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Preserving Eyesight
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1 Vision loss is widespreadBackgroundcauses of vision impairment
Normal vision means attaining 2020 on a routine eye exam ie one can read 38-inch letters at 20 feet Readers who explore this presentation will gain an understanding of the epidemiology of vision impairment world the worldwide distribution of the most common causes and the cost of treating conditions that affect at least 285 million people worldwide Learners will also develop a better understanding of risk factors and management strategies for common eye diseases
Who is affected
Causes
Worldwide distribution of vision
impairment
Cost
Vision loss is widespreadWho is affected
1
~285 million people worldwidecannot pass a routine eye examSight problems range from normal to moderate or severe visual impairment Thirty-nine million people are blind and ~90 of visually impaired people live in low-income settings Nearly two-thirds of visually impaired (65) and 82 of blind people are over the age of 50 although this group comprises only 20 of the worldrsquos population Moreover the preventable causes of the global visual impairment burden are as high as 80
Vision loss is widespread1990ndash2010 data
1
Cataracts uncorrected refractive errorsand macular degeneration widespreadIn 2010 higher proportions of blindness or moderate and severe vision impairments (MSVI) were caused by cataracts and macular degeneration in women than men Uncorrected refractive errorscaused a larger proportion of MSVI in South Asia than other regions (654 vs 432 481) However macular degeneration in South Asia was low compared to regions with older populations (26 compared with gt15 of blindness attributed to macular degeneration in Central and Eastern Europe) Lowest and highest glaucoma rates were seen in east sub-Saharan Africa and tropical Latin America respectively (40 vs 155)
lack of epidemiological data in countries with trachoma may affect data
CausesUncorrected refractive errors cataracts age-related macular degeneration diabetic retinopathy and eye
cancer
1
Major causes of vision problems range from treatable to lethal diseasesUncorrected refractive errors cataracts and glaucoma are the major causes of visual impairments ii Cataracts glaucoma and age-related macular degeneration are the major causes of blindness Diabetic retinopathy (DR) a key microvascular complication of diabetes mellitus is also a major cause of visual impairment in 20- to 74-year-old adults Eye cancer whether occurring as primary tumors in the immune-privileged eye or as secondary diseases that started somewhere else and spread to the eye is an umbrella term for a group of rare diseases that can also cause vision impairment
CostThe high costs of low or no vision worldwide
1
At $139 billion in 2013 vision impairments are costly to the USADirect costs equal $668 billion ie medical costs for diagnosingeye disorderslow vision medical vision aids vision assistive devices and adaptations and direct services including special education and assistance programs Indirect costs of $722 billioncapture the burden of consequences of low vision including productivity losses long-term care informal care and the costs of transfer and entitlement programs
Overview of vision impairments
2
image placeholder
image placeholder
Refractive errorsCataracts GlaucomaAge-relatedmaculardegeneration
DiabeticRetinopathy Eye cancers
3 Age-related eye diseasesBackgroundcauses of vision impairment
Vision changes are a normal part of the aging process The National Eye Institute recommends a dilated eye exam for anyone at or over the age of 50 In addition to low vision and dry eyes older adults may be affected by two forms of age-related macular degeneration (AMD) suffer clouding of lenses known as cataracts or may be affected by a secondary complication of diabetes mellitus known as diabetic eye diseases Diabetic retinopathy is the most common diabetic eye disease and the leading cause of vision impairment and blindness among working-age adults in the USA
Dry AMD
Cataracts
Wet AMD
Diabetic retinopathy
3 Dry AMDBackgroundcauses of vision impairment
Dry AMD (also called non-neovascular or non-exudative AMD) is characterized by progressive thinning and loss of function of layers of the macula (including the photoreceptors and the retinal pigment epithelium) The color of the macular changes and tiny piles of cellular debris called drusen appears on the retina
DescriptionAMD is more common among whites and is the leading cause of permanent vision loss in the elderly Dry or atrophic AMD lowers the central vision and can affect the preception of color Although not as severe as the wet form of the disease dry AMD can lead to profound vision loss over time More information can be found at amdorgMerck Professional Manual ldquoFunduscopic changes in dry AMD include drusen areas of chorioretinal atrophy and changes to the retinal pigment epitheliumrdquo
3 Wet AMDBackgroundcauses of vision impairment
Wet AMD (also called neovascular AMD or exudative AMD) is characterized by choroidal neovascularization Fluid lipids and blood from the new weaker vessels may leak into the retina (including layers of the macula)- resulting retinal scarring and reduced function
DescriptionWhile most people have the dry version of the disease up to 90 of severe vision loss is due to the wet type
Merck Professional Manualrdquo Funduscopic changes in wet AMD include retinal edema and localized elevation detachment of the retinal pigment epithelium a gray-green discoloration under the macula and exudates in and around the maculardquo
3 CataractsBackgroundcauses of vision impairment
Blindness around the world is predominantly caused by cataracts Most cataracts form as part of the aging process and reflect clouding of the lenses in eyes The lens which is mostly made up of lens and water becomes cloudy with clumps of protein which reduce the sharpness of images reaching the retina Over time a barely noticeable cataract may change the lens to a yellowishbrownish color adding a brownish tint to vision
ManagementOther symptoms
Clouded blurred or dim visionIncreasing difficulty with vision at nightSensitivity to light and glareNeed for brighter light for reading and other activitiesSeeing halos around lightsFrequent changes in eyeglass or contact lens prescriptionFading or yellowing of colorsDouble vision in a single eye
Cataracts can be diagnosed by visual acuity slit lamp or retinal examinations Cataract surgery ndash a routine procedure in which the cloudy lens is replaced by an artificial lens ndash is typically used as treatment Continuing vision problems may be corrected with glasses or contact lenses
3 Diabetic Retinopathy (DR)Backgroundcauses of vision impairment
DR can cause cause blood vessels in the retina to leak fluid or hemorrhage (bleed) distorting vision In its most advanced stage new abnormal blood vessels proliferate (increase in number) on the surface of the retina which can lead to scarring and cell loss in the retina Asymptomatic patients may experience vision fluctuations related to blood glucose levels or as a symptom of cataracts while symptomatic patients may have gradual or acute vision loss depending on the nature of the underlying changes eg macular edemavitreous hemorrhageDiagnosis
Symptomsbull Mild or moderate nonproliferaive DR
(NPDR) symptoms may include microaneurysms intraretinal hemorrhage cotton wool spots and lipid exudates
bull Symptoms may be more severe in severe NDPR
bull NPDR may progress to proliferative DR (PDR)
Strong risk factors include young-onset diabetes longer duration of diabetes poor glycemic control hypertension renal diseaseChange from the first photograph of the fundus Change from the first scan by optical coherence tomography scanning Fluorescein angiography or B scan ultrasonography may also be used as tests
3 Diabetic Retinopathy (DR)Treatment Approach
Hypertensive and glycemic control are key priorities in order to stem vision sight-threatening loss Once symptoms of DR are present ophthalmic treatment should include macular laser therapy intravitreal therapy pan-retinal photocoagulation vitrectomy surgery or combinations of these treatments
TreatmentCurrent
For non-severe NPDR prescribed treatments may be intravitreal anti-VEGF therapy plusmn macular laser therapy Non-high-risk NPDR or severe PDR may be treated with intravitreal anti-VEGF therapy plusmn macular laser therapy plusmn pan-retinal photocoagulation or pan-retinal photocoagulation may be considered as 1st line treatment High risk PDR with iris neovascularization may require urgent pan-retinal photocoagulation as a single treatment or in combination with intravitreal anti-VEGF therapy and macular laser therapy A vitrectomy may be prescribed for severe PDR
Very common and rare vision impairmentsUncorrected refractive errorseye cancer
4
Prevalence of vision problemsCollectively uncorrected refractive errors affected an estimated 153 million people worldwide in 2013 This number does not include uncorrected presbyopia The most common conditions are myopia hyperopia astigmatism and presbyopia At the other end of the spectrum eye cancer comprises a group of rare primary or secondary tumors that can occur in and around the eyeballconjunctivaeyelid of an adult or child Most of the new primary intraocular cancers estimated to be diagnosed in the USA in 2016 are likely to be melanomas (2810 adults)
Uncorrected refractive errors (REs)~$2688 billion US dollars lost per year in lost
productivity (2014 estimate)
4
Most common uncorrected REsREs occur when the shape of the eye stops light from focusing on the retina Changes in the shape of cornea length of the eyeball genetics or aging can lead to REs The most common types of refractive errors are myopia hyperopia astigmatism and presbyopia Some of the diagnostic tests include visual acuity and peripheral vision assessments Typically vision can be corrected with glasses contact lenses or refractive surgery
Uncorrected REsDiagnosis
4
c
Get the facts on testsDoctors determine how near or far you can see by looking at letters and symbols of different sizes on an eye chart eg a Snellen chart Refraction tests are done to determine levels of near- or far-sightedness in order to determine the correct prescription for glasses or contact lenses Gaps in peripheral vision are assessed with visual field tests Some people with retinal or optic nerve damage may be color bling and this condition can be determined with color vision tests
Uncorrected REsManagement
4
Treatment optionsGenerally refractive errors can be corrected with glasses contact lenses or refractive surgeries (eg LASIK) For instance early contact lens and spectacle interventions can reduce the rate of progression of myopia and these non-pharmacological interventions are also able to significantly reduce the burden of myopia Additionally pharmacotherapies that cause changes in the sclera show promising efficacies Laser in situ keratomileusis (LASIK) is one of the lens-based procedures that can be considered by appropriate patients
Eye cancerTumor types
4
c
The most common primary intraocular cancer in adults is melanomaEye cancer whether occurring as primary tumors in the immune-privileged eye or as secondary diseases that started somewhere else and spread to the eye is an umbrella term for a group of rare diseases that can also cause vision impairment Primary intraocular lymphoma a type of non-Hodgkin lymphoma can also occur in adults Cancers of the orbit and adnexa can develop from tissues such as muscle nerve and skin around the eyeball In children the most common primary intraocular cancer is retinoblastoma
Eye cancerSpread and lethality of eye cancer in the USA
4
Eye cancer is rare and can be lethal2810 new cancers (mainly melanomas) of the eye and orbit280 deaths from cancers of the eye and orbit 150 in men and 130 in women3 out of 4 people with eye melanoma survive for at least 5 yearsFor localized disease the 5-year relative survival rate is about 80For tumors that have spread beyond the eye the 5-year relative survival rate is about 15
Eye cancerDiagnosis of choroidal melanoma (CM)
4
Whites of Northern Europeans prone to CMCM is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma After excluding other causes a differential diagnosis can be made based on choroidal detachmentintraocular foreign body chronic angle closure glaucomaglaucoma hyphema neovascular glaucoma cavernous hemangioma vitreous hemorrhage hyphema ciliary body melanoma conjunctival melanoma and iris melanoma
Eye cancerMost common primary ocular tumor Melanoma
4
Management in AdultsDepending on the site and spread of the disease doctors may suggest radiation treatment surgery thermotherapy or intraocular injections Metastatic disease may be managed with liver-directed treatment options radiation and ablation Systemic therapies such as targeted chemo- and immunotherapies are also treatment options for appropriate patients
5 Saving vision through preventionGlobal Action Plan
It remains a shocking fact that 80 of visual impairments could have been prevented or treated The International Agency for the Prevention of Blindness (IAPB) has proposed a WHO-endorsed global action plan for preventing blindness (see Figure) This plan forms part of VISION 2020 The Right to Sight The long-term goal of VISION 2020 and other international plans are to rid the world of avoidable blindness and visual impairment
Creditsbull Articulate E-learning for the templatebull Wikimedia and freepikcom for imagesbull In addition to the Merck Professional Manual the
IAPB (see Prevention Infographic)and the Mayo Clinic some of the key sources are listed in the pdf
Adobe Acrobat Document
1 Vision loss is widespreadBackgroundcauses of vision impairment
Normal vision means attaining 2020 on a routine eye exam ie one can read 38-inch letters at 20 feet Readers who explore this presentation will gain an understanding of the epidemiology of vision impairment world the worldwide distribution of the most common causes and the cost of treating conditions that affect at least 285 million people worldwide Learners will also develop a better understanding of risk factors and management strategies for common eye diseases
Who is affected
Causes
Worldwide distribution of vision
impairment
Cost
Vision loss is widespreadWho is affected
1
~285 million people worldwidecannot pass a routine eye examSight problems range from normal to moderate or severe visual impairment Thirty-nine million people are blind and ~90 of visually impaired people live in low-income settings Nearly two-thirds of visually impaired (65) and 82 of blind people are over the age of 50 although this group comprises only 20 of the worldrsquos population Moreover the preventable causes of the global visual impairment burden are as high as 80
Vision loss is widespread1990ndash2010 data
1
Cataracts uncorrected refractive errorsand macular degeneration widespreadIn 2010 higher proportions of blindness or moderate and severe vision impairments (MSVI) were caused by cataracts and macular degeneration in women than men Uncorrected refractive errorscaused a larger proportion of MSVI in South Asia than other regions (654 vs 432 481) However macular degeneration in South Asia was low compared to regions with older populations (26 compared with gt15 of blindness attributed to macular degeneration in Central and Eastern Europe) Lowest and highest glaucoma rates were seen in east sub-Saharan Africa and tropical Latin America respectively (40 vs 155)
lack of epidemiological data in countries with trachoma may affect data
CausesUncorrected refractive errors cataracts age-related macular degeneration diabetic retinopathy and eye
cancer
1
Major causes of vision problems range from treatable to lethal diseasesUncorrected refractive errors cataracts and glaucoma are the major causes of visual impairments ii Cataracts glaucoma and age-related macular degeneration are the major causes of blindness Diabetic retinopathy (DR) a key microvascular complication of diabetes mellitus is also a major cause of visual impairment in 20- to 74-year-old adults Eye cancer whether occurring as primary tumors in the immune-privileged eye or as secondary diseases that started somewhere else and spread to the eye is an umbrella term for a group of rare diseases that can also cause vision impairment
CostThe high costs of low or no vision worldwide
1
At $139 billion in 2013 vision impairments are costly to the USADirect costs equal $668 billion ie medical costs for diagnosingeye disorderslow vision medical vision aids vision assistive devices and adaptations and direct services including special education and assistance programs Indirect costs of $722 billioncapture the burden of consequences of low vision including productivity losses long-term care informal care and the costs of transfer and entitlement programs
Overview of vision impairments
2
image placeholder
image placeholder
Refractive errorsCataracts GlaucomaAge-relatedmaculardegeneration
DiabeticRetinopathy Eye cancers
3 Age-related eye diseasesBackgroundcauses of vision impairment
Vision changes are a normal part of the aging process The National Eye Institute recommends a dilated eye exam for anyone at or over the age of 50 In addition to low vision and dry eyes older adults may be affected by two forms of age-related macular degeneration (AMD) suffer clouding of lenses known as cataracts or may be affected by a secondary complication of diabetes mellitus known as diabetic eye diseases Diabetic retinopathy is the most common diabetic eye disease and the leading cause of vision impairment and blindness among working-age adults in the USA
Dry AMD
Cataracts
Wet AMD
Diabetic retinopathy
3 Dry AMDBackgroundcauses of vision impairment
