Retinal Conditions
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Challenges in Ophthalmic Pathology: the Vitreoretinal Membrane Biopsy
Challenges in PAUL HISCOTT, DAVID WONG, IAN GRIERSON ophthalmic pathology: The vitreoretinal membrane biopsy Abstract detachment.s Sheets or strands crossing the vitreous are sometimes called transvitreous The introduction of vitreoretinal microsurgery membranes. Anteriorly, membranes can arise has produced a new type of biopsy; that of the in, or be continuous with, the vitreous base and vitreoretinal membrane. This review even extend as far as the posterior iris surface or investigates methods by which these scar-like pupil. tissues are handled in the laboratory and Biopsies of pathological tissue are usually explores the implications of the results of such undertaken to establish a diagnosis. evaluations. The study of vitreoretinal Vitreoretinal biopsies also may be for diagnostic membrane biopsies has provided much purposes as, for example, in the case of information concerning the pathobiology of intraocular lymphoma, but such conditions are the various conditions which may give rise to rare and tend not to produce membranes. the tissue as well as insights into how Conversely, in the conditions which do produce membranes themselves develop. Moreover, membranes the diagnosis is seldom in doubt. the application of new laboratory techniques Why, then, attempt laboratory studies of is expected to enhance our understanding of vitreoretinal membranes? Laboratory findings the formation of vitreoretinal membranes, and from the membranes may have a number of lead to further advances in their surgical and uses, for example providing 'feed-back' to the medical management. surgeon concerning surgical dissection planes Key words Age-related macular degeneration, (see below). However, the principal objective of Epiretinal membrane, Proliferative diabetic these investigations is to improve our retinopathy, Proliferative vitreoretinopathy, understanding of the pathogenesis of P Hiscott D. -
SHOULD YOU OPEN a DRY-EYE CLINIC? Experts Help You Weigh the Pros and Cons
RETINAL PHOTOS ON THE GO P. 16 • CHANGES TO MEDICARE ABN FORMS P. 20 ENSURING A HAPPY CATARACT PATIENT P. 22 • MANAGING GLAUCOMA IN KPRO PATIENTS P. 58 THE CURRENT STATE OF VITREORETINAL EDUCATION P. 64 • WILLS EYE RESIDENT CASE REPORT P. 70 September 2020 reviewofophthalmology.com SHOULD YOU OPEN A DRY-EYE CLINIC? Experts help you weigh the pros and cons. P. 28 ALSO INSIDE: • The Latest Treatments for Dry Eye P. 38 • Comprehensive Ophthalmologists and Anti-VEGF Injections P. 48 • How to Manage Ocular Herpes P. 54 SHE MAY NEED MORE THAN ARTIFICIAL TEARS TO DISRUPT INFLAMMATION IN DRY EYE DISEASE1,2 Her eyes deserve a change. Choose twice-daily Xiidra for lasting relief that can start as early as 2 weeks.3*† Not an actual patient. *In some patients with continued daily use. One drop in each eye, twice daily (approximately 12 hours apart).3 †XiidraisanLFA-1antagonistforthetreatmentofdryeyedisease.Pivotaltrialdata:ThesafetyandefficacyofXiidrawereassessedinfour Important Safety Information (cont) 12-week,randomized,multicenter,double-masked,vehicle-controlledstudies(N=2133).Patientsweredosedtwicedaily.Useofartificial • I n clinicaltrials,themostcommonadversereactionsreportedin5-25%ofpatientswereinstillationsite tearswasnotallowedduringthestudies.Thestudyendpointsincludedassessmentofsigns(basedonInferiorfluoresceinCornealStaining irritation,dysgeusiaandreducedvisualacuity.Otheradversereactionsreportedin1%to5%ofthepatients Score [ICSS] on a scale of 0 to 4) and symptoms (based on patient-reported Eye Dryness Score [EDS] on a visual analogue scale of 0 to 100).3 were blurred vision, conjunctival hyperemia, eye irritation, headache, increased lacrimation, eye discharge, A larger reduction in EDS favoring Xiidra was observed in all studies at day 42 and day 84. Xiidra reduced symptoms of eye dryness at eye discomfort, eye pruritus and sinusitis. 2 weeks (based on EDS) compared to vehicle in 2 out of 4 clinical trials. -
Exploring Topical Anti-Glaucoma Medication Effects on the Ocular Surface in the Context of the Current Understanding of Dry Eye
