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Ocular Pathology I
6234_16385
Rm HBSB 203-E
1:00-3:00pm
Tonya G. Ketcham, OD, PhD
[email protected]
3-1799, RM 2113
Course Syllabus
Course Description
• To describe “normal” anomalies and
“pathologic” abnormalities of the orbit
and eye
• To describe ocular pathologies and
ocular diseases (in general terms)
– Symptoms and signs
• Clinical diagnostic process
Course Objectives
• To become familiar with observable
“differences” (some normal and some
abnormal) seen in the orbit and eye
• To identify various presentations of ocular
signs and symptoms
• To identify a pathological condition and to
understand the pathophysiology of the
disease (in general terms)
• To introduce the concept of evidence-based
medicine
Blackboard Learn
• Expected to sign up for and be able to
access
• Grades posted here
• Supplemental lectures and materials
• NOTE
– Lectures also on “intranet” page
Examinations
• Two two-hour examinations: during test weeks
– Consist of best answer multiple choice with slide
recognition and [each] will be comprehensive.
• The “final” will be 3 hours: during finals week.
– Best answer multiple choice with slid recognition
and an additional section of best answer multiple
choice “National Boards Questions”.
• Comment on
– Missing examinations
– Viewing examinations
Quizzes
• Unannounced at any time during the
semester
• Computer-based (VISTA)
– Lecture material
– Additional material posted with quiz
• 10 points each and no more than 5 in
the semester
Homework Assignments
• Announced in lecture
• Blackboard
Grades
• Performance based
• To pass class MUST earn enough
points to be within 2 SD of mean
Mean = 45.14 Stdev = 3.24
Suzie = 35
Suzie’s z-score is
(35-45.14)/3.24= -3.19
Suzie’s t-score is
(50+(10*-3.13)) = 18.7
Books
• Spalton, Hitchings, Hunter, Atlas of
Clinical Ophthalmology, 3rd Edition,
Elsevier Mosby, 2005
• Yanoff and Duker, Ophthalmology, 3rd
Edition, Elsevier Mosby, 2009.
• NO longer going to be able to depend
only on lecture material….
– You are going to have to take the initiative
to look things up
– Use reference books…..
My Disclaimer
• Photos used are from various sources
– When I know source I try to give credit
– Some I don’t know source
• Scientific papers are acknowledge by
first authors name and date (at the very
least)
Introduction
What is________?
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Epidemiology
Risk Factors
Pathophysiology
Etiology
Symptoms
Signs
Chief complaint
HPI
Complications
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Pathognomonic
Treatment
Management
Differential Diagnosis
• Diagnostic process
• Evidence-based
medicine
– VS Traditional
medicine
Outline I. clinical terminology
DD to Diagnosis
• History +
APPLYING BASIC
• Evaluation/examination +
KNOWLEDGE OF
GEOMETRIC
• “Additional
OPTICS,
testing/procedures” +
ANATOMY
• Scientific papers and your
PHYSIOLOGY,
BIOCHEMISTRY,
knowledge of these
OCULAR
papers plus your clinical
PATHOLOGY
experience
• Unfortunately, it’s NO longer multiple choice
with 2-3 hours to get “correct” answer !!!!!
History
• Chief Complaint (CC)/Reason for Visit (RFV)
– What brought the patient in to see you
– Usually closely associated with patient’s
symptoms
– As their Doctor you must know as much about the
CC as you can…..
• Questions start very general and then become more
and more specific
– LISTEN
History
• HPI
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Location- OD/OS/OU
Quality- Loss of vision or blur
Context- Sudden or gradual
Severity- mild, moderate, severe
Modifying factors- distance, near, both
Duration- Intermittent, transient, constant
Timing- Short term, long term, months, years
Previous Interventions
Associated Symptoms- HA, nausea, dizziness
• Let’s Practice
– Blurred vision
General HPI Questions
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• Constant vs fluctuation?
• Other ocular symptoms
associated with blurred
vision?
With or without specs?
Distance or near?
Right eye or Left eye?
How long?
Sudden or gradual?
Gotten worse?
• BLURRED VISION
Does anything relieve it?
– PATIENT 1
– PATIENT 2
Ocular Examination
• Last year and this year you are going to
be given a very large arsenal of
procedures/tools
– November there will be a “competency”
• VISUAL ACUITIES
– Unaided
– Aided
– Entering
– BEST
– Pinhole
Best Corrected Visual Acuity
• What is the very, very best that this
patient can see??
– DISTANT MONOCULAR ACUITY
– Pinhole
– Refraction
• Always correct to 20/15 !!!!!
• If the patient whizzes thru the 20/15 line, show
them the 20/10 line
– Big question
• Is the CC refractive (myope, hyperope,
astigmate, presbyope) or pathologic in
nature????
Other “Visual Acuities”
• Contrast Sensitivity
• Color vision
– Monocular
• Visual field
Physical Examination
• Preliminary testing
– Pupils
– EOM
– Confrontation fields
– Photo stress test
– Cover test
– Monocular color vision
– Red-cap test
– Cover test
– Amsler grid
• Metamorphopsia
– Distorted vision
Physical Evaluation
• Slit lamp evaluation
– Undilated
• Can this patient be dilated?
– Dilated
• Stereo view of ONH, macula, posterior pole
– 78D lens, 90D lens, ruby lens
• Peripheral retina views
– BIO, Goldmann 3-mirror, scleral depression
• Intraocular pressure (IOP)
• Direct ophthalmoscope
– Monocular view
– GREAT MAG
• Binocular indirect ophthalmoscope
Physical Examination
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Specular microscopy
Corneal topography
Gonioscopy
Imaging of globe and orbit
– Ophthalmoscopy to CT and MRI
– A and B Ultrasound
– Optical coherence tomography (OCT)
• Electrophysiology
How does any of this start?
• YOU MUST, MUST, MUST FIRST
KNOW “NORMAL”
– We will look at some anomalies of
structures that are “unusual” however
normal
– You must look at as many healthy eyes as
you can with as many of these different
procedures as possible to get to know
“normal”
PATHOLOGY 101
• Refractive Error
– cornea, lens
• Media Opacity
– Tear film, cornea, aqueous humor,
lens, vitreous
• Retina or Optic Nerve Disease
• Neurological Deficit
– Posterior to Optic Nerve {CN II}