Debilitating Eye DiseasesDebilitating Eye Diseases

ByByMa. Teresa G. Martinez, M.D.Ma. Teresa G. Martinez, M.D.

International Eye InstituteInternational Eye InstituteSt. Luke’s Medical CenterSt. Luke’s Medical Center

Diabetes mellitusDiabetes mellitus HypertensionHypertension GlaucomaGlaucoma Age-Related Macular DegenerationAge-Related Macular Degeneration Retinal DetachmentRetinal Detachment UveitisUveitis

Diabetic RetinopathyDiabetic Retinopathy

Non-ProliferativeNon-Proliferative mild, moderate, mild, moderate, severe, very severesevere, very severe

ProliferativeProliferative earlyearly high riskhigh risk

S/SxS/Sx

painless blurring of vision (gradual or sudden)painless blurring of vision (gradual or sudden)

retinal changesretinal changes

TreatmentTreatment

blood sugar controlblood sugar control

panretinal photocoagulationpanretinal photocoagulation

pars plana vitrectomypars plana vitrectomy

HPN RetinopathyHPN Retinopathy

Modified Scheie ClassificationModified Scheie ClassificationGrade 0 No changesGrade 0 No changesGrade 1 Barely detectable arterial narrowingGrade 1 Barely detectable arterial narrowingGrade 2 Obvious arterial narrowing withGrade 2 Obvious arterial narrowing with focal irregularitiesfocal irregularitiesGrade 3 Grade 2 plus retinal hges and/ orGrade 3 Grade 2 plus retinal hges and/ or exudateexudateGrade 4 Grade 3 plus disc swellingGrade 4 Grade 3 plus disc swelling

S/SxS/Sx

blurring of visionblurring of vision

retinal changesretinal changes

TreatmentTreatment

Blood pressure controlBlood pressure control

ComplicationsComplications

Central Retinal Artery OcclusionCentral Retinal Artery Occlusion Branch Retinal Artery OcclusionBranch Retinal Artery Occlusion Central Retinal Vein OcclusionCentral Retinal Vein Occlusion Branch Retinal Vein OcclusionBranch Retinal Vein Occlusion

Central Retinal Artery OcclusionCentral Retinal Artery Occlusion Caused by atherosclerosis-related Caused by atherosclerosis-related

thrombosis (ophthalmic artery)thrombosis (ophthalmic artery) S/SxS/Sx

acute and profound loss of visionacute and profound loss of vision

pale retinapale retina

cherry red spotcherry red spot

TreatmentTreatment

Immediate (within 90 mins)Immediate (within 90 mins)

↓ ↓ IOP by ocular massageIOP by ocular massage

Anterior Chamber Paracentesis orAnterior Chamber Paracentesis or

Retrobulbar AnesthesiaRetrobulbar Anesthesia

Inhalation Therapy (95% O2/ 5% CO2)Inhalation Therapy (95% O2/ 5% CO2)

Oral Acetazolamide & AspirinOral Acetazolamide & Aspirin

Branch Retinal Artery OcclusionBranch Retinal Artery Occlusion

Most commonly caused by emboliMost commonly caused by emboli Cholesterol, Platelet-fibrin, CalcificCholesterol, Platelet-fibrin, Calcific Other associations:Other associations:

trauma, coagulation disorders, sickle cell trauma, coagulation disorders, sickle cell disease, oral contraceptives, mitral valve disease, oral contraceptives, mitral valve prolapse, inflammatory &/or infectious prolapse, inflammatory &/or infectious etiologies, connective tissue disordersetiologies, connective tissue disorders

S/SxS/Sx Acute & severe altitudinal visual field defectAcute & severe altitudinal visual field defect Pale retina in the area supplied by the affected Pale retina in the area supplied by the affected

arteryartery TreatmentTreatment Mgt is directed toward determination of systemic Mgt is directed toward determination of systemic

etiologic factorsetiologic factors No specific ocular therapy proven to improve No specific ocular therapy proven to improve

visual prognosisvisual prognosis

Central Retinal Vein OcclusionCentral Retinal Vein Occlusion Non-IschaemicNon-Ischaemic (most common) (most common)

moderate loss of visual acuitymoderate loss of visual acuity

FA shows venous stasis but good retinal FA shows venous stasis but good retinal capillary perfusioncapillary perfusion

50% - normal or near normal visual acuity50% - normal or near normal visual acuity

Chronic Cystoid macular edema – poor visual Chronic Cystoid macular edema – poor visual acuityacuity

IschaemicIschaemic Severe loss of visual acuitySevere loss of visual acuity Marked tortuosity & engorgement of retinal veinsMarked tortuosity & engorgement of retinal veins Retinal hemorrhages, Cotton wool spotsRetinal hemorrhages, Cotton wool spots Severe optic disc edema & hyperemiaSevere optic disc edema & hyperemia Visual acuity is permanently impairedVisual acuity is permanently impaired Monthly follow-up for 6 monthsMonthly follow-up for 6 months (+) neovascularization – PRP treatment(+) neovascularization – PRP treatment Tx of associated medical Tx of associated medical conditioncondition

