VR Disorders; Clinical presentation, classification and RD Ayesha S Abdullah

Learning outcomes By the end of the lecture the students would be able to:  Identify the symptoms of VR disorders and correlate them with underlying pathophysiological mechanisms.  Classify VR disorders into broad categories.  Describe the clinical presentation and epidemiology of RD  Correlate the mechanism of retinal detachment with the development (RD) of the eye  Classify RD  Identify major causes of RD  Outline the principles of management

Common symptoms of VR diseases  Blurred vision/decreased vision  Distorted vision ( metamorphopsia)  Difficulty in near work  difficulty in recognizing faces  Something blocking central vision ( positive scotoma)  Minified image/micoropsia-spreading apart of foveal cones  Magnification of images/ macropsia-crowding of cones at fovea

 Problems with colour vision  Difficulty in dark adaptation  Field loss  Seeing sparkilign bright lights/ photopsia  Seeing webs/ black dots -floaters  Difficulty in night vision-nyctalopia  Difficulty in day vision-hemeralopia

Common signs  Decreased visual acuity  RAPD  Opacities in the vitreous  Liquified vitreous gel  Cells in the vitreous  Signs in the retina specific to the specific disease entity  Self-reported Amsler grid  Nystagmus

Classification of VR disorders  Diseases of the vitreous  Retinal Detachment  Vascular retinopahties  Vitreoretinal degenerations  Inflammatory & infective disorders  Tumours of the retina

DEVELOPMENT OF THE EYE

What is RD? Separation of the sensory retina from the retinal pigment epithelium by the subretinal fluid

 Rhegmatogenous RD  Non- rhegmatogenous –Exudative RD –Tractional TYPES

RRD-some anatomical considerations  Vitreo-retinal adhesions disc, ora, blood vessels & at fovea  Potential subretinal space

RRD RD secondary to a break in the retina

Causes & risk factors  In 15% of cases with Posterior vitreous detachment (PVD) a tear develops in the retina  60% of tears develop in peripheral retina with retinal degenerations like Lattice degeneration  40% of the RD occur in myopic eyes; the higher the error the greater the risk  Post- Cataract surgery (pseudophakia) ; especially in eyes with retinal degeneration and myopia can develop retinal tears and RRD

Clinical presentation –symptoms  Flashes of light  Floaters  Visual loss  Visual field loss  Usually an acute event  History of predisposing factors, myopia, cataract surgery, trauma etc

Field loss

Clinical examination –signs Visual acuity Anterior segment examination Pupils, (RAPD) Posterior segment examination Vitreous- tobacco dust Retinal signs IOP ( may be low)

Clinical examination –signs Direct ophthalmoscopy

Indirect Ophthalmoscopy

Normal fundus

Rtinal detachment with tear

RD

RD with giant tear

Tractional retina detachment

Principles of management  External temponade/ scleral buckling –Seal the break –Create a buckle –Drain the SRF-if required  Internal temponade/

Management

Prophylaxis of RRD  Photocoagulation of the risky lesions with laser  So patients with risk facotrs should be referred for treatment/ consideration of the treatment

Let us Summarize