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Josh Olson, M.D.

Assistant Professor of Ophthalmology

No financial disclosures to report

Who am I/What do I do?

Basics of Ophthalmic Anatomy/Physiology

Basics of Ophthalmic Exam

Recording an Ophthalmic Exam

Common ocular diseases causing visual impairment

Example Cases

Low Vision Services and Adaptive Devices

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General Ophthalmology

M.D. specialized in the study and treatment of disorders/diseases of the eye and visual system

Associate Residency Director

Organize, coordinate, recruit, and implement training of future ophthalmologists

Orbit and Adnexa

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Orbit and Adnexa

Orbit and Adnexa

Orbit and Adnexa

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Orbit and Adnexa

Orbit and Adnexa

Orbit and Adnexa

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Extraocular muscles

Globe

Globe – Retina

Fovea

Macula

Optic Nerve

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Neuro pathway

Basic goals of the eye exam

1) Determine a patient’s uncorrected visual ability

2) Determine if optical correction will improve vision

3) Identify any structural abnormality

4) Identify disease states that may lead to vision loss

5) Screen for ocular evidence of systemic disease

6) Address patients’ ocular symptoms or visual complaints

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1) Assessing Vision

Assessing Vision (Low Vision)

What happens when patients can’t see the “Big E?”

Bring them closer to the chart (changing numerator)

< 3 feet, assess for ability to count fingers (CF)

Hand Motion (HM)

Light Perception (LP)

Non-Light Perception (NLP)

Uncooperative patients?

Visual Field Exam

Confrontational Visual Fields

Manual Perimetry

Automated Perimetry

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Visual Field Exam

Confrontational Visual Fields

Manual Perimetry

Automated Perimetry

Visual Field Exam

Confrontational Visual Fields

Manual Perimetry

Automated Perimetry

Pupils

CNIII lesion

Adie’s

Horner’s

Pons stroke

Brain injury

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Eye alignment and movement

Refraction

Intraocular pressure

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Anterior Exam

Posterior Exam

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Visual Impairment

Physical condition of the eyes (Best level of acuity)

Visual Disability

Condition of the individual

Dependent on ability of person to adapt/compensate to level of impairment

Adapted from Basic Ophthalmology

8th ed. AAO 2004

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Low vision

Vision between 20/70 and 20/400 with the best possible correction, or a visual field of 20 degrees or less in the better eye

Blindness

Legal blindness in the US means visual acuity of 20/200 or worse with the best possible correction, or a visual field of 20 degrees or less in the better eye

Diabetic eye disease

Macular degeneration

Cataracts

Glaucoma

Many eye manifestations:

Refractive changes, cataracts, dry eyes, macular edema, retinopathy

Retinal changes are the greatest cause of permeant vision loss

Chronic blood glucose variability and elevation leads to microvascular damage

Areas of the retina become ischemic and vessels become incompetent

The retina sends SOS signals to help grow new blood vessels (Neovascularization)

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22 million patients worldwide

Estimated >30 million by 2020

3 million U.S. surgeries each year

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Patient with significant visual impairment and mild visual disability

Discussed impaired vision likely to result in driving restriction if not treated

Potential permanent blinding disease states if left untreated

Recommended to undergo intravitreal anti-VEGF injection

Cataract extraction to follow in both eyes

PRP laser and periocular steroid in both eyes

Improve systemic disease with primary physician

With surgery and new glasses, vision expected to improve to 20/20

Needs multimodal therapy to prevent worsened, untreatable vision loss

Glaucoma = 2nd leading cause of blindness

60M cases worldwide in 2010 Estimated to grow to 78M by 2020

Bilateral blindness = 7.5% Growing from 4.4M to 6M patients from 2010 to 2020

Optic nerve disease most commonly due to high pressure

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⬆Pressure⬆

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Started on all available topical glaucoma drops

IOP improves to 22-24 mm Hg

SLT laser

IOP improves to 18 mm Hg

Visual field and nerve still worsening

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Proceed to trabeculectomy surgery

3 months post-op

Now off all drops and doing well

IOP 10 mm Hg

Patient with significant visual impairment but no functional visual disability

Works in an office without need for visual aides

Leading cause of central vision loss in the U.S.

Degenerative build up of metabolic waste over time. Collection of drusen, resultant retinal breakdown, +/- neovascular membrane

80% Dry – slowly progressive atrophy

20% Wet – leaking/bleeding vessels with fibrotic scar formation

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Risk: Age, Smoking, UV exposure, genetic predisposition

Dry

Smoking cessation, AREDS vitamins

Wet

Anti-VEGF injections, Laser

Both

Low vision aids

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Last seen in 2005

VA: Right-CF@3’ Left-20/200

20042005

Patient with severe visual impairment and severe functional visual disability

Legally blind in both eyes

No medical treatment available at this time

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I can’t see

anything in

these glasses?!

General inquiries:

Debbie Hannem - dhannem10@umphysicians.umn.edu

Appointments:

612-625-4400

General information:

https://www.ophthalmology.umn.edu