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

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

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

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

6. 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

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

8. Complications Central Retinal Artery Occlusion
Branch Retinal Artery Occlusion
Central Retinal Vein Occlusion
Branch Retinal Vein Occlusion

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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

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

18. Early Disc Changes
Advanced Disc Changes

19. 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

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

21. Nonneovascular Neovascular

22. 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

23. Retinal Detachment

24. 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

25. 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

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

27. Anterior Uveitis
Posterior Uveitis

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

29. 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.

30. Visual Acuity
Snellen Chart

31. Visual Fields/ Perimetry

35. Fluorescein Angiography

37. B-Scan Ultrasound

38. Optical Coherence Tomography

39. THANK YOU