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Lecture # 3 for Primary Care Physicians Eyecare Review: Part I

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Lecture # 3 for Primary Care Physicians Eyecare Review: Part I 1/15/2016 EYECARE REVIEW LECTURE # 3 FOR PRIMARY CARE PHYSICIANS EYECARE REVIEW: PART I FOR PRIMARY PHYSICIANS Steve Butzon, O.D. Member Director – IDOC STEVE BUTZON, O.D. President of W.S.O.S. [email protected] BACKGROUND Undetected and untreated eye diseases and conditions are major public health problems that can lead to vision loss and blindness . OBJECTIVES METHODS: The objective of the study was The data was collected using a face-valid 69-question Web-based survey that to gather and analyze what included 17 questions specific to vision primary care physicians know health. about vision health and A random sample of 1,500 physicians was disease and their attitudes, drawn from the Epocrates Honors Panel opinions, and practices (a verified panel of 142,000 physicians). regarding the counseling and Physicians were screened to include only those who have been practicing medicine treatment of their patients. in the United States for at least three years and actively see patients . 1 1/15/2016 RESULTS: DISSCUSION: Forty-eight percent of invited physicians responded to the survey. The respondent sample was very similar to published statistics regarding American physicians (e.g., race, ethnicity, Findings from this research reveal a need and gender). and an opportunity to better educate Only 51 percent of physicians believe they have adequate knowledge to advise their patients on vision health. primary care physicians with regard to Further, only 58 percent believe they can identify patients at eye health and disease including how to higher risk for eye disease. recognize patients at higher risk of Conversely, nearly all physicians who treat patients with blindness and how to best counsel and diabetes more frequently discuss eye health and disease with refer their patients to seek Eye Care . their patients, counsel their patients regarding the complications that diabetes presents for eye health and disease, and encourage regular eye examinations. EYECARE REVIEW PART I LEARNING OBJECTIVES Identify and recognize the various Anatomy and Structures of the Eye Know the refractive conditions of the Eye Understand causes of Crossed Eyes, recognize the many causes of Amblyopia and treatment options for these conditions INTERESTING FACTS ABOUT THE EYE The eye is the second most complex organ in our body The cornea is avascular The eye muscles are the strongest and most active in the body Seeing is such a big part of everyday life it takes about half of the brain to get involved The eye requires no rest, at their A-game 24/7 We blink about 25,000 times a day Your eyes are about 1 inch across and weigh about 0.25 0unce 2 1/15/2016 LIDS Lashes—protection from foreign material Glands—lubricate anterior surface Meibomian glands Glands of Zeis Glands of Moll TEAR FILM & LACRIMAL SYSTEM 3 1/15/2016 CONJINTIVA Thin, transparent, vascular layer lining Backs of eyelids Fornices Anterior sclera CORNEA Composed of regularly oriented collagen fibers 5 layers Avascular Thickness of a human hair. 4 1/15/2016 ANTERIOR / POSTERIOR Sclera CHAMBER Tough outer shell Composed of collagen bundles Protects from penetration Two main function IRIS PUPIL Iris gives eye Allows light to enter clues to systemic health Eye Colors WW Enables view to back 2 muscles: of eye and eye health evaluation Dilator—opens Sphincter— Effects to drugs constricts LENS Located behind iris Focuses light on retina Allows for accommodation Normally transparent Where cataracts form 5 1/15/2016 CILIARY BODY VITREOUS HUMOR Primary functions Gel-like fluid that fills back cavity Pulls on lens for accommodation Serves as support structure for blood Epithelium secretes vessels while eye aqueous fluid that formed—before birth fills anterior After birth, just chamber ‘hangs out’ in there Where floaters are located FUNDUS OPTIC NERVE HEAD Collection of nerve Interior surface fibers and blood of eye vessels from retina Transfers info to Includes brain’s visual cortex Optic nerve Slightly yellow-pink when healthy Retina White ‘full moon’ appearance can Vasculature mean trouble! OPTIC NERVE HEAD RETINA Ten Layers Cup is natural depression in center of Dense collection of nerve three types of photoreceptors Cup size varies between people Fine detail and