DISEASE (Macular Hole) Flashcards
Warning signs of retinal problems
- Flashing lights
- Dimmer Vision
- Double Vision
- Distorted vision
- Specks/Lines in vision
- Blind spot/Scotoma
- Noticeable vision issues that worsen over time
Flashing lights could be a symptom of which conditions: (REM)
- Migraine
- Eye injury
- Retinal problems
if a person doesnt suffer headache or have never experienced random flashing lights before:
A sign that of a retinal disease or a problem
When retina is damaged/diseased, it can send incorrect/abnormal signals to the brain, which could cause to experience
“Flashing light” phenomenon
characterized as things looking darker than usual, being “muddied”, and seeing less contarst
Dimmer vision
doubled version is often blurry & less sharp compared to what is usually seen
Double vision
________ can be a symptom of various disorder, it often points to a retinal issue
Double vision
Retinal problems experience a few types of distorted vision, including:
- Double vision
- Wavy lines
- Things appearing crooked
- Blurred vision
severity of these vision problems can vary, many people mistake their blurry vision as simply worsening vision relation to age
Distorted vision
_________ don’t go away, could be a sign of retinal damage or degeneration
Lines/specks
developing larger or increased number of ___________ is cause for concern & is a definite warning sign of retinal issues
Blind spot
Blind spot/scotoma could be in the form of: (CLS)
- Complete blind spots
- Large shadows
- Something “blocking” the vision in a certain area
drastic changes in a short period of time, cause for concern
Noticeable Vision that worsens over time
a defect of foveal retina involving its full thickness from the internal limiting membrane (ILM) to the outer segment of photoreceptor layer
Macular hole
Early stages of Macular hole (BTSD)
- Blurred
- Distorted vision
- Straight lines look wavy/distorted
- Trouble reading small print
Advance stages of Macular hole (SAM)
- See a small black patch
- “Missing patch” in the center of vision
- A painless total loss of central vision
Macular hole picture example (FSS)
- Full thickness macular hole
- Showing a grayish macular rim (surrounding cuff of fluid)
- Suggestive of subretinal fluid
Types of Macular hole
a. Trauma-Related Macular Hole
b. Idiopathic-Related Macular Hole
Type of Macular hole: linked to a concussive blow delivered from the opposite site of the head
Trauma-Related Macular hole
Type of Macular hole: as a result, the macula ruptures at its thinnest point
Trauma-Related Macular hole
Type of Macular hole: as we age, the vitreous gel begins to liquefy/clump & shrink
Idiopathic-Related Macular hole
Type of Macular hole: causing to the pulling of the vitreous to the side as the gel & vitreous sac contracts
Idiopathic-Related Macular hole
Type of Macular hole: when vitreous shrinks, it pulls the retina & creates a hole at the thinnest part of macula
Idiopathic-Related Macular hole
Stages of Macular hole
Stage 1,2,3,4
What stage: known as foveal detachments, the first indication of a small macular hole
Stage 1
about half of all stage ___ macular hole will progress into a worsened state without treatment
Stage 1
What stage: occasionally referred to as “yellow dot stage”
Stage 1
What is the expected vision/VA for Stage 1
20/40
Stage 1 is occasionally referred to as
“Yellow dot stage”
What stage: is called partial-thickness holes
Stage 2
What stage: vitreous gel continues to pull on the edges of the hole its more likely to continue & require medical intervention
Stage 2
What is stage 2 called?
Partial-thickness holes
What stage: when a full-thickness hole exists
Stage 3
What stage: the central & detailed vision has become severely affected
Stage 3
What stage: likely to have little to no central vision left
Stage 3
What stage: it is still attached with patrial vitreomacular adhesion/traction
Stage 3
What is Stage 3 attached with
Partial vitreomacular adhesion/traction
What is the expected vision/VA for Stage 3?
20/160
What stage: when full-thickness macular hole exists
Stage 4
What stage: with presence of a complete separation of the vitreous from the macula & optic disc
Stage 4
What stage: posterior vitreous detaches
Stage 4
What is the expected vision/VA for Stage 4?
20/200
How to determine how much it will affect vision:
- The size of the hole
- Location on the retina
If left untreated, macular hole can lead to _______
Detached retina
Clinical manifestation: severity of the symptom depend on
- Partial thickness
- Full-thickness
Clinical manifestation of Macular hole (BCDM)
- Metamorphopsia (distorted, wavy vision)
- Blurred central vision
- Difficulty in detail tasks such as reading
- Central blind spot or gray area
In Amsler Grid, what does a person with macular problem notice?
Distortion of the grid pattern such as bent lines & irregular box shapes or a grey shaded area.
Ophthalmoscopic/Fundus photo finding
- Well-defined round/oval lesion in macula
- Yellow-white deposits at the base (drusen-like deposits)
- Cuff of subretina fluid, intraretinal edema
In Ophthalmoscopic/fundus findings, what does the yellow dots represent
- Lipofuscin-laden macrophages (Lipid, poteins, carbohydrates)
- Nodular proliferations (Plaques)
- Associated eosinophilic material (protein)
Long standing cases may have retinal pogment epithelial changes at ____________
margin of subretinal fluid
Risk factors of Macular hole
- Vitreomacular traction (vitreous shrinkage/separation)
- Diabetic eye disease
- Severe myopia
- Macular pucker - formation of scar tissue over the macula that can warp & contact, causing wrinkling of the retina
- Retina detachment
- Best’s disease (inherited condition causing macular damage)
- Eye injury
Diagnostic testing for Macular hole
Optical coherence tomography (OCT)
Current gold standard in diagnosing, staging & management of Macular holes
OCT
Treatment/Surgical approach for Macular hole
- Vitrectomy (Pars plana vitrectomy (PPV))
Surgical technique involving removal of vitreous body
Vitrectomy (PPV)
Surgeon inserts thin tubes called
Cannulas
Macular hole surgery two parts
a. The operation itself (involves vitrectomy with peeling of inner limiting membrane & gas injection)
b. “Posturing” after surgery
Three small holes (ports) in the sclera
- The first of these will have a constant flow of fluid passing through it for “infusion”.
- The second is used to insert fibre-optic “light pipe” into the eye for adequate illumination
- The third port is used for all instruments that are required during the macular hole repair, including the “cutter” for removal of the membrane on the retina’s surface
VVP: Importance of “posturing”
- Air in eye is replaced with gas
- At the end of macular hole repair operation
- Forms bubble in the eye & floats upwards to press against the macular hole
- Let the patient look vertically down towards the floor to get the gas bubble to press against the macula
VVP: “Face-down posturing”
- Tilt the head forward & point the face down
- For 50 mins out of every hour for 5 days
- But not during sleep
VVP: During sleep time
- It is recommended to sleep on either side or event front, but not sleep on their back,
- As that would make bubble move away from the macular hole
VVP: Walking during post-surgery period
- Allowed & encouraged for its health benefits
- Done by looking vertically downward when walking
- Trying to keep the head up as upright as possible
