loss .
The optic nerve head and fundus are initially normal.
Pallor develops over subsequent days and weeks .
Spontaneous visual improvement occurs in up to about half of patients.
Steroids (intravenous methylprednisolone) should be considered.
Optic nerve decompression may be considered.
TRAUMATIC OPTIC
NEUROPATHY
78. Late stage changes that take place in the optic nerve
Results from axonal degeneration in the pathway between the retina
and the lateral geniculate body
Important causes
○ Optic neuritis
○ Compression by tumours and aneurysms
○ Hereditary optic neuropathies
○ Toxic and nutritional optic neuropathy
○ Trauma
OPTIC ATROPHY
79. PRIMARY
Disc margins well
defined
Chalky white disc
Vessels normal
Periphery normal
SECONDARY
Ill defined disc
margins
Grey white disc
Sheathing present
May/may not be
normal
CONSECUTIVE
Disc margins well
defined
Waxy pale disc
Attenuated vessels
Pigments or
degeneration
OPTIC ATROPHY
80. SUMMARY
The optic nerve head is the distal portion of the optic nerve which is actually a continuation of the ganglion cell layer.
The normal optic nerve has considerable variation in size and contour.
Examination of the optic nerve head is one of the simplest and most overlooked skills in ophthalmology.
Clinical examination of optic nerve head is qualitative and needs documentation.
Computed imaging analysis and blood flow measures provide more precise method of observation.
Glaucoma, despite its multifactorial etiology, is an optic neuropathy with characteristic quantitative and qualitative optic nerve
defects.
Epidemiology and statistics have shown that ONH assessment is superior to tonometry and perimetry for diagnosis and follow up of
glaucoma patient when all these tests are used individually.
81. REFERENCES
Allingham, R. Rand. Shields Textbook of Glaucoma, 6th Ed. 2011
Diagnostic Procedures in Ophthalmology- H V Nema - 3rd Ed
Anthony J. Bron. Wolff’s Anatomy of the Orbit, 8th Ed. 1997, p 279-282
Brad Bowling. Kanski’s Clinical Ophthalmology, 8th Ed. 2016, p 306-316
Myron Yanoff, Jay S Duker. Yanoff Duker Ophthalmology, 5th Ed. 2019
Parsons’Diseases of the Eye, 22nd Ed. 2017, p 287-308
Oliveira C, Harizman N, Girkin CA, Xie A, Tello C, Liebmann JM,Ritch R. Axial length and optic disc size in
normal eyes. Br JOphthalmol 2007 Jan;91(1):37-39.
Jonas JB, Fernández MC. Shape of the neuroretinal rim and position of the central retinal vessels in glaucoma. Br
J Ophthalmol 1994Feb;78(2):99-102
Images and Videos for Internet –
•https://www.google.com
•http://en.wikipedia.org
•https://www.youtube.com
Editor's Notes
The thirty-degree test, developed by Ossoinig et al is a dynamic A-scan technique for differentiating increased subarachnoid fluid from thickening of the optic nerve parenchyma or the perineural sheaths. It is based on the assumption that when the eye is turned, the optic nerve & its sheaths are stretched, thus distributing the increased subarachnoid fluid over a greater area. Once a widened optic nerve pattern is detected, the maximum thickness of the nerve is documented both anteriorly & posteriorly as the patient fixates in primary gaze. The patient then re-fixates 30 degree or more toward the probe & the nerve is measured again. If increased subarachnoid fluid is presemt, measurement of the optic nerve pattern will decrease in size as compared to the size obtained in the primary gaze.
In brief, the fundus is scanned by a low-power laser
beam (670 nm). The light that reflects back from the scanned
points is detected by a photodetector. The images formed from
this detection are digitized and stored on computer.