Debilitating Eye Diseases By Ma. Teresa G. Martinez, M.D. International Eye Institute St. Luke’s Medical Center

Diabetes mellitus Hypertension Glaucoma Age-Related Macular Degeneration Retinal Detachment Uveitis

Diabetic Retinopathy Non-Proliferative mild, moderate, severe, very severe Proliferative early high risk

S/Sx painless blurring of vision (gradual or sudden) retinal changes Treatment blood sugar control panretinal photocoagulation pars plana vitrectomy

HPN Retinopathy Modified Scheie Classification Grade 0 No changes Grade 1 Barely detectable arterial narrowing Grade 2 Obvious arterial narrowing with focal irregularities Grade 3 Grade 2 plus retinal hges and/ or exudate Grade 4 Grade 3 plus disc swelling

S/Sx blurring of vision retinal changes Treatment Blood pressure control

Complications Central Retinal Artery Occlusion Branch Retinal Artery Occlusion Central Retinal Vein Occlusion Branch Retinal Vein Occlusion

Central Retinal Artery Occlusion Caused by atherosclerosis-related thrombosis (ophthalmic artery) S/Sx acute and profound loss of vision pale retina cherry red spot

Immediate (within 90 mins) ↓ IOP by ocular massage Treatment Immediate (within 90 mins) ↓ IOP by ocular massage Anterior Chamber Paracentesis or Retrobulbar Anesthesia Inhalation Therapy (95% O2/ 5% CO2) Oral Acetazolamide & Aspirin Patent cilioretinal artery better prognosis

Branch Retinal Artery Occlusion Most commonly caused by emboli Cholesterol, Platelet-fibrin, Calcific Other associations: trauma, coagulation disorders, sickle cell disease, oral contraceptives, mitral valve prolapse, inflammatory &/or infectious etiologies, connective tissue disorders

S/Sx Acute & severe altitudinal visual field defect Pale retina in the area supplied by the affected artery Treatment Mgt is directed toward determination of systemic etiologic factors No specific ocular therapy proven to improve visual prognosis

Central Retinal Vein Occlusion Non-Ischaemic (most common) moderate loss of visual acuity FA shows venous stasis but good retinal capillary perfusion 50% - normal or near normal visual acuity Chronic Cystoid macular edema – poor visual acuity

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

Branch Retinal Vein Occlusion Sudden blurring of vision Metamorphopsia or relative visual field defect Dilated & tortuous veins, hemorrhages, edema, cotton wool spots Complications- chronic macular edema & neovascularization Within 6 mos 50% of eyes w/ collaterals will have better visual acuity

Glaucoma Increase in IOP, Optic Nerve changes, Visual Field defects Types: Congenital, Infantile, Juvenile Open Angle (Primary, Secondary) Closed Angle (Primary, Secondary)

Early Disc Changes Advanced Disc Changes

S/Sx Decrease or loss in peripheral vision, eye pain with or without headache, eye redness, haloes around light Optic Nerve changes Treatment Medical – oral, IV, eyedrops Surgical Laser or Cryotherapy

Age-Related Macular Degeneration Severe central visual acuity loss in one or both eyes Types: Nonneovascular Neovascular

Nonneovascular Neovascular

S/Sx : Decrease or loss in central visual acuity Treatment Education & follow up Micronutrients Laser treatment (PDT) Intravitreal injection of steroids Intravitreal injection of anti-VEGF

Retinal Detachment

Types: Rhegmatogenous – liquefied vitreous passing through a retinal break into the potential space between the sensory retina and the RPE Tractional –caused by proliferative mem- branes that contract & elevate the retina Exudative – caused by retinal or cho- roidal diseases in which leakage of fluid accumulates beneath the sensory retina

S/Sx: light flashes, wavy or watery vision, veil or curtain obstructing vision, shower of floaters that resemble spots, bugs or spider webs & sudden decrease of vision Treatment Surgery : Scleral Buckling Pneumatic retinopexy Cryotherapy, Laser or Diathermy Vitrectomy

Uveitis Inflammation of the uveal tract Types: Anterior Intermediate Posterior Panuveitis

Anterior Uveitis Posterior Uveitis

S/Sx floaters, blurring of vision, eye redness, eye pain, systemic manifestations anterior chamber findings, retinal changes Treatment steroids immunosuppressives surgery

Legal Blindness Visual acuity of 20/200 or worse in the better eye w/ corrective lenses (20/200 means that a person at 20 ft from an eye chart can see what a person w/ normal vision can see at 200 ft) OR Visual field restriction to 20 degrees diameter or less (tunnel vision) in the better eye.

Visual Acuity Snellen Chart

Visual Fields/ Perimetry

Fluorescein Angiography

B-Scan Ultrasound

Optical Coherence Tomography

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