Dry AMD (also called non-neovascular or non-exudative AMD) is characterized by progressive thinning and loss of function of layers of the macula (including the photoreceptors and the retinal pigment epithelium) The color of the macular changes and tiny piles of cellular debris called drusen appears on the retina
DescriptionAMD is more common among whites and is the leading cause of permanent vision loss in the elderly Dry or atrophic AMD lowers the central vision and can affect the preception of color Although not as severe as the wet form of the disease dry AMD can lead to profound vision loss over time More information can be found at amdorgMerck Professional Manual ldquoFunduscopic changes in dry AMD include drusen areas of chorioretinal atrophy and changes to the retinal pigment epitheliumrdquo
3 Wet AMDBackgroundcauses of vision impairment
Wet AMD (also called neovascular AMD or exudative AMD) is characterized by choroidal neovascularization Fluid lipids and blood from the new weaker vessels may leak into the retina (including layers of the macula)- resulting retinal scarring and reduced function
DescriptionWhile most people have the dry version of the disease up to 90 of severe vision loss is due to the wet type
Merck Professional Manualrdquo Funduscopic changes in wet AMD include retinal edema and localized elevation detachment of the retinal pigment epithelium a gray-green discoloration under the macula and exudates in and around the maculardquo
3 CataractsBackgroundcauses of vision impairment
Blindness around the world is predominantly caused by cataracts Most cataracts form as part of the aging process and reflect clouding of the lenses in eyes The lens which is mostly made up of lens and water becomes cloudy with clumps of protein which reduce the sharpness of images reaching the retina Over time a barely noticeable cataract may change the lens to a yellowishbrownish color adding a brownish tint to vision
ManagementOther symptoms
Clouded blurred or dim visionIncreasing difficulty with vision at nightSensitivity to light and glareNeed for brighter light for reading and other activitiesSeeing halos around lightsFrequent changes in eyeglass or contact lens prescriptionFading or yellowing of colorsDouble vision in a single eye
Cataracts can be diagnosed by visual acuity slit lamp or retinal examinations Cataract surgery ndash a routine procedure in which the cloudy lens is replaced by an artificial lens ndash is typically used as treatment Continuing vision problems may be corrected with glasses or contact lenses
3 Diabetic Retinopathy (DR)Backgroundcauses of vision impairment
DR can cause cause blood vessels in the retina to leak fluid or hemorrhage (bleed) distorting vision In its most advanced stage new abnormal blood vessels proliferate (increase in number) on the surface of the retina which can lead to scarring and cell loss in the retina Asymptomatic patients may experience vision fluctuations related to blood glucose levels or as a symptom of cataracts while symptomatic patients may have gradual or acute vision loss depending on the nature of the underlying changes eg macular edemavitreous hemorrhageDiagnosis
Symptomsbull Mild or moderate nonproliferaive DR
(NPDR) symptoms may include microaneurysms intraretinal hemorrhage cotton wool spots and lipid exudates
bull Symptoms may be more severe in severe NDPR
bull NPDR may progress to proliferative DR (PDR)
Strong risk factors include young-onset diabetes longer duration of diabetes poor glycemic control hypertension renal diseaseChange from the first photograph of the fundus Change from the first scan by optical coherence tomography scanning Fluorescein angiography or B scan ultrasonography may also be used as tests
3 Diabetic Retinopathy (DR)Treatment Approach
Hypertensive and glycemic control are key priorities in order to stem vision sight-threatening loss Once symptoms of DR are present ophthalmic treatment should include macular laser therapy intravitreal therapy pan-retinal photocoagulation vitrectomy surgery or combinations of these treatments
TreatmentCurrent
For non-severe NPDR prescribed treatments may be intravitreal anti-VEGF therapy plusmn macular laser therapy Non-high-risk NPDR or severe PDR may be treated with intravitreal anti-VEGF therapy plusmn macular laser therapy plusmn pan-retinal photocoagulation or pan-retinal photocoagulation may be considered as 1st line treatment High risk PDR with iris neovascularization may require urgent pan-retinal photocoagulation as a single treatment or in combination with intravitreal anti-VEGF therapy and macular laser therapy A vitrectomy may be prescribed for severe PDR
Very common and rare vision impairmentsUncorrected refractive errorseye cancer
4
Prevalence of vision problemsCollectively uncorrected refractive errors affected an estimated 153 million people worldwide in 2013 This number does not include uncorrected presbyopia The most common conditions are myopia hyperopia astigmatism and presbyopia At the other end of the spectrum eye cancer comprises a group of rare primary or secondary tumors that can occur in and around the eyeballconjunctivaeyelid of an adult or child Most of the new primary intraocular cancers estimated to be diagnosed in the USA in 2016 are likely to be melanomas (2810 adults)
Uncorrected refractive errors (REs)~$2688 billion US dollars lost per year in lost
productivity (2014 estimate)
4
Most common uncorrected REsREs occur when the shape of the eye stops light from focusing on the retina Changes in the shape of cornea length of the eyeball genetics or aging can lead to REs The most common types of refractive errors are myopia hyperopia astigmatism and presbyopia Some of the diagnostic tests include visual acuity and peripheral vision assessments Typically vision can be corrected with glasses contact lenses or refractive surgery
Uncorrected REsDiagnosis
4
c
Get the facts on testsDoctors determine how near or far you can see by looking at letters and symbols of different sizes on an eye chart eg a Snellen chart Refraction tests are done to determine levels of near- or far-sightedness in order to determine the correct prescription for glasses or contact lenses Gaps in peripheral vision are assessed with visual field tests Some people with retinal or optic nerve damage may be color bling and this condition can be determined with color vision tests
Uncorrected REsManagement
4
Treatment optionsGenerally refractive errors can be corrected with glasses contact lenses or refractive surgeries (eg LASIK) For instance early contact lens and spectacle interventions can reduce the rate of progression of myopia and these non-pharmacological interventions are also able to significantly reduce the burden of myopia Additionally pharmacotherapies that cause changes in the sclera show promising efficacies Laser in situ keratomileusis (LASIK) is one of the lens-based procedures that can be considered by appropriate patients
Eye cancerTumor types
4
c
The most common primary intraocular cancer in adults is melanomaEye cancer whether occurring as primary tumors in the immune-privileged eye or as secondary diseases that started somewhere else and spread to the eye is an umbrella term for a group of rare diseases that can also cause vision impairment Primary intraocular lymphoma a type of non-Hodgkin lymphoma can also occur in adults Cancers of the orbit and adnexa can develop from tissues such as muscle nerve and skin around the eyeball In children the most common primary intraocular cancer is retinoblastoma
Eye cancerSpread and lethality of eye cancer in the USA
4
Eye cancer is rare and can be lethal2810 new cancers (mainly melanomas) of the eye and orbit280 deaths from cancers of the eye and orbit 150 in men and 130 in women3 out of 4 people with eye melanoma survive for at least 5 yearsFor localized disease the 5-year relative survival rate is about 80For tumors that have spread beyond the eye the 5-year relative survival rate is about 15
Eye cancerDiagnosis of choroidal melanoma (CM)
4
Whites of Northern Europeans prone to CMCM is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma After excluding other causes a differential diagnosis can be made based on choroidal detachmentintraocular foreign body chronic angle closure glaucomaglaucoma hyphema neovascular glaucoma cavernous hemangioma vitreous hemorrhage hyphema ciliary body melanoma conjunctival melanoma and iris melanoma
Eye cancerMost common primary ocular tumor Melanoma
4
Management in AdultsDepending on the site and spread of the disease doctors may suggest radiation treatment surgery thermotherapy or intraocular injections Metastatic disease may be managed with liver-directed treatment options radiation and ablation Systemic therapies such as targeted chemo- and immunotherapies are also treatment options for appropriate patients
5 Saving vision through preventionGlobal Action Plan
It remains a shocking fact that 80 of visual impairments could have been prevented or treated The International Agency for the Prevention of Blindness (IAPB) has proposed a WHO-endorsed global action plan for preventing blindness (see Figure) This plan forms part of VISION 2020 The Right to Sight The long-term goal of VISION 2020 and other international plans are to rid the world of avoidable blindness and visual impairment
Creditsbull Articulate E-learning for the templatebull Wikimedia and freepikcom for imagesbull In addition to the Merck Professional Manual the
IAPB (see Prevention Infographic)and the Mayo Clinic some of the key sources are listed in the pdf
Adobe Acrobat Document
Vision loss is widespreadWho is affected
1
~285 million people worldwidecannot pass a routine eye examSight problems range from normal to moderate or severe visual impairment Thirty-nine million people are blind and ~90 of visually impaired people live in low-income settings Nearly two-thirds of visually impaired (65) and 82 of blind people are over the age of 50 although this group comprises only 20 of the worldrsquos population Moreover the preventable causes of the global visual impairment burden are as high as 80
Vision loss is widespread1990ndash2010 data
1
Cataracts uncorrected refractive errorsand macular degeneration widespreadIn 2010 higher proportions of blindness or moderate and severe vision impairments (MSVI) were caused by cataracts and macular degeneration in women than men Uncorrected refractive errorscaused a larger proportion of MSVI in South Asia than other regions (654 vs 432 481) However macular degeneration in South Asia was low compared to regions with older populations (26 compared with gt15 of blindness attributed to macular degeneration in Central and Eastern Europe) Lowest and highest glaucoma rates were seen in east sub-Saharan Africa and tropical Latin America respectively (40 vs 155)
lack of epidemiological data in countries with trachoma may affect data
CausesUncorrected refractive errors cataracts age-related macular degeneration diabetic retinopathy and eye
cancer
1
Major causes of vision problems range from treatable to lethal diseasesUncorrected refractive errors cataracts and glaucoma are the major causes of visual impairments ii Cataracts glaucoma and age-related macular degeneration are the major causes of blindness Diabetic retinopathy (DR) a key microvascular complication of diabetes mellitus is also a major cause of visual impairment in 20- to 74-year-old adults Eye cancer whether occurring as primary tumors in the immune-privileged eye or as secondary diseases that started somewhere else and spread to the eye is an umbrella term for a group of rare diseases that can also cause vision impairment
CostThe high costs of low or no vision worldwide
1
At $139 billion in 2013 vision impairments are costly to the USADirect costs equal $668 billion ie medical costs for diagnosingeye disorderslow vision medical vision aids vision assistive devices and adaptations and direct services including special education and assistance programs Indirect costs of $722 billioncapture the burden of consequences of low vision including productivity losses long-term care informal care and the costs of transfer and entitlement programs
Overview of vision impairments
2
image placeholder
image placeholder
Refractive errorsCataracts GlaucomaAge-relatedmaculardegeneration
DiabeticRetinopathy Eye cancers
3 Age-related eye diseasesBackgroundcauses of vision impairment
Vision changes are a normal part of the aging process The National Eye Institute recommends a dilated eye exam for anyone at or over the age of 50 In addition to low vision and dry eyes older adults may be affected by two forms of age-related macular degeneration (AMD) suffer clouding of lenses known as cataracts or may be affected by a secondary complication of diabetes mellitus known as diabetic eye diseases Diabetic retinopathy is the most common diabetic eye disease and the leading cause of vision impairment and blindness among working-age adults in the USA
Dry AMD
Cataracts
Wet AMD
Diabetic retinopathy
3 Dry AMDBackgroundcauses of vision impairment
Dry AMD (also called non-neovascular or non-exudative AMD) is characterized by progressive thinning and loss of function of layers of the macula (including the photoreceptors and the retinal pigment epithelium) The color of the macular changes and tiny piles of cellular debris called drusen appears on the retina
DescriptionAMD is more common among whites and is the leading cause of permanent vision loss in the elderly Dry or atrophic AMD lowers the central vision and can affect the preception of color Although not as severe as the wet form of the disease dry AMD can lead to profound vision loss over time More information can be found at amdorgMerck Professional Manual ldquoFunduscopic changes in dry AMD include drusen areas of chorioretinal atrophy and changes to the retinal pigment epitheliumrdquo
3 Wet AMDBackgroundcauses of vision impairment
Wet AMD (also called neovascular AMD or exudative AMD) is characterized by choroidal neovascularization Fluid lipids and blood from the new weaker vessels may leak into the retina (including layers of the macula)- resulting retinal scarring and reduced function
DescriptionWhile most people have the dry version of the disease up to 90 of severe vision loss is due to the wet type
Merck Professional Manualrdquo Funduscopic changes in wet AMD include retinal edema and localized elevation detachment of the retinal pigment epithelium a gray-green discoloration under the macula and exudates in and around the maculardquo
3 CataractsBackgroundcauses of vision impairment
Blindness around the world is predominantly caused by cataracts Most cataracts form as part of the aging process and reflect clouding of the lenses in eyes The lens which is mostly made up of lens and water becomes cloudy with clumps of protein which reduce the sharpness of images reaching the retina Over time a barely noticeable cataract may change the lens to a yellowishbrownish color adding a brownish tint to vision
ManagementOther symptoms
Clouded blurred or dim visionIncreasing difficulty with vision at nightSensitivity to light and glareNeed for brighter light for reading and other activitiesSeeing halos around lightsFrequent changes in eyeglass or contact lens prescriptionFading or yellowing of colorsDouble vision in a single eye
Cataracts can be diagnosed by visual acuity slit lamp or retinal examinations Cataract surgery ndash a routine procedure in which the cloudy lens is replaced by an artificial lens ndash is typically used as treatment Continuing vision problems may be corrected with glasses or contact lenses
3 Diabetic Retinopathy (DR)Backgroundcauses of vision impairment
DR can cause cause blood vessels in the retina to leak fluid or hemorrhage (bleed) distorting vision In its most advanced stage new abnormal blood vessels proliferate (increase in number) on the surface of the retina which can lead to scarring and cell loss in the retina Asymptomatic patients may experience vision fluctuations related to blood glucose levels or as a symptom of cataracts while symptomatic patients may have gradual or acute vision loss depending on the nature of the underlying changes eg macular edemavitreous hemorrhageDiagnosis
Symptomsbull Mild or moderate nonproliferaive DR
(NPDR) symptoms may include microaneurysms intraretinal hemorrhage cotton wool spots and lipid exudates
bull Symptoms may be more severe in severe NDPR
bull NPDR may progress to proliferative DR (PDR)
Strong risk factors include young-onset diabetes longer duration of diabetes poor glycemic control hypertension renal diseaseChange from the first photograph of the fundus Change from the first scan by optical coherence tomography scanning Fluorescein angiography or B scan ultrasonography may also be used as tests
3 Diabetic Retinopathy (DR)Treatment Approach
Hypertensive and glycemic control are key priorities in order to stem vision sight-threatening loss Once symptoms of DR are present ophthalmic treatment should include macular laser therapy intravitreal therapy pan-retinal photocoagulation vitrectomy surgery or combinations of these treatments
TreatmentCurrent
For non-severe NPDR prescribed treatments may be intravitreal anti-VEGF therapy plusmn macular laser therapy Non-high-risk NPDR or severe PDR may be treated with intravitreal anti-VEGF therapy plusmn macular laser therapy plusmn pan-retinal photocoagulation or pan-retinal photocoagulation may be considered as 1st line treatment High risk PDR with iris neovascularization may require urgent pan-retinal photocoagulation as a single treatment or in combination with intravitreal anti-VEGF therapy and macular laser therapy A vitrectomy may be prescribed for severe PDR
Very common and rare vision impairmentsUncorrected refractive errorseye cancer
4
