1. Ocular Pathology I 6234_16385 Rm HBSB 203-E 1:00-3:00pm Tonya G. Ketcham, OD, PhD tketcham@optometry.uh.edu 3-1799, RM 2113

2. Course Syllabus

3. Course Description To describe “normal” anomalies and “pathologic” abnormalities of the orbit and eye To describe ocular pathologies and ocular diseases (in general terms) –Symptoms and signs Clinical diagnostic process

4. Course Objectives To become familiar with observable “differences” (some normal and some abnormal) seen in the orbit and eye To identify various presentations of ocular signs and symptoms To identify a pathological condition and to understand the pathophysiology of the disease (in general terms) To introduce the concept of evidence-based medicine

5. Blackboard Learn Expected to sign up for and be able to access Grades posted here Supplemental lectures and materials NOTE –Lectures also on “intranet” page

6. Examinations Two two-hour examinations: during test weeks –Consist of best answer multiple choice with slide recognition and [each] will be comprehensive. The “final” will be 3 hours: during finals week. –Best answer multiple choice with slid recognition and an additional section of best answer multiple choice “National Boards Questions”. Comment on –Missing examinations –Viewing examinations

7. Quizzes Unannounced at any time during the semester Computer-based (VISTA) –Lecture material –Additional material posted with quiz 10 points each and no more than 5 in the semester Announced in lecture Blackboard Homework Assignments

8. Grades Performance based To pass class MUST earn enough points to be within 2 SD of mean Mean = 45.14 Stdev = 3.24 Suzie = 35 Suzie’s z-score is (35-45.14)/3.24= -3.19 Suzie’s t-score is (50+(10*-3.13)) = 18.7

9. Books Spalton, Hitchings, Hunter, Atlas of Clinical Ophthalmology, 3 rd Edition, Elsevier Mosby, 2005 Yanoff and Duker, Ophthalmology, 3 rd Edition, Elsevier Mosby, 2009. NO longer going to be able to depend only on lecture material…. –You are going to have to take the initiative to look things up –Use reference books…..

10. My Disclaimer Photos used are from various sources –When I know source I try to give credit –Some I don’t know source Scientific papers are acknowledge by first authors name and date (at the very least)

11. Introduction What is________? Epidemiology Risk Factors Pathophysiology Etiology Symptoms Signs Chief complaint HPI Complications Pathognomonic Treatment Management Differential Diagnosis Diagnostic process Evidence-based medicine –VS Traditional medicine Outline I. clinical terminology

12. History + Evaluation/examination + “Additional testing/procedures” + Scientific papers and your knowledge of these papers plus your clinical experience DD to Diagnosis APPLYING BASIC KNOWLEDGE OF GEOMETRIC OPTICS, ANATOMY PHYSIOLOGY, BIOCHEMISTRY, OCULAR PATHOLOGY Unfortunately, it’s NO longer multiple choice with 2-3 hours to get “correct” answer !!!!!

13. History Chief Complaint (CC)/Reason for Visit (RFV) –What brought the patient in to see you –Usually closely associated with patient’s symptoms –As their Doctor you must know as much about the CC as you can….. Questions start very general and then become more and more specific –LISTEN

14. History HPI –Location- OD/OS/OU –Quality- Loss of vision or blur –Context- Sudden or gradual –Severity- mild, moderate, severe –Modifying factors- distance, near, both –Duration- Intermittent, transient, constant –Timing- Short term, long term, months, years –Previous Interventions –Associated Symptoms- HA, nausea, dizziness Let’s Practice –Blurred vision

15. General HPI Questions With or without specs? Distance or near? Right eye or Left eye? How long? Sudden or gradual? Gotten worse? Does anything relieve it? Constant vs fluctuation? Other ocular symptoms associated with blurred vision? BLURRED VISION –PATIENT 1 –PATIENT 2

16. Ocular Examination Last year and this year you are going to be given a very large arsenal of procedures/tools –November there will be a “competency” VISUAL ACUITIES –Unaided –Aided –Entering –BEST –Pinhole

17. Best Corrected Visual Acuity What is the very, very best that this patient can see?? –DISTANT MONOCULAR ACUITY –Pinhole –Refraction Always correct to 20/15 !!!!! If the patient whizzes thru the 20/15 line, show them the 20/10 line –Big question Is the CC refractive (myope, hyperope, astigmate, presbyope) or pathologic in nature????

18. Other “Visual Acuities” Contrast Sensitivity Color vision –Monocular Visual field

19. Physical Examination Preliminary testing –Pupils –EOM –Confrontation fields –Photo stress test –Cover test –Monocular color vision –Red-cap test –Cover test –Amsler grid Metamorphopsia –Distorted vision

20. Physical Evaluation Slit lamp evaluation –Undilated Can this patient be dilated? –Dilated Stereo view of ONH, macula, posterior pole –78D lens, 90D lens, ruby lens Peripheral retina views –BIO, Goldmann 3-mirror, scleral depression Intraocular pressure (IOP) Direct ophthalmoscope –Monocular view –GREAT MAG Binocular indirect ophthalmoscope

21. Physical Examination Specular microscopy Corneal topography Gonioscopy Imaging of globe and orbit –Ophthalmoscopy to CT and MRI –A and B Ultrasound –Optical coherence tomography (OCT) Electrophysiology

22. How does any of this start? YOU MUST, MUST, MUST FIRST KNOW “NORMAL” –We will look at some anomalies of structures that are “unusual” however normal –You must look at as many healthy eyes as you can with as many of these different procedures as possible to get to know “normal”

24. PATHOLOGY 101 Refractive Error –cornea, lens Media Opacity –Tear film, cornea, aqueous humor, lens, vitreous Retina or Optic Nerve Disease Neurological Deficit –Posterior to Optic Nerve {CN II}