ham tong eye

8/3/2019 Ham Tong Eye

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Victorio N. Cajita,MD

ACES Eye Referral Clinics

Cebu & Dumaguete Cities

Frances Yap, MD

Velez Hospital

Cebu City



The Aging Eye




Frances Yap, MD

Velez Hospital

Cebu City



Ang Mata sa mga Hamtong




Frances Yap, MD

Velez Hospital

Cebu City



OUTLINE

Introduction

Basic Anatomy

Common Age-related Eye Conditions

definition

symptomalogy (complaints)

clinical significance

treatment



Age Related Eye Diseases

(AREDs)

Aging individuals are at risk for multiple eye

problems wear and tear

law of diminishing returns

Some are preventable and reversible but

generally progressive



AREDs Significance

Vision non-threatening (cosmetic blemish)

Vision threatening

associated with a myriad problems in older adults(falls, fractures, depression)

affects quality of life

economically crippling



BASIC ANATOMY



Fundus Examination



COMMON COMPLAINTS

Tearing, discomfort, foreign body sensation

Blurring of vision

Glare Loss of central vision

Floaters



COMMON EYE CONDITIONS IN ELDERLY

Dermatochalasia

Entropion/Ectropion

Dry Eye Arcus Senilis

Cataract

Presbyopia

Vitreous Floaters

Age related MacularD

egeneration Age Related RetinalVasculopathies



Dermatochalasia

Sagging eyelids/Eyebags

Excess of skin in upper or lowereyelids

Cosmetic problem

Treatment

Nothing

Blepharoplasty



Involutional Ectropion/Entropion

an abnormal outwardor inward turning of the lid margin

Complaints

Tearing, foreign bodysensation

Exposure keratitis

Potentially blinding

Treatment

Drops/ointment

Surgery



Dry Eye Syndrome

A disorder of the tear film which causes

damage to the exposed ocular surface

Symptoms:

ocular discomfort, foreign body sensation,redness

blurring of vision

build up of debris

Itchiness



Dry Eye

Controllable chronic disease;

Not completely curable

Clinical significance Mild - annoying, uncomfortable

Severe - potentially vision threatening



Dry Eye

Treatment

Eye drops: ocular lubricants or artificial tears, anti-

inflammatory eye drops Surgery: plugs

Diet: increase intake of omega-3 essential fattyacids (flaxseed oil, fish oil, nuts)



Arcus Senilis

yellow-white ring inperipheral cornea

accumulations of

cholesterol esters,triglycerides andphospholipids

No vision impairment

No treatment



PRESBYOPIA

SHORT ARM SYNDROME: PRESBYOPIA

short arm syndromeAGE RELATED FOCUSDYSFUNCTION

Signs of Presbyopia

Loss of ability to read up close Holding objects away to read

Need reading glasses or bifocals



Cataract

Opacity of thecrystalline lens

May develop as a resultof aging, metabolicdisorders, trauma orheredity



Cataract

Generally, decrease in visual acuity is directlyproportionate to the density of the cataract



Cataract

Most common cause of

bilateral blindness

RP backlog: 0.7% (630,000)

ReversibleTreatment: surgery



Management

Indications for surgery visual defect interferes with daily activities

Potential complications: glaucoma or uveitis

to visualize the posterior segment Surgery: phacoemulsification with lens

implantation (IOL)

NOT laser!!!



Phacoemulsification



Phacoemulsification

Outpatient

Topical anesthesia

No sutures

No patch



Vitreous Floaters

Small specks or dotsseen against a brightbackground

May be due tocondensations of vitreous collagen ordue to blood

Dilated fundus examshould be done



Vitreous Floaters

not visually impairing

annoying

treatment: NONE



Macular Degeneration

Degenerative disease of central retina

Clinical features

Blurring of the central vision Distorted vision

Retinal exam

Drusens - yellowish deposits in center of retina

Macular scar

macular hemorrhages and lipid exudates



Risk Factors of macular degeneration

Modifiable

Smoking

High Blood Pressure

Obesity

Low levels of nutrients

Sun exposure

Non-modifiable

Aging

Family History

Female gender

Caucasian



Age Related Macular Degeneration




Retinal and choroidalangiography

Intraretinal hemorrhage

and edema of macula Fluorescein angiogram

with leakage

Indocyanine green

angiogram choroidalvasculature




Clinical Advances

Laser treatments for choroidal neovascularization

Radiation treatment may preserve near vision and

contrast sensitivity

Anti-angiogenesis eg. Avastin, lucentis, macugen

Prevention: High dose Zn andVit A,C,E,lutein,

zeaxanthine



Age-related Eye Comorbities

Retinal vascular diseases due to underlyingmedical conditions common with age

Diabetes

Hypertension

High cholesterol

others



Retinal Vein Occlusion (Retinal Stroke)

