Ophthalmology. Juliette Stenz, MD

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1 Ophthalmology Juliette Stenz, MD

2 Required Slide Disclosures NO SIGNIFICANT FINANCIAL, GENERAL, OR OBLIGATION INTERESTS TO REPORT

3 Required Slide At the end of this session, students will be able to: 1. Optics 1. Explain how converging and diverging lenses work and how they are relevant to the eye 2. Explain the pathology, evaluation, and treatment of common or sight threatening conditions affecting the cornea, lens, and retina 2. Blood Supply 1. Explain the blood supply of the eye 2. Explain the pathology, evaluation, and treatment of common or sight threatening conditions affecting the retinal veins and arteries 3. Fluidics Session Objectives 1. Explain how aqueous is formed and drains from the eye 2. Explain the pathology, evaluation, and treatment of open and closed angle glaucoma

4 Optics: Convex Lens Convex Lens Causes light to converge Images are magnified D = 1/f D = Diopters f = focal length (meters) +4 D lens has a focal length of 0.25 m (25 cm) +10 lens has a focal length of 0.1 m (10 cm)

5 Optics: Concave Lens Concave lens Causes light to diverge Images are minified D = 1/f D = Diopters f = focal length (meters) -4 D lens has a focal length of 0.25 m (25 cm) -10 lens has a focal length of 0.1 m (10 cm)

6 Question??? Which lens will start a fire?

7 Question Concave or Convex lenses?

8 Optics Light rays are refracted, by the Cornea and Lens The resulting image is focused on the retina The Iris regulates how much light enters the eye

$refracting power Light rays are further bent so that near objects are in focus on the$

9 Accommodation When focusing on a near object, the lens changes shape to increase in refracting power Light rays are further bent so that near objects are in focus on the retina

10 Myopia AKA nearsighted Images are in focus in front of the retina Corrective lenses are concave, causing light to diverge

11 Hyperopia AKA farsighted Images are in focus behind the retina Corrective lenses are convex, causing light to converge, magnifying images

12 Presbyopia In presbyopia, the lens does not change shape as well when focusing on near objects Reading glasses correct presbyopia

13 Astigmatism Cornea is shaped like a football rather than a soccer ball 2 images are formed in different planes Corrected with cylindrical lenses

14 Myopic or Hyperopic?

15 Myopic or Hyperopic?

16 Corneal Ulcer Sight threatening infection of the cornea May be caused by bacteria, virus, or fungus Risk Factors include contact lens wear, epithelial defects Assess with culture Treat with antibiotics/antifungals/an tiviral

17 Cataract Cloudy lens The most common cause of preventable blindness in the world Treated with cataract surgery

18 Macular Degeneration Most common cause of vision loss in Americans > 60 Dry Macular Degeneration AREDS, smoking cessation, Amsler Wet Macular degeneration Anti VEGF (vascular endothelial Growth factor)

19 Required Slide Session Objectives At the end of this session, students will be able to: 1. Optics 1. Explain how converging and diverging lenses work and how they are relevant to the eye 2. Explain the pathology, evaluation, and treatment of common or sight threatening conditions affecting the cornea, lens, and retina 2. Blood Supply 1. Explain the blood supply of the eye 2. Explain the pathology, evaluation, and treatment of common or sight threatening conditions affecting the retinal veins and arteries 3. Fluidics 1. Explain how aqueous is formed and drains from the eye 2. Explain the pathology, evaluation, and treatment of open and closed angle glaucoma

20 Circulation Inner 2/3 of retina are supplied by Retinal Artery Tight junctions form blood retinal barrier Outer 1/3 of retina is supplies by choroid, from posterior ciliary arteries

