Gradual loss of sight David.Kinshuck@goodhope.nhs.uk This talk relies on files accessible on line. If you want to load the entire talk onto a lap top not online, load the files below and place them in the same folder as the talk. As you give the talk, click on the appropriate link. The talk is prepared for the UK. It is designed to be interactive.
What conditions are we talking about? In pairs, in 1-2 minutes, write down the names of the conditions you think are relevant. Next, try and put them in order of frequency. Next, try and think of the ages they apply to.
Conditions causing gradual loss of sight Cataracts………………… Glaucoma……………….. Macular degeneration…. Diabetic retinopathy……. 100s of other conditions.. eg retinitis pigmentosa elderly, injury, steroids elderly (babies rarely) elderly after adolescence any age (Diabetic retinopathy: later)
Surgery online tiny folder Cataracts Examination technique: See ‘chronic eye problems’ > > top right ‘?’ online 1.7mb folder Symptoms Glare Difficulty seeing faces Misty vision Refraction changes (need new specs often) Cataract is a cloudy lens Surgery online tiny folder
Chronic glaucoma
Chronic glaucoma: what is happening Or poor blood supply here Either: the drain blocks here Damages the optic nerve..looks ‘caved in’, called ‘cupped’
Characteristic pattern of loss of visual field Rim of optic nerve becomes thinner as disc caves in and becomes more cupped
Types of glaucoma Congenital Secondary Juvenile Chronic open angle Acute closed angle Many different types
Acute glaucoma Emergency Can be more gradual Red eye Achy, abdominal pain Misty vision Go from light into dark Small eye, shallow anterior chamber, pupil mid dilated, Iris lens contact Push the iris forward Eye feels hard
Chronic glaucoma Painless, common in elderly Don’t notice anything wrong detected by optometrist Screening vital field, pressure, disc
Glaucoma damage
Glaucoma tonometry (pressure test)
Glaucoma epidemiolgy Genes, genes (trauma, other eye disease, steroids) Congenital rare but important Familial Afro-caribbean Optic disc size…large optic discs are weaker Damaged discs need a lower pressure Screen, screen, screen..optometrists, not GPs Target pressure
Glaucoma drops Timolol, teoptic, and other beta blockers Reduce production of aqueous, increase drainage Carbonic anhydrase inhibitors (eg azopt) Reduce production of aqueous Xalatan and other prostaglandin inhibitors) increase drainage++ Carbonic anhydrase tablets…acetazolamide Reduce production of aqueous++++++++ And CSF/electrolyte changes….feels ill etc
Macular degeneration Pathogenesis online (small) folder Effect
Macular degeneration Pathogenesis online (small) folder Effect Case online 400kb folder Epidemiology Smoking 29% UK, increase risk 2-3x, brings it 10 years earlier 25-50% genes 25% or more UK blindness High blood pressure, salt, alcohol Saturated fat, (& related) diet Rare in rural china 1970s rare in Japan, now commoner Data linking with cholesterol Vegetables/fruit…. 9 portions day (men) 7 (women) 5 (children)
Macular degeneration 100,000 blind people in the UK Major impact: 64,000 blind from ARMD 770,000 have early ARMD 84:16 female:male ratio Major impact: falls...x8 risk of fractured hip, x4 risk of needing home care each line of vision represents about 20% 'quality of life' persons own self-esteem soft drusen progressing
Macular degeneration
Retinitis pigmentosa/miscellaneous Many other disease causing gradual loss of sight; Retinal Eg retinitis pigmentosa Optic atrophy Eg pernicious anaemia
Macular hole
Retinitis pigmentosa
Optic Atrophy
Coping with poor sight In pairs, 1-2 minute, think of the difficulties Then, 1 minute specifically Getting dressed, washed, toilet Reading TV Radio Walking Bus Train Mental health
Coping with poor sight Contrast, felt pens, Magnification…for reading mainly Falls…prevent in the home Social services/blind registration Low vision rehabilitation programs Counselling (50% depressed) Coping Learning new skill, eg computers Coping at work Talking books contrast