Prevalence of vision problemsCollectively uncorrected refractive errors affected an estimated 153 million people worldwide in 2013 This number does not include uncorrected presbyopia The most common conditions are myopia hyperopia astigmatism and presbyopia At the other end of the spectrum eye cancer comprises a group of rare primary or secondary tumors that can occur in and around the eyeballconjunctivaeyelid of an adult or child Most of the new primary intraocular cancers estimated to be diagnosed in the USA in 2016 are likely to be melanomas (2810 adults)
Uncorrected refractive errors (REs)~$2688 billion US dollars lost per year in lost
productivity (2014 estimate)
4
Most common uncorrected REsREs occur when the shape of the eye stops light from focusing on the retina Changes in the shape of cornea length of the eyeball genetics or aging can lead to REs The most common types of refractive errors are myopia hyperopia astigmatism and presbyopia Some of the diagnostic tests include visual acuity and peripheral vision assessments Typically vision can be corrected with glasses contact lenses or refractive surgery
Uncorrected REsDiagnosis
4
c
Get the facts on testsDoctors determine how near or far you can see by looking at letters and symbols of different sizes on an eye chart eg a Snellen chart Refraction tests are done to determine levels of near- or far-sightedness in order to determine the correct prescription for glasses or contact lenses Gaps in peripheral vision are assessed with visual field tests Some people with retinal or optic nerve damage may be color bling and this condition can be determined with color vision tests
Uncorrected REsManagement
4
Treatment optionsGenerally refractive errors can be corrected with glasses contact lenses or refractive surgeries (eg LASIK) For instance early contact lens and spectacle interventions can reduce the rate of progression of myopia and these non-pharmacological interventions are also able to significantly reduce the burden of myopia Additionally pharmacotherapies that cause changes in the sclera show promising efficacies Laser in situ keratomileusis (LASIK) is one of the lens-based procedures that can be considered by appropriate patients
Eye cancerTumor types
4
c
The most common primary intraocular cancer in adults is melanomaEye cancer whether occurring as primary tumors in the immune-privileged eye or as secondary diseases that started somewhere else and spread to the eye is an umbrella term for a group of rare diseases that can also cause vision impairment Primary intraocular lymphoma a type of non-Hodgkin lymphoma can also occur in adults Cancers of the orbit and adnexa can develop from tissues such as muscle nerve and skin around the eyeball In children the most common primary intraocular cancer is retinoblastoma
Eye cancerSpread and lethality of eye cancer in the USA
4
Eye cancer is rare and can be lethal2810 new cancers (mainly melanomas) of the eye and orbit280 deaths from cancers of the eye and orbit 150 in men and 130 in women3 out of 4 people with eye melanoma survive for at least 5 yearsFor localized disease the 5-year relative survival rate is about 80For tumors that have spread beyond the eye the 5-year relative survival rate is about 15
Eye cancerDiagnosis of choroidal melanoma (CM)
4
Whites of Northern Europeans prone to CMCM is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma After excluding other causes a differential diagnosis can be made based on choroidal detachmentintraocular foreign body chronic angle closure glaucomaglaucoma hyphema neovascular glaucoma cavernous hemangioma vitreous hemorrhage hyphema ciliary body melanoma conjunctival melanoma and iris melanoma
Eye cancerMost common primary ocular tumor Melanoma
4
Management in AdultsDepending on the site and spread of the disease doctors may suggest radiation treatment surgery thermotherapy or intraocular injections Metastatic disease may be managed with liver-directed treatment options radiation and ablation Systemic therapies such as targeted chemo- and immunotherapies are also treatment options for appropriate patients
5 Saving vision through preventionGlobal Action Plan
It remains a shocking fact that 80 of visual impairments could have been prevented or treated The International Agency for the Prevention of Blindness (IAPB) has proposed a WHO-endorsed global action plan for preventing blindness (see Figure) This plan forms part of VISION 2020 The Right to Sight The long-term goal of VISION 2020 and other international plans are to rid the world of avoidable blindness and visual impairment
Creditsbull Articulate E-learning for the templatebull Wikimedia and freepikcom for imagesbull In addition to the Merck Professional Manual the
IAPB (see Prevention Infographic)and the Mayo Clinic some of the key sources are listed in the pdf
Adobe Acrobat Document
Vision loss is widespread1990ndash2010 data
1
Cataracts uncorrected refractive errorsand macular degeneration widespreadIn 2010 higher proportions of blindness or moderate and severe vision impairments (MSVI) were caused by cataracts and macular degeneration in women than men Uncorrected refractive errorscaused a larger proportion of MSVI in South Asia than other regions (654 vs 432 481) However macular degeneration in South Asia was low compared to regions with older populations (26 compared with gt15 of blindness attributed to macular degeneration in Central and Eastern Europe) Lowest and highest glaucoma rates were seen in east sub-Saharan Africa and tropical Latin America respectively (40 vs 155)
lack of epidemiological data in countries with trachoma may affect data
CausesUncorrected refractive errors cataracts age-related macular degeneration diabetic retinopathy and eye
cancer
1
Major causes of vision problems range from treatable to lethal diseasesUncorrected refractive errors cataracts and glaucoma are the major causes of visual impairments ii Cataracts glaucoma and age-related macular degeneration are the major causes of blindness Diabetic retinopathy (DR) a key microvascular complication of diabetes mellitus is also a major cause of visual impairment in 20- to 74-year-old adults Eye cancer whether occurring as primary tumors in the immune-privileged eye or as secondary diseases that started somewhere else and spread to the eye is an umbrella term for a group of rare diseases that can also cause vision impairment
CostThe high costs of low or no vision worldwide
1
At $139 billion in 2013 vision impairments are costly to the USADirect costs equal $668 billion ie medical costs for diagnosingeye disorderslow vision medical vision aids vision assistive devices and adaptations and direct services including special education and assistance programs Indirect costs of $722 billioncapture the burden of consequences of low vision including productivity losses long-term care informal care and the costs of transfer and entitlement programs
Overview of vision impairments
2
image placeholder
image placeholder
Refractive errorsCataracts GlaucomaAge-relatedmaculardegeneration
DiabeticRetinopathy Eye cancers
3 Age-related eye diseasesBackgroundcauses of vision impairment
Vision changes are a normal part of the aging process The National Eye Institute recommends a dilated eye exam for anyone at or over the age of 50 In addition to low vision and dry eyes older adults may be affected by two forms of age-related macular degeneration (AMD) suffer clouding of lenses known as cataracts or may be affected by a secondary complication of diabetes mellitus known as diabetic eye diseases Diabetic retinopathy is the most common diabetic eye disease and the leading cause of vision impairment and blindness among working-age adults in the USA
Dry AMD
Cataracts
Wet AMD
Diabetic retinopathy
3 Dry AMDBackgroundcauses of vision impairment
Dry AMD (also called non-neovascular or non-exudative AMD) is characterized by progressive thinning and loss of function of layers of the macula (including the photoreceptors and the retinal pigment epithelium) The color of the macular changes and tiny piles of cellular debris called drusen appears on the retina
DescriptionAMD is more common among whites and is the leading cause of permanent vision loss in the elderly Dry or atrophic AMD lowers the central vision and can affect the preception of color Although not as severe as the wet form of the disease dry AMD can lead to profound vision loss over time More information can be found at amdorgMerck Professional Manual ldquoFunduscopic changes in dry AMD include drusen areas of chorioretinal atrophy and changes to the retinal pigment epitheliumrdquo
3 Wet AMDBackgroundcauses of vision impairment
Wet AMD (also called neovascular AMD or exudative AMD) is characterized by choroidal neovascularization Fluid lipids and blood from the new weaker vessels may leak into the retina (including layers of the macula)- resulting retinal scarring and reduced function
DescriptionWhile most people have the dry version of the disease up to 90 of severe vision loss is due to the wet type
Merck Professional Manualrdquo Funduscopic changes in wet AMD include retinal edema and localized elevation detachment of the retinal pigment epithelium a gray-green discoloration under the macula and exudates in and around the maculardquo
3 CataractsBackgroundcauses of vision impairment
Blindness around the world is predominantly caused by cataracts Most cataracts form as part of the aging process and reflect clouding of the lenses in eyes The lens which is mostly made up of lens and water becomes cloudy with clumps of protein which reduce the sharpness of images reaching the retina Over time a barely noticeable cataract may change the lens to a yellowishbrownish color adding a brownish tint to vision
ManagementOther symptoms
Clouded blurred or dim visionIncreasing difficulty with vision at nightSensitivity to light and glareNeed for brighter light for reading and other activitiesSeeing halos around lightsFrequent changes in eyeglass or contact lens prescriptionFading or yellowing of colorsDouble vision in a single eye
Cataracts can be diagnosed by visual acuity slit lamp or retinal examinations Cataract surgery ndash a routine procedure in which the cloudy lens is replaced by an artificial lens ndash is typically used as treatment Continuing vision problems may be corrected with glasses or contact lenses
3 Diabetic Retinopathy (DR)Backgroundcauses of vision impairment
DR can cause cause blood vessels in the retina to leak fluid or hemorrhage (bleed) distorting vision In its most advanced stage new abnormal blood vessels proliferate (increase in number) on the surface of the retina which can lead to scarring and cell loss in the retina Asymptomatic patients may experience vision fluctuations related to blood glucose levels or as a symptom of cataracts while symptomatic patients may have gradual or acute vision loss depending on the nature of the underlying changes eg macular edemavitreous hemorrhageDiagnosis
Symptomsbull Mild or moderate nonproliferaive DR
(NPDR) symptoms may include microaneurysms intraretinal hemorrhage cotton wool spots and lipid exudates
bull Symptoms may be more severe in severe NDPR
bull NPDR may progress to proliferative DR (PDR)
Strong risk factors include young-onset diabetes longer duration of diabetes poor glycemic control hypertension renal diseaseChange from the first photograph of the fundus Change from the first scan by optical coherence tomography scanning Fluorescein angiography or B scan ultrasonography may also be used as tests
3 Diabetic Retinopathy (DR)Treatment Approach
Hypertensive and glycemic control are key priorities in order to stem vision sight-threatening loss Once symptoms of DR are present ophthalmic treatment should include macular laser therapy intravitreal therapy pan-retinal photocoagulation vitrectomy surgery or combinations of these treatments
TreatmentCurrent
For non-severe NPDR prescribed treatments may be intravitreal anti-VEGF therapy plusmn macular laser therapy Non-high-risk NPDR or severe PDR may be treated with intravitreal anti-VEGF therapy plusmn macular laser therapy plusmn pan-retinal photocoagulation or pan-retinal photocoagulation may be considered as 1st line treatment High risk PDR with iris neovascularization may require urgent pan-retinal photocoagulation as a single treatment or in combination with intravitreal anti-VEGF therapy and macular laser therapy A vitrectomy may be prescribed for severe PDR
Very common and rare vision impairmentsUncorrected refractive errorseye cancer
4
Prevalence of vision problemsCollectively uncorrected refractive errors affected an estimated 153 million people worldwide in 2013 This number does not include uncorrected presbyopia The most common conditions are myopia hyperopia astigmatism and presbyopia At the other end of the spectrum eye cancer comprises a group of rare primary or secondary tumors that can occur in and around the eyeballconjunctivaeyelid of an adult or child Most of the new primary intraocular cancers estimated to be diagnosed in the USA in 2016 are likely to be melanomas (2810 adults)
Uncorrected refractive errors (REs)~$2688 billion US dollars lost per year in lost
productivity (2014 estimate)
4
Most common uncorrected REsREs occur when the shape of the eye stops light from focusing on the retina Changes in the shape of cornea length of the eyeball genetics or aging can lead to REs The most common types of refractive errors are myopia hyperopia astigmatism and presbyopia Some of the diagnostic tests include visual acuity and peripheral vision assessments Typically vision can be corrected with glasses contact lenses or refractive surgery
Uncorrected REsDiagnosis
4
c
Get the facts on testsDoctors determine how near or far you can see by looking at letters and symbols of different sizes on an eye chart eg a Snellen chart Refraction tests are done to determine levels of near- or far-sightedness in order to determine the correct prescription for glasses or contact lenses Gaps in peripheral vision are assessed with visual field tests Some people with retinal or optic nerve damage may be color bling and this condition can be determined with color vision tests
Uncorrected REsManagement
4
Treatment optionsGenerally refractive errors can be corrected with glasses contact lenses or refractive surgeries (eg LASIK) For instance early contact lens and spectacle interventions can reduce the rate of progression of myopia and these non-pharmacological interventions are also able to significantly reduce the burden of myopia Additionally pharmacotherapies that cause changes in the sclera show promising efficacies Laser in situ keratomileusis (LASIK) is one of the lens-based procedures that can be considered by appropriate patients
Eye cancerTumor types
4
c
The most common primary intraocular cancer in adults is melanomaEye cancer whether occurring as primary tumors in the immune-privileged eye or as secondary diseases that started somewhere else and spread to the eye is an umbrella term for a group of rare diseases that can also cause vision impairment Primary intraocular lymphoma a type of non-Hodgkin lymphoma can also occur in adults Cancers of the orbit and adnexa can develop from tissues such as muscle nerve and skin around the eyeball In children the most common primary intraocular cancer is retinoblastoma
Eye cancerSpread and lethality of eye cancer in the USA
4
Eye cancer is rare and can be lethal2810 new cancers (mainly melanomas) of the eye and orbit280 deaths from cancers of the eye and orbit 150 in men and 130 in women3 out of 4 people with eye melanoma survive for at least 5 yearsFor localized disease the 5-year relative survival rate is about 80For tumors that have spread beyond the eye the 5-year relative survival rate is about 15
Eye cancerDiagnosis of choroidal melanoma (CM)
4
Whites of Northern Europeans prone to CMCM is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma After excluding other causes a differential diagnosis can be made based on choroidal detachmentintraocular foreign body chronic angle closure glaucomaglaucoma hyphema neovascular glaucoma cavernous hemangioma vitreous hemorrhage hyphema ciliary body melanoma conjunctival melanoma and iris melanoma
Eye cancerMost common primary ocular tumor Melanoma
4
Management in AdultsDepending on the site and spread of the disease doctors may suggest radiation treatment surgery thermotherapy or intraocular injections Metastatic disease may be managed with liver-directed treatment options radiation and ablation Systemic therapies such as targeted chemo- and immunotherapies are also treatment options for appropriate patients
5 Saving vision through preventionGlobal Action Plan
It remains a shocking fact that 80 of visual impairments could have been prevented or treated The International Agency for the Prevention of Blindness (IAPB) has proposed a WHO-endorsed global action plan for preventing blindness (see Figure) This plan forms part of VISION 2020 The Right to Sight The long-term goal of VISION 2020 and other international plans are to rid the world of avoidable blindness and visual impairment
Creditsbull Articulate E-learning for the templatebull Wikimedia and freepikcom for imagesbull In addition to the Merck Professional Manual the
IAPB (see Prevention Infographic)and the Mayo Clinic some of the key sources are listed in the pdf
Adobe Acrobat Document
CausesUncorrected refractive errors cataracts age-related macular degeneration diabetic retinopathy and eye
cancer
1
Major causes of vision problems range from treatable to lethal diseasesUncorrected refractive errors cataracts and glaucoma are the major causes of visual impairments ii Cataracts glaucoma and age-related macular degeneration are the major causes of blindness Diabetic retinopathy (DR) a key microvascular complication of diabetes mellitus is also a major cause of visual impairment in 20- to 74-year-old adults Eye cancer whether occurring as primary tumors in the immune-privileged eye or as secondary diseases that started somewhere else and spread to the eye is an umbrella term for a group of rare diseases that can also cause vision impairment