Branch Retinal Vein OcclusionBranch Retinal Vein Occlusion Sudden blurring of visionSudden blurring of vision

Metamorphopsia or relative visual field defectMetamorphopsia or relative visual field defect

Dilated & tortuous veins, hemorrhages, edema, Dilated & tortuous veins, hemorrhages, edema, cotton wool spotscotton wool spots

Complications- chronic macular edema & Complications- chronic macular edema & neovascularizationneovascularization

Within 6 mos 50% of eyesWithin 6 mos 50% of eyes

w/ collaterals will have w/ collaterals will have

better visual acuitybetter visual acuity

GlaucomaGlaucoma

Increase in IOP, Optic Nerve changes, Increase in IOP, Optic Nerve changes, Visual Field defectsVisual Field defects

Types:Types: Congenital, Infantile, JuvenileCongenital, Infantile, Juvenile Open Angle (Primary, Secondary)Open Angle (Primary, Secondary) Closed Angle (Primary, Secondary)Closed Angle (Primary, Secondary)

Early Disc ChangesEarly Disc Changes

Advanced Disc ChangesAdvanced Disc Changes

S/SxS/Sx Decrease or loss in peripheral vision,Decrease or loss in peripheral vision, eye pain with or without headache, eye redness, eye pain with or without headache, eye redness,

haloes around light haloes around light Optic Nerve changesOptic Nerve changes

TreatmentTreatment Medical – oral, IV, eyedropsMedical – oral, IV, eyedrops SurgicalSurgical Laser or CryotherapyLaser or Cryotherapy

Age-Related Macular DegenerationAge-Related Macular Degeneration

Severe central visual acuity loss in one or Severe central visual acuity loss in one or both eyesboth eyes

Types:Types:

NonneovascularNonneovascular

NeovascularNeovascular

Nonneovascular Neovascular

S/Sx :S/Sx : Decrease or loss in central visual acuityDecrease or loss in central visual acuity

TreatmentTreatment Education & follow upEducation & follow up MicronutrientsMicronutrients Laser treatment (PDT)Laser treatment (PDT) Intravitreal injection of steroidsIntravitreal injection of steroids Intravitreal injection of anti-VEGFIntravitreal injection of anti-VEGF

Retinal DetachmentRetinal Detachment

Types:Types:

RhegmatogenousRhegmatogenous – liquefied vitreous – liquefied vitreous

passing through a retinal break into the passing through a retinal break into the

potential space between the sensorypotential space between the sensory

retina and the RPEretina and the RPE

Tractional Tractional –caused by proliferative mem-–caused by proliferative mem-

branes that contract & elevate the retina branes that contract & elevate the retina

Exudative – caused by retinal or cho- – caused by retinal or cho-

roidal diseases in which leakage of fluidroidal diseases in which leakage of fluid

accumulates beneath the sensory retinaaccumulates beneath the sensory retina

S/Sx:S/Sx:

light flashes, wavy or watery vision, veil or curtain light flashes, wavy or watery vision, veil or curtain obstructing vision, shower of floatersobstructing vision, shower of floaters

that resemble spots, bugs or spider webs &that resemble spots, bugs or spider webs &

sudden decrease of visionsudden decrease of vision TreatmentTreatment

Surgery : Scleral BucklingSurgery : Scleral Buckling

Pneumatic retinopexyPneumatic retinopexy

Cryotherapy, Laser or DiathermyCryotherapy, Laser or Diathermy

VitrectomyVitrectomy

UveitisUveitis

Inflammation of the uveal tractInflammation of the uveal tract

Types:Types:

AnteriorAnterior

IntermediateIntermediate

PosteriorPosterior

PanuveitisPanuveitis

Anterior UveitisAnterior Uveitis

Posterior UveitisPosterior Uveitis

S/SxS/Sx floaters, blurring of vision, eye redness, eye pain, floaters, blurring of vision, eye redness, eye pain,

systemic manifestationssystemic manifestations anterior chamber findings, retinal changesanterior chamber findings, retinal changes

TreatmentTreatment steroidssteroids immunosuppressivesimmunosuppressives surgerysurgery

Legal BlindnessLegal Blindness

Visual acuity of 20/200 or worse in the Visual acuity of 20/200 or worse in the better eye w/ corrective lenses better eye w/ corrective lenses (20/200(20/200 means that a person at 20 ft from an eye chart means that a person at 20 ft from an eye chart can see what a person w/ normal vision can see can see what a person w/ normal vision can see at 200 ft)at 200 ft)

OROR Visual field restriction to 20 degrees Visual field restriction to 20 degrees

diameter or less (tunnel vision) in the diameter or less (tunnel vision) in the better eye.better eye.

Visual AcuityVisual Acuity

Snellen ChartSnellen Chart

Visual Fields/ PerimetryVisual Fields/ Perimetry

Fluorescein AngiographyFluorescein Angiography

B-Scan UltrasoundB-Scan Ultrasound

Optical Coherence TomographyOptical Coherence Tomography

THANK YOUTHANK YOU