The Ocular Surface 16 (2018) 289e293 Contents lists available at ScienceDirect The Ocular Surface journal homepage: www.theocularsurface.com Original Research Exploring topical anti-glaucoma medication effects on the ocular surface in the context of the current understanding of dry eye Aaron B.C. Wong, Michael T.M. Wang, Kevin Liu, Zak J. Prime, Helen V. Danesh-Meyer, * Jennifer P. Craig Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand article info abstract Article history: Purpose: To assess tear film parameters, ocular surface characteristics, and dry eye symptomology in Received 11 November 2017 patients receiving topical anti-glaucoma medications. Received in revised form Methods: Thirty-three patients with a diagnosis of open angle glaucoma or ocular hypertension, 26 February 2018 receiving unilateral topical anti-glaucoma medication for at least 6 months, were recruited in a cross- Accepted 2 March 2018 sectional, investigator-masked, paired-eye comparison study. Tear film parameters, ocular surface characteristics, and dry eye symptomology of treated and fellow eyes were evaluated and compared. Keywords: Results: The mean ± SD age of the participants was 67 ± 12 years, and the mean ± SD treatment duration Glaucoma ± fi ¼ fi Prostaglandin analogue was 5.3 4.4 years. Treated eyes had poorer non-invasive tear lm breakup time (p 0.03), tear lm ¼ ¼ Tear film osmolarity (p 0.04), bulbar conjunctival hyperaemia (p 0.04), eyelid margin abnormality grade Ocular surface (p ¼ 0.01), tear meniscus height (p ¼ 0.03), and anaesthetised Schirmer value (p ¼ 0.04) than fellow eyes. Dry eye There were no significant differences in dry eye symptomology, meibomian gland assessments, and Meibomian gland ocular surface staining between treated and fellow eyes (all p > 0.05). -
Approved and Unapproved Abbreviations and Symbols For
Facility: Illinois College of Optometry and Illinois Eye Institute Policy: Approved And Unapproved Abbreviations and Symbols for Medical Records Manual: Information Management Effective: January 1999 Revised: March 2009 (M.Butz) Review Dates: March 2003 (V.Conrad) March 2008 (M.Butz) APPROVED AND UNAPPROVED ABBREVIATIONS AND SYMBOLS FOR MEDICAL RECORDS PURPOSE: To establish a database of acceptable ocular and medical abbreviations for patient medical records. To list the abbreviations that are NOT approved for use in patient medical records. POLICY: Following is the list of abbreviations that are NOT approved – never to be used – for use in patient medical records, all orders, and all medication-related documentation that is either hand-written (including free-text computer entry) or pre-printed: DO NOT USE POTENTIAL PROBLEM USE INSTEAD U (unit) Mistaken for “0” (zero), the Write “unit” number “4”, or “cc” IU (international unit) Mistaken for “IV” (intravenous) Write “international unit” or the number 10 (ten). Q.D., QD, q.d., qd (daily) Mistaken for each other Write “daily” Q.O.D., QOD, q.o.d., qod Period after the Q mistaken for Write (“every other day”) (every other day) “I” and the “O” mistaken for “I” Trailing zero (X.0 mg) ** Decimal point is missed. Write X mg Lack of leading zero (.X mg) Decimal point is missed. Write 0.X mg MS Can mean morphine sulfate or Write “morphine sulfate” or magnesium sulfate “magnesium sulfate” MSO4 and MgSO4 Confused for one another Write “morphine sulfate” or “magnesium sulfate” ** Exception: A trailing zero may be used only where required to demonstrate the level of precision of the value being reported, such as for laboratory results, imaging studies that report size of lesions, or catheter/tube sizes. -
Bilateral Rhegmatogenous Retinal Detachment in an Asymptomatic Patient Julie L
Bilateral Rhegmatogenous Retinal Detachment in an Asymptomatic Patient Julie L. Marsh, OD; Heather R. Miller, OD; Renae E. Welke, OD; Andrew Gurwood, OD Retinal detachments occur in approximately 2.8% of patients who have lattice degeneration with holes.1,2 We present a case of bilateral asymptomatic rhegmatogenous retinal detachments successfully repaired with a silicone exoplant encircling buckle, cryotherapy, and barrier laser. I. Case history A 44-year-old African-American male presented with no visual or ocular complaints for an ocular examination to update their spectacle and contact lens prescriptions. The patient denied history of trauma, flashes, floaters, or decreased vision. The patient’s ocular and medical histories were unremarkable. II. Pertinent findings Best-corrected visual acuities measured 20/20 OD and 20/70 OS. Pupils were equal, round, and responsive to light with an afferent pupillary defect noted OS. Brightness