Presentation is loading. Please wait.

Presentation is loading. Please wait.

Medical Retina and Macular Diseases Dr. Timothy Y. Y. Lai MBBS, MMedSc, MRCSEd, FCOphthHK, FHKAM(Ophth) Department of Ophthalmology and Visual Sciences.

Similar presentations

Presentation on theme: "Medical Retina and Macular Diseases Dr. Timothy Y. Y. Lai MBBS, MMedSc, MRCSEd, FCOphthHK, FHKAM(Ophth) Department of Ophthalmology and Visual Sciences."— Presentation transcript:

1 Medical Retina and Macular Diseases Dr. Timothy Y. Y. Lai MBBS, MMedSc, MRCSEd, FCOphthHK, FHKAM(Ophth) Department of Ophthalmology and Visual Sciences The Chinese University of Hong Kong

2 Medical Retina A specialty that deals with the investigation and non-surgical treatment of retinal disorders Retinal diseases associated with systemic diseases –Diabetic Retinopathy –Hypertensive Retinopathy Vascular retinopathies Medical macular diseases –Age-related Macular Degeneration

3 Retinal Diseases Associated with Systemic Diseases

4 Diabetic Retinopathy One of the leading causes of blindness Risk factors –Duration of diabetes 80% of type I and 70% of type II diabetics have retinopathy after 15 yrs –Type of diabetes mellitus –Control of hyperglycemia –Hypertension –Associated renal disease –Pregnancy

5 Diabetic Retinopathy Classification –Non-proliferative (NPDR) Mild Moderate Severe –Proliferative (PDR)

6 Pathogenesis –Microvascular disease causing capillary damage –Leakage of blood constituents into the retina Retinal hemorrhages Retinal edema Lipid exudation Non-proliferative Diabetic Retinopathy (NPDR)

7 Dot and blot hemorrhage Hard exudate Cotton-wool spots Venous beading Venous loops

8 Non-proliferative Diabetic Retinopathy (NPDR)

9 Progression from NPDR to PDR StageProgression to PDR in 1 year Mild NPDR <5% Moderate NPDR 20% Severe NPDR 50%

10 Proliferative Diabetic Retinopathy (PDR) Pathogenesis –Retinal ischemia causing neovascularization May be asymptomatic if only neovascularization without hemorrhage

11 Neovascularization at Disc (NVD) Neovascularization elsewhere (NVE)

12 Causes of Visual Loss in DR Macular Edema Complications of PDR –Vitreous hemorrhage –Fibrous tissue proliferation –Retinal detachment

13 Microaneurysms Circinate exudate Retinal edema

14 Vitreous HemorrhageTractional Retinal Detachment Combined Retinal Detachment

15 Diabetic Retinopathy Treatment –Laser photocoagulation Focal or grid: for macular edema Pan-retinal photocoagulation: for PDR –Control of systemic disease Hyperglycemia Hypertension Renal disease –Vitreous surgery

16 Laser Photocoagulation Outpatient procedure Topical Anesthesia Multiple Sessions In PDR, laser should be performed before vitreous hemorrhage and retinal detachment develops

17 Diabetic Retinopathy Early identification of the disease and prompt referral to the ophthalmologist Dilate your patients for examination with ophthalmoscope regularly Prompt treatment reduces risk of visual loss by 50% Patients may be asymptomatic but still have advanced PDR

18 Hypertensive Retinopathy Focal or generalized narrowing of retinal arteries associated with hypertension Clinical features –Cotton-wool spots –Hard exudates –Macular star –Macular edema –Retinal hemorrhage –Optic disc swelling

19 Hypertensive Retinopathy GradeOphthalmoscopy Features 1Mild arteriolar narrowing (copper-wiring) 2Marked arteriolar narrowing with deflection of veins at AV crossing (silver wiring and AV nipping) 32 + Flame-shaped hemorrhage, cotton- wool spots Disc swelling


21 Severe Hypertensive Retinopathy Macular starDisc swelling

22 Hypertensive Retinopathy Management –Rule out secondary hypertension –Control of hypertension

23 Vascular Retinopathies

24 Retinal Vascular Occlusions Venous occlusion more common than arterial occlusion Pathogenesis –Arterial occlusion – embolus Central retinal artery occlusion (CRAO) Branch retinal artery occlusion (BRAO) –Venous occlusion – abnormal blood flow Central Retinal Vein Occlusion (CRVO) Branch Retinal Vein Occlusion (BRVO)