CostThe high costs of low or no vision worldwide
1
At $139 billion in 2013 vision impairments are costly to the USADirect costs equal $668 billion ie medical costs for diagnosingeye disorderslow vision medical vision aids vision assistive devices and adaptations and direct services including special education and assistance programs Indirect costs of $722 billioncapture the burden of consequences of low vision including productivity losses long-term care informal care and the costs of transfer and entitlement programs
Overview of vision impairments
2
image placeholder
image placeholder
Refractive errorsCataracts GlaucomaAge-relatedmaculardegeneration
DiabeticRetinopathy Eye cancers
3 Age-related eye diseasesBackgroundcauses of vision impairment
Vision changes are a normal part of the aging process The National Eye Institute recommends a dilated eye exam for anyone at or over the age of 50 In addition to low vision and dry eyes older adults may be affected by two forms of age-related macular degeneration (AMD) suffer clouding of lenses known as cataracts or may be affected by a secondary complication of diabetes mellitus known as diabetic eye diseases Diabetic retinopathy is the most common diabetic eye disease and the leading cause of vision impairment and blindness among working-age adults in the USA
Dry AMD
Cataracts
Wet AMD
Diabetic retinopathy
3 Dry AMDBackgroundcauses of vision impairment
Dry AMD (also called non-neovascular or non-exudative AMD) is characterized by progressive thinning and loss of function of layers of the macula (including the photoreceptors and the retinal pigment epithelium) The color of the macular changes and tiny piles of cellular debris called drusen appears on the retina
DescriptionAMD is more common among whites and is the leading cause of permanent vision loss in the elderly Dry or atrophic AMD lowers the central vision and can affect the preception of color Although not as severe as the wet form of the disease dry AMD can lead to profound vision loss over time More information can be found at amdorgMerck Professional Manual ldquoFunduscopic changes in dry AMD include drusen areas of chorioretinal atrophy and changes to the retinal pigment epitheliumrdquo
3 Wet AMDBackgroundcauses of vision impairment
Wet AMD (also called neovascular AMD or exudative AMD) is characterized by choroidal neovascularization Fluid lipids and blood from the new weaker vessels may leak into the retina (including layers of the macula)- resulting retinal scarring and reduced function
DescriptionWhile most people have the dry version of the disease up to 90 of severe vision loss is due to the wet type
Merck Professional Manualrdquo Funduscopic changes in wet AMD include retinal edema and localized elevation detachment of the retinal pigment epithelium a gray-green discoloration under the macula and exudates in and around the maculardquo
3 CataractsBackgroundcauses of vision impairment
Blindness around the world is predominantly caused by cataracts Most cataracts form as part of the aging process and reflect clouding of the lenses in eyes The lens which is mostly made up of lens and water becomes cloudy with clumps of protein which reduce the sharpness of images reaching the retina Over time a barely noticeable cataract may change the lens to a yellowishbrownish color adding a brownish tint to vision
ManagementOther symptoms
Clouded blurred or dim visionIncreasing difficulty with vision at nightSensitivity to light and glareNeed for brighter light for reading and other activitiesSeeing halos around lightsFrequent changes in eyeglass or contact lens prescriptionFading or yellowing of colorsDouble vision in a single eye
Cataracts can be diagnosed by visual acuity slit lamp or retinal examinations Cataract surgery ndash a routine procedure in which the cloudy lens is replaced by an artificial lens ndash is typically used as treatment Continuing vision problems may be corrected with glasses or contact lenses
3 Diabetic Retinopathy (DR)Backgroundcauses of vision impairment
DR can cause cause blood vessels in the retina to leak fluid or hemorrhage (bleed) distorting vision In its most advanced stage new abnormal blood vessels proliferate (increase in number) on the surface of the retina which can lead to scarring and cell loss in the retina Asymptomatic patients may experience vision fluctuations related to blood glucose levels or as a symptom of cataracts while symptomatic patients may have gradual or acute vision loss depending on the nature of the underlying changes eg macular edemavitreous hemorrhageDiagnosis
Symptomsbull Mild or moderate nonproliferaive DR
(NPDR) symptoms may include microaneurysms intraretinal hemorrhage cotton wool spots and lipid exudates
bull Symptoms may be more severe in severe NDPR
bull NPDR may progress to proliferative DR (PDR)
Strong risk factors include young-onset diabetes longer duration of diabetes poor glycemic control hypertension renal diseaseChange from the first photograph of the fundus Change from the first scan by optical coherence tomography scanning Fluorescein angiography or B scan ultrasonography may also be used as tests
3 Diabetic Retinopathy (DR)Treatment Approach
Hypertensive and glycemic control are key priorities in order to stem vision sight-threatening loss Once symptoms of DR are present ophthalmic treatment should include macular laser therapy intravitreal therapy pan-retinal photocoagulation vitrectomy surgery or combinations of these treatments
TreatmentCurrent
For non-severe NPDR prescribed treatments may be intravitreal anti-VEGF therapy plusmn macular laser therapy Non-high-risk NPDR or severe PDR may be treated with intravitreal anti-VEGF therapy plusmn macular laser therapy plusmn pan-retinal photocoagulation or pan-retinal photocoagulation may be considered as 1st line treatment High risk PDR with iris neovascularization may require urgent pan-retinal photocoagulation as a single treatment or in combination with intravitreal anti-VEGF therapy and macular laser therapy A vitrectomy may be prescribed for severe PDR
Very common and rare vision impairmentsUncorrected refractive errorseye cancer
4
Prevalence of vision problemsCollectively uncorrected refractive errors affected an estimated 153 million people worldwide in 2013 This number does not include uncorrected presbyopia The most common conditions are myopia hyperopia astigmatism and presbyopia At the other end of the spectrum eye cancer comprises a group of rare primary or secondary tumors that can occur in and around the eyeballconjunctivaeyelid of an adult or child Most of the new primary intraocular cancers estimated to be diagnosed in the USA in 2016 are likely to be melanomas (2810 adults)
Uncorrected refractive errors (REs)~$2688 billion US dollars lost per year in lost
productivity (2014 estimate)
4
Most common uncorrected REsREs occur when the shape of the eye stops light from focusing on the retina Changes in the shape of cornea length of the eyeball genetics or aging can lead to REs The most common types of refractive errors are myopia hyperopia astigmatism and presbyopia Some of the diagnostic tests include visual acuity and peripheral vision assessments Typically vision can be corrected with glasses contact lenses or refractive surgery
Uncorrected REsDiagnosis
4
c
Get the facts on testsDoctors determine how near or far you can see by looking at letters and symbols of different sizes on an eye chart eg a Snellen chart Refraction tests are done to determine levels of near- or far-sightedness in order to determine the correct prescription for glasses or contact lenses Gaps in peripheral vision are assessed with visual field tests Some people with retinal or optic nerve damage may be color bling and this condition can be determined with color vision tests
Uncorrected REsManagement
4
Treatment optionsGenerally refractive errors can be corrected with glasses contact lenses or refractive surgeries (eg LASIK) For instance early contact lens and spectacle interventions can reduce the rate of progression of myopia and these non-pharmacological interventions are also able to significantly reduce the burden of myopia Additionally pharmacotherapies that cause changes in the sclera show promising efficacies Laser in situ keratomileusis (LASIK) is one of the lens-based procedures that can be considered by appropriate patients
Eye cancerTumor types
4
c
The most common primary intraocular cancer in adults is melanomaEye cancer whether occurring as primary tumors in the immune-privileged eye or as secondary diseases that started somewhere else and spread to the eye is an umbrella term for a group of rare diseases that can also cause vision impairment Primary intraocular lymphoma a type of non-Hodgkin lymphoma can also occur in adults Cancers of the orbit and adnexa can develop from tissues such as muscle nerve and skin around the eyeball In children the most common primary intraocular cancer is retinoblastoma
Eye cancerSpread and lethality of eye cancer in the USA
4
Eye cancer is rare and can be lethal2810 new cancers (mainly melanomas) of the eye and orbit280 deaths from cancers of the eye and orbit 150 in men and 130 in women3 out of 4 people with eye melanoma survive for at least 5 yearsFor localized disease the 5-year relative survival rate is about 80For tumors that have spread beyond the eye the 5-year relative survival rate is about 15
Eye cancerDiagnosis of choroidal melanoma (CM)
4
Whites of Northern Europeans prone to CMCM is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma After excluding other causes a differential diagnosis can be made based on choroidal detachmentintraocular foreign body chronic angle closure glaucomaglaucoma hyphema neovascular glaucoma cavernous hemangioma vitreous hemorrhage hyphema ciliary body melanoma conjunctival melanoma and iris melanoma
Eye cancerMost common primary ocular tumor Melanoma
4
Management in AdultsDepending on the site and spread of the disease doctors may suggest radiation treatment surgery thermotherapy or intraocular injections Metastatic disease may be managed with liver-directed treatment options radiation and ablation Systemic therapies such as targeted chemo- and immunotherapies are also treatment options for appropriate patients
5 Saving vision through preventionGlobal Action Plan
It remains a shocking fact that 80 of visual impairments could have been prevented or treated The International Agency for the Prevention of Blindness (IAPB) has proposed a WHO-endorsed global action plan for preventing blindness (see Figure) This plan forms part of VISION 2020 The Right to Sight The long-term goal of VISION 2020 and other international plans are to rid the world of avoidable blindness and visual impairment
Creditsbull Articulate E-learning for the templatebull Wikimedia and freepikcom for imagesbull In addition to the Merck Professional Manual the
IAPB (see Prevention Infographic)and the Mayo Clinic some of the key sources are listed in the pdf
Adobe Acrobat Document
CostThe high costs of low or no vision worldwide
1
At $139 billion in 2013 vision impairments are costly to the USADirect costs equal $668 billion ie medical costs for diagnosingeye disorderslow vision medical vision aids vision assistive devices and adaptations and direct services including special education and assistance programs Indirect costs of $722 billioncapture the burden of consequences of low vision including productivity losses long-term care informal care and the costs of transfer and entitlement programs
Overview of vision impairments
2
image placeholder
image placeholder
Refractive errorsCataracts GlaucomaAge-relatedmaculardegeneration
DiabeticRetinopathy Eye cancers
3 Age-related eye diseasesBackgroundcauses of vision impairment
Vision changes are a normal part of the aging process The National Eye Institute recommends a dilated eye exam for anyone at or over the age of 50 In addition to low vision and dry eyes older adults may be affected by two forms of age-related macular degeneration (AMD) suffer clouding of lenses known as cataracts or may be affected by a secondary complication of diabetes mellitus known as diabetic eye diseases Diabetic retinopathy is the most common diabetic eye disease and the leading cause of vision impairment and blindness among working-age adults in the USA
Dry AMD
Cataracts
Wet AMD
Diabetic retinopathy
3 Dry AMDBackgroundcauses of vision impairment
Dry AMD (also called non-neovascular or non-exudative AMD) is characterized by progressive thinning and loss of function of layers of the macula (including the photoreceptors and the retinal pigment epithelium) The color of the macular changes and tiny piles of cellular debris called drusen appears on the retina
DescriptionAMD is more common among whites and is the leading cause of permanent vision loss in the elderly Dry or atrophic AMD lowers the central vision and can affect the preception of color Although not as severe as the wet form of the disease dry AMD can lead to profound vision loss over time More information can be found at amdorgMerck Professional Manual ldquoFunduscopic changes in dry AMD include drusen areas of chorioretinal atrophy and changes to the retinal pigment epitheliumrdquo
3 Wet AMDBackgroundcauses of vision impairment
Wet AMD (also called neovascular AMD or exudative AMD) is characterized by choroidal neovascularization Fluid lipids and blood from the new weaker vessels may leak into the retina (including layers of the macula)- resulting retinal scarring and reduced function
DescriptionWhile most people have the dry version of the disease up to 90 of severe vision loss is due to the wet type
Merck Professional Manualrdquo Funduscopic changes in wet AMD include retinal edema and localized elevation detachment of the retinal pigment epithelium a gray-green discoloration under the macula and exudates in and around the maculardquo
3 CataractsBackgroundcauses of vision impairment
Blindness around the world is predominantly caused by cataracts Most cataracts form as part of the aging process and reflect clouding of the lenses in eyes The lens which is mostly made up of lens and water becomes cloudy with clumps of protein which reduce the sharpness of images reaching the retina Over time a barely noticeable cataract may change the lens to a yellowishbrownish color adding a brownish tint to vision
ManagementOther symptoms
Clouded blurred or dim visionIncreasing difficulty with vision at nightSensitivity to light and glareNeed for brighter light for reading and other activitiesSeeing halos around lightsFrequent changes in eyeglass or contact lens prescriptionFading or yellowing of colorsDouble vision in a single eye
Cataracts can be diagnosed by visual acuity slit lamp or retinal examinations Cataract surgery ndash a routine procedure in which the cloudy lens is replaced by an artificial lens ndash is typically used as treatment Continuing vision problems may be corrected with glasses or contact lenses
3 Diabetic Retinopathy (DR)Backgroundcauses of vision impairment
DR can cause cause blood vessels in the retina to leak fluid or hemorrhage (bleed) distorting vision In its most advanced stage new abnormal blood vessels proliferate (increase in number) on the surface of the retina which can lead to scarring and cell loss in the retina Asymptomatic patients may experience vision fluctuations related to blood glucose levels or as a symptom of cataracts while symptomatic patients may have gradual or acute vision loss depending on the nature of the underlying changes eg macular edemavitreous hemorrhageDiagnosis
Symptomsbull Mild or moderate nonproliferaive DR
(NPDR) symptoms may include microaneurysms intraretinal hemorrhage cotton wool spots and lipid exudates
bull Symptoms may be more severe in severe NDPR
bull NPDR may progress to proliferative DR (PDR)
Strong risk factors include young-onset diabetes longer duration of diabetes poor glycemic control hypertension renal diseaseChange from the first photograph of the fundus Change from the first scan by optical coherence tomography scanning Fluorescein angiography or B scan ultrasonography may also be used as tests
3 Diabetic Retinopathy (DR)Treatment Approach
Hypertensive and glycemic control are key priorities in order to stem vision sight-threatening loss Once symptoms of DR are present ophthalmic treatment should include macular laser therapy intravitreal therapy pan-retinal photocoagulation vitrectomy surgery or combinations of these treatments
TreatmentCurrent
For non-severe NPDR prescribed treatments may be intravitreal anti-VEGF therapy plusmn macular laser therapy Non-high-risk NPDR or severe PDR may be treated with intravitreal anti-VEGF therapy plusmn macular laser therapy plusmn pan-retinal photocoagulation or pan-retinal photocoagulation may be considered as 1st line treatment High risk PDR with iris neovascularization may require urgent pan-retinal photocoagulation as a single treatment or in combination with intravitreal anti-VEGF therapy and macular laser therapy A vitrectomy may be prescribed for severe PDR
Very common and rare vision impairmentsUncorrected refractive errorseye cancer
4
Prevalence of vision problemsCollectively uncorrected refractive errors affected an estimated 153 million people worldwide in 2013 This number does not include uncorrected presbyopia The most common conditions are myopia hyperopia astigmatism and presbyopia At the other end of the spectrum eye cancer comprises a group of rare primary or secondary tumors that can occur in and around the eyeballconjunctivaeyelid of an adult or child Most of the new primary intraocular cancers estimated to be diagnosed in the USA in 2016 are likely to be melanomas (2810 adults)
Uncorrected refractive errors (REs)~$2688 billion US dollars lost per year in lost
productivity (2014 estimate)
4