and red cap testing were negative. Versions were smooth and full in all positions of gaze. Confrontation visual fields were full to finger counting OD. Confrontation visual field testing OS revealed an 8- degree superior nasal defect, which was confirmed with an Amsler grid. Refractive error was measured with negligible changes at -5.50 – 2.50 X 180 OD and - 7.50 – 3.00 X 180 OS. Slit lamp examination was unremarkable in both eyes. Intraocular pressures measured 14 mmHg OU by Goldmann applanation tonometry. Dilated fundus examination of both eyes revealed lattice degeneration with holes in all quadrants. The left eye demonstrated an inferior temporal retinal tear infiltrated with subretinal fluid creating a rhegmatogenous retinal detachment, extending into the macula. -
Root Eye Dictionary a "Layman's Explanation" of the Eye and Common Eye Problems
Welcome! This is the free PDF version of this book. Feel free to share and e-mail it to your friends. If you find this book useful, please support this project by buying the printed version at Amazon.com. Here is the link: http://www.rooteyedictionary.com/printversion Timothy Root, M.D. Root Eye Dictionary A "Layman's Explanation" of the eye and common eye problems Written and Illustrated by Timothy Root, M.D. www.RootEyeDictionary.com 1 Contents: Introduction The Dictionary, A-Z Extra Stuff - Abbreviations - Other Books by Dr. Root 2 Intro 3 INTRODUCTION Greetings and welcome to the Root Eye Dictionary. Inside these pages you will find an alphabetical listing of common eye diseases and visual problems I treat on a day-to-day basis. Ophthalmology is a field riddled with confusing concepts and nomenclature, so I figured a layman's dictionary might help you "decode" the medical jargon. Hopefully, this explanatory approach helps remove some of the mystery behind eye disease. With this book, you should be able to: 1. Look up any eye "diagnosis" you or your family has been given 2. Know why you are getting eye "tests" 3. Look up the ingredients of your eye drops. As you read any particular topic, you will see that some words are underlined. An underlined word means that I've written another entry for that particular topic. You can flip to that section if you'd like further explanation, though I've attempted to make each entry understandable on its own merit. I'm hoping this approach allows you to learn more about the eye without getting bogged down with minutia .. -
Macular Hole Formation Following Choroidal Neovascularization
Yoshida et al., Int J Ophthalmol Clin Res 2015, 2:1 International Journal of ISSN: 2378-346X Ophthalmology and Clinical Research Case Report: Open Access Macular Hole Formation Following Choroidal Neovascularization Treatment in A High Myopic Eye with Epiretinal Membrane Yusaku Yoshida*, Manabu Yamamoto, Takeya Kohno and Kunihiko Shiraki Department of Ophthalmology and Visual Science, Osaka City University Graduate School of Medicine, Japan *Corresponding author: Yusaku Yoshida, MD, Department of Ophthalmology and Visual Science, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan, Fax:+81-666-343- 873, E-mail: [email protected] macular hole development where post-treatment regression of CNV Abstract seemed to have played a major role in a high myopic eye with ERM. Purpose: To report on the development of macular hole after treatment of choroidal neovascularization (CNV) in a patient with Case high myopia and epiretinal membrane (ERM). A 60-year-old man was examined in the Department of Methods: Retrospective single case report. Ophthalmology of Osaka City University Hospital for reduced vision Patients: A 60-year-old man presented with reduced vision in his in his right eye in January 2009. On initial examination, decimal best- right eye. On the initial examination, the right eye was high myopic corrected visual acuity (BCVA) was 0.3 in the right eye and 1.5 in with decimal best-corrected visual acuity (BCVA) of 0.3. the left eye, while intraocular pressures were 13 and 14 mmHg in the right and left eye, respectively. His previous medical and family Results: A subretinal grayish-white lesion was seen at the macula with hemorrhage, and optical coherence tomography showed a histories included nothing of note. -
Epiretinal Membrane
