VISION

PROBLEMS TUTOR:
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DOING & PRESENTED BY:

THINKING Hakeem
Learning
Objectives

1- Development of visual acuity

2- Refractive Errors
3- Strabismus
4- Open Angle Glaucoma
5- The Cataract
6- ARMD
 01

Vision
development
How do human vision
develop?
Newborns postnatally have
immature fovea and macula, the
reason makes it hard for them to
recognize objects !
How ever around 15 and 45 months
of age the fovea shows histological
maturity.

Babies of 2 years are proved to

have a completely myelinated optic
nerve.
 Development is shown in
multiple phases ( milestones ) 18-24 months
Build towers and structures,
0-6 months making it through an obstacle
Follows up his mother’s face course.
and turn toward noises . 2-3 years
Running, tumbling and climbing,
putting together simple shape
6-12 months puzzles., drawing on paper,
Play peek-a-boo, follows
classifying objects and colors.
objects, filling and emptying
containers, watching dropped 3-4 years
stuff. Dodging and throwing objects,
12-18 months playing with hidden pictures ,
Scribbling on paper, fitting reading books with his mother.
shapes into holes .
 Anatomy of Eye

fovea:The pit or depression

at the center of the
macula that provides
greatest visual acuity.

Macula: The portion of eye

at the center of the retina
that processes sharp,
clear, straight-ahead
vision.
 02
Emmetropia
And refractive
Errors
 Refractive Errors

When parallel rays of light from a distant

object are brought to a focus on the retina
with the eye at rest (i.e. not
accommodating) the refractive state of the
eye is known as emmetropia

In ametropia, parallel rays of light are not

brought to a focus on the retina with the
eye at rest. A change in refraction is
required to achieve sharp vision. Point of ideal reflection
Types of ametropia
Myopia (short - sightedness) A
parallel rays of light are brought
to a focus in front of the retina.
(A)

Hypermetropia (long - sightedness)

B
and parallel rays of light converge
towards a point behind the retina .
(B)

Astigmatism:
eye does not focus light evenly on C
the retina. This results in
distorted or blurred vision at any
distance. (C)
 1-Eye strain
Myobia symptoms
2-Headache
Diagnosis
3-Learning difficulties

Causes
:
1- refra
ctive my
2- axial opia
myopia
3- acut
1- Test charts e myopia
Snellen, Random E ,
landolt
2- Device
Retinoscope
 t h er
O
pics
OTHER examinations
 How myopia is corrected ?
Myopia is corrected by spectacles or contact lenses with lenses which
are 'minus' or concave in shape.
Explanation of slide 11
Causes of myopia

What is retinoscope
The retinoscope consists of a light, a condensing lens that concentrates the light, and
a mirror. During the procedure, our doctors use the retinoscope to shine light through
the pupil, then moves the light vertically and horizontally across each eye and
observes how the light reflects off the retina.
 symptoms
Hypermetropia
Eye strain
Diagnosis Headache
Learning difficulties

Causes
:
1- refra
ctive hy
2- axial permetr
hyperm opia
etropia

0%
1- Reading charts Prevalence 1
2- Device(e.g Hereditary
Retinoscope)
 How hypermetropia is corrected ?
The picture is moved forward by positioning a convex lens in front of
a hypermetropic eye and is correctly centred on the retina.
Explanation of slide 15
 Eye Accommodation
As an object of regard is brought nearer
to the eye it increases the power of the
lens of the eye by:

ciliary muscle contraction

relaxes zonular tension on the lens Presbyopia

equator
The ability to accommodate decreases
lens takes up a more spherical shape. with age, reaching a critical point at
about 40 - plus years, when the subject
focus experiences difficulty with near vision.

Patients are provides convex lenses as a

correction.
 Other
Classifications
Strabismus 1- Based on direction
classifications of
strabismus
include:
A condition in which the eyes do
not properly align with each other 1-The frequency
when looking at an object. The eye with which it
occurs (either
that is focused on an object can
constant or
alternate. intermittent).

Causes 2-Whether it always

1-problems with the eye muscles. involves the same
eye (unilateral).
2-nerves that transmit
information to the muscles. 3-If the turning eye
t3-he control center in the brain is sometimes the
right eye and other
that directs eye movements. times the left eye
(alternating).