Painless decreased vision due to obstructed

retinal veins

2nd most common sight threatening vascular

disorder Types:

Branch retinal vein occlusion (BRVO)

Central retinal vein occlusion (CR

VO)




Predisposing factors

high blood pressure

high blood cholesterol high blood sugar

hahayyyy




Types:

Branch retinal vein occlusion (BRVO)

Central retinal vein occlusion (CRVO)



Branch Retinal Vein Occlusion (BRVO)



Central Retinal Vein Occlusion (CRVO)



RVO treatment

Medical Treat the underlying cause

ophthalmic

Treat the complications (macular edema, vitreous

hemorrhage, retinal detachment, glaucoma)

Eye drops, laser, surgery

Collaboration between the ophthalmologist andother physicians for management



Retinal Artery Occlusion

Painless sudden blurringof vision due toblockade in the retinal

artery

Associated witdAtherosclerosis, DM,H

PN, dysrrhythmias



Retinal Artery Occlusion

A true ocular emergency

Treatment is usually ineffective



Diabetic Retinopathy

Retinal complication of prolonged, poorly

controlled diabetes

Most common retinal vasculopathy Potentially blinding




Longer diabetes + poor control =

worse retinopathy



Non-proliferative Diabetic

Retinopathy



Proliferative Diabetic Retinopathy




Treatment Medical

Strict diabetic control

T

reat other medical problems Ophthalmic

Laser - mainstay of treatment

Anti-vegf eg avastin, lucentis

Surgery



Summary / take home message

Prevent what is preventable

Treat what is treatable

Accept what has to be accepted



Do not regret growing older. It is a privilegedenied to many. ~Author Unknown



Thank you!



People like you and I, though mortal of course

like everyone else, do not grow old no matter

how long we live... [We] never cease to standlike curious children before the great mystery

into which we were born." (Letter to Otto

Juliusburger) Albert Einstein



A mans age is something impressive, it sums up

his life: maturity reached slowly and against

many obstacles, illnesses cured, grieve anddespairs overcome, and unconscious risks

taken; maturity formed through so many

desires, hopes, regrets, forgotten things,

loves. A mans age represents a fine cargo of experiences and memories." Antoine de

Saint-Exupéry



Age is a high price to pay for maturity."Tom

Stoppard

..and the odds are never good enough, for allwe knownothing lasts forever in this life.



How can we help

Significantly reduce the level of disability

caused by visual problems by

Increase public awareness about age related eyeproblems

Integrate and coordinate timely screening,diagnosis and treatment to prevent or correctvision loss

Ensure continuity of care

Monitor status of visual impairment



Age-Related Cataract

Nuclear cataracts

Nuclear sclerosis resulting from the normalcondensation process in the lens nucleus

Earliest symptom: improved near vision withoutglasses (second sight)

- results from increase in focus power of the central

lens, creating a myopic shift in refraction

Most are bilateral, but may be assymetric




Cortical cataracts

Opacities in the lens cortex

Changes in the hydration of lens fibers createclefts in a radial pattern around the equatorialregion

Tend to be bilateral, but often assymmetric

Visual function is variably affected, depending onhow near the opacities are to the visual axis




Posterior subcapsular cataracts

In the cortex near the central posterior capsule

Tend to cause visual symptoms early in theirdevelopment due to visual axis involvement

Common symptoms: glare, reduced vision underbright lighting conditions

Can result from: trauma, corticosteroid use,inflammation, exposure to ionizing radiation



Basic ANATOMY



BASIC ANATOMY



Dry Eye



Cataract



Cataract

protein alterations result in yellow or brownishdiscoloration

There may be vesicles between lens fibers,migration and aberrant enlargement of epithelial cells

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