PATIENT INFORMATION LEAFLET British and Eire Association of Vitreoretinal Surgeons EPIRETINAL MEMBRANE What is an Epiretinal Membrane? An Epiretinal Membrane is a condition where a very thin layer of scar tissue forms on the surface of the retina, where the vision is sharpest. The part of the eye affected by the Epiretinal Membrane is called the Macula, which is made of special nerve cells and it provides our sharp central vision needed for seeing fine detail (reading and driving etc.). When an Epiretinal Membrane forms over the Macula, it may contract and crumple up the Macula resulting in distorted and/or blurred vision. The normal anatomy of the eye *Image courtesy of the National Eye Institute http://www.nei.nih.gov Page 1 of 5 PATIENT INFORMATION British and Eire Association of Vitreoretinal Surgeons LEAFLET EPIRETINAL MEMBRANE Why do I have an Epiretinal Membrane? In most cases the development of an Epiretinal Membrane appears to be related to normal aging changes inside the eye. In some cases it can be related to other conditions such as diabetes, blockage of blood vessel, inflammation or following retinal surgery. Epiretinal membranes are not related to Macular Degeneration. Epiretinal Membranes do not usually affect the other eye. They are quite common and affect up to 8% of people in later years. Cross-section of a healthy macula Cross-section of a macula with an epiretinal membrane Assessment for Epiretinal Membrane Your eye doctor is able to detect an Epiretinal Membrane during an eye examination following the use of eye drops that temporarily make your pupils large. -
Myopic Macular Degeneration Myopic Macular Degeneration Can Occur in People Who Are Severely Short-Sighted Due to Extreme Elongation of the Eyeball
Myopic Macular Degeneration Myopic macular degeneration can occur in people who are severely short-sighted due to extreme elongation of the eyeball. The stretching of the retina can result in tears in the macula and bleeding beneath the retina. How the eye works Light passes through the cornea at the front of your eye, and is focused by the lens onto your retina. The retina is a delicate tissue that lines the inside of your eye. The retina converts the light into electrical signals that travel along the optic nerve to your brain. The brain interprets these signals to “see” the world around you. Light from the object you are looking at directly is focused onto a tiny area of the retina called the macula at the back of the eye. The macula is about 4mm across and is responsible for detailed central vision and most colour vision. It provides the vision you need to read, recognise faces, drive a car, see colours clearly, and any other activity that requires detailed, fine vision. The rest of the retina gives you side vision (peripheral vision). What is myopia? Myopia, often known as “being short-sighted”, causes vision to be blurry in the distance but clearer when looking at things up close. It is a very common condition of the eyes and, for most people, it can easily be dealt with using contact lenses or glasses which will make vision clear and crisp. Most people have myopia because their eyeball has grown too long or their cornea (the clear window at the front of the eye) is more steeply curved than usual. -
A Comparative Study of Chart 1 and Chart 7 of Amsler Grid in Early Detection of Symptomatic Diabetic Macular Edema
Available online at www.iponlinejournal.com Journal homepage: www.innovativepublication.com/journal/ijooo Original Research Article A comparative study of chart 1 and chart 7 of amsler grid in early detection of symptomatic diabetic macular edema Nilesh Shrimali1, Minhaz Karkhanawala2, Somesh Aggarwal3*, Uma Gajiwala4, Pratik katariya5 1,4,5Resident, 2Senior Resident, 3Professor and Head of Retina Unit, M and J Western Regional Intitute of Ophthalmology Ahmedabad, Gujarat, India Abstract Objective: The aim of this study is to compare the sensitivities of chart 1 and chart 7 of the Amsler grid in early detection of metamorphopsia suggestive of diabetic macular edema. Design: It was a randomized, prospective, analytical study. Eighty patients were divided into two equal groups- A and B. Group A patients were given Amsler chart 1 and group B patients given Amsler chart 7.Regular 3 monthly follow up was done for 2 years with Optical Coherence Tomography (OCT) to detect DME on every follow up. Setting: Retina Unit, M And J Western Regional Institute Of Ophthalmology, Civil Hospital, Asarwa, Ahmedabad, Gujarat, India. Subjects: 80 eyes of 80 patients were enrolled, equally divided into 2 groups of 40 patients each. Intervention: No intervention was done for purpose of study. DME was treated as per clinical guidelines. Main outcome and Measures: Sensitivity and Specificity of both Amsler chart were calculated and compared using statistical analysis. Results: The sensitivity of Chart 1 of Amsler grid in detecting metamorphopsia was 56.25 percent, whereas the sensitivity of Chart 7 of Amsler grid was 76.47 percent. The difference was statistically significant (P< 0.05). -
