Download A Deeper Look at Sight Threatening Conditions: Glaucoma, Macular

Survey
yes no Was this document useful for you?
   Thank you for your participation!

* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project

Document related concepts

Gene therapy of the human retina wikipedia, lookup

Computer-aided diagnosis wikipedia, lookup

Transcript
A Deeper Look at Sight Threatening
Conditions: Glaucoma, Macular
Degeneration, and Diabetic Retinopathy
Ashley S. Reddell, OD, FCOVD
HOACLS 2015
About Me
From Haysville, KS
Graduated from KU…..Rock Chalk!
Graduated from Southern College of Optometry
Completed pediatric residency at SCO
Joined a private practice in Leavenworth in
2010
Now have 3 locations, 5 ODs, and ~28 staff
Housekeeping
I have no financial interests in any of the
products I may mention during this presentation.
If you have questions please email me….
[email protected]
Glaucoma
 Glaucoma Facts
2.2 million Americans have been diagnosed with
Glaucoma
Prevalence 3x higher in African-Americans than nonHispanic Caucasians
Our screening and diagnostic techniques have vastly
improved over the last decade
People with a family history of glaucoma are 3-10x
more likely to develop glaucoma
Types of Glaucoma
 Primary Open Angle Glaucoma
 Angle Closure Glaucoma
 Normal Tension Glaucoma
 Ocular Hypertension
 Infantile Glaucoma
 Etc.
Primary Open Angle Glaucoma
(POAG)
 Mechanism
POAG - Signs
 Increased Intraocular Pressure (IOP)
Not enough fluid drained
 Enlarged cup-to-disc ratio
POAG - Symptoms
 Very few symptoms the patient will notice
 Eventually peripheral field
Ask about driving, clumsiness, tracking a golfball
Angle Closure Glaucoma
 Mechanism
Angle Closure Signs/Symptoms
 Feeling of pain/pressure
 Red eye
 Photophobia
 Headache/nausea/vomiting
 Often coming from a setting where pupil would be
mid-dilated (i.e. movie theatre)
 Emergency situation!!!! IOPs typically above 40
Other Glaucoma Types
 Normal Tension Glaucoma
ONH changes with normal IOPs
 Ocular Hypertension
IOPs are high, however no changes/damage to optic
nerve
 Infantile Glaucoma
Critical to educate parents
Diagnostic Testing
 Intraocular Pressures
 Gonioscopy
 Visual Field Test
 Pachymetry
 Optical Coherence Tomography (OCT)
 VEP/ERG
Glaucoma Treatment
 Goal: Stop Progression
 Medications
Goal is to reduce aqueous production or increase
outflow to reduce pressures
Prostaglandins, Beta Blockers, CAIs, Alpha Agonists
 Surgeries
Goal to increase outflow
Laser Surgeries (ALT/SLT)
Conventional Surgeries (Filtering Microsurgery)
Age Related Macular Degeneration
 ARMD Facts
Disease is most likely to occur after age 60
Smoking doubles the risk for developing ARMD
Family history of ARMD increases your risk of having it
ARMD is more common among Caucasians/Females
Types of ARMD
 Dry ARMD
More common type (80-90%)
Less severe
Aka. Non-neovascular
 Wet ARMD
More severe
Aka. Neovascular type
Leads to vision loss
Dry ARMD
 Mechanism
Wet ARMD
 Mechanism
ARMD - Signs
 Reduced central vision
Watch the patient on VAs!!!!!!!
Will often move/turn their head
May miss letters at center of line
 Presence of drusen
ARMD - Symptoms
 Blurred/distorted central vision
 Lines appear wavy or missing
 Watch for turning head or skipping central letters on
VAs
 Need more light for close work
 Difficulty seeing faces
Diagnostic Testing
 Visual Acuities
 Fundus exam
 Optical Coherence Tomography (OCT)
 Fluorescein Angiography
 Preferential Hyperacuity Perimetry
(PHP)
 Amsler Grid
ARMD Treatment
 GOAL: stop progression, damage not reversible
 Dry ARMD
Anti-oxidant medications
AREDS II
 Wet ARMD
Injections
Laser photocoagulation
Photodynamic Therapy (PDT)
Diabetic Retinopathy
 Diabetic Retinopathy Facts
The longer someone has DM the more likely they are
to have retinopathy
Between 40-45% of Americans diagnosed with
diabetes have some form of retinopathy
Better control of blood sugar levels slows onset and
progression of diabetic retinopathy
Leading cause of blindness in American adults
Stages of Diabetic Retinopathy
 Mild Non-proliferative DR
 Moderate Non-proliferative DR
 Severe Non-proliferative DR
 Proliferative DR
Diabetic Retinopathy
 Mechanism
Diabetic Retinopathy - Signs
 Blood vessel changes in the eye
 Presence of hemorrhages/infarctions in the eye
 Reduced VAs
Diabetic Retinopathy - Symptoms
 Variable vision
 Blurred vision
 Floaters/spots in vision
 Or NONE
Diagnostic Testing
 Fundus examination
 Visual acuities
 Fluorescein Angiography
 Optical Coherence Tomography (OCT)
Diabetic Retinopathy - Treatment
 Goal: Some bleeding/signs are reversible.
Important to get ahold of systemic condition as
soon as changes noted.
 Tx of underlying condition
 Monitoring
 Laser Surgery
 Injections
 Communication with PCPs and endocrinologists
Questions
[email protected]