Approach to: Acute vision loss

Acute vision loss is the temporary reduction of visual acuity or visual field, lasting from a few minutes to a few days. The etiologies of acute vision loss may be divided into anterior segment disease, retinal disease, optic nerve disease, or neurovascular disease. It is recommended to refer all presentations of acute vision loss for ophthalmologic consultation; however, the primary care physician plays an important role in determining the urgency of referral. The following article describes an approach to narrowing the differential diagnosis of acute vision loss, using relevant ocular history and physical exam findings. The features of common eye disorders relating to acute vision loss and their treatments are also discussed.

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Approach to: Red eye

McGill Journal of Medicine ◽

10.26443/mjm.v19i1.196 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Sangeetha Santhakumaran

Keyword(s):

Primary Care ◽

Anterior Segment ◽

Care Physician ◽

Treatment Modalities ◽

Care Practice ◽

Common Symptom ◽

Red Eye ◽

Eye Disorders ◽

Associated Symptoms ◽

Respective Treatment

Red eye is a common symptom that presents in primary care practice, and may be accompanied by pain, irritation, or discharge. It is a sign of ocular inflammation, often involving the anterior segment of the eye. Most causes of red eye are benign; however, the primary care physician must identify when urgent referral to an ophthalmologist is required. This may be achieved through targeted questioning regarding the chronicity, intensity of pain, vision changes, and associated symptoms. The following article outlines an approach to identifying the cause of red eye using history and physical exam findings. Common features of red eye disorders and their respective treatment modalities are discussed.

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Factors influencing occlusion therapy in refractive amblyopia

The Journal of Medical Research ◽

10.31254/jmr.2019.5105 ◽

2019 ◽

Vol 5 (1) ◽

pp. 15-21

Author(s):

Niharika K Shetty ◽

◽

Indireddy Prathyusha ◽

Keyword(s):

Visual Acuity ◽

Refractive Error ◽

Vision Loss ◽

Anterior Segment ◽

Influential Factor ◽

Adaptation Period ◽

Health Care Centre ◽

Factors Affecting ◽

Occlusion Therapy ◽

Myopic Astigmatism

Introduction: Amblyopia is an of important cause of preventable blindness and early detection with timely rehabilitation can prevent blindness in childhood age. It also carries a higher risk of vision loss in fellow eye. The most common method of treatment to recover the monocular function involves patching the good eye in an effort to reinforce the amblyopic eye to improve. In our study we evaluated the factors affecting occlusion therapy in amblyopia patients in terms of age, gender, amount of refractive error and the time period of occlusion as the influential factor in rehabilitation of amblyopia. Methods: In this observational study, all patients between 3 years to 25 years who attended the ophthalmic OPD at Sri Siddhartha Medical College, a tertiary health care centre for ocular evaluation and diagnosed with amblyopia were included in the study. The patients were evaluated for Visual acuity on Snellens visual acuity chart and then subjected to Refractive error evaluation on Unique RK 800 Autorefractometer. Anterior segment was evaluated on Slit lamp and Fundus examination was done on Direct and indirect ophthalmoscope. Post refraction and Post treatment visual acuity was evaluated for the patients on Snellens visual acuity chart. Results: Total of 42 patients were studied out of which 16 were males and 26 were females. All patients were between 3- 35 years of age, with maximum patients 20 (47. 6%) in the age group of 6 to 15 years. 21 patients (50%) were having a baseline visual acuity in the range of 3 meter finger counting to 6/36. The commonest refractive error was astigmatism 23(54.8%) amongst whom compound myopic astigmatism was commonest in 9 patients (21.4%). In our study the post correction visual acuity improvement was 6/24 to 6/6 which was found in maximum patients 31 (73.8%), which further improved in the post occlusion visual acuity in 35 patients (83.3%) from 6/24 to 6/6. Conclusion: In this study we found myopic astigmatism as the commonest refractive error in anisometropic amblyopias. Though we found a female preponderance, the gender association was not found significant in the visual recovery or the treatment response. A good improvement following occlusion treatment as well as refractive adaptation period

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Modulated anti-VEGF therapy under the influence of lipid metabolizing proteins in Age related macular degeneration: a pilot study

Scientific Reports ◽

10.1038/s41598-021-04269-6 ◽

2022 ◽

Vol 12 (1) ◽

Author(s):