21 Central Retinal Artery Occlusion Painless, sudden onset of vision loss in one eye Edema causes whitening of retina and cherry red spot where choroid is visible in foveola Evaluate for emboli, GCA, hypercoagulable state Carotid Doppler 2-d echo CBC

of painless monocular blurred vision Treat with with intravitreal anti-vegf

22 Central Retinal Vein Occlusion Thrombosis of Central Retinal Vein Risk factors: Age, Diabetes, Glaucoma, Hypertension, Dyslipidemia Sudden onset of painless monocular blurred vision Treat with with intravitreal anti-vegf agents, intravitreal steroid, laser, or vitrectomy May develop neovascular glaucoma

nonproliferative diabetic retinopathy Diabetic

23 Diabetic Retinopathy Most common cause of vision loss among working age adults Background or nonproliferative diabetic retinopathy Diabetic macular edema Proliferative Diabetic Retinopathy, neovascular glaucoma

24 Retinal Detachment Rhegmatogenous From a hole or tear in the retina Tractional Caused by neovascularization Serous Caused by a tumor or systemic disease

25 Required Slide Session Objectives At the end of this session, students will be able to: 1. Optics 1. Explain how converging and diverging lenses work and how they are relevant to the eye 2. Explain the pathology, evaluation, and treatment of common or sight threatening conditions affecting the cornea, lens, and retina 2. Blood Supply 1. Explain the blood supply of the eye 2. Explain the pathology, evaluation, and treatment of common or sight threatening conditions affecting the retinal veins and arteries 3. Fluidics 1. Explain how aqueous is formed and drains from the eye 2. Explain the pathology, evaluation, and treatment of open and closed angle glaucoma

26 Fluidics

27 Glaucoma Optic Neuropathy Open Angle Closed Angle

28 Closed Angle Glaucoma Less common than open angle glaucoma in US, but acutely vision threatening Treatment: cataract removal or laser iridotomy If angle closure is secondary to a tumor or abnormal blood vessels the underlying cause must be addressed.

29 Open Angle Glaucoma Glaucoma is second leading cause of blindness in world Optic neuropathy affecting peripheral vision first and then central vision Treated with lowering pressure in eyes

30 Glaucoma Medications Alpha agonists Beta Blockers Carbonic Anhydrase Inhibitors Prostaglandin Analogs

31 Uveitis Inflammation of the uveal tract: Iris, ciliary body, choroid Anterior, Intermediate, Posterior, or panuveitis Acute or Chronic Infectious, Autoimmune, or Masquerade (malignancy)

32 Iritis Idiopathic (~50%) Infectious HSV, Endophthalmitis Autoimmune HLA-B27, Behcet s, Sarcoidosis, JIA Lens Related Treatment Steroid Cycloplegic Treat underlying cause

33 Intermediate Uveitis Pars Planitis (>70%) Infectious Lyme Disease, syphillis, toxocariasis, Endophthalmitis Autoimmune Multiple Sclerosis, Sarcoidosis **Lymphoma**

34 Chorioretinitis Infectious HSV, VZV, CMV Fungal Autoimmune White Dot Syndrome Vasculitis

35 Panuveitis Infectious Syphillis, Tuberculosis, endophthalmitis Autoimmune Sarcoidosis, VKH, Behcet s, Sympathetic Ophthalmia, Lens induced

36 Which Eye Disease? Glaucoma Cataract Macular Degeneration

37 Which Eye Disease? Glaucoma Cataract Macular Degeneration

38 Which Eye Disease? Glaucoma Cataract Macular Degeneration

39 Further Reading dex.htm

40 Images d_physiology_of_animals_how_light_travels_from_the _object_to_the_retina_of_the_eye.jpg _9.9.png _(Eye).png, Bruce Blaus ng, Bruce Blaus commons.wikimedia.org/wiki1/file:celulitis_ojo_izq.jpg

41 Thank You!

Scrub In. What is the function of vitreous humor? What does the pupil do when exposed to bright light? a. Maintain eye shape and provide color vision

Scrub In. What is the function of vitreous humor? What does the pupil do when exposed to bright light? a. Maintain eye shape and provide color vision Scrub In What is the function of vitreous humor? a. Maintain eye shape and provide color vision b. Maintain eye shape and refract light rays c. Provide night vision and color vision d. Provide night vision