Most common uncorrected REsREs occur when the shape of the eye stops light from focusing on the retina Changes in the shape of cornea length of the eyeball genetics or aging can lead to REs The most common types of refractive errors are myopia hyperopia astigmatism and presbyopia Some of the diagnostic tests include visual acuity and peripheral vision assessments Typically vision can be corrected with glasses contact lenses or refractive surgery
Uncorrected REsDiagnosis
4
c
Get the facts on testsDoctors determine how near or far you can see by looking at letters and symbols of different sizes on an eye chart eg a Snellen chart Refraction tests are done to determine levels of near- or far-sightedness in order to determine the correct prescription for glasses or contact lenses Gaps in peripheral vision are assessed with visual field tests Some people with retinal or optic nerve damage may be color bling and this condition can be determined with color vision tests
Uncorrected REsManagement
4
Treatment optionsGenerally refractive errors can be corrected with glasses contact lenses or refractive surgeries (eg LASIK) For instance early contact lens and spectacle interventions can reduce the rate of progression of myopia and these non-pharmacological interventions are also able to significantly reduce the burden of myopia Additionally pharmacotherapies that cause changes in the sclera show promising efficacies Laser in situ keratomileusis (LASIK) is one of the lens-based procedures that can be considered by appropriate patients
Eye cancerTumor types
4
c
The most common primary intraocular cancer in adults is melanomaEye cancer whether occurring as primary tumors in the immune-privileged eye or as secondary diseases that started somewhere else and spread to the eye is an umbrella term for a group of rare diseases that can also cause vision impairment Primary intraocular lymphoma a type of non-Hodgkin lymphoma can also occur in adults Cancers of the orbit and adnexa can develop from tissues such as muscle nerve and skin around the eyeball In children the most common primary intraocular cancer is retinoblastoma
Eye cancerSpread and lethality of eye cancer in the USA
4
Eye cancer is rare and can be lethal2810 new cancers (mainly melanomas) of the eye and orbit280 deaths from cancers of the eye and orbit 150 in men and 130 in women3 out of 4 people with eye melanoma survive for at least 5 yearsFor localized disease the 5-year relative survival rate is about 80For tumors that have spread beyond the eye the 5-year relative survival rate is about 15
Eye cancerDiagnosis of choroidal melanoma (CM)
4
Whites of Northern Europeans prone to CMCM is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma After excluding other causes a differential diagnosis can be made based on choroidal detachmentintraocular foreign body chronic angle closure glaucomaglaucoma hyphema neovascular glaucoma cavernous hemangioma vitreous hemorrhage hyphema ciliary body melanoma conjunctival melanoma and iris melanoma
Eye cancerMost common primary ocular tumor Melanoma
4
Management in AdultsDepending on the site and spread of the disease doctors may suggest radiation treatment surgery thermotherapy or intraocular injections Metastatic disease may be managed with liver-directed treatment options radiation and ablation Systemic therapies such as targeted chemo- and immunotherapies are also treatment options for appropriate patients
5 Saving vision through preventionGlobal Action Plan
It remains a shocking fact that 80 of visual impairments could have been prevented or treated The International Agency for the Prevention of Blindness (IAPB) has proposed a WHO-endorsed global action plan for preventing blindness (see Figure) This plan forms part of VISION 2020 The Right to Sight The long-term goal of VISION 2020 and other international plans are to rid the world of avoidable blindness and visual impairment
Creditsbull Articulate E-learning for the templatebull Wikimedia and freepikcom for imagesbull In addition to the Merck Professional Manual the
IAPB (see Prevention Infographic)and the Mayo Clinic some of the key sources are listed in the pdf
Adobe Acrobat Document
Overview of vision impairments
2
image placeholder
image placeholder
Refractive errorsCataracts GlaucomaAge-relatedmaculardegeneration
DiabeticRetinopathy Eye cancers
3 Age-related eye diseasesBackgroundcauses of vision impairment
Vision changes are a normal part of the aging process The National Eye Institute recommends a dilated eye exam for anyone at or over the age of 50 In addition to low vision and dry eyes older adults may be affected by two forms of age-related macular degeneration (AMD) suffer clouding of lenses known as cataracts or may be affected by a secondary complication of diabetes mellitus known as diabetic eye diseases Diabetic retinopathy is the most common diabetic eye disease and the leading cause of vision impairment and blindness among working-age adults in the USA
Dry AMD
Cataracts
Wet AMD
Diabetic retinopathy
3 Dry AMDBackgroundcauses of vision impairment
Dry AMD (also called non-neovascular or non-exudative AMD) is characterized by progressive thinning and loss of function of layers of the macula (including the photoreceptors and the retinal pigment epithelium) The color of the macular changes and tiny piles of cellular debris called drusen appears on the retina
DescriptionAMD is more common among whites and is the leading cause of permanent vision loss in the elderly Dry or atrophic AMD lowers the central vision and can affect the preception of color Although not as severe as the wet form of the disease dry AMD can lead to profound vision loss over time More information can be found at amdorgMerck Professional Manual ldquoFunduscopic changes in dry AMD include drusen areas of chorioretinal atrophy and changes to the retinal pigment epitheliumrdquo
3 Wet AMDBackgroundcauses of vision impairment
Wet AMD (also called neovascular AMD or exudative AMD) is characterized by choroidal neovascularization Fluid lipids and blood from the new weaker vessels may leak into the retina (including layers of the macula)- resulting retinal scarring and reduced function
DescriptionWhile most people have the dry version of the disease up to 90 of severe vision loss is due to the wet type
Merck Professional Manualrdquo Funduscopic changes in wet AMD include retinal edema and localized elevation detachment of the retinal pigment epithelium a gray-green discoloration under the macula and exudates in and around the maculardquo
3 CataractsBackgroundcauses of vision impairment
Blindness around the world is predominantly caused by cataracts Most cataracts form as part of the aging process and reflect clouding of the lenses in eyes The lens which is mostly made up of lens and water becomes cloudy with clumps of protein which reduce the sharpness of images reaching the retina Over time a barely noticeable cataract may change the lens to a yellowishbrownish color adding a brownish tint to vision
ManagementOther symptoms
Clouded blurred or dim visionIncreasing difficulty with vision at nightSensitivity to light and glareNeed for brighter light for reading and other activitiesSeeing halos around lightsFrequent changes in eyeglass or contact lens prescriptionFading or yellowing of colorsDouble vision in a single eye
Cataracts can be diagnosed by visual acuity slit lamp or retinal examinations Cataract surgery ndash a routine procedure in which the cloudy lens is replaced by an artificial lens ndash is typically used as treatment Continuing vision problems may be corrected with glasses or contact lenses
3 Diabetic Retinopathy (DR)Backgroundcauses of vision impairment
DR can cause cause blood vessels in the retina to leak fluid or hemorrhage (bleed) distorting vision In its most advanced stage new abnormal blood vessels proliferate (increase in number) on the surface of the retina which can lead to scarring and cell loss in the retina Asymptomatic patients may experience vision fluctuations related to blood glucose levels or as a symptom of cataracts while symptomatic patients may have gradual or acute vision loss depending on the nature of the underlying changes eg macular edemavitreous hemorrhageDiagnosis
Symptomsbull Mild or moderate nonproliferaive DR
(NPDR) symptoms may include microaneurysms intraretinal hemorrhage cotton wool spots and lipid exudates
bull Symptoms may be more severe in severe NDPR
bull NPDR may progress to proliferative DR (PDR)
Strong risk factors include young-onset diabetes longer duration of diabetes poor glycemic control hypertension renal diseaseChange from the first photograph of the fundus Change from the first scan by optical coherence tomography scanning Fluorescein angiography or B scan ultrasonography may also be used as tests
3 Diabetic Retinopathy (DR)Treatment Approach
Hypertensive and glycemic control are key priorities in order to stem vision sight-threatening loss Once symptoms of DR are present ophthalmic treatment should include macular laser therapy intravitreal therapy pan-retinal photocoagulation vitrectomy surgery or combinations of these treatments
TreatmentCurrent
For non-severe NPDR prescribed treatments may be intravitreal anti-VEGF therapy plusmn macular laser therapy Non-high-risk NPDR or severe PDR may be treated with intravitreal anti-VEGF therapy plusmn macular laser therapy plusmn pan-retinal photocoagulation or pan-retinal photocoagulation may be considered as 1st line treatment High risk PDR with iris neovascularization may require urgent pan-retinal photocoagulation as a single treatment or in combination with intravitreal anti-VEGF therapy and macular laser therapy A vitrectomy may be prescribed for severe PDR
Very common and rare vision impairmentsUncorrected refractive errorseye cancer
4
Prevalence of vision problemsCollectively uncorrected refractive errors affected an estimated 153 million people worldwide in 2013 This number does not include uncorrected presbyopia The most common conditions are myopia hyperopia astigmatism and presbyopia At the other end of the spectrum eye cancer comprises a group of rare primary or secondary tumors that can occur in and around the eyeballconjunctivaeyelid of an adult or child Most of the new primary intraocular cancers estimated to be diagnosed in the USA in 2016 are likely to be melanomas (2810 adults)
Uncorrected refractive errors (REs)~$2688 billion US dollars lost per year in lost
productivity (2014 estimate)
4
Most common uncorrected REsREs occur when the shape of the eye stops light from focusing on the retina Changes in the shape of cornea length of the eyeball genetics or aging can lead to REs The most common types of refractive errors are myopia hyperopia astigmatism and presbyopia Some of the diagnostic tests include visual acuity and peripheral vision assessments Typically vision can be corrected with glasses contact lenses or refractive surgery
Uncorrected REsDiagnosis
4
c
Get the facts on testsDoctors determine how near or far you can see by looking at letters and symbols of different sizes on an eye chart eg a Snellen chart Refraction tests are done to determine levels of near- or far-sightedness in order to determine the correct prescription for glasses or contact lenses Gaps in peripheral vision are assessed with visual field tests Some people with retinal or optic nerve damage may be color bling and this condition can be determined with color vision tests
Uncorrected REsManagement
4
Treatment optionsGenerally refractive errors can be corrected with glasses contact lenses or refractive surgeries (eg LASIK) For instance early contact lens and spectacle interventions can reduce the rate of progression of myopia and these non-pharmacological interventions are also able to significantly reduce the burden of myopia Additionally pharmacotherapies that cause changes in the sclera show promising efficacies Laser in situ keratomileusis (LASIK) is one of the lens-based procedures that can be considered by appropriate patients
Eye cancerTumor types
4
c
The most common primary intraocular cancer in adults is melanomaEye cancer whether occurring as primary tumors in the immune-privileged eye or as secondary diseases that started somewhere else and spread to the eye is an umbrella term for a group of rare diseases that can also cause vision impairment Primary intraocular lymphoma a type of non-Hodgkin lymphoma can also occur in adults Cancers of the orbit and adnexa can develop from tissues such as muscle nerve and skin around the eyeball In children the most common primary intraocular cancer is retinoblastoma
Eye cancerSpread and lethality of eye cancer in the USA
4
Eye cancer is rare and can be lethal2810 new cancers (mainly melanomas) of the eye and orbit280 deaths from cancers of the eye and orbit 150 in men and 130 in women3 out of 4 people with eye melanoma survive for at least 5 yearsFor localized disease the 5-year relative survival rate is about 80For tumors that have spread beyond the eye the 5-year relative survival rate is about 15
Eye cancerDiagnosis of choroidal melanoma (CM)
4
Whites of Northern Europeans prone to CMCM is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma After excluding other causes a differential diagnosis can be made based on choroidal detachmentintraocular foreign body chronic angle closure glaucomaglaucoma hyphema neovascular glaucoma cavernous hemangioma vitreous hemorrhage hyphema ciliary body melanoma conjunctival melanoma and iris melanoma
Eye cancerMost common primary ocular tumor Melanoma
4
Management in AdultsDepending on the site and spread of the disease doctors may suggest radiation treatment surgery thermotherapy or intraocular injections Metastatic disease may be managed with liver-directed treatment options radiation and ablation Systemic therapies such as targeted chemo- and immunotherapies are also treatment options for appropriate patients
5 Saving vision through preventionGlobal Action Plan
It remains a shocking fact that 80 of visual impairments could have been prevented or treated The International Agency for the Prevention of Blindness (IAPB) has proposed a WHO-endorsed global action plan for preventing blindness (see Figure) This plan forms part of VISION 2020 The Right to Sight The long-term goal of VISION 2020 and other international plans are to rid the world of avoidable blindness and visual impairment
Creditsbull Articulate E-learning for the templatebull Wikimedia and freepikcom for imagesbull In addition to the Merck Professional Manual the
IAPB (see Prevention Infographic)and the Mayo Clinic some of the key sources are listed in the pdf
Adobe Acrobat Document
3 Age-related eye diseasesBackgroundcauses of vision impairment
Vision changes are a normal part of the aging process The National Eye Institute recommends a dilated eye exam for anyone at or over the age of 50 In addition to low vision and dry eyes older adults may be affected by two forms of age-related macular degeneration (AMD) suffer clouding of lenses known as cataracts or may be affected by a secondary complication of diabetes mellitus known as diabetic eye diseases Diabetic retinopathy is the most common diabetic eye disease and the leading cause of vision impairment and blindness among working-age adults in the USA
Dry AMD
Cataracts
Wet AMD
Diabetic retinopathy
3 Dry AMDBackgroundcauses of vision impairment
Dry AMD (also called non-neovascular or non-exudative AMD) is characterized by progressive thinning and loss of function of layers of the macula (including the photoreceptors and the retinal pigment epithelium) The color of the macular changes and tiny piles of cellular debris called drusen appears on the retina
DescriptionAMD is more common among whites and is the leading cause of permanent vision loss in the elderly Dry or atrophic AMD lowers the central vision and can affect the preception of color Although not as severe as the wet form of the disease dry AMD can lead to profound vision loss over time More information can be found at amdorgMerck Professional Manual ldquoFunduscopic changes in dry AMD include drusen areas of chorioretinal atrophy and changes to the retinal pigment epitheliumrdquo
3 Wet AMDBackgroundcauses of vision impairment
Wet AMD (also called neovascular AMD or exudative AMD) is characterized by choroidal neovascularization Fluid lipids and blood from the new weaker vessels may leak into the retina (including layers of the macula)- resulting retinal scarring and reduced function
DescriptionWhile most people have the dry version of the disease up to 90 of severe vision loss is due to the wet type
Merck Professional Manualrdquo Funduscopic changes in wet AMD include retinal edema and localized elevation detachment of the retinal pigment epithelium a gray-green discoloration under the macula and exudates in and around the maculardquo
3 CataractsBackgroundcauses of vision impairment
Blindness around the world is predominantly caused by cataracts Most cataracts form as part of the aging process and reflect clouding of the lenses in eyes The lens which is mostly made up of lens and water becomes cloudy with clumps of protein which reduce the sharpness of images reaching the retina Over time a barely noticeable cataract may change the lens to a yellowishbrownish color adding a brownish tint to vision
ManagementOther symptoms
Clouded blurred or dim visionIncreasing difficulty with vision at nightSensitivity to light and glareNeed for brighter light for reading and other activitiesSeeing halos around lightsFrequent changes in eyeglass or contact lens prescriptionFading or yellowing of colorsDouble vision in a single eye
Cataracts can be diagnosed by visual acuity slit lamp or retinal examinations Cataract surgery ndash a routine procedure in which the cloudy lens is replaced by an artificial lens ndash is typically used as treatment Continuing vision problems may be corrected with glasses or contact lenses
3 Diabetic Retinopathy (DR)Backgroundcauses of vision impairment
