VR Disorders Common Clinical Presentation & Retinal Detachment (RD) Ayesha S Abdullah 31.12.2015

Learning outcomes By the end of this lecture the students would be able to; Identify the common symptoms and signs of VR disorders (VRD) and correlate them with the underlying problem Define retinal detachment, describe its epidemiology, identify symptoms and signs of retinal detachment and outline the principles of treatment

Common Presenting Symptoms in VRD Visual loss, mostly painless, sudden/ gradual Loss of central vision Loss of peripheral vision Loss of visual field Loss of colour vision Distorted vision; metamorphopsia, micropsia, macropsia

Common Presenting Symptoms in VRD Loss of contrast sensitivity Glare sensitivity Night blindness Photopsia/ flashes Floaters ;  'specks', 'flies', 'spiders' and, ‘cobweb‘, ‘mosquitoes’.

Loss of central vision http://www.retina-international.org/

Loss of peripheral vision http://www.retina-international.org/

Contrast sensitivity and light & dark adaptation problems

Contrast sensitivity and light & dark adaptation problems

Glare particular shades of reds and greens (most common) or blues and yellows (less common).

Flashes of light/ photopsia

Floaters

Colour vision deficiency http://www.achromatopsia.info/childrens-vision/

Field loss

Scotoma Negative Scotoma Positive Scotoma

Swollen optic disc

Pale optic disc

Cupped optic disc

? RAPD

RNC Definitions What is Retinal Detachment? Rhegmatogenous RD (RRD) Separation of the neurosensory retina from the retinal pigment epithelium Types Rhegmatogenous RD (RRD) Non- rhegmatogenous RD (NRD) Exudative RD Tractional RD Combined Tractional Rhegmatogenous RNC

Definitions RRD: RD secondary to a retinal break NRD: RD without a retinal break Exudative RD: RD where the detachment is secondary to fluid that leaks from the vessels of the retina/ choroid Tractional RD: RD due to retinal fibrosis and traction

Epidemiology 1 in 10,000/ year Bilateral in about 10% Risk factors? An ophthalmic emergency

RRD Some Anatomical Considerations Vitreo-retinal adhesions disc, ora, blood vessels & at fovea Potential subretinal space

RRD RD secondary to a break in the retina

Causes & risk factors PVD Lattice degeneration, 8% in general population, 40% in eyes with RD Myopia Post- Cataract surgery (pseudophakia) Trauma PVD In 15% of cases with Posterior vitreous detachment (PVD) a tear develops in the retina Lattice degeneration 60% of tears develop in peripheral retina with retinal degenerations like Lattice degeneration Myopia 40% of the RD occur in myopic eyes; the higher the error the greater the risk Post- Cataract surgery (pseudophakia) especially in eyes with retinal degeneration and myopia can develop retinal tears and RRD

Clinical presentation –symptoms Flashes of light Floaters Visual loss Visual field loss Usually an acute event History of predisposing factors, myopia, cataract surgery, trauma etc

Clinical examination –signs Reduced Visual acuity Anterior segment examination Pupils, (RAPD) Posterior segment examination Vitreous- tobacco dust Retinal signs IOP ( may be low)

Clinical examination –signs Direct Ophthalmoscopy

Indirect Ophthalmoscopy

Normal fundus

Retinal detachment with tear

RD

NRD Exudative RD

Exudative RD

Tractional RD

Tractional RD

Principles of management Identify & Seal the break Drain the SRF (subretinal fluid)-if required Apply temponade External temponade/ scleral buckling Internal temponade IDeA

Prophylaxis of RRD Photocoagulation of the risky lesions with laser So patients with risk factors should be referred to an ophthalmologist

Announcements HW Three common causes of exudative retinal detachment