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 Risk Factors
Symptoms
1. Eyes that look misaligned. Family history.
2. Eyes that do not move
together.
Refractive error.
3. Frequent blinking or squinting,
Medical conditions.
especially in bright sunlight.
People with conditions
4. Tilting the head to look at such as Down Syndrome and
things. cerebral palsy or who have
5. Faulty depth perception suffered a stroke or head
6. Double vision injury are at a higher risk
for developing strabismus.
 Diagnosis

Cover-Uncover test

Alternating test
 Treatment

❏ Eyeglasses or contact lenses. This may be the only treatment

needed for some patients.
❏ Prism lenses. These special lenses are thicker on one side than
the other. The prisms alter the light entering the eye and
reduce how much turning the eye must do to view objects.
Sometimes the prisms can eliminate the eye turning.
❏ Vision therapy. Your doctor of optometry might prescribe a
structured program of visual activities to improve eye
coordination and eye focusing.
❏ Eye muscle surgery.
 Amblyopia symptoms
1. An eye that wanders inward or outward
Definition 2. Eyes that appear to not work together
3. Poor depth perception
Lazy eye (amblyopia) is reduced 4. Squinting or shutting an eye
vision in one eye caused by
abnormal visual development early
in life. Causes :
1- Strabismus
Amblyopia generally develops from
2- Cataract
birth up to age 7 years. It is the Risk Factors
leading cause of decreased vision Premature birth
among children. Rarely, lazy eye Small size at birth
affects both eyes. Family history of lazy eye
Developmental disabilities
 03
Open Angle
Glaucoma
 Glaucoma
Optic Nerve damage induced by
increased intraocular pressure
>22 mmHg as a result of
obstructed drainage system.

Cupping
Optic cup
>0.5 size of
optic disc
Open angle Glaucoma Clinical Presentation:
1- might be asymptomatic
2- peripheral vision
Risk Factors :
1- Aging
2- Myopia
3- Black Ethnic
Origin
4- Family History 3- Halos Surrounding Light Others include :
4- Blurred vision
5- Fluctuating pain
6- Headache
Diagnosis
1-Non-Contact Tonometry
Air-Puff Tonometer, applies air to the cornea and
measures its response. The higher the pressure
within the AC the lesser the response reflected
by the cornea .
2- Goldmann applanation Tonometry
Device placed in the corneal surface
measures the pressure and resistance
within the cornea.
3- Fundoscopy
In order to assess the cupping of optic
disc.
4- Visual Field Examination
In order to assess the peripheral vision.
 treatment
1-Patient is provided with
agents reduce the production of
aqueous humor or increase the
outflow of it .

2-New drainage pathways could

be created by surgical
intervention .
 04
Cataract
 What is Optic Causes and risk factors
Cataract? 1- Age Related
mon Cause
Most Com le
Ocular condition 2- Systemic Diseases sib
Of Irrever the
involving OPACITY of In
3- Endocrine Diseases Blindness
the LENS World
4- ocular diseases
Pathophysiology 5- medication induced
6- substances induced
Denaturation or coagulation 7- trauma
processes disturbing the capsulated 8- congenital
epithelium of the gelatinous lens
which eventually leads to impaired
physiological passageway of light to
the retina.
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Toxoplasmosis or rubilla
 Cataract Classification
Based on which component of the lens is affected
Mature vs Immature
 Clinical presentation
Issues with Vision Altered Color
Glare Loss Perception
Night time driving Painless, progressive Patient might perceive
difficulties and gradual white objects as yellow

Second sight
Phenomenon

Patient in the beginning show

hypermetropia then develop myopia.
Gain the ability or reading without
glasses in patients over 55
Diagnosis
(A)

1-Overt Cataract (A)

2- Ophthalmoscope(B) (B)

3- Slit Lamp (C)

(C)
 treatment
1-No medical treatment is
reliable.

2-Surgical intervention is
highly necessitated and the
lens is replaced with artificial
one ( e.g. pseudophakia )
 05
ARMD
Age-Related Macular Most common

Degeneration
cause of
permanent
Chronic ocular condition of vision loss in
elderly
unknown etiology causing
progressive central visual loss ,
typically in older pts
Two Types :
1- Dry ( geographic) AMD
More common 90%, associated with yellow
drusen.

2- Wet ( exudative ) AMD Cholesterol based material and

More severe , faster progressing and cellular debris that accumulate
between the retina pigment
associated with neovascularization in choroid
epithelium and underlying choroid,
which lead to hemorrhage, scarring and however could occur in normal pts
finally ischemia.
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 Symptoms
1- Blurred Central vision
2- Scotomas
3- Metamorphopsia , distorted
vision
4- decreased visual acuity ( at
least 2 levels in snellen chart)
affect their normal life RFs:
5- decreased contrast sensitivity 1- Age (+60)
2- HTN
3- obesity
4- UV exposure
 Diagnosis
1- ophthalmoscopy is the
best

2- snellen chart

3- amsler grid / sees curved

lines

4- fluorescent angiography
 Treatment
Dry eye ;

improve quality of life , no treatment

Wet eye: two approaches

1- PDT : surgical intervention

2-Anti- VEGF Aagents

3- oral vitamins and antioxidants