25 Retinal Arterial Occlusions Symptoms –Sudden, painless, marked loss of vision –Immediate treatment within hours may be beneficial in some patients Systemic Associations –Cardiovascular disease –Carotid artery disease –Temporal arteritis / inflammatory arteritis –Coagulopathies

26 Central Retinal Artery Occlusion Branch Retinal Artery Occlusion Afferent Pupillary Defect Cherry Red Spot Retinal Edema

27 Retinal Venous Occlusions Symptoms –Sudden painless loss of vision –Various extent of visual loss Systemic Associations –Diabetes Mellitus –Hypertension –Hematological diseases –Vasculitis

28 Central Retinal Vein Occlusion Branch Retinal Vein Occlusion

29 Macular edema Neovascular glaucoma Laser photocoagulation

30 Macular Diseases

31 Where is the macula? Retina Choroid Sclera Cornea Lens Iris Cilliary body Optic nerve Macula

32 Fovea Macula

33 Macular Diseases Common surgical macular diseases –Macular hole –Epiretinal membrane Common medical macular diseases –Age-related macular degeneration (AMD) –Myopic maculopathy –Central serous chorioretinopathy (CSC)

34 Age-related Macular Degeneration (AMD) Leading cause of severe vision loss in people > 50 years in the western world Visual loss due to drusens / RPE degeneration or development choroidal neovascularization (CNV)

35 Age-related Macular Degeneration (AMD) Two forms –Dry (non-neovascular) AMD (80% to 90%) –Wet (neovascular) AMD (10% to 20%) 90% of vision loss is caused by wet form of AMD

36 Decrease in color and contrast sensitivity Symptoms of AMD – Early

37 Impairment of central visual function Symptoms of AMD – Intermediate

38 Metamorphopsia, distortion of central image Symptoms of AMD – Intermediate

39 Central Scotoma Symptoms of AMD – Late

40 Bruch s Membrane DrusenDrusen Hallmark of AMD Development of Drusen

41 Early Dry AMD Asymptomatic Examination reveals several small drusen or a few medium-sized drusen ( m)

42 Intermediate Dry AMD Many medium- sized drusen or 1 large drusen (>125 m) Vision may be impaired

43 Advanced Dry AMD More severe visual impairment Presence of drusen with degeneration of RPE Geographic atrophy

44 Choroidal Neovascularization Dry AMD Wet AMD Formation of New Vessels

45 Diagnosis Vision function testing –Visual acuity –Amsler grid Ophthalmolscopy Fluorescein angiography

46 Amsler Grid Adequate lighting Wear reading glasses Hold the Amsler grid at normal reading distance (about 30cm) Cover one eye at a time Stare at the center dot Ask the following questions: Are any of the lines wavy, missing, blurry, or discolored? Are any of the boxes different in size or shape from the others? Early Diagnosis 5mm squares 10 cm x 10 cm

47 Self monitoring with Amsler Grid Normal Abnormal

48 Intravenous injection Uptake of fluorescein dye at the site of abnormal vessels - Size, Location, Activity Fluorescein angiography

49 Management of AMD Treatment for neovascular AMD –Laser photocoagulation –Submacular surgery –Photodynamic therapy (PDT) with Verteporfin –Anti-angiogenesis therapy (Anti-VEGF) Prevent progression to advanced AMD –Antioxidants –Quit smoking Low-vision aids

50 Laser Photocoagulation Non-selective thermal laser photocoagulation –Destroy CNV –Irreversible damage to the overlying retina and RPE –Side effects of immediate scotoma or drop in central vision –CNV persist or recur in 50% of patients

51 Step 1: Infusion Step 2: Nonthermal Laser Application PDT with Verteporfin

52 Mechanisms of action Chain of reactions vessel thrombosis Non-thermal Laser Drug infusion 1 2

53 .

54 High dose AREDS supplements Beta-carotene Vitamin A Vitamin C Vitamin E Zinc Copper Decrease risk of progression from dry to wet AMD

55 Most important risk factors for AMD Smokers have 300% to 400% more risk in developing AMD than non-smokers Even passive smoking increase the risk of AMD by 30% to 40% Smoking and AMD

56 Prevention is better than cure Increasing prevalence of AMD due to aging and western life-style Recognize and correct risk factors –Quit smoking –Healthy diet Self screening test in high-risk group Regular dilated fundus examination to evaluate AMD findings Early diagnosis is the key to save vision

57 Thank You

Download ppt "Medical Retina and Macular Diseases Dr. Timothy Y. Y. Lai MBBS, MMedSc, MRCSEd, FCOphthHK, FHKAM(Ophth) Department of Ophthalmology and Visual Sciences."

Similar presentations

Ads by Google