DR can cause cause blood vessels in the retina to leak fluid or hemorrhage (bleed) distorting vision In its most advanced stage new abnormal blood vessels proliferate (increase in number) on the surface of the retina which can lead to scarring and cell loss in the retina Asymptomatic patients may experience vision fluctuations related to blood glucose levels or as a symptom of cataracts while symptomatic patients may have gradual or acute vision loss depending on the nature of the underlying changes eg macular edemavitreous hemorrhageDiagnosis
Symptomsbull Mild or moderate nonproliferaive DR
(NPDR) symptoms may include microaneurysms intraretinal hemorrhage cotton wool spots and lipid exudates
bull Symptoms may be more severe in severe NDPR
bull NPDR may progress to proliferative DR (PDR)
Strong risk factors include young-onset diabetes longer duration of diabetes poor glycemic control hypertension renal diseaseChange from the first photograph of the fundus Change from the first scan by optical coherence tomography scanning Fluorescein angiography or B scan ultrasonography may also be used as tests
3 Diabetic Retinopathy (DR)Treatment Approach
Hypertensive and glycemic control are key priorities in order to stem vision sight-threatening loss Once symptoms of DR are present ophthalmic treatment should include macular laser therapy intravitreal therapy pan-retinal photocoagulation vitrectomy surgery or combinations of these treatments
TreatmentCurrent
For non-severe NPDR prescribed treatments may be intravitreal anti-VEGF therapy plusmn macular laser therapy Non-high-risk NPDR or severe PDR may be treated with intravitreal anti-VEGF therapy plusmn macular laser therapy plusmn pan-retinal photocoagulation or pan-retinal photocoagulation may be considered as 1st line treatment High risk PDR with iris neovascularization may require urgent pan-retinal photocoagulation as a single treatment or in combination with intravitreal anti-VEGF therapy and macular laser therapy A vitrectomy may be prescribed for severe PDR
Very common and rare vision impairmentsUncorrected refractive errorseye cancer
4
Prevalence of vision problemsCollectively uncorrected refractive errors affected an estimated 153 million people worldwide in 2013 This number does not include uncorrected presbyopia The most common conditions are myopia hyperopia astigmatism and presbyopia At the other end of the spectrum eye cancer comprises a group of rare primary or secondary tumors that can occur in and around the eyeballconjunctivaeyelid of an adult or child Most of the new primary intraocular cancers estimated to be diagnosed in the USA in 2016 are likely to be melanomas (2810 adults)
Uncorrected refractive errors (REs)~$2688 billion US dollars lost per year in lost
productivity (2014 estimate)
4
Most common uncorrected REsREs occur when the shape of the eye stops light from focusing on the retina Changes in the shape of cornea length of the eyeball genetics or aging can lead to REs The most common types of refractive errors are myopia hyperopia astigmatism and presbyopia Some of the diagnostic tests include visual acuity and peripheral vision assessments Typically vision can be corrected with glasses contact lenses or refractive surgery
Uncorrected REsDiagnosis
4
c
Get the facts on testsDoctors determine how near or far you can see by looking at letters and symbols of different sizes on an eye chart eg a Snellen chart Refraction tests are done to determine levels of near- or far-sightedness in order to determine the correct prescription for glasses or contact lenses Gaps in peripheral vision are assessed with visual field tests Some people with retinal or optic nerve damage may be color bling and this condition can be determined with color vision tests
Uncorrected REsManagement
4
Treatment optionsGenerally refractive errors can be corrected with glasses contact lenses or refractive surgeries (eg LASIK) For instance early contact lens and spectacle interventions can reduce the rate of progression of myopia and these non-pharmacological interventions are also able to significantly reduce the burden of myopia Additionally pharmacotherapies that cause changes in the sclera show promising efficacies Laser in situ keratomileusis (LASIK) is one of the lens-based procedures that can be considered by appropriate patients
Eye cancerTumor types
4
c
The most common primary intraocular cancer in adults is melanomaEye cancer whether occurring as primary tumors in the immune-privileged eye or as secondary diseases that started somewhere else and spread to the eye is an umbrella term for a group of rare diseases that can also cause vision impairment Primary intraocular lymphoma a type of non-Hodgkin lymphoma can also occur in adults Cancers of the orbit and adnexa can develop from tissues such as muscle nerve and skin around the eyeball In children the most common primary intraocular cancer is retinoblastoma
Eye cancerSpread and lethality of eye cancer in the USA
4
Eye cancer is rare and can be lethal2810 new cancers (mainly melanomas) of the eye and orbit280 deaths from cancers of the eye and orbit 150 in men and 130 in women3 out of 4 people with eye melanoma survive for at least 5 yearsFor localized disease the 5-year relative survival rate is about 80For tumors that have spread beyond the eye the 5-year relative survival rate is about 15
Eye cancerDiagnosis of choroidal melanoma (CM)
4
Whites of Northern Europeans prone to CMCM is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma After excluding other causes a differential diagnosis can be made based on choroidal detachmentintraocular foreign body chronic angle closure glaucomaglaucoma hyphema neovascular glaucoma cavernous hemangioma vitreous hemorrhage hyphema ciliary body melanoma conjunctival melanoma and iris melanoma
Eye cancerMost common primary ocular tumor Melanoma
4
Management in AdultsDepending on the site and spread of the disease doctors may suggest radiation treatment surgery thermotherapy or intraocular injections Metastatic disease may be managed with liver-directed treatment options radiation and ablation Systemic therapies such as targeted chemo- and immunotherapies are also treatment options for appropriate patients
5 Saving vision through preventionGlobal Action Plan
It remains a shocking fact that 80 of visual impairments could have been prevented or treated The International Agency for the Prevention of Blindness (IAPB) has proposed a WHO-endorsed global action plan for preventing blindness (see Figure) This plan forms part of VISION 2020 The Right to Sight The long-term goal of VISION 2020 and other international plans are to rid the world of avoidable blindness and visual impairment
Creditsbull Articulate E-learning for the templatebull Wikimedia and freepikcom for imagesbull In addition to the Merck Professional Manual the
IAPB (see Prevention Infographic)and the Mayo Clinic some of the key sources are listed in the pdf
Adobe Acrobat Document
3 Dry AMDBackgroundcauses of vision impairment
Dry AMD (also called non-neovascular or non-exudative AMD) is characterized by progressive thinning and loss of function of layers of the macula (including the photoreceptors and the retinal pigment epithelium) The color of the macular changes and tiny piles of cellular debris called drusen appears on the retina
DescriptionAMD is more common among whites and is the leading cause of permanent vision loss in the elderly Dry or atrophic AMD lowers the central vision and can affect the preception of color Although not as severe as the wet form of the disease dry AMD can lead to profound vision loss over time More information can be found at amdorgMerck Professional Manual ldquoFunduscopic changes in dry AMD include drusen areas of chorioretinal atrophy and changes to the retinal pigment epitheliumrdquo
3 Wet AMDBackgroundcauses of vision impairment
Wet AMD (also called neovascular AMD or exudative AMD) is characterized by choroidal neovascularization Fluid lipids and blood from the new weaker vessels may leak into the retina (including layers of the macula)- resulting retinal scarring and reduced function
DescriptionWhile most people have the dry version of the disease up to 90 of severe vision loss is due to the wet type
Merck Professional Manualrdquo Funduscopic changes in wet AMD include retinal edema and localized elevation detachment of the retinal pigment epithelium a gray-green discoloration under the macula and exudates in and around the maculardquo
3 CataractsBackgroundcauses of vision impairment
Blindness around the world is predominantly caused by cataracts Most cataracts form as part of the aging process and reflect clouding of the lenses in eyes The lens which is mostly made up of lens and water becomes cloudy with clumps of protein which reduce the sharpness of images reaching the retina Over time a barely noticeable cataract may change the lens to a yellowishbrownish color adding a brownish tint to vision
ManagementOther symptoms
Clouded blurred or dim visionIncreasing difficulty with vision at nightSensitivity to light and glareNeed for brighter light for reading and other activitiesSeeing halos around lightsFrequent changes in eyeglass or contact lens prescriptionFading or yellowing of colorsDouble vision in a single eye
Cataracts can be diagnosed by visual acuity slit lamp or retinal examinations Cataract surgery ndash a routine procedure in which the cloudy lens is replaced by an artificial lens ndash is typically used as treatment Continuing vision problems may be corrected with glasses or contact lenses
3 Diabetic Retinopathy (DR)Backgroundcauses of vision impairment
DR can cause cause blood vessels in the retina to leak fluid or hemorrhage (bleed) distorting vision In its most advanced stage new abnormal blood vessels proliferate (increase in number) on the surface of the retina which can lead to scarring and cell loss in the retina Asymptomatic patients may experience vision fluctuations related to blood glucose levels or as a symptom of cataracts while symptomatic patients may have gradual or acute vision loss depending on the nature of the underlying changes eg macular edemavitreous hemorrhageDiagnosis
Symptomsbull Mild or moderate nonproliferaive DR
(NPDR) symptoms may include microaneurysms intraretinal hemorrhage cotton wool spots and lipid exudates
bull Symptoms may be more severe in severe NDPR
bull NPDR may progress to proliferative DR (PDR)
Strong risk factors include young-onset diabetes longer duration of diabetes poor glycemic control hypertension renal diseaseChange from the first photograph of the fundus Change from the first scan by optical coherence tomography scanning Fluorescein angiography or B scan ultrasonography may also be used as tests
3 Diabetic Retinopathy (DR)Treatment Approach
Hypertensive and glycemic control are key priorities in order to stem vision sight-threatening loss Once symptoms of DR are present ophthalmic treatment should include macular laser therapy intravitreal therapy pan-retinal photocoagulation vitrectomy surgery or combinations of these treatments
TreatmentCurrent
For non-severe NPDR prescribed treatments may be intravitreal anti-VEGF therapy plusmn macular laser therapy Non-high-risk NPDR or severe PDR may be treated with intravitreal anti-VEGF therapy plusmn macular laser therapy plusmn pan-retinal photocoagulation or pan-retinal photocoagulation may be considered as 1st line treatment High risk PDR with iris neovascularization may require urgent pan-retinal photocoagulation as a single treatment or in combination with intravitreal anti-VEGF therapy and macular laser therapy A vitrectomy may be prescribed for severe PDR
Very common and rare vision impairmentsUncorrected refractive errorseye cancer
4
Prevalence of vision problemsCollectively uncorrected refractive errors affected an estimated 153 million people worldwide in 2013 This number does not include uncorrected presbyopia The most common conditions are myopia hyperopia astigmatism and presbyopia At the other end of the spectrum eye cancer comprises a group of rare primary or secondary tumors that can occur in and around the eyeballconjunctivaeyelid of an adult or child Most of the new primary intraocular cancers estimated to be diagnosed in the USA in 2016 are likely to be melanomas (2810 adults)
Uncorrected refractive errors (REs)~$2688 billion US dollars lost per year in lost
productivity (2014 estimate)
4
Most common uncorrected REsREs occur when the shape of the eye stops light from focusing on the retina Changes in the shape of cornea length of the eyeball genetics or aging can lead to REs The most common types of refractive errors are myopia hyperopia astigmatism and presbyopia Some of the diagnostic tests include visual acuity and peripheral vision assessments Typically vision can be corrected with glasses contact lenses or refractive surgery
Uncorrected REsDiagnosis
4
c
Get the facts on testsDoctors determine how near or far you can see by looking at letters and symbols of different sizes on an eye chart eg a Snellen chart Refraction tests are done to determine levels of near- or far-sightedness in order to determine the correct prescription for glasses or contact lenses Gaps in peripheral vision are assessed with visual field tests Some people with retinal or optic nerve damage may be color bling and this condition can be determined with color vision tests
Uncorrected REsManagement
4
Treatment optionsGenerally refractive errors can be corrected with glasses contact lenses or refractive surgeries (eg LASIK) For instance early contact lens and spectacle interventions can reduce the rate of progression of myopia and these non-pharmacological interventions are also able to significantly reduce the burden of myopia Additionally pharmacotherapies that cause changes in the sclera show promising efficacies Laser in situ keratomileusis (LASIK) is one of the lens-based procedures that can be considered by appropriate patients
Eye cancerTumor types
4
c
The most common primary intraocular cancer in adults is melanomaEye cancer whether occurring as primary tumors in the immune-privileged eye or as secondary diseases that started somewhere else and spread to the eye is an umbrella term for a group of rare diseases that can also cause vision impairment Primary intraocular lymphoma a type of non-Hodgkin lymphoma can also occur in adults Cancers of the orbit and adnexa can develop from tissues such as muscle nerve and skin around the eyeball In children the most common primary intraocular cancer is retinoblastoma
Eye cancerSpread and lethality of eye cancer in the USA
4
Eye cancer is rare and can be lethal2810 new cancers (mainly melanomas) of the eye and orbit280 deaths from cancers of the eye and orbit 150 in men and 130 in women3 out of 4 people with eye melanoma survive for at least 5 yearsFor localized disease the 5-year relative survival rate is about 80For tumors that have spread beyond the eye the 5-year relative survival rate is about 15
Eye cancerDiagnosis of choroidal melanoma (CM)
4
Whites of Northern Europeans prone to CMCM is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma After excluding other causes a differential diagnosis can be made based on choroidal detachmentintraocular foreign body chronic angle closure glaucomaglaucoma hyphema neovascular glaucoma cavernous hemangioma vitreous hemorrhage hyphema ciliary body melanoma conjunctival melanoma and iris melanoma
Eye cancerMost common primary ocular tumor Melanoma
4
Management in AdultsDepending on the site and spread of the disease doctors may suggest radiation treatment surgery thermotherapy or intraocular injections Metastatic disease may be managed with liver-directed treatment options radiation and ablation Systemic therapies such as targeted chemo- and immunotherapies are also treatment options for appropriate patients
5 Saving vision through preventionGlobal Action Plan
It remains a shocking fact that 80 of visual impairments could have been prevented or treated The International Agency for the Prevention of Blindness (IAPB) has proposed a WHO-endorsed global action plan for preventing blindness (see Figure) This plan forms part of VISION 2020 The Right to Sight The long-term goal of VISION 2020 and other international plans are to rid the world of avoidable blindness and visual impairment
Creditsbull Articulate E-learning for the templatebull Wikimedia and freepikcom for imagesbull In addition to the Merck Professional Manual the
IAPB (see Prevention Infographic)and the Mayo Clinic some of the key sources are listed in the pdf
Adobe Acrobat Document
3 Wet AMDBackgroundcauses of vision impairment
Wet AMD (also called neovascular AMD or exudative AMD) is characterized by choroidal neovascularization Fluid lipids and blood from the new weaker vessels may leak into the retina (including layers of the macula)- resulting retinal scarring and reduced function
DescriptionWhile most people have the dry version of the disease up to 90 of severe vision loss is due to the wet type
Merck Professional Manualrdquo Funduscopic changes in wet AMD include retinal edema and localized elevation detachment of the retinal pigment epithelium a gray-green discoloration under the macula and exudates in and around the maculardquo
3 CataractsBackgroundcauses of vision impairment
Blindness around the world is predominantly caused by cataracts Most cataracts form as part of the aging process and reflect clouding of the lenses in eyes The lens which is mostly made up of lens and water becomes cloudy with clumps of protein which reduce the sharpness of images reaching the retina Over time a barely noticeable cataract may change the lens to a yellowishbrownish color adding a brownish tint to vision
ManagementOther symptoms
Clouded blurred or dim visionIncreasing difficulty with vision at nightSensitivity to light and glareNeed for brighter light for reading and other activitiesSeeing halos around lightsFrequent changes in eyeglass or contact lens prescriptionFading or yellowing of colorsDouble vision in a single eye
