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

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]