Threshold Amsler Grid As a Screening Tool for Asymptomatic Patients On
569 EXTENDED REPORT Br J Ophthalmol: first published as 10.1136/bjo.2004.050120 on 15 April 2005. Downloaded from Threshold Amsler grid as a screening tool for asymptomatic patients on hydroxychloroquine therapy A Almony, S Garg, R K Peters, R Mamet, J Tsong, B Shibuya, R Kitridou, A A Sadun ............................................................................................................................... Br J Ophthalmol 2005;89:569–574. doi: 10.1136/bjo.2004.050120 See end of article for Background/aims: Patients taking hydroxychloroquine (HCQ) are at risk of developing classic bull’s eye authors’ affiliations maculopathy. Currently, the standard Amsler grid (AG) is one of the most useful methods to identify such ....................... lesions. However, AG is a suprathreshold target and may not detect relative central scotomas. The aim of Correspondence to: this study was to determine if the threshold Amsler grid (TAG) test, which varies light transmission through Alfredo A Sadun, two cross polarising filters, allows increased detection of scotomas caused by HCQ toxicity. MD, PhD, Department of Ophthalmology, Keck Methods: 56 rheumatological patients taking HCQ and 12 similar patients not taking HCQ were tested by School of Medicine, AG, red Amsler grid (RAG), and TAG. University of Southern Results: No scotomas were observed in patients never treated with HCQ. Among patients who had been California, Doheny Eye treated with HCQ, AG revealed scotomas in two of 56 (3.64%) patients; in contrast, six (10.7%) and 37 Institute, 1450 San Pablo Street, Los Angeles, CA (66.1%) scotomas were identified by RAG and TAG testing respectively. Additionally, the average area of 90033-1026, USA; each scotoma detected by all three methods expanded from 34.5 square degrees of central field loss on [email protected] AG testing to 71 square degrees on RAG and 117 on TAG. -
Clinical Findings and Management of Pathological Myopic Degeneration with Secondary Choroidal Neo-Vascular Membrane Macular Hemorrhages
Case Report JOJ Ophthal Volume 6 Issue 3 - February 2018 Copyright © All rights are reserved by Brad Thomas Cunningham DOI: 10.19080/JOJO.2018.06.555690 Clinical Findings and Management of Pathological Myopic Degeneration with Secondary Choroidal Neo-Vascular Membrane Macular Hemorrhages Brad Thomas Cunningham* New England College of Optometry, USA Submission: January 29, 2018; Published: February 21, 2018 *Corresponding author: Brad Thomas Cunningham, New England College of Optometry, USA, Email: Abstract appears to be increasing [2]. Considered a small subpopulation of myopia, pathological myopia (PM) is a disease affecting up to three percent of theMyopia, world populationor nearsightedness with a 31 affects percent over chance 40 percent of inheritability of the people [3,4]. aged Since 12-54 the typical in the courseUnited ofStates PM varies [1]. This greatly gender with non-specific visual outcomes, condition it is treatmentcritical for optionsclinicians as tothey appreciate relate to the the severity case presented. of the clinical The expected findings, prevalence the course of of myopia the disease, and PM and demands take a collaborative our attention approach and further to treatment analysis. Newoptions and before alternative pursuing treatment interventions. options must This becase evaluated. report reviews the management of a patient with PM and discusses clinical findings and Keywords: Pathological myopia; Fluorescein angiography; Choroidal neovascular membrane Case Report surgeon, who successfully completed bilateral DCR’s. The patient Patient #1, a 36-year-old Filipino female Army active duty healed completely and continues her regiment of daily patanol dentist, presented in the optometry clinic on May 15, 2012 as an urgent walk-in due to “a black spot” in her vision.