Cataracts can be diagnosed by visual acuity slit lamp or retinal examinations Cataract surgery ndash a routine procedure in which the cloudy lens is replaced by an artificial lens ndash is typically used as treatment Continuing vision problems may be corrected with glasses or contact lenses
3 Diabetic Retinopathy (DR)Backgroundcauses of vision impairment
DR can cause cause blood vessels in the retina to leak fluid or hemorrhage (bleed) distorting vision In its most advanced stage new abnormal blood vessels proliferate (increase in number) on the surface of the retina which can lead to scarring and cell loss in the retina Asymptomatic patients may experience vision fluctuations related to blood glucose levels or as a symptom of cataracts while symptomatic patients may have gradual or acute vision loss depending on the nature of the underlying changes eg macular edemavitreous hemorrhageDiagnosis
Symptomsbull Mild or moderate nonproliferaive DR
(NPDR) symptoms may include microaneurysms intraretinal hemorrhage cotton wool spots and lipid exudates
bull Symptoms may be more severe in severe NDPR
bull NPDR may progress to proliferative DR (PDR)
Strong risk factors include young-onset diabetes longer duration of diabetes poor glycemic control hypertension renal diseaseChange from the first photograph of the fundus Change from the first scan by optical coherence tomography scanning Fluorescein angiography or B scan ultrasonography may also be used as tests
3 Diabetic Retinopathy (DR)Treatment Approach
Hypertensive and glycemic control are key priorities in order to stem vision sight-threatening loss Once symptoms of DR are present ophthalmic treatment should include macular laser therapy intravitreal therapy pan-retinal photocoagulation vitrectomy surgery or combinations of these treatments
TreatmentCurrent
For non-severe NPDR prescribed treatments may be intravitreal anti-VEGF therapy plusmn macular laser therapy Non-high-risk NPDR or severe PDR may be treated with intravitreal anti-VEGF therapy plusmn macular laser therapy plusmn pan-retinal photocoagulation or pan-retinal photocoagulation may be considered as 1st line treatment High risk PDR with iris neovascularization may require urgent pan-retinal photocoagulation as a single treatment or in combination with intravitreal anti-VEGF therapy and macular laser therapy A vitrectomy may be prescribed for severe PDR
Very common and rare vision impairmentsUncorrected refractive errorseye cancer
4
Prevalence of vision problemsCollectively uncorrected refractive errors affected an estimated 153 million people worldwide in 2013 This number does not include uncorrected presbyopia The most common conditions are myopia hyperopia astigmatism and presbyopia At the other end of the spectrum eye cancer comprises a group of rare primary or secondary tumors that can occur in and around the eyeballconjunctivaeyelid of an adult or child Most of the new primary intraocular cancers estimated to be diagnosed in the USA in 2016 are likely to be melanomas (2810 adults)
Uncorrected refractive errors (REs)~$2688 billion US dollars lost per year in lost
productivity (2014 estimate)
4
Most common uncorrected REsREs occur when the shape of the eye stops light from focusing on the retina Changes in the shape of cornea length of the eyeball genetics or aging can lead to REs The most common types of refractive errors are myopia hyperopia astigmatism and presbyopia Some of the diagnostic tests include visual acuity and peripheral vision assessments Typically vision can be corrected with glasses contact lenses or refractive surgery
Uncorrected REsDiagnosis
4
c
Get the facts on testsDoctors determine how near or far you can see by looking at letters and symbols of different sizes on an eye chart eg a Snellen chart Refraction tests are done to determine levels of near- or far-sightedness in order to determine the correct prescription for glasses or contact lenses Gaps in peripheral vision are assessed with visual field tests Some people with retinal or optic nerve damage may be color bling and this condition can be determined with color vision tests
Uncorrected REsManagement
4
Treatment optionsGenerally refractive errors can be corrected with glasses contact lenses or refractive surgeries (eg LASIK) For instance early contact lens and spectacle interventions can reduce the rate of progression of myopia and these non-pharmacological interventions are also able to significantly reduce the burden of myopia Additionally pharmacotherapies that cause changes in the sclera show promising efficacies Laser in situ keratomileusis (LASIK) is one of the lens-based procedures that can be considered by appropriate patients
Eye cancerTumor types
4
c
The most common primary intraocular cancer in adults is melanomaEye cancer whether occurring as primary tumors in the immune-privileged eye or as secondary diseases that started somewhere else and spread to the eye is an umbrella term for a group of rare diseases that can also cause vision impairment Primary intraocular lymphoma a type of non-Hodgkin lymphoma can also occur in adults Cancers of the orbit and adnexa can develop from tissues such as muscle nerve and skin around the eyeball In children the most common primary intraocular cancer is retinoblastoma
Eye cancerSpread and lethality of eye cancer in the USA
4
Eye cancer is rare and can be lethal2810 new cancers (mainly melanomas) of the eye and orbit280 deaths from cancers of the eye and orbit 150 in men and 130 in women3 out of 4 people with eye melanoma survive for at least 5 yearsFor localized disease the 5-year relative survival rate is about 80For tumors that have spread beyond the eye the 5-year relative survival rate is about 15
Eye cancerDiagnosis of choroidal melanoma (CM)
4
Whites of Northern Europeans prone to CMCM is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma After excluding other causes a differential diagnosis can be made based on choroidal detachmentintraocular foreign body chronic angle closure glaucomaglaucoma hyphema neovascular glaucoma cavernous hemangioma vitreous hemorrhage hyphema ciliary body melanoma conjunctival melanoma and iris melanoma
Eye cancerMost common primary ocular tumor Melanoma
4
Management in AdultsDepending on the site and spread of the disease doctors may suggest radiation treatment surgery thermotherapy or intraocular injections Metastatic disease may be managed with liver-directed treatment options radiation and ablation Systemic therapies such as targeted chemo- and immunotherapies are also treatment options for appropriate patients
5 Saving vision through preventionGlobal Action Plan
It remains a shocking fact that 80 of visual impairments could have been prevented or treated The International Agency for the Prevention of Blindness (IAPB) has proposed a WHO-endorsed global action plan for preventing blindness (see Figure) This plan forms part of VISION 2020 The Right to Sight The long-term goal of VISION 2020 and other international plans are to rid the world of avoidable blindness and visual impairment
Creditsbull Articulate E-learning for the templatebull Wikimedia and freepikcom for imagesbull In addition to the Merck Professional Manual the
IAPB (see Prevention Infographic)and the Mayo Clinic some of the key sources are listed in the pdf
Adobe Acrobat Document
3 CataractsBackgroundcauses of vision impairment
Blindness around the world is predominantly caused by cataracts Most cataracts form as part of the aging process and reflect clouding of the lenses in eyes The lens which is mostly made up of lens and water becomes cloudy with clumps of protein which reduce the sharpness of images reaching the retina Over time a barely noticeable cataract may change the lens to a yellowishbrownish color adding a brownish tint to vision
ManagementOther symptoms
Clouded blurred or dim visionIncreasing difficulty with vision at nightSensitivity to light and glareNeed for brighter light for reading and other activitiesSeeing halos around lightsFrequent changes in eyeglass or contact lens prescriptionFading or yellowing of colorsDouble vision in a single eye
Cataracts can be diagnosed by visual acuity slit lamp or retinal examinations Cataract surgery ndash a routine procedure in which the cloudy lens is replaced by an artificial lens ndash is typically used as treatment Continuing vision problems may be corrected with glasses or contact lenses
3 Diabetic Retinopathy (DR)Backgroundcauses of vision impairment
DR can cause cause blood vessels in the retina to leak fluid or hemorrhage (bleed) distorting vision In its most advanced stage new abnormal blood vessels proliferate (increase in number) on the surface of the retina which can lead to scarring and cell loss in the retina Asymptomatic patients may experience vision fluctuations related to blood glucose levels or as a symptom of cataracts while symptomatic patients may have gradual or acute vision loss depending on the nature of the underlying changes eg macular edemavitreous hemorrhageDiagnosis
Symptomsbull Mild or moderate nonproliferaive DR
(NPDR) symptoms may include microaneurysms intraretinal hemorrhage cotton wool spots and lipid exudates
bull Symptoms may be more severe in severe NDPR
bull NPDR may progress to proliferative DR (PDR)
Strong risk factors include young-onset diabetes longer duration of diabetes poor glycemic control hypertension renal diseaseChange from the first photograph of the fundus Change from the first scan by optical coherence tomography scanning Fluorescein angiography or B scan ultrasonography may also be used as tests
3 Diabetic Retinopathy (DR)Treatment Approach
Hypertensive and glycemic control are key priorities in order to stem vision sight-threatening loss Once symptoms of DR are present ophthalmic treatment should include macular laser therapy intravitreal therapy pan-retinal photocoagulation vitrectomy surgery or combinations of these treatments
TreatmentCurrent
For non-severe NPDR prescribed treatments may be intravitreal anti-VEGF therapy plusmn macular laser therapy Non-high-risk NPDR or severe PDR may be treated with intravitreal anti-VEGF therapy plusmn macular laser therapy plusmn pan-retinal photocoagulation or pan-retinal photocoagulation may be considered as 1st line treatment High risk PDR with iris neovascularization may require urgent pan-retinal photocoagulation as a single treatment or in combination with intravitreal anti-VEGF therapy and macular laser therapy A vitrectomy may be prescribed for severe PDR
Very common and rare vision impairmentsUncorrected refractive errorseye cancer
4
Prevalence of vision problemsCollectively uncorrected refractive errors affected an estimated 153 million people worldwide in 2013 This number does not include uncorrected presbyopia The most common conditions are myopia hyperopia astigmatism and presbyopia At the other end of the spectrum eye cancer comprises a group of rare primary or secondary tumors that can occur in and around the eyeballconjunctivaeyelid of an adult or child Most of the new primary intraocular cancers estimated to be diagnosed in the USA in 2016 are likely to be melanomas (2810 adults)
Uncorrected refractive errors (REs)~$2688 billion US dollars lost per year in lost
productivity (2014 estimate)
4
Most common uncorrected REsREs occur when the shape of the eye stops light from focusing on the retina Changes in the shape of cornea length of the eyeball genetics or aging can lead to REs The most common types of refractive errors are myopia hyperopia astigmatism and presbyopia Some of the diagnostic tests include visual acuity and peripheral vision assessments Typically vision can be corrected with glasses contact lenses or refractive surgery
Uncorrected REsDiagnosis
4
c
Get the facts on testsDoctors determine how near or far you can see by looking at letters and symbols of different sizes on an eye chart eg a Snellen chart Refraction tests are done to determine levels of near- or far-sightedness in order to determine the correct prescription for glasses or contact lenses Gaps in peripheral vision are assessed with visual field tests Some people with retinal or optic nerve damage may be color bling and this condition can be determined with color vision tests
Uncorrected REsManagement
4
Treatment optionsGenerally refractive errors can be corrected with glasses contact lenses or refractive surgeries (eg LASIK) For instance early contact lens and spectacle interventions can reduce the rate of progression of myopia and these non-pharmacological interventions are also able to significantly reduce the burden of myopia Additionally pharmacotherapies that cause changes in the sclera show promising efficacies Laser in situ keratomileusis (LASIK) is one of the lens-based procedures that can be considered by appropriate patients
Eye cancerTumor types
4
c
The most common primary intraocular cancer in adults is melanomaEye cancer whether occurring as primary tumors in the immune-privileged eye or as secondary diseases that started somewhere else and spread to the eye is an umbrella term for a group of rare diseases that can also cause vision impairment Primary intraocular lymphoma a type of non-Hodgkin lymphoma can also occur in adults Cancers of the orbit and adnexa can develop from tissues such as muscle nerve and skin around the eyeball In children the most common primary intraocular cancer is retinoblastoma
Eye cancerSpread and lethality of eye cancer in the USA
4
Eye cancer is rare and can be lethal2810 new cancers (mainly melanomas) of the eye and orbit280 deaths from cancers of the eye and orbit 150 in men and 130 in women3 out of 4 people with eye melanoma survive for at least 5 yearsFor localized disease the 5-year relative survival rate is about 80For tumors that have spread beyond the eye the 5-year relative survival rate is about 15
Eye cancerDiagnosis of choroidal melanoma (CM)
4
Whites of Northern Europeans prone to CMCM is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma After excluding other causes a differential diagnosis can be made based on choroidal detachmentintraocular foreign body chronic angle closure glaucomaglaucoma hyphema neovascular glaucoma cavernous hemangioma vitreous hemorrhage hyphema ciliary body melanoma conjunctival melanoma and iris melanoma
Eye cancerMost common primary ocular tumor Melanoma
4
Management in AdultsDepending on the site and spread of the disease doctors may suggest radiation treatment surgery thermotherapy or intraocular injections Metastatic disease may be managed with liver-directed treatment options radiation and ablation Systemic therapies such as targeted chemo- and immunotherapies are also treatment options for appropriate patients
5 Saving vision through preventionGlobal Action Plan
It remains a shocking fact that 80 of visual impairments could have been prevented or treated The International Agency for the Prevention of Blindness (IAPB) has proposed a WHO-endorsed global action plan for preventing blindness (see Figure) This plan forms part of VISION 2020 The Right to Sight The long-term goal of VISION 2020 and other international plans are to rid the world of avoidable blindness and visual impairment
Creditsbull Articulate E-learning for the templatebull Wikimedia and freepikcom for imagesbull In addition to the Merck Professional Manual the
IAPB (see Prevention Infographic)and the Mayo Clinic some of the key sources are listed in the pdf
Adobe Acrobat Document
3 Diabetic Retinopathy (DR)Backgroundcauses of vision impairment
DR can cause cause blood vessels in the retina to leak fluid or hemorrhage (bleed) distorting vision In its most advanced stage new abnormal blood vessels proliferate (increase in number) on the surface of the retina which can lead to scarring and cell loss in the retina Asymptomatic patients may experience vision fluctuations related to blood glucose levels or as a symptom of cataracts while symptomatic patients may have gradual or acute vision loss depending on the nature of the underlying changes eg macular edemavitreous hemorrhageDiagnosis
Symptomsbull Mild or moderate nonproliferaive DR
(NPDR) symptoms may include microaneurysms intraretinal hemorrhage cotton wool spots and lipid exudates
bull Symptoms may be more severe in severe NDPR
bull NPDR may progress to proliferative DR (PDR)
Strong risk factors include young-onset diabetes longer duration of diabetes poor glycemic control hypertension renal diseaseChange from the first photograph of the fundus Change from the first scan by optical coherence tomography scanning Fluorescein angiography or B scan ultrasonography may also be used as tests
3 Diabetic Retinopathy (DR)Treatment Approach
Hypertensive and glycemic control are key priorities in order to stem vision sight-threatening loss Once symptoms of DR are present ophthalmic treatment should include macular laser therapy intravitreal therapy pan-retinal photocoagulation vitrectomy surgery or combinations of these treatments
TreatmentCurrent
For non-severe NPDR prescribed treatments may be intravitreal anti-VEGF therapy plusmn macular laser therapy Non-high-risk NPDR or severe PDR may be treated with intravitreal anti-VEGF therapy plusmn macular laser therapy plusmn pan-retinal photocoagulation or pan-retinal photocoagulation may be considered as 1st line treatment High risk PDR with iris neovascularization may require urgent pan-retinal photocoagulation as a single treatment or in combination with intravitreal anti-VEGF therapy and macular laser therapy A vitrectomy may be prescribed for severe PDR
Very common and rare vision impairmentsUncorrected refractive errorseye cancer
4
