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Chronic Visual Loss - Coggle Diagram

- - - - Vacuum-like tip
      - Ultrasound energy to break cataract into tiny pieces and aspirates them, small corneal wound
    - - Laser makes wounds and breaks cataract into small pieces to minimize ultrasound
    - - Lens removed as a whole or in pieces
    - - Options for replacing Natural Lens
      - Spectacles (thick, impractical), contact lenses, intraocular lens
      - Intraocular lens (Do not allow simultaneous perfect vision at distance and at near - Typically sees well at distance)
- - - - Pathophysiology
        
        Microaneurysms, Dot and blot intraretinal hemorrahges, retinal edema, Hard exudates, dilation/beading of retinal veins, nerve fibre layer infarcts, capillary non-perfusion
      - Vision Loss
        
        Intraretinal capillary closure - Macular ischemia, Increased vascular permeability - Macular edema
    - - Pathophysiology
        
        New, abnormal blood vessles, growth stimulated by hypoxic conditions (fragil vessels bleed), carry brous tissue leading to scarring
  - - - Begin at 5 years after diagnosis
      - Begin at puberty
    - - Begin at time of diagnosis
    - - No Retinopathy
        
        Annual for Type 1, Every 1-2 years for type 2
      - Mild NPDR
        
        Type 1: every 3-6 months
        
        Type 2: Yearly
      - Moderate to severe BPDR
        
        Every 3-6 months
  - - - HBA1C <7.0
- - - - Slow steady loss of Central vision over the years
      - Drusen - Small yellowish deposits
      - Macular pigment changes - Hypo/hyperpigmentation
      - Central visual field loss - Mild to severe
      - Risk Reduction
        
        Diet, smoking cessation, vitamin/mineral supplementation, limit UV exposure
        
        Daily Supplementation of Vitamin C/E, zinc copper, Lutein
    - - Symptoms
        
        Typically in patients with dry AMD, Severe sudden (central visual Loss - Scotoma), Central visual distortion (Metamorphopsia)
      - Signs
        
        Clinical Exam (Hemorrhage, edema, retinal pigment epithelial elevation)
        
        Retinal imaging (neovascular membrane, leaking blood vessels)
      - Pathophysiology
        
        Drusen associated with breaks bruch's membrane, RPE releases angiogenic factors, abnormal leaky blood vessels
        
        VEGF
        
        Produced by hypoxic tissues, recruits new blood vessels in wet AMD, promotes vascular permeability
      - Treatment
        
        Anti-angiogenesis - Limit new blood vessel gorwth by blocking vascular endothelial growth factor
        
        Intraocular injections every 4 to 10 weeks