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

2. 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

3. 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

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

5. Loss of central vision

6. Loss of peripheral vision

7. Contrast sensitivity and light & dark adaptation problems

8. Contrast sensitivity and light & dark adaptation problems

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

10. Flashes of light/ photopsia

11. Floaters

12. Colour vision deficiency

13. Field loss

14. Scotoma
Negative Scotoma
Positive Scotoma

16. Swollen optic disc

17. Pale optic disc

18. Cupped optic disc

22. ?
RAPD

26. 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

27. 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

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

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

32. RRD
RD secondary to a break in the retina

35. 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

36. 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

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

38. Clinical examination –signs
Direct Ophthalmoscopy

39. Indirect Ophthalmoscopy

40. Normal fundus

41. Retinal detachment with tear

42. RD

43. NRD
Exudative RD

44. Exudative RD

45. Tractional RD

46. Tractional RD

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

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

54. Announcements HW
Three common causes of exudative retinal detachment