Kaushal Sharma ◽

Priya Battu ◽

Ramandeep Singh ◽

Suresh Kumar Sharma ◽

Akshay Anand

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

Vision Loss ◽

Retinal Disease ◽

Age Related Macular Degeneration ◽

Clinical Images ◽

Anti Vegf ◽

Age Related ◽

Wet Amd ◽

Group 1

AbstractAge-related macular degeneration (AMD) is a devastating retinal disease that results in irreversible vision loss in the aged population. The complex genetic nature and degree of genetic penetrance require a redefinition of the current therapeutic strategy for AMD. We aimed to investigate the role of modifiers for current anti-VEGF therapy especially for non-responder AMD patients. We recruited 78 wet AMD cases (out of 278 AMD patients) with their socio-demographic and treatment regimen. Serum protein levels were estimated by ELISA in AMD patients. Data pertaining to the number of anti-VEGF injections given (in 1 year) along with clinical images (FFA and OCT) of AMD patients were also included. Visual acuity data (logMAR) for 46 wet AMD cases out of a total of 78 patients were also retrieved to examine the response of anti-VEGF injections in wet AMD cases. Lipid metabolizing genes (LIPC and APOE) have been identified as chief biomarkers for anti-VEGF response in AMD patients. Both genotypes ‘CC’ and ‘GC’ of LIPC have found to be associated with a number of anti-VEGF injections in AMD patients which could influence the expression of B3GALTL,HTRA1, IER3, LIPC and SLC16A8 proteins in patients bearing both genotypes as compared to reference genotype. Elevated levels of APOE were also observed in group 2 wet AMD patients as compared to group 1 suggesting the significance of APOE levels in anti-VEGF response. The genotype of B3GALTL has also been shown to have a significant association with the number of anti-VEGF injections. Moreover, visual acuity of group 1 (≤ 4 anti-VEGF injections/year) AMD patients was found significantly improved after 3 doses of anti-VEGF injections and maintained longitudinally as compared to groups 2 and 3. Lipid metabolising genes may impact the outcome of anti-VEGF AMD treatment.

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Sudden Painless Unilateral Vision Loss Caused by Branch Retinal Artery Occlusion: Implications for the Primary Care Physician

The American Journal of the Medical Sciences ◽

10.1097/00000441-200401000-00009 ◽

2004 ◽

Vol 327 (1) ◽

pp. 44-46 ◽

Cited By ~ 4

Author(s):

Vasantha Kondamudi ◽

Rekha Reddy ◽

Noah Kondamudi ◽

Raymond Harvey ◽

Maritza Delarosa

Keyword(s):

Primary Care ◽

Primary Care Physician ◽

Vision Loss ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Care Physician ◽

Branch Retinal Artery Occlusion ◽

Retinal Artery

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Epidemiology of visually impaired and blindness as a medical and social problem

Medicine and Physical Education: Science and Practice ◽

10.20310/2658-7688-2020-2-1(5)-46-53 ◽

2020 ◽

pp. 46-53

Author(s):

Yliana V. ZHABINA ◽

Denis B. EFIMOV

Keyword(s):

Visual Impairment ◽

Visually Impaired ◽

Retinal Disease ◽

Age Related Macular Degeneration ◽

Steady Increase ◽

Ongoing Research ◽

Optic Nerve Disease ◽

Age Related ◽

Near Future ◽

Nerve Disease

The article provides comparative data on the level of visual impairment and blindness in different countries and in the world as a whole. We found out that 1.3 billion people worldwide suffer from visual impairment, among which 36 million are blind. The main causes of visual impairment were cataracts, refraction disorders and glaucoma. Up to 80 % of the causes of visual impairment are thought to be possibly prevented or cured. However, taking into account the low availability of ophthalmological care, it is difficult to achieve. The proportion of visual impairment resulting from cataract and trachoma is projected to decrease in the near future, but the proportion of refraction, glaucoma, diabetic retinopathy and age-related macular degeneration will increase. In Russia, there is a steady increase in disability as a result of ophthalmopathology, the prevalence of which reaches 28.8 per 10 thousand adults, with the first five causes of disability being retinal disease (25 %), glaucoma (24.9 %), degenerative myopia (19.3 %), optic nerve disease (15.1 %), lens pathology (4.4 %). Despite ongoing research, which would reduce the burden of ophthalmopathology, the problem of visually impaired and blindness remains relevant worldwide to date. The development and implementation of preventive programs will contribute to the prevention of visual impairment and blindness among the population with eye diseases

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Anti-Vegf in Management of Macular Edema in Retinal Disease

Macedonian Medical Review ◽

10.1515/mmr-2017-0004 ◽

2017 ◽

Vol 71 (1) ◽

pp. 15-19

Author(s):

Natasha T Shekerinov ◽

Vesna Dimovska Jordanova ◽

Milco Bogoev

Keyword(s):

