Retina: Examination and Interpretation - APVCapvc.ca/notes/2019notes/Wilkie7-vet.pdf1 Retina:...
Transcript of Retina: Examination and Interpretation - APVCapvc.ca/notes/2019notes/Wilkie7-vet.pdf1 Retina:...
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Retina: Examination and Interpretation
David A. Wilkie DVM, MS, Diplomate ACVO
Professor EmeritusThe Ohio State University
Retina
Optic Nerve
Tapetum
RetinalBloodVessel
ChoroidalVessels
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Retina Examinationn Routine physical examinationn Patient with a visual
disturbancen Differential diagnoses include:
n systemic infectious diseasen vascular disordersn Hypertension/hyperviscoscityn central nervous system
disease
Retina Examinationn Clinicians should realize this is the only
location in the body where blood vessels and the central nervous system can be seen directly.
Retina Examinationn In addition, the high blood flow of the
choroid makes it very susceptible to blood-borne infectious and neoplastic diseases.
Know Equipment & Anatomy!
I can�t see a thing?
Maze Test Finoff & Magnification
Anyone over 40?
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Pupillary Light Reflex
!
Dazzle Reflex
Hey!That�s Bright
Cotton Ball Menace Response
Intraocular Exam Intraocular Exam
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Indirect Ophthalmoscopy Indirect Ophthalmoscopy
Direct Ophthalmoscopy
PanOptic
This is an indirect ophthalmoscope
Courtesy of Dr. David Ramsey
Ocular ultrasound
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ElectroretinographyInterpretation
Let’s build a fundus
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Fundic Examinationn Optic nerve
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Fundic Examinationn Optic nerve
n Sizen Elevation/Depression Too
Small
TooBig
TooSunken
JustRight
Fundic Examinationn Optic nerve
n Sizen Elevation/Depression
n Retinal blood vesselsn Colorn Marginn Hemorrhage
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Peri-vascular Cuffing Lipemia Retinalis
Hyperviscosity Vascular Attenuation
Vascular AttenuationFundic Examination
n Optic nerven Size/colorn Elevation/Depression
n Retinal blood vesselsn Colorn Marginn Hemorrhage
n Reflectivity
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Fundic Examinationn Optic nerve
n Sizen Elevation/Depression
n Retinal blood vesselsn Colorn Marginn Hemorrhage
n Reflectivityn Hyper vs Hypo
Which is correct – Hyper or Hypo?
Which is correct – Hyper or Hypo?Angle of Light Reflection
Angle of Light ReflectionComplete Retinal Degeneration
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Focal Retinal Degeneration Hyporeflective
Hyporeflective
Are You
Ready Yet?
The world of normal variation…Here we go…
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The message is:you need to look at the retina more often to know normal variations before interpreting abnormalities
Abnormalities – Retina
Progressive Retinal Atrophy n American & English Cocker Spanieln Collien Miniature Poodlen Akitan Tibetan Terriern Labrador Retrievern Irish Settern Miniature Schnauzern Norwegian Elkhoundn Briardn Siberian Huskyn Portugese Water Dog
Progressive Retinal Atrophyn night blindness (nyctalopia)n progress to total blindness with timen pupils may be dilated and the PLR slow
and incompleten Tapetal hyperreflectionn Pale optic discn Vascular attenuation
Labrador retriever
3yr
4yr
3yr
5yrSpringer spaniel
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American Cocker Spaniels - OptiGen® PFK test & prcd-PRA test American Eskimo Dogs - OptiGen® prcd-PRA test Australian Cattle Dogs - OptiGen® prcd-PRA test Australian Shepherds - OptiGen® CEA/CH test & prcd-PRA test Australian Stumpy Tail Cattle Dogs - OptiGen® prcd-PRA test Basenjis - OptiGen® PK test Border Collies - OptiGen® CEA/CH & CL tests Briards - OptiGen® CSNB test Bullmastiffs - OptiGen® Dominant PRA & CMR tests Cardigan Welsh Corgis - OptiGen® rcd3-PRA test Chesapeake Bay Retrievers - OptiGen® prcd-PRA test Chinese Cresteds - OptiGen® prcd-PRA test Cockapoos - OptiGen® prcd-PRA test Coton de Tulear - OptiGen® CMR test Dachshunds - OptiGen® NARC test Doberman Pinschers - OptiGen® NARC test Dogue de Bordeaux (French Mastiff) - OptiGen® CMR test English Cocker Spaniels - OptiGen® prcd-PRA & Familial Nephropathy tests English Springer Spaniels - OptiGen® PFK test Entlebucher Mountain Dogs - OptiGen® prcd-PRA test Finnish Lapphunds - OptiGen® prcd-PRA test German Shorthaired Pointers - OptiGen® CD test Golden Retrievers - OptiGen® prcd-PRA test Great Pyrenees - OptiGen® CMR test Irish Setters and Irish Red & White Setters - OptiGen® CLAD & rcd1-PRA tests
