04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre

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Macular Function Test and Clinical assessment

Dr. Anand SudhalkarBaroda

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre

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Why look at Macula?Clinically compelling

situationsPointing Symptoms

Vision does not improve after cataract surgery

After refractionReferred cases with

unexplained vision lossChildren with strabismus

Inability to read fine prints

MetamorphopsiaMinification,

magnificationObstruction:

Positive/Negative scotomas

Colour vision changes

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre

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What are we looking for?Known Macular

Pathologies“Other” conditions

CME, CSRMacular HoleHeredomacular

degenerationsRetinoblastomaInfective conditionsTrauma, Eclipse burnsARMDDiabetic MaculopathyRetinal Vascular DiseasesVitreoretinal conditions

Amblyopia AstigmatismNystagmusMasqueradesNeurological: Pituitary Hemianopia, Optic neuritis Toxic

amblyopias Inferior RDAdvanced glaucomatous

damageMalingering

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre

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Multiple sclerosis UHTHOFF'S SIGN OR PHENOMENON: This is a temporary worsening of

vision and other neurologic functions commonly seen in patients with multiple sclerosis just after exertion or in situations where they are exposed to heat. The condition is of importance because multiple sclerosis (a demyelinizing condition which can be related to optic neuropathy) may present with optic neuritis. Patients may report they notice their central vision becomes blurry and will show a positive defect when tested with an amsler grid. The condition is commonly reported after exercising or simply sitting in front of a fireplace, it is important if you suspect multiple sclerosis that you ask questions related to this phenomenon.

PULFRICH PHENOMENON: There have been reported cases of patients with multiple sclerosis who experience this phenomenon. Using the test diagnostically is somewhat questionable, however, suspect patients should be questioned. It is the perception (a binocular stereo phenomenon) that objects they know are moving in a straight line appear to be moving in an elliptical pattern. These patients may suddenly start having motion sickness problems unrelated to an ear infection. They may also complain that things just look odd to them or they are having problems with depth perception.

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre

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Routine Examination: How to look? Inspection Common tests

Eccentric viewing, Searching movementsPupillary reflex:Fixation Reflex

RefractionPinholeIshihara ChartsMacular Field of vision

by: Amsler/ Auto perimeter

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre

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How best to see?Binocular Indirect

Panoramic view, 4* mag. , 14 and 20D

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre

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Slit Lamp Biomicroscopy

Biomicroscope with 78/90D

40* Mag, Binocular, oblique illumination

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Documentation, Comparison, progress/prognosis, Treatment monitoring patient education Fundus Camera FFA CSR

Sudhalkar Eye Hospital and Retinal Laser Centre

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre

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Macular (Foveal) acuity chartsVryghem MacularFunction Test: The Parinaud chart ETDRS Chart

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre

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Amsler Grid: Each square measures 5 mm and when the grids are held at 30 cm from the patient each square subtends 1 degree on

the retina. The First Grid Has

White Lines On A Black Back Ground And Central White Dot On Which The Patient Is To Fixate.

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre

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If The Patient Reports On The First Chart They Cannot See The Central White Spot. This Would Indicate A Positive Scotoma. The Following Chart Should Be Used On Which Diagonal Lines Help Maintain Central Fixation. This Helps Them Point Out The Limits Of The Scotoma. This Chart Also Has White Lines On A Black Back Ground And Central White Fixation Dot.

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre

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The Third Chart Has Red Lines On A Black Back Ground And Is Very Helpful In Diagnosis Of Optic Nerve, Chiasmal, Or Toxic Amblyopia Related Problems.

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre

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Central Scotoma As Seen By A Patient With A Positive Or Absolute Scotoma. For Example This Might Be Secondary To Central Areolar Choroidal Dystrophy Or Congenital Toxoplasmosis .

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre

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Next is An Arcuate Scotoma As Seen By An Advanced Glaucoma Patient.

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre

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Above A Positive Or Absolute Paracentral Scotoma As Seen By The Patient That Might Be The Result Of A Healed Chorioretinal Scar.

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre

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A Space-Taking Pathology Such as A Tumor That Forces The Cones Closer Together Will Cause The Grid To Be Seen Distorted. The Retinal Image Will Fall On More Cones Than Normal And The Lines Of The Amsler Grid Will Be Seen As Larger And Bend Outward As In The Above. This Is Known As "Macropsia".

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre

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A Patient With Macular Edema Or Any Other Pathology That Forces The Cones Apart The Retinal Image Will Stimulate Fewer Cones Than Normal And The Lines Of The Amsler Grid Will Be Seen As Smaller And Tend To Bend Away From The Patient. This Condition Is Termed "Micropsia".

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre

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A Combination Of Squeezing And Spreading Of The Cones Causes An Overall Distortion Of The Image. The Lines Of The Amsler Grid Become Distorted And Non-Uniform. This Can Occur In A Number Of Macular And Retinal Conditions. This Condition Is Termed Metamorphopsia.

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre

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Macular Field of Vision

04/12/2023 Sudhalkar Eye Hospital and Retinal Laser Centre

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Thank You

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Special testsMacular Field of vision

Bailliart (1954) photostress test

FFAOCTSLO microperimetry,Preferential

hyperacuity perimeter