1. Gradual loss of sight David.Kinshuck@goodhope.nhs.uk
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The talk is prepared for the UK.
It is designed to be interactive.

2. 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.

3. 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)

4. 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

5. Chronic glaucoma

6. Chronic glaucoma: what is happening
Or poor blood supply here
Either: the drain blocks here
Damages the optic nerve..looks ‘caved in’, called ‘cupped’

7. Characteristic pattern of loss of visual field
Rim of optic nerve becomes thinner as disc caves in and becomes more cupped

8. Types of glaucoma Congenital Secondary Juvenile Chronic open angle
Acute closed angle
Many different types

9. 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

10. Chronic glaucoma Painless, common in elderly
Don’t notice anything wrong
detected by optometrist
Screening vital
field, pressure, disc

11. Glaucoma damage

12. Glaucoma tonometry (pressure test)

13. 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

14. 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

15. Macular degeneration
Pathogenesis online (small) folder
Effect

16. 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)

17. 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

18. Macular degeneration

19. Retinitis pigmentosa/miscellaneous
Many other disease causing gradual loss of sight;
Retinal
Eg retinitis pigmentosa
Optic atrophy
Eg pernicious anaemia

20. Macular hole

21. Retinitis pigmentosa

22. Optic Atrophy

23. 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

24. 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