Kuvasz - OptiGen® prcd-PRA test Labradoodles - OptiGen® prcd-PRA test Labrador Retrievers - OptiGen® prcd-PRA & NARC tests Lancashire Heelers - OptiGen® CEA/CH test Lapponian Herders - OptiGen® prcd-PRA test Mastiffs (Old English) - OptiGen® Dominant PRA & CMR tests Miniature Poodles - OptiGen® prcd-PRA test Miniature Schnauzers - OptiGen® Type A-PRA test Newfoundlands - OptiGen® Cystinuria test Nova Scotia Duck Tolling Retrievers - OptiGen® CEA/CH & prcd-PRA tests Portuguese Water Dogs - OptiGen® prcd-PRA test Rough Collies - OptiGen® CEA/CH test Samoyeds - OptiGen® XL-PRA test Shetland Sheepdogs - OptiGen® CEA/CH test Siberian Huskies - OptiGen® XL-PRA test Sloughis - OptiGen® rcd1a-PRA test Smooth Collies - OptiGen® CEA/CH test Spanish Water Dogs - OptiGen® prcd-PRA test Swedish Lapphunds - OptiGen® prcd-PRA test Toy Poodles - OptiGen® prcd-PRA test Whippets: Longhaired -
Genetic TestingRetinal Detachment
Retinal Detachmentn Hypertension
n Systolic pressure exceeds 180 mmHg, the diastolic exceeds 95 mmHg.
n Etiologies of hypertension:n Renal -#1n Diabetes #2n Hyperthyroidismn Pheochromocytoman Idiopathic
Feline hypertension
Feline hypertension Feline hypertension
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Retinal Detachment n Immune-mediated
n Uveo-Dermatologic Syndrome or VKHn Akita, Samoyed and Siberian Husky
Pre Tx Pre Tx
Post Tx Post Tx
Retinal Detachment n Infectious
Retinal Detachment n Hyperviscosity
Retinal Detachment n Neoplastic
Lymphosarcoma
Retinal Detachment – Breed Associated
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Retinal Dysplasia Retinal Dysplasia
Retinal Dysplasia
Retinal Dysplasia n The most severe form of retinal dysplasia occurs as
a non-attachment of the retina resulting in blindness in the affected eye
Sudden Acquired Retinal Degeneration Syndrome
(SARDS)n Acute onset blindnessn PLR is variable from fixed and dilated
or sluggish to normaln No visible fundic abnormalities on
initial presentationn 2-3 months the typical appearance of
generalized retinal degeneration will be present
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SARDS
n History of polyuria, polyphagia, polydypsia and weight gain
n On serum biochemical profile increased alkaline phosphatase (steroid isoenzyme), cholesterol or liver values may suggest mild Cushings or hepatic disease.
SARDS
n Depending on the PLR the differential diagnoses are:n Retrobulbar optic neuritis (Dilated
and non-responsive pupil) n Cortical blindness (normal PLR)
SARDS
n Definitive diagnosis of SARDS requires an electroretinogram to differentiate it from these diseases
n A normal ERG response indicates normal retinal function n Visual Evoked Potentialn Cerebrospinal fluid tapn MRI or CT scan
Abnormalities – Optic Nerven Micropapilla/Optic Nerve Hypoplasian Coloboman Papilledema/Papillitis/Optic Neuritisn Optic Nerve Atrophy/Degeneration
Micropapilla/Optic Nerve Hypoplasia
n Congenital abnormality of the optic nerve.
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Optic Nerve Hypoplasia
Optic Nerve Degeneration
Coloboman Pit or defect in the optic nerve and
often adjacent fundusn Collie Eye Anomalyn Multiple ocular anomalies
Papilledema/Papillitis/Optic Neuritis
n Papilledeman non-inflammatory
swelling of the optic nerve
Papilledema/Papillitis/Optic Neuritis
n Papillitis n inflammation of
the optic nerve
Optic Nerve Atrophy/Degeneration
n Gray, flat optic nerven Vascular attenuationn Cupping or
depression of the optic nerve head -Glaucoma
n Peripapillary hyper-reflectivity