1. A Deeper Look at Sight Threatening Conditions: Glaucoma, Macular Degeneration, and Diabetic Retinopathy Ashley S. Reddell, OD, FCOVD HOACLS 2015

2. 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

3. Housekeeping  I have no financial interests in any of the products I may mention during this presentation.  If you have questions please email me…. areddell@FamilyEyeCareCenterLV.com

4. Glaucoma  Glaucoma Facts  2.2 million Americans have been diagnosed with Glaucoma  Prevalence 3x higher in African-Americans than non- Hispanic 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

5. Types of Glaucoma  Primary Open Angle Glaucoma  Angle Closure Glaucoma  Normal Tension Glaucoma  Ocular Hypertension  Infantile Glaucoma  Etc.

6. Primary Open Angle Glaucoma (POAG)  Mechanism

7. POAG - Signs  Increased Intraocular Pressure (IOP)  Not enough fluid drained  Enlarged cup-to-disc ratio

8.  Very few symptoms the patient will notice  Eventually peripheral field  Ask about driving, clumsiness, tracking a golfball POAG - Symptoms

9. Angle Closure Glaucoma  Mechanism

10. 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

11. 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

12.  Intraocular Pressures  Gonioscopy  Visual Field Test  Pachymetry  Optical Coherence Tomography (OCT)  VEP/ERG Diagnostic Testing

13. 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)

14. 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

15. 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

16. Dry ARMD  Mechanism

17. Wet ARMD  Mechanism

18. 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

19. 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

20. Diagnostic Testing  Visual Acuities  Fundus exam  Optical Coherence Tomography (OCT)  Fluorescein Angiography  Preferential Hyperacuity Perimetry (PHP)  Amsler Grid

21. ARMD Treatment  GOAL: stop progression, damage not reversible  Dry ARMD  Anti-oxidant medications  AREDS II  Wet ARMD  Injections  Laser photocoagulation  Photodynamic Therapy (PDT)

22. 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

23. Stages of Diabetic Retinopathy  Mild Non-proliferative DR  Moderate Non-proliferative DR  Severe Non-proliferative DR  Proliferative DR

24. Diabetic Retinopathy  Mechanism

25. Diabetic Retinopathy - Signs  Blood vessel changes in the eye  Presence of hemorrhages/infarctions in the eye  Reduced VAs

26. Diabetic Retinopathy - Symptoms  Variable vision  Blurred vision  Floaters/spots in vision  Or NONE

27. Diagnostic Testing  Fundus examination  Visual acuities  Fluorescein Angiography  Optical Coherence Tomography (OCT)

28. 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

29. Questions  areddell@FamilyEyeCareCenterLV.com