World Sight Day Case Studies. Mark Frost Screening Manager South East London DESP

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Christopher Woods
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1 World Sight Day 2015 Case Studies Mark Frost Screening Manager South East London DESP

2 Introduction All of the following cases have been identified in our screening programme over the last 3 years. The majority of these cases are non-dr

3 Case 1 Screened 8 th July Year Old Male Caribbean Type 1 Diabetes (Insulin) Diagnosed 2 Years

4 Right Eye VA 6/6

5 Right Eye VA 6/6

6 Left Eye VA 6/6

7 Left Eye VA 6/6

8 Left Eye VA 6/6

10 Possible Diagnosis? A) Diabetic Related R3A B) Neovascularisation following Retinal Occlusion

11 Actual Diagnosis Neovascularisation following Branch Retinal Vein Occlusion (BRVO) The new vessels are confined to one quadrant of the patients eye The other eye has no obvious Diabetic Retinopathy

12 Case 2 Screened 13 th September Year Old Male Caribbean Type 2 Diabetes (Diet) Diagnosed 5 Years

13 Right Eye VA 6/6

14 Right Eye VA 6/6

15 Left Eye VA 6/7

16 Left Eye VA 6/7

17 What type of Haemorrhage is this? A) Pre-retinal B) Flame C) Blot D) Sub-Retinal

18 Sub - Retinal Sub RPE Bleed (Pigmented) Exudate

19 Pre-Retinal and Vitreous Haemorrhages Pre-Retinal Vitreous

20 Flame Haemorrhages

21 Blot Haemorrhages

22 Is a sub-retinal Haemorrhage a sign of Diabetic Retinopathy? A) Yes B) No

23 What is the diagnosis for this patient?

24 Polypoidal Choroidal Vasculopathy (PCV) With PCV there are polyps from the choroid layer which have burst resulting in the sub-retinal bleed we see here These polyps can be identified using indocyanine green angiography (ICGA) and new OCT-A techniques. These techniques can help to confirm diagnosis. This patient was treated with focal laser treatment. Photodynamic Therapy (PDT) and Anti-VEGF treatments can also be used especially if the bleed is centre involving.

25 2015

Case 3 Screened 5 th July 2012 74 Year Old Female

26 Case 3 Screened 5 th July Year Old Female Caribbean Type 2 Diabetes (Diet) Diagnosed 9 Years

27 14 th June 2011

28 Right Eye VA 6/9

29 Right Eye VA 6/9

30 Left Eye VA 6/9

31 Left Eye VA 6/9

32 5 th July 2012

33 Right Eye VA 6/12

34 Right Eye VA 6/12

35 Left Eye VA 6/18

36 Left Eye VA 6/18

37 Left Eye VA 6/18

38 Is this a typical presentation of R3A pathology from Diabetic Retinopathy? A) Yes B) No

39 Differential Diagnosis Posterior Vitreous Detachment (PVD) Valsalva Retinopathy Vasoproliferative Tumour

40 Vasoproliferative Tumour Vasoproliferative tumours of the retina are uncommon and have only recently been recognized as a distinct clinical entity. They are characterised by one or more retinal nodules, which are usually located inferotemporally, and which cause retinal exudates, macular oedema, and epiretinal membranes. Treated with focal photocoagulation

42 Case 4 Screened 4 th December Year Old Female Caribbean Type 2 Diabetes (Tablets) Diagnosed 2 Years

43 Right Eye VA 6/9

44 Right Eye VA 6/9

45 Left Eye VA HM

46 Left Eye VA HM

49 Possible Diagnosis? A) Branch Retinal Vein Occlusion (BRVO) B) Branch Retinal Artery Occlusion (BRAO)

50 Branch Retinal Artery Occlusion (BRAO) A Branch Retinal Artery Occlusion (BRAO) refers to obstruction or blockage of one of the branches of the central retinal artery by an embolus, thrombus or inflammatory/ traumatic vessel wall damage or spasm. The lack of oxygen delivery to the retina during the blockage may result in severe loss of vision. The area of retina affected is associated with the area and degree of visual loss.

51 Retinal Whitening

52 Case 5 Screened 26 th September Year Old Female White British Type 1 Diabetes (Insulin) Diabetic 6 Years

53 Right Eye VA 6/5

54 Right Eye VA 6/5

55 Left Eye VA 6/60

56 Left Eye VA 6/60

57 What s Happening in this Picture?

58 Additional Information Patient has a portwine coloured birthmark on their face

59 Sturge-Weber Syndrome This is a rare disorder that is present from birth Despite this fact the condition is NOT thought to be hereditary. Sturge Weber is usually indicated by a birthmark (port wine stain) somewhere on the face, usually involving the eye and forehead. Those with Sturge Weber often suffer from epilepsy, hemiplegia, glaucoma and learning difficulties. Symptoms usually occur in the child s first year of life. Charity -

60 Diffuse Choroidal Haemongioma Choroidal hemangioma is a benign vascular tumour of the choroid with two sub-types Diffuse & Circumscribed. The Diffuse sub-type is generally evident at birth and generally occurs as part of Sturge-Weber Syndrome. The swelling can result in a distortion of vision or as in this case a loss of central vision if centre involving. There is a risk of exudative retinal detachment if the tumour leaks fluid and because of this such a detachment may not occur until adolecence

61 Treatment The decision to treat a DCH may be challenging and should be individualized, based on the extent of symptoms, loss of vision, and the potential for visual recovery. Retinal Detachments must be treated to prevent neovascular glaucoma and loss of the eye. Treatment options available include radiotherapy, Photodynamic Therapy (PDT) and intra-retinal anti-vegf treatments. Most asymptomatic patients are just monitored

62 Case 6 Screened 29 th June Year Old Male White Caucasian Type 1 Diabetes (Insulin) Diagnosed 31 Years

63 Right Eye VA 6/6

64 Right Eye VA 6/6

65 Right Eye VA 6/6

66 Right Eye VA 6/6

67 Left Eye VA 6/6

68 Left Eye VA 6/6

69 Left Eye VA 6/6

70 Left Eye VA 6/6

71 Based on these Images what grade would you give this patient?

72 Right Eye VA 6/6

73 Left Eye VA 6/6

74 R3A in Periphery This patient had been diagnosed for over 30 years and this is the main risk factor that the patient may have proliferative changes The detection of R3A was only possible due to the extra images captured

75 Thanks for Listening

The Human Eye. Cornea Iris. Pupil. Lens. Retina

The Human Eye. Cornea Iris. Pupil. Lens. Retina The Retina Thin layer of light-sensitive tissue at the back of the eye (the film of the camera). Light rays are focused on the retina then transmitted to the brain. The macula is the very small area in