Macular disorders
Thomas H. Williamson in Vitreoretinal Disorders in Primary Care, 2017
Patients’ symptoms consist of blurred vision or distortion. In the early stages (grade 1), the patient sees a small central grey patch in their central vision, and because the receptors are not yet displaced, distortion of the image is usually absent. Distortion becomes a feature as the fovea splits apart and the photoreceptors are moved outwards onto the rim of the hole (grades 2 and 3). Typically, the features at the centre of the patient’s visual image (e.g. the nose of a face) are reduced in size (micropsia). The brain receives fewer signals than it should in the centre of the macula because the receptors are spread apart on the rim of the macular hole. The patient’s visual system interprets this as a falsely small image centrally, hence the reduction in the size of the nose when the patient looks at a face. Eventually, over time the receptors at the edge of the hole will stop functioning (grades 3 and 4), and the patient will have a central scotoma and the nose will be missing (Figure 6.1).
Neurologic Disorders in Film
Eelco F.M. Wijdicks in Neurocinema, 2014
The first sign of Nick’s MS is numbness, resulting in a sledgehammer falling down a shaft. Soon he has blurred vision, leading to an extensive ophthalmologic evaluation with visual field testing. “You won’t make the dart team,” his girlfriend Karen (Juliet Aubrey) jokingly remarks. The ophthalmologist calls it a “trapped nerve and overcompensating,” resulting in a new eyeglass prescription. These symptoms worry Karen, and she goes to the library and finds out that these signs could mean MS. Another meeting follows, and the film shows a conversation with the ophthalmologist, where he suggests withholding the diagnosis. Such reluctance has been predicated on the uncertainty of predicting the course of MS. The scene reflects what might have been the practice in the United Kingdom (and elsewhere in the 1960s) but not in current office practices. Neurologists tell patients the diagnosis when there is a reasonable certainty of MS and on the basis of actual evidence.
The Neurologic Disorders in Film
Eelco F. M. Wijdicks in Neurocinema—The Sequel, 2022
The first sign of Nick’s MS is numbness and hand weakness, resulting in a sledgehammer falling down a shaft during work. Soon he has blurred vision, leading to an extensive ophthalmologic evaluation with visual field testing. “You won’t make the dart team,” his girlfriend Karen (Juliet Aubrey) jokingly remarks. The ophthalmologist calls it a “trapped nerve and overcompensating,” resulting in a new eyeglass prescription. These symptoms worry Karen, and she goes to the library and finds out that these signs could mean MS. Another meeting follows, and the film shows a conversation with the ophthalmologist, who suggests withholding the diagnosis. As previously noted, such reluctance has been predicated on the uncertainty of predicting the course of MS. The scene reflects practice in the 1960s but not currently. Neurologists tell patients the diagnosis when there is a reasonable certainty of MS based on actual evidence.
Amplitude of Accommodation in Patients with Multiple Sclerosis
Published in Current Eye Research, 2019
Bekir Küçük, Mehmet Hamamcı, Seray Aslan Bayhan, Hasan Ali Bayhan, Levent Ertuğrul Inan
Dysregulation of the autonomic nervous system is a common phenomenon in patients with MS.28,29 One of the clinical symptoms associated with autonomic nervous system dysfunction includes visual problems.30–35 Visual disturbances occur in up to 80% of cases with MS, including afferent and efferent disorders.36–40 The most common complaints are generally high light sensitivity, color vision defects, and blurred vision. In patients with MS, blurred vision is a frequent symptom that reduces the quality of life. One possible reason for blurred vision is accommodative dysfunction. To the best of our knowledge, this is the first study that evaluates accommodative ability in patients with MS. In this study, we found significantly lower AA values (measured by the minus lens method) in patients with MS who had VEP abnormalities when compared to healthy individuals (p= .02). The physiological properties of the lens are not directly affected in MS; however, the neural pathways that control the lens function can be affected by demyelination. In the literature, several case studies support our finding that accommodative abnormalities are associated with MS.41–43
Antenatal and postpartum comparison of HD-OCT findings of macula, retinal nerve fiber layer, ganglion cell density between severe preeclampsia patients and healthy pregnant woman
Published in Hypertension in Pregnancy, 2020
Abdullah Tok, Abdullah Beyoğlu
Preeclampsia is a clinical syndrome that affects 3-5% of pregnancies, and is a significant cause of maternal and fetal morbidity and mortality. This syndrome is defined as hypertension and proteinuria emerging after the 20th week of pregnancy. Preeclampsia is a multi-systemic syndrome which may cause hepatic and renal function disorders, cardiovascular changes and neurological, and hematological anomalies (1,2). There may also be ocular complications with the visual pathway affected from the anterior segment to the visual cortex. Visual symptoms may be seen in 25%-100% of preeclampsia cases. These symptoms include blurred vision, losses in the field of vision, difficulty in focussing, photopsia, and even blindness. Ocular findings include optic neuropathy, retinal edema, retinopathy, central serous retinopathy, retinal hemorrhage, retinal detachment, cotton wool spots, Elschnig spots, and segmental or generalized retinal arteriole constriction (3,4). These ocular changes in preeclampsia can possibly be attributed to the co-existence or preexistence of systemic vascular disease, hormonal changes, damage to the endothelium, alterations in cerebral autoregulation, and ischemia as a result of hypoperfusion, or hyperperfusion leading to retinal edema (5).
Common systemic medications that every optometrist should know
Published in Clinical and Experimental Optometry, 2022
A number of case studies have reported ocular complications associated with PPI use. Six reports detailed findings of irreversible anterior ischaemic optic neuropathy with PPI use.77 However, a large retrospective cohort study of 94,063 subjects showed a minimal association between inflammatory and vascular disorders of the eye and omeprazole or histamine H2-receptor antagonists.78 However, when the data was analysed dividing the patients into separate medication groups, researchers discovered an increased risk of visual impairment in the treatment group using PPIs. Visual impairment included incidence of visual disturbance, blurred vision, unilateral or bilateral blindness, transient blindness, night blindness, visual field defect, or sudden vision loss. This large-scale data analysis provides reinforcement to the case studies reporting ocular side effects of PPI use and this medication side effect should be considered as part of the work up of patients with newly reported visual impairment.79 Discontinuation of the medication may be necessary in order to determine whether the ocular symptoms are linked to GERD medication use.
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