Chronic Vision Loss

Astigmatism

  • Irregular shape of cornea

  • Both near and distance vision unclear

Myopia

  • Eye is too long

  • Distance vision unclear

Hyperopia

  • Eye is too short

  • Near vision unclear

Presbyopia:

  • Lens becomes more rigid with aging

  • Near vision unclear

Refractive Error

  • Age related opacification of the lens

  • Pathognomonic words/descriptors: white pupil reflex in adult

  • Presentation: Glare, halos, painless and bilateral blurry vision

  • Common Etiologies: Aging (most common), steroid use (ocular or systemic), diabetes

  • Treatment:

    • Cataract surgery

Cataracts

A leading cause of global blindness (“Silent thief of sight”)

  • Pathognomonic words/descriptors:

    • Elevated intraocular pressure, slow loss of peripheral vision, optic disc cupping/increased cup-to-disc ratio

  • Presentation: Insidious, gradual irreversible loss of peripheral vision associated with optic nerve changes. Associated with increased intraocular pressure (IOP>20)

  • Treatment:

    • Eyedrops to decrease aqueous humor production:

      • Alpha agonist, beta blockers, carbonic anhydrase inhibitors

    • Eyedrops to Increase aqueous humor outflow:

      • prostaglandin analogues

    • Laser/surgical trabeculoplasty

Open Angle Glaucoma

Leading cause of blindness >65 years in developed countries

  • Etiology - 2 Types:

    • Dry: slow progression with drusen deposition in the retina (due to complex lifestyle and genetic causes)

    • Wet: Rapid vision loss with fluid leakage due to choroidal neovascularization

  • Pathognomonic words/descriptors: Drusen in the retinal pigment epithelium, metamorphosia (straight lines appear wavy), abnormal Amsler grid test

  • Risk Factors: smoking, advanced age

  • Treatment: supportive, smoking cessation, vitamin supplementation (AREDs vitamins), anti-VEGF intravitreal injections for wet AMD.

Age Related Macular Degeneration (AMD)

Most common cause of blindness in age 25-74 in the US

  • 2 Types:

    • Non-proliferative: microaneurysms, exudates, cotton wool spots, hemorrhages

    • Proliferative: neovascularization, macular edema, hemorrhages, retinal detachment

  • Risk Factors: diabetes duration, poor glucose control, hypertension, dyslipidemia, smoking

  • Treatment:

    • Diabetic control, laser photocoagulation, anti-VEGF injections, surgery in case of retinal detachment

Diabetic Retinopathy

Normal retina on Left. Retina with features of diabetic retinopathy on right

Retinal Neovascularization, as can be seen in proliferative diabetic retinopathy