Module 7 ocular disease

Convert light rays to electrical impulses to the brain

Photoreceptor cells

Warning signs of retinal disease

Flashing lights, dimmer vision, double vision, distorted vision, specks/lines in vision, blind spots (scotoma), progressive vision worsening

Why can retinal disease cause flashing lights?

Damaged retina sends incorrect or abnormal signals to the brain

A defect of the foveal retina involving its full thickness from the internal limiting membrane (ILM) to the outer segment of the photoreceptor layer

Macular hole

Early symptoms of macular hole

Blurred vision, distorted vision, straight lines appear wavy, difficulty reading small print

Advanced symptoms of macular hole

Central blind spot, missing patch in central vision, painless loss of central vision

Two major types of macular hole

1. Trauma-related

2. Idiopathic-related macular hole

Concussive blow causing rupture of the macula at its thinnest point

Cause of trauma-related macular hole

Age-related vitreous shrinkage and traction on the retina creating a hole at the thinnest part of the macula

Cause of idiopathic macular hole

Foveal detachment (yellow dot stage)

Stage 1 macular hole

Partial-thickness hole

Stage 2 macular hole

Full-thickness hole with partial vitreomacular adhesion/traction

Stage 3 macular hole

Full-thickness hole with complete separation of the vitreous from the macula and optic disc (posterior vitreous detachment)

Stage 4 macular hole

What determines the visual impact of a macular hole?

Size of the hole and location on the retina

Major complication of untreated macular hole

Retinal detachment

Clinical manifestations of macular hole

Metamorphopsia, blurred central vision, difficulty reading, central blind spot or gray area

Amsler grid finding in macular hole

Bent lines, irregular boxes, or gray shaded areas

Well-defined round or oval lesion in the macula with yellow-white deposits and cuff of subretinal fluid

Macular hole characteristic ophthalmoscopic finding

Risk factors for macular hole

Vitreomacular traction, diabetic eye disease, severe myopia, macular pucker, retinal detachment, Best disease, eye injury

Gold standard for diagnosis, staging, and management of macular holes

Optical coherence tomography (OCT)

Definitive surgical treatment for macular hole

Pars plana vitrectomy (PPV)

Separation of the retina from the underlying blood vessels that provide oxygen and nourishment

Retinal detachment

Why is retinal detachment an emergency?

Untreated detachment can cause permanent vision loss

Classic symptoms of retinal detachment

Floaters, flashes of light, curtain or veil across vision, sudden unexplained vision loss

Most common type of retinal detachment

Rhegmatogenous retinal detachment

Cause of rhegmatogenous retinal detachment

Retinal hole or tear allowing fluid to collect beneath the retina

Most common cause of rhegmatogenous retinal detachment

Aging

Scar tissue on the retinal surface pulling the retina away from the back of the eye

Retinal detachment tractional cause

Condition commonly associated with tractional retinal detachment

Poorly controlled diabetes

Risk factors for retinal detachment

Age over 50, previous retinal detachment, family history, severe myopia, eye surgery, eye trauma, diabetic retinopathy

Laser treatment for retinal detachment

Photocoagulation

Therapy that creates a scar that reconnects the retina to the eye wall

Cryotherapy purpose in retinal detachment

Placement of silicone bands on the sclera to support retinal reattachment

Scleral buckling?

Removal of vitreous gel followed by gas or silicone oil bubble placement

Vitrectomy in retinal detachment

Possible complications of retinal detachment surgery

Cataract, glaucoma, infection, vitreous hemorrhage, vision loss

A rare inherited retinal degeneration causing progressive loss of photoreceptor function

Retinitis pigmentosa (RP)

Earliest symptom of retinitis pigmentosa

Nyctalopia

Classic visual field defect in retinitis pigmentosa

Tunnel vision

Visual symptoms of retinitis pigmentosa

Nyctalopia, tunnel vision, photopsia, ring scotoma, central vision loss in advanced disease

Hallmark fundus finding of retinitis pigmentosa

Bone spicule pigment deposits

Classic triad of fundus findings in retinitis pigmentosa

Bone spicule pigmentation, vessel attenuation, waxy optic disc pallor

Diagnostic test that measures retinal function in retinitis pigmentosa

Electroretinography (ERG)

ERG finding in retinitis pigmentosa

Reduced electrical activity of the retina

Is there a cure for retinitis pigmentosa?

No known effective cure currently exists

Supplement that may slow progression of retinitis pigmentosa

Vitamin A palmitate

Experimental treatment for retinitis pigmentosa

Gene therapy

Serous detachment of the neurosensory retina caused by leakage through the retinal pigment epithelium

Central serous chorioretinopathy (CSCR)

Typical duration of CSCR

Approximately 3 months

Classic symptoms of CSCR

Blurred vision, distortion, and metamorphopsia

Signs and symptoms of CSCR

Blurred vision, central scotoma, metamorphopsia, micropsia, dyschromatopsia, reduced contrast sensitivity

Clinical presentation of CSCR

There is serous retinal detachment without subretinal blood and pigment epithelial detachments

Potential complication of recurrent CSCR

Choroidal neovascularization

Population most commonly affected by CSCR

Young to middle-aged adults (25–50 years)

Sex most commonly affected by CSCR

Men

Personality type associated with CSCR

Type A personality

Major risk factors for CSCR

Stress, steroid use, Helicobacter pylori infection, autoimmune disease, insomnia, hypertension

What hormone links stress to CSCR?

Cortisol

Diagnostic tests for CSCR

Ophthalmoscopy, OCT, fluorescein angiography

Natural course of CSCR

Usually self-limiting with resolution in 3–4 months

Recurrence rate of CSCR within the first year

Approximately 50%

Treatment for persistent CSCR

Photodynamic therapy

Treatment for choroidal neovascularization secondary to CSCR

Anti-VEGF medications

CSCR that is caused by isolated leaks in the RPE

Classic CSCR

CSCR that occurs when the leakage and changes to the RPE are widespread

Diffuse RPE dysfunction

CSCR that endures for 6 months or more, compared to the normal duration of about 3 months

Chronic CSCR

CSCR described as retinal detachment, combined with:

• RPE atrophy

• Pigment mottling - fundal pigment granularity

• Degenerate with time

Decompensated RPE