color vision located in Very large cup, or Fovea change in appearance over time, can indicate Macular degeneration glaucoma affects this area OCT makes the invisible, visible 6 1/15/2016 PERIPHERAL RETINA Can only be evaluated with dilated pupil Important to evaluate periodically to fully assess eye health VASCULATURE OPTICS REVIEW Include arteries and veins Myopia Hyperopia Only place in body where you can directly visualize Astigmatism Prebyopia blood vessels Excellent indicators of systemic diseases HTN Diabetes High cholesterol Carotid disease MYOPIA HYPEROPIA Farsightedness Nearsightedness See well in distance See well up close Eye is too short but blurry in distance Focus point is Eye is too long behind retina Light focuses in front of retina 7 1/15/2016 ASTIGMATISM PRESBYOPIA Surface of cornea is irregular or Normal, age-related misshapen change Light focuses at Near vision becomes various points difficult causing Mid-40s lens becomes distorted vision less elastic and loses Often combined ability to change focus with Time for bifocals…Nah, nearsightedness and Progressive Lenses. farsightedness CROSSED EYES & AMBLYPOIA CROSSED EYES - STRABISMUS ESOTROPIA Usually an early childhood vision disorder which the child “won’t out grow”. May Lead to severe complications if left untreated, poor self esteem and developing Lazy eye. 3 Kinds of Strabismus Esotropia Exotropia Hyper/Hypo-tropia 8 1/15/2016 THREE TYPES OF ESOTROPIA IF YOU SEE ESOTROPIA Refer to Eyecare 1. Infantile (congenital) Provider for Differential Diagnosis & 2. Accommodative Treatment Sooner the better 3. Partially Accommodative for best chance of good vision EXOTROPIA EXOTROPIA Eye turns outward When intermittent Congenital—present at birth Brain sometimes receives information from Surgery usually needed to re-align both eyes (binocular) Many exotropias are Less chance of amblyopia intermittent May occur when patient is tired or not However, important to be seen by eyecare paying attention provider when deviation noted Concentration can force eyes to re-align Vision therapy and/or glasses with prism can help HYPERTROPIA TYPES One eye vertically misaligned Congenital Usually from paresis Most common type of an extra-ocular muscle Patients can compensate for Typically much more years by tilting head subtle for patient to describe and provider to Can be discovered by looking at diagnose childhood photos 9 1/15/2016 TYPES LAZY EYE - AMBLYOPIA Acquired Decreased vision uncorrectable Trauma— Extra-ocular muscle ‘trapped’ by orbital fracture by glasses or contacts—not due Vascular infarct— to eye disease Systemic diseases that affect blood supply to nerves can cause temporary nerve palsy For some reason, brain doesn’t Diabetes and HTN most common fully acknowledge images seen Palsies tend to resolve over weeks or months Neurological In rare cases a tumor or aneurysm can cause symptoms LAZY EYE - AMBLYOPIA 1. STRABISMIC AMBLYOPIA One eye deviates from other and sends 3 Types of Amblyopia conflicting information to the brain Brain doesn’t like to see double—so “turns Strabismic off” information from deviated eye Results in under developed visual cortex for Refractive that eye Stimulus deprivation Can usually be reversed or decreased if treated early Need to visit eye care provider ASAP to determine cause and treatment options 2. REFRACTIVE AMBLYOPIA 2. REFRACTIVE AMBLYOPIA Significant difference in Rx between If not caught, one eye won’t learn to eyes see as well as other Commonly one eye more farsighted Vision therapy and glasses are both beneficial Farsighted eye works hard to see clearly—and sometimes gives up Sooner the better Brain relies on info from other eye 10 1/15/2016 BINOCULAR VISION 3. DEPRIVATIONAL AMBLYOPIA DYSFUNTION PANDEMIC Any opacity in visual pathway can About 10% of the population has be devastating to developing visual either some form of Strabismus system or amblyopia. Congenital cataracts In comparison to other ocular Corneal opacities diseases in children, Binocular Ptosis (droopy eyelid) Vision disorders are about 9 X Other media opacities more prevalent. TREATMENT Did you Know? If caught early, treatment can teach the brain how to see better Vision therapy/patching Of the 3-4 million Babies Infantsee.org Glasses born in the US Surgical re-alignment 1 in 20,000 has retinaoblastoma 1 in 25 will develop Strabismus Early Eye Exams are critical! 1 in 30 will develop Amblopia 11.
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