Ocular Pathology I 6234_16385 Rm HBSB 203-E 1:00-3:00pm. Tonya G. Ketcham, OD, PhD , RM 2113

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1 Ocular Pathology I 6234_16385 Rm HBSB 203-E 1:00-3:00pm Tonya G. Ketcham, OD, PhD tketcham@optometry.uh.edu , RM 2113

2 Course Syllabus

3 Course Description To describe normal anomalies and pathologic abnormalities of the orbit and eye To describe ocular pathologies and ocular diseases (in general terms) Symptoms and signs Clinical diagnostic process

4 Course Objectives To become familiar with observable differences (some normal and some abnormal) seen in the orbit and eye To identify various presentations of ocular signs and symptoms To identify a pathological condition and to understand the pathophysiology of the disease (in general terms) To introduce the concept of evidence-based medicine

5 Blackboard Learn Expected to sign up for and be able to access Grades posted here Supplemental lectures and materials NOTE Lectures also on intranet page

6 Examinations Two two-hour examinations: during test weeks Consist of best answer multiple choice with slide recognition and [each] will be comprehensive. The final will be 3 hours: during finals week. Best answer multiple choice with slid recognition and an additional section of best answer multiple choice National Boards Questions. Comment on Missing examinations Viewing examinations

7 Quizzes Unannounced at any time during the semester Computer-based (VISTA) Lecture material Additional material posted with quiz 10 points each and no more than 5 in the semester Homework Assignments Announced in lecture Blackboard

8 Grades Performance based To pass class MUST earn enough points to be within 2 SD of mean Mean = Stdev = 3.24 Suzie = 35 Suzie s z-score is ( )/3.24= Suzie s t-score is (50+(10*-3.13)) = 18.7

9 Books Spalton, Hitchings, Hunter, Atlas of Clinical Ophthalmology, 3 rd Edition, Elsevier Mosby, 2005 Yanoff and Duker, Ophthalmology, 3 rd Edition, Elsevier Mosby, NO longer going to be able to depend only on lecture material. You are going to have to take the initiative to look things up Use reference books..

10 My Disclaimer Photos used are from various sources When I know source I try to give credit Some I don t know source Scientific papers are acknowledge by first authors name and date (at the very least)

11 Introduction What is? Epidemiology Risk Factors Pathophysiology Etiology Symptoms Signs Chief complaint HPI Complications Pathognomonic Treatment Management Differential Diagnosis Diagnostic process Evidence-based medicine VS Traditional medicine Outline I. clinical terminology

12 DD to Final (accurate) Diagnosis History + Evaluation/examination + Additional testing/procedures + APPLYING BASIC KNOWLEDGE OF: GEOMETRIC OPTICS, ANATOMY PHYSIOLOGY, BIOCHEMISTRY, OCULAR PATHOLOGY PHARMACOLOGY NEUROLOGY PREVIOUS PATIENTS Basic course knowledge, Scientific papers and your knowledge of these papers plus your clinical experience Unfortunately, it s NO longer multiple choice with 2-3 hours to get correct answer!!!!!

13 History Chief Complaint (CC)/Reason for Visit (RFV) What brought the patient in to see you Usually closely associated with patient s symptoms As their Doctor you must know as much about the CC as you can.. Questions start very general and then become more and more specific LISTEN

14 HPI Location- OD/OS/OU History Quality- Loss of vision or blur Context- Sudden or gradual Severity- mild, moderate, severe Modifying factors- distance, near, both Duration- Intermittent, transient, constant Timing- Short term, long term, months, years Previous Interventions Associated Symptoms- HA, nausea, dizziness Let s Practice Blurred vision

15 General HPI Questions With or without specs? Distance or near? Right eye, Left eye or Both? How long? Sudden or gradual? Gotten worse? Does anything relieve it? Constant vs fluctuation? Worse in morning Worse in evening Other ocular symptoms associated with blurred vision? Pain HA BLURRED VISION PATIENT 1 PATIENT 2

16 Ocular Examination Last year and this year you are going to be given a very large arsenal of procedures/tools November there will be a competency VISUAL ACUITIES Unaided Aided Entering BEST Pinhole

17 Best Corrected Visual Acuity What is the very, very best that this patient can see?? DISTANT MONOCULAR ACUITY Pinhole Refraction Always correct to 20/15!!!!! If the patient whizzes thru the 20/15 line, show them the 20/10 line Big question Is the CC refractive (myope, hyperope, astigmate, presbyope) or pathologic in nature????

18 Other Visual Acuities Contrast Sensitivity Color vision Monocular Visual field

19 Physical Examination Preliminary testing Pupils EOM Confrontation fields Photo stress test Cover test Monocular color vision Red-cap test Cover test Amsler grid Metamorphopsia Distorted vision

20 Physical Evaluation Slit lamp evaluation Undilated Can this patient be dilated? Dilated Stereo view of ONH, macula, posterior pole 78D lens, 90D lens, ruby lens Peripheral retina views BIO, Goldmann 3-mirror, scleral depression Intraocular pressure (IOP) Direct ophthalmoscope Monocular view GREAT MAG Binocular indirect ophthalmoscope

21 Physical Examination Specular microscopy Corneal topography Gonioscopy Imaging of globe and orbit Ophthalmoscopy to CT and MRI A and B Ultrasound Optical coherence tomography (OCT) Electrophysiology

22 How does any of this start? YOU MUST, MUST, MUST FIRST KNOW NORMAL We will look at some anomalies of structures that are unusual however normal You must look at as many healthy eyes as you can with as many of these different procedures as possible to get to know normal

24 PATHOLOGY 101 Refractive Error cornea, lens Media Opacity Tear film, cornea, aqueous humor, lens, vitreous Retina or Optic Nerve Disease Neurological Deficit Posterior to Optic Nerve {CN II}

Goals. Glaucoma PARA PEARL TO DO. Vision Loss with Glaucoma

Goals. Glaucoma PARA PEARL TO DO. Vision Loss with Glaucoma Glaucoma Janet R. Fett, OD Drs. Kincaid, Fett and Tharp So Sioux City, NE eyewear21@hotmail.com Goals Understand Glaucoma Disease process Understand how your data (objective and subjective) assists in