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THEORY LECTURES reduced from 80 --- 40 hours 2 x per week [ Tues and Fri.] In 7th semester there will be no lectures BUT in your case it is going to be an exception because of Electives in JUNE Cover all major topics

Text books : Khurana , Parson’s Diseases of the Eye Reference books : Kanski Reading on your own and consistent No more spoonfeeding Attendance 75 % .     

Practicals or clinical posting Reduced from 10 weeks to 4 weeks 4 weeks meaning morning and afternoon In the 7th Semester in H. Melaka. You may do a rotation in other hospitals such as in Muar or Terendak

Practicals or clinical posting Log book - 5 cases Instruments - torchlight and ophthalmoscope Dress code in hospital No jeans, slippers , tee- shirts , hipsters Skirts – below knee level Males - proper shoes, shirts with ties Hair- neatly combed nto hanging over your face bor BOTH Language -courteous Behaviour - professional

Examinations 6th semester – Midsemester + 5o marks -- Sessional -EPT -OSCE Eligibility for University Examinations – attendance and internal asssesment

LENS Development: ectodermal Transparent Avascular Spherical Location : between the iris and vitreous Suspended by zonules

ANATOMY cortex nucleus capsule

Anatomy Capsule: Thicker anteriorly especially at the equator. Cuboidal cells form the ant. subcapsular epithelium It is not present on the post.lens epithelium . Becomes columnar at the equator--- Lens fibres. Lens fibres arise from the anterior epithelial cells. Nucleus In children it is soft In adults it is firm In older age it looses transparency and it is flat on both surfaces.

PHYSIOLOGY Nutrition from aqueous + vitreous 66% of water + 34% of proteins[ 85% are soluble proteins] Traces of mineral Glutathione + Ascorbic acid [ Reduces with age + cataract formation] Carbohydrates-- energy Amino Acids ---structure Metabolism ---Low metabolism and utilisation of O2 and glucose. Carbohydrates—HMP- shunt, glycolysis, citric acid cycle Amino acids and fatty acids via the citric acid cycle in the mitochondria of lens epithelium.

Classification of cataract Aetiological : Congenital / developmental : Acquired Morphological: location and configuration

Acquired causes Senile :Age Complicated :Uveitis , R.D, endophthalmitis Traumatic Metabolic : D.M., Wilson’s disease ,galactosemia Maternal infections : TORCHES Drugs [Toxic] : Steroids Radiation : Gamma rays ,X-Rays, Microwave??? Dermatogenic :Atopic dermatitis Cataract associated with syndromes e.g. Downs syndrome, Dystrophia myotonica

Acquired causes Senile :Age Complicated :Uveitis , R.D, endophthalmitis Traumatic

Acquired causes Metabolic : D.M., Wilson’s disease ,galactosemia Maternal infections : TORCHES Drugs [Toxic] : Steroids

Acquired causes Radiation : Gamma rays , X-Rays, Microwave??? Dermatogenic :Atopic dermatitis Cataract associated with syndromes e.g. Downs syndrome, Dystrophia myotonica

Morphological Classification Capsular Cortical Nuclear Polar 1

Morphological Classification Capsular Cortical Nuclear Polar

Cataract Is an opacity in a clear lens. Is the most common cause of painless visual loss in the elderly. Is the most common cause of preventable blindness. Normally the human lens converges the light rays. What happens when there is an opacity?

What happens when there is a opacity in the lens ?

Senile cataract Bilateral above 60 yrs Can occur at a younger age—hereditary tendency Both sexes are equally affected Two forms : Cortical : Nuclear

Development of senile cortical cataract Lamellar separation or presenile changes Incipient stage Intumuscent stage Mature cataract Hypermature cataract

Stages of maturation in cortical cataract Lamellar separation Collection of fluid between the lens fibres. Change in refraction—hypermetropic [mild ] No symptoms

Stages of maturation in cortical cataract Incipient stage Cuneiform – spokes in the periphery Cupuliform– opacity in the posterior cortex Does the vision get affected ?

Clinical features of the incipient form Change in refractive index of lens Polyopia Haloes Defective vision in the evening or night On examination they appear black against the red glow with the direct ophthalmoscope Or grey opacities

What do you think the vision is ? Intumuscent stage Progression of the hydration of the lens fibres Swelling and opacification of the lens Lens pushed forward A.C. shallow and Sec. Angle closure glaucoma Opaque lens Pupil in contact with the lens No iris shadow What do you think the vision is ?

Stages of maturation in cortical cataract Mature cataract Loss of fluid Entire cortex is opaque ?? visual acuity

Hypermature Cataract Signs of hypermature cataract Wrinkled capsule / calcification Iridodonesis Ac may be deep Subluxation due to weak zonules Sclerotic cataract Morgagnian cataract

Calcification of the capsule in hypermature cataract

Cortex liquifies Hard nucleus sinks nucleus Morgagnian cataract

Nuclear cataract Progressive sclerosis in the nucleus Brown [brunescent ] + refractive index Myopic Seldom becomes hypermature