By
Ma. Teresa G. Martinez, M.D.
International Eye Institute
St. Luke’s Medical Center

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Diabetes mellitus
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Hypertension
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Glaucoma
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Age-Related Macular Degeneration
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Retinal Detachment
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Uveitis

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Non-Proliferative mild, moderate, severe, very severe
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Proliferative early high risk

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S/Sx painless blurring of vision (gradual or sudden) retinal changes
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Treatment blood sugar control panretinal photocoagulation pars plana vitrectomy

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Modified Scheie Classification
Grade 0 No changes
Grade 1 Barely detectable arterial narrowing
Grade 2 Obvious arterial narrowing with focal irregularities
Grade 3 Grade 2 plus retinal hges and/ or exudate
Grade 4 Grade 3 plus disc swelling

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S/Sx blurring of vision retinal changes
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Treatment
Blood pressure control

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Central Retinal Artery Occlusion
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Branch Retinal Artery Occlusion
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Central Retinal Vein Occlusion
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Branch Retinal Vein Occlusion

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Caused by atherosclerosis-related thrombosis (ophthalmic artery)
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S/Sx acute and profound loss of vision pale retina cherry red spot

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Treatment
Immediate (within 90 mins)
↓ IOP by ocular massage
Anterior Chamber Paracentesis or
Retrobulbar Anesthesia
Inhalation Therapy (95% O2/ 5% CO2)
Oral Acetazolamide & Aspirin

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Most commonly caused by emboli
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Cholesterol, Platelet-fibrin, Calcific
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Other associations: trauma, coagulation disorders, sickle cell disease, oral contraceptives, mitral valve prolapse, inflammatory &/or infectious etiologies, connective tissue disorders

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S/Sx
Acute & severe altitudinal visual field defect
Pale retina in the area supplied by the affected artery
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Treatment
Mgt is directed toward determination of systemic etiologic factors
No specific ocular therapy proven to improve visual prognosis

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Non-Ischaemic (most common) moderate loss of visual acuity
FA shows venous stasis but good retinal capillary perfusion
50% - normal or near normal visual acuity
Chronic Cystoid macular edema – poor visual acuity

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Ischaemic
Severe loss of visual acuity
Marked tortuosity & engorgement of retinal veins
Retinal hemorrhages, Cotton wool spots
Severe optic disc edema & hyperemia
Visual acuity is permanently impaired
Monthly follow-up for 6 months
(+) neovascularization – PRP treatment
Tx of associated medical condition

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Sudden blurring of vision
Metamorphopsia or relative visual field defect
Dilated & tortuous veins, hemorrhages, edema, cotton wool spots
Complications- chronic macular edema & neovascularization
Within 6 mos 50% of eyes w/ collaterals will have better visual acuity

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Increase in IOP, Optic Nerve changes,
Visual Field defects
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Types:
Congenital, Infantile, Juvenile
Open Angle (Primary, Secondary)
Closed Angle (Primary, Secondary)

Early Disc Changes
Advanced Disc Changes

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S/Sx
Decrease or loss in peripheral vision, eye pain with or without headache, eye redness, haloes around light
Optic Nerve changes
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Treatment
Medical – oral, IV, eyedrops
Surgical
Laser or Cryotherapy

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Severe central visual acuity loss in one or both eyes
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Types:
Nonneovascular
Neovascular

Nonneovascular Neovascular

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S/Sx :
Decrease or loss in central visual acuity
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Treatment
Education & follow up
Micronutrients
Laser treatment (PDT)
Intravitreal injection of steroids
Intravitreal injection of anti-VEGF

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Types:
Rhegmatogenous – liquefied vitreous passing through a retinal break into the potential space between the sensory retina and the RPE
Tractional –caused by proliferative membranes that contract & elevate the retina
Exudative – caused by retinal or choroidal diseases in which leakage of fluid accumulates beneath the sensory retina

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S/Sx: light flashes, wavy or watery vision, veil or curtain obstructing vision, shower of floaters that resemble spots, bugs or spider webs & sudden decrease of vision
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Treatment
Surgery : Scleral Buckling
Pneumatic retinopexy
Cryotherapy, Laser or Diathermy
Vitrectomy

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Inflammation of the uveal tract
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Types:
Anterior
Intermediate
Posterior
Panuveitis

Posterior Uveitis
Anterior Uveitis

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S/Sx floaters, blurring of vision, eye redness, eye pain, systemic manifestations anterior chamber findings, retinal changes
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Treatment steroids immunosuppressives surgery

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Visual acuity of 20/200 or worse in the better eye w/ corrective lenses (20/200 means that a person at 20 ft from an eye chart can see what a person w/ normal vision can see at 200 ft)
OR
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Visual field restriction to 20 degrees diameter or less (tunnel vision) in the better eye.

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Snellen Chart