Visual Acuity ◽

Diabetic Retinopathy ◽

Macular Edema ◽

Vision Loss ◽

Vascular Occlusion ◽

Retinal Disease ◽

Age Related Macular Degeneration ◽

Blood Retinal Barrier ◽

Anti Vegf ◽

Age Related

Abstract Aim. To present new opportunities, clinical implications and benefits of the available VEGF therapy as a treatment of macular edema, which is a result of venous vascular occlusions, diabetic macular edema in diabetic retinopathy and age-related macular degeneration. Background. The pathophysiology of macular edema is complex and various processes are involved in its development. It is actually an abnormal retinal capillary permeability and a disorder in the blood retinal barrier, which only increases the vascular permeability. This causes an expansion of the extracellular spaces, which leads to fluid accumulation, which additionally leads to macular thickening and eventual vision loss. Methods. The studies included 40 patients, of whom17 was diagnosed with macular edema in diabetic retinopathy and were treated with anti-VEGF therapy. Also, there were 11 patients diagnosed with wet form of AMD, and 12 cases diagnosed with macular edema secondary to vein occlusion. This retrospective study of 18 months monitored the effects of visual acuity on Snellen chart and the effects of macula anatomy using Optical Coherent tomography /OCT/. All patients received intravitreal injection of Bevacizumab /Avastin/ of 1.25mg /0.04ml/ and were evaluated monthly or every 4 to 8weeks. We monitored the potential ocular and systematic side effects in all our cases. Results. In the first group which included patients with edema due to venous vascular occlusion improvement of visual acuity in 58.33% patients, 25.0% showed no change in visual acuity and 16.66% showed slight worsening of 0.029 and regression of CMT entirely to 393.22 after 4.6 intravitreal injections on average. In the second group there was no improvement of VA 0.172 and reducing central macular thickness for 218.34μm by 5.6 intravitreal applications. The third group, 17 patients with macular edema due to diabetic retinopathy had stabilization of visual acuity, i.e. slight improvement in 8 of them by 0.14; and, in 9 and improvement of 0.21 and regression CMT, an average of 174.3 μm. Although it has been shown that benefit of intravitreal use of Bevacizumab and improvement of visual acuity has not been always change hand in hand with the reduction of macular edema, the need for this kind of treatment in certain cases are needed to maintain stable CMT and VA in such patients. Conclusion. Over the last few years monoclonal antibodies have become a standard therapy in treatment of wet form of AMD. Switch on anti-VEGF drugs has shown significant results in clinical and visual out-comes in patients with changes of the macula as a result of other disease. In fact, they caused a revolution in the treatment of refractory macular edema.

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Surgeon effects on cataract refractive outcomes are minimal compared with patient comorbidity and gender: an analysis of 490 987 cases

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2021-320231 ◽

2021 ◽

pp. bjophthalmol-2021-320231

Author(s):

Rachael Hughes ◽

Petros Aristodemou ◽

John M Sparrow ◽

Stephen Kaye

Keyword(s):

Diabetic Retinopathy ◽

Optic Nerve ◽

High Myopia ◽

Retinal Disease ◽

Refractive Outcome ◽

Refractive Outcomes ◽

Inherited Retinal Disease ◽

Optic Nerve Disease ◽

And Gender ◽

Nerve Disease

AimTo investigate effect of patient age, gender, comorbidities and surgeon on refractive outcomes following cataract surgery.MethodsStudy population: patients on UK national ophthalmic cataract database on cataract operations undertaken between 1 April 2010 and 31 August 2018. Variables examined included gender, age, diabetic retinopathy, glaucoma, high myopia, inherited retinal disease, optic nerve disease, uveitis, pseudoexfoliation, vitreous opacities, retinal pathology, cataract type, previous surgery and posterior capsular rupture. A multivariate normal cross-classified model was fitted to the refractive outcome using Markov Chain Monte Carlo (MCMC) methods with diffuse priors to approximate maximum likelihood estimation. A MCMC chain was generated with a burn-in of 5000 iterations and a monitoring chain of 50 000 iterations.Results490 987 cataract operations were performed on 351 864 patients by 2567 surgeons. Myopic and astigmatic errors were associated with posterior capsule rupture (−0.38/+0.04×72), glaucoma (−0.10/+0.05×95), previous vitrectomy (−0.049/+0.03×66) and high myopia (−0.07/+0.03×57). Hyperopic and astigmatic errors were associated with diabetic retinopathy (+0.08/+0.03×104), pseudoexfoliation (+0.07/+0.01×158), male gender (+0.12/+0.05×91) and age (−0.01/+0.06×97 per increasing decade). Inherited retinal disease, optic nerve disease, previous trabeculectomy, uveitis, brunescent/white cataract had no significant impact on the error of the refractive outcome. The effect of patient gender and comorbidity was additive. Surgeons only accounted for 4% of the unexplained variance in refractive outcome.ConclusionPatient comorbidities and gender account for small but statistically significant differences in refractive outcome, which are additive. Surgeon effects are very small.

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