Chronic Visual Loss by

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Chronic Visual Lossby

• SAMIR AL-MANSOURI, MD

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Chronic slowly progressive visual loss
Major causes

• e.g. - cataract
• - glaucoma
• - macular degeneration
• - diabetic retinopathy

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One should recognize the normal 1st to be able
to identify the abnormal.

• e.g. ? Normal macula
• ? Lens clarity
• ? Optic nerve head
• ? Normal retina
• etc.

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Cataract
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Glaucoma

• - Definition
• NB a) If detected early and treated, blindness
• can be prevented.
• b) Most patients in early glaucoma are
• asymptomatic.

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Investigation

• IOP
• V.F.
• Exam ONH
• Gonioscopy

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Basic information

• IOP
• Aqueous humor circulation
• Open-angle glaucoma
• Acute angle-closure glaucoma ? symptoms

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Basic information

• Optic nerve
• Optic disc
• physiological
• Cupping
• pathological

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Q What happens when IOP ??
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Examination

• Q When? Every 2 ? 4 y past age 40.
• Particular attention when family history ve.
• Q How? Tonometry / cup disc ratio

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Should be referred for management if

• 1. IOP over 21 mmHg.
• 2. C/D ratio 0.5 or greater.
• 3. One cup significantly larger in one eye.

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Age-Related Macular Degeneration
Changes in the macular affect

• Outer retinal layer
• Retinal pigment epithelium
• Bruchs membrane
• chorio capillaris

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Pathological changes include

• Drusen deposition
• Degenerative changes
• subretinal neovascular membranes.

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Examination Tests

• Visual acuity
• Amsler grid testing
• Ophthalmoscopy
• Others
• Fluorescein angiography
• Indocyanine green dye
• OCT (Optical Coherence Tomography)

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Amsler Grid Testing
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Symptoms include

1. ? visual acuity
2. Metamorphosia or distortion of vision.
3. Scotoma or blind spot

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Management

• Laser treatment of neovascular membrane
• Low-vision aids

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Diabetic Retinopathy
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