Ophthalmology. Juliette Stenz, MD

Ophthalmology Juliette Stenz, MD

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

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

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)

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)

Question??? Which lens will start a fire?

Question Concave or Convex lenses?

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

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

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

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

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

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

Myopic or Hyperopic?

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

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

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)

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

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

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

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

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

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

Fluidics

Glaucoma Optic Neuropathy Open Angle Closed Angle

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.

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

Glaucoma Medications Alpha agonists Beta Blockers Carbonic Anhydrase Inhibitors Prostaglandin Analogs

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

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

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

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

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

Which Eye Disease? Glaucoma Cataract Macular Degeneration

Further Reading https://en.wikipedia.org/wiki/lens_(optics) https://webeye.ophth.uiowa.edu/eyeforum/in dex.htm http://eyewiki.aao.org/main_page https://www.aao.org/youngophthalmologists/yo-info

Images https://commons.wikimedia.org/wiki/file:anatomy_an d_physiology_of_animals_how_light_travels_from_the _object_to_the_retina_of_the_eye.jpg https://www.flickr.com/photos/nationaleyeinstitute/75 44457582 https://commons.wikimedia.org/wiki/file:lawrence_1 960_9.9.png https://commons.wikimedia.org/wiki/file:astigmatism _(Eye).png, Bruce Blaus https://commons.wikimedia.org/wiki/file:presbyopia.p ng, Bruce Blaus commons.wikimedia.org/wiki1/file:celulitis_ojo_izq.jpg

Thank You!