Prevalence of vision problemsCollectively uncorrected refractive errors affected an estimated 153 million people worldwide in 2013 This number does not include uncorrected presbyopia The most common conditions are myopia hyperopia astigmatism and presbyopia At the other end of the spectrum eye cancer comprises a group of rare primary or secondary tumors that can occur in and around the eyeballconjunctivaeyelid of an adult or child Most of the new primary intraocular cancers estimated to be diagnosed in the USA in 2016 are likely to be melanomas (2810 adults)
Uncorrected refractive errors (REs)~$2688 billion US dollars lost per year in lost
productivity (2014 estimate)
4
Most common uncorrected REsREs occur when the shape of the eye stops light from focusing on the retina Changes in the shape of cornea length of the eyeball genetics or aging can lead to REs The most common types of refractive errors are myopia hyperopia astigmatism and presbyopia Some of the diagnostic tests include visual acuity and peripheral vision assessments Typically vision can be corrected with glasses contact lenses or refractive surgery
Uncorrected REsDiagnosis
4
c
Get the facts on testsDoctors determine how near or far you can see by looking at letters and symbols of different sizes on an eye chart eg a Snellen chart Refraction tests are done to determine levels of near- or far-sightedness in order to determine the correct prescription for glasses or contact lenses Gaps in peripheral vision are assessed with visual field tests Some people with retinal or optic nerve damage may be color bling and this condition can be determined with color vision tests
Uncorrected REsManagement
4
Treatment optionsGenerally refractive errors can be corrected with glasses contact lenses or refractive surgeries (eg LASIK) For instance early contact lens and spectacle interventions can reduce the rate of progression of myopia and these non-pharmacological interventions are also able to significantly reduce the burden of myopia Additionally pharmacotherapies that cause changes in the sclera show promising efficacies Laser in situ keratomileusis (LASIK) is one of the lens-based procedures that can be considered by appropriate patients
Eye cancerTumor types
4
c
The most common primary intraocular cancer in adults is melanomaEye cancer whether occurring as primary tumors in the immune-privileged eye or as secondary diseases that started somewhere else and spread to the eye is an umbrella term for a group of rare diseases that can also cause vision impairment Primary intraocular lymphoma a type of non-Hodgkin lymphoma can also occur in adults Cancers of the orbit and adnexa can develop from tissues such as muscle nerve and skin around the eyeball In children the most common primary intraocular cancer is retinoblastoma
Eye cancerSpread and lethality of eye cancer in the USA
4
Eye cancer is rare and can be lethal2810 new cancers (mainly melanomas) of the eye and orbit280 deaths from cancers of the eye and orbit 150 in men and 130 in women3 out of 4 people with eye melanoma survive for at least 5 yearsFor localized disease the 5-year relative survival rate is about 80For tumors that have spread beyond the eye the 5-year relative survival rate is about 15
Eye cancerDiagnosis of choroidal melanoma (CM)
4
Whites of Northern Europeans prone to CMCM is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma After excluding other causes a differential diagnosis can be made based on choroidal detachmentintraocular foreign body chronic angle closure glaucomaglaucoma hyphema neovascular glaucoma cavernous hemangioma vitreous hemorrhage hyphema ciliary body melanoma conjunctival melanoma and iris melanoma
Eye cancerMost common primary ocular tumor Melanoma
4
Management in AdultsDepending on the site and spread of the disease doctors may suggest radiation treatment surgery thermotherapy or intraocular injections Metastatic disease may be managed with liver-directed treatment options radiation and ablation Systemic therapies such as targeted chemo- and immunotherapies are also treatment options for appropriate patients
5 Saving vision through preventionGlobal Action Plan
It remains a shocking fact that 80 of visual impairments could have been prevented or treated The International Agency for the Prevention of Blindness (IAPB) has proposed a WHO-endorsed global action plan for preventing blindness (see Figure) This plan forms part of VISION 2020 The Right to Sight The long-term goal of VISION 2020 and other international plans are to rid the world of avoidable blindness and visual impairment
Creditsbull Articulate E-learning for the templatebull Wikimedia and freepikcom for imagesbull In addition to the Merck Professional Manual the
IAPB (see Prevention Infographic)and the Mayo Clinic some of the key sources are listed in the pdf
Adobe Acrobat Document
3 Diabetic Retinopathy (DR)Treatment Approach
Hypertensive and glycemic control are key priorities in order to stem vision sight-threatening loss Once symptoms of DR are present ophthalmic treatment should include macular laser therapy intravitreal therapy pan-retinal photocoagulation vitrectomy surgery or combinations of these treatments
TreatmentCurrent
For non-severe NPDR prescribed treatments may be intravitreal anti-VEGF therapy plusmn macular laser therapy Non-high-risk NPDR or severe PDR may be treated with intravitreal anti-VEGF therapy plusmn macular laser therapy plusmn pan-retinal photocoagulation or pan-retinal photocoagulation may be considered as 1st line treatment High risk PDR with iris neovascularization may require urgent pan-retinal photocoagulation as a single treatment or in combination with intravitreal anti-VEGF therapy and macular laser therapy A vitrectomy may be prescribed for severe PDR
Very common and rare vision impairmentsUncorrected refractive errorseye cancer
4
Prevalence of vision problemsCollectively uncorrected refractive errors affected an estimated 153 million people worldwide in 2013 This number does not include uncorrected presbyopia The most common conditions are myopia hyperopia astigmatism and presbyopia At the other end of the spectrum eye cancer comprises a group of rare primary or secondary tumors that can occur in and around the eyeballconjunctivaeyelid of an adult or child Most of the new primary intraocular cancers estimated to be diagnosed in the USA in 2016 are likely to be melanomas (2810 adults)
Uncorrected refractive errors (REs)~$2688 billion US dollars lost per year in lost
productivity (2014 estimate)
4
Most common uncorrected REsREs occur when the shape of the eye stops light from focusing on the retina Changes in the shape of cornea length of the eyeball genetics or aging can lead to REs The most common types of refractive errors are myopia hyperopia astigmatism and presbyopia Some of the diagnostic tests include visual acuity and peripheral vision assessments Typically vision can be corrected with glasses contact lenses or refractive surgery
Uncorrected REsDiagnosis
4
c
Get the facts on testsDoctors determine how near or far you can see by looking at letters and symbols of different sizes on an eye chart eg a Snellen chart Refraction tests are done to determine levels of near- or far-sightedness in order to determine the correct prescription for glasses or contact lenses Gaps in peripheral vision are assessed with visual field tests Some people with retinal or optic nerve damage may be color bling and this condition can be determined with color vision tests
Uncorrected REsManagement
4
Treatment optionsGenerally refractive errors can be corrected with glasses contact lenses or refractive surgeries (eg LASIK) For instance early contact lens and spectacle interventions can reduce the rate of progression of myopia and these non-pharmacological interventions are also able to significantly reduce the burden of myopia Additionally pharmacotherapies that cause changes in the sclera show promising efficacies Laser in situ keratomileusis (LASIK) is one of the lens-based procedures that can be considered by appropriate patients
Eye cancerTumor types
4
c
The most common primary intraocular cancer in adults is melanomaEye cancer whether occurring as primary tumors in the immune-privileged eye or as secondary diseases that started somewhere else and spread to the eye is an umbrella term for a group of rare diseases that can also cause vision impairment Primary intraocular lymphoma a type of non-Hodgkin lymphoma can also occur in adults Cancers of the orbit and adnexa can develop from tissues such as muscle nerve and skin around the eyeball In children the most common primary intraocular cancer is retinoblastoma
Eye cancerSpread and lethality of eye cancer in the USA
4
Eye cancer is rare and can be lethal2810 new cancers (mainly melanomas) of the eye and orbit280 deaths from cancers of the eye and orbit 150 in men and 130 in women3 out of 4 people with eye melanoma survive for at least 5 yearsFor localized disease the 5-year relative survival rate is about 80For tumors that have spread beyond the eye the 5-year relative survival rate is about 15
Eye cancerDiagnosis of choroidal melanoma (CM)
4
Whites of Northern Europeans prone to CMCM is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma After excluding other causes a differential diagnosis can be made based on choroidal detachmentintraocular foreign body chronic angle closure glaucomaglaucoma hyphema neovascular glaucoma cavernous hemangioma vitreous hemorrhage hyphema ciliary body melanoma conjunctival melanoma and iris melanoma
Eye cancerMost common primary ocular tumor Melanoma
4
Management in AdultsDepending on the site and spread of the disease doctors may suggest radiation treatment surgery thermotherapy or intraocular injections Metastatic disease may be managed with liver-directed treatment options radiation and ablation Systemic therapies such as targeted chemo- and immunotherapies are also treatment options for appropriate patients
5 Saving vision through preventionGlobal Action Plan
It remains a shocking fact that 80 of visual impairments could have been prevented or treated The International Agency for the Prevention of Blindness (IAPB) has proposed a WHO-endorsed global action plan for preventing blindness (see Figure) This plan forms part of VISION 2020 The Right to Sight The long-term goal of VISION 2020 and other international plans are to rid the world of avoidable blindness and visual impairment
Creditsbull Articulate E-learning for the templatebull Wikimedia and freepikcom for imagesbull In addition to the Merck Professional Manual the
IAPB (see Prevention Infographic)and the Mayo Clinic some of the key sources are listed in the pdf
Adobe Acrobat Document
Very common and rare vision impairmentsUncorrected refractive errorseye cancer
4
Prevalence of vision problemsCollectively uncorrected refractive errors affected an estimated 153 million people worldwide in 2013 This number does not include uncorrected presbyopia The most common conditions are myopia hyperopia astigmatism and presbyopia At the other end of the spectrum eye cancer comprises a group of rare primary or secondary tumors that can occur in and around the eyeballconjunctivaeyelid of an adult or child Most of the new primary intraocular cancers estimated to be diagnosed in the USA in 2016 are likely to be melanomas (2810 adults)
Uncorrected refractive errors (REs)~$2688 billion US dollars lost per year in lost
productivity (2014 estimate)
4
Most common uncorrected REsREs occur when the shape of the eye stops light from focusing on the retina Changes in the shape of cornea length of the eyeball genetics or aging can lead to REs The most common types of refractive errors are myopia hyperopia astigmatism and presbyopia Some of the diagnostic tests include visual acuity and peripheral vision assessments Typically vision can be corrected with glasses contact lenses or refractive surgery
Uncorrected REsDiagnosis
4
c
Get the facts on testsDoctors determine how near or far you can see by looking at letters and symbols of different sizes on an eye chart eg a Snellen chart Refraction tests are done to determine levels of near- or far-sightedness in order to determine the correct prescription for glasses or contact lenses Gaps in peripheral vision are assessed with visual field tests Some people with retinal or optic nerve damage may be color bling and this condition can be determined with color vision tests
Uncorrected REsManagement
4
Treatment optionsGenerally refractive errors can be corrected with glasses contact lenses or refractive surgeries (eg LASIK) For instance early contact lens and spectacle interventions can reduce the rate of progression of myopia and these non-pharmacological interventions are also able to significantly reduce the burden of myopia Additionally pharmacotherapies that cause changes in the sclera show promising efficacies Laser in situ keratomileusis (LASIK) is one of the lens-based procedures that can be considered by appropriate patients
Eye cancerTumor types
4
c
The most common primary intraocular cancer in adults is melanomaEye cancer whether occurring as primary tumors in the immune-privileged eye or as secondary diseases that started somewhere else and spread to the eye is an umbrella term for a group of rare diseases that can also cause vision impairment Primary intraocular lymphoma a type of non-Hodgkin lymphoma can also occur in adults Cancers of the orbit and adnexa can develop from tissues such as muscle nerve and skin around the eyeball In children the most common primary intraocular cancer is retinoblastoma
Eye cancerSpread and lethality of eye cancer in the USA
4
Eye cancer is rare and can be lethal2810 new cancers (mainly melanomas) of the eye and orbit280 deaths from cancers of the eye and orbit 150 in men and 130 in women3 out of 4 people with eye melanoma survive for at least 5 yearsFor localized disease the 5-year relative survival rate is about 80For tumors that have spread beyond the eye the 5-year relative survival rate is about 15
Eye cancerDiagnosis of choroidal melanoma (CM)
4
Whites of Northern Europeans prone to CMCM is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma After excluding other causes a differential diagnosis can be made based on choroidal detachmentintraocular foreign body chronic angle closure glaucomaglaucoma hyphema neovascular glaucoma cavernous hemangioma vitreous hemorrhage hyphema ciliary body melanoma conjunctival melanoma and iris melanoma
Eye cancerMost common primary ocular tumor Melanoma
4
Management in AdultsDepending on the site and spread of the disease doctors may suggest radiation treatment surgery thermotherapy or intraocular injections Metastatic disease may be managed with liver-directed treatment options radiation and ablation Systemic therapies such as targeted chemo- and immunotherapies are also treatment options for appropriate patients
5 Saving vision through preventionGlobal Action Plan
It remains a shocking fact that 80 of visual impairments could have been prevented or treated The International Agency for the Prevention of Blindness (IAPB) has proposed a WHO-endorsed global action plan for preventing blindness (see Figure) This plan forms part of VISION 2020 The Right to Sight The long-term goal of VISION 2020 and other international plans are to rid the world of avoidable blindness and visual impairment
Creditsbull Articulate E-learning for the templatebull Wikimedia and freepikcom for imagesbull In addition to the Merck Professional Manual the
IAPB (see Prevention Infographic)and the Mayo Clinic some of the key sources are listed in the pdf
Adobe Acrobat Document
Uncorrected refractive errors (REs)~$2688 billion US dollars lost per year in lost
productivity (2014 estimate)
4
Most common uncorrected REsREs occur when the shape of the eye stops light from focusing on the retina Changes in the shape of cornea length of the eyeball genetics or aging can lead to REs The most common types of refractive errors are myopia hyperopia astigmatism and presbyopia Some of the diagnostic tests include visual acuity and peripheral vision assessments Typically vision can be corrected with glasses contact lenses or refractive surgery
Uncorrected REsDiagnosis
4
c
Get the facts on testsDoctors determine how near or far you can see by looking at letters and symbols of different sizes on an eye chart eg a Snellen chart Refraction tests are done to determine levels of near- or far-sightedness in order to determine the correct prescription for glasses or contact lenses Gaps in peripheral vision are assessed with visual field tests Some people with retinal or optic nerve damage may be color bling and this condition can be determined with color vision tests
Uncorrected REsManagement
4
Treatment optionsGenerally refractive errors can be corrected with glasses contact lenses or refractive surgeries (eg LASIK) For instance early contact lens and spectacle interventions can reduce the rate of progression of myopia and these non-pharmacological interventions are also able to significantly reduce the burden of myopia Additionally pharmacotherapies that cause changes in the sclera show promising efficacies Laser in situ keratomileusis (LASIK) is one of the lens-based procedures that can be considered by appropriate patients
Eye cancerTumor types
4
c
The most common primary intraocular cancer in adults is melanomaEye cancer whether occurring as primary tumors in the immune-privileged eye or as secondary diseases that started somewhere else and spread to the eye is an umbrella term for a group of rare diseases that can also cause vision impairment Primary intraocular lymphoma a type of non-Hodgkin lymphoma can also occur in adults Cancers of the orbit and adnexa can develop from tissues such as muscle nerve and skin around the eyeball In children the most common primary intraocular cancer is retinoblastoma
Eye cancerSpread and lethality of eye cancer in the USA
4
Eye cancer is rare and can be lethal2810 new cancers (mainly melanomas) of the eye and orbit280 deaths from cancers of the eye and orbit 150 in men and 130 in women3 out of 4 people with eye melanoma survive for at least 5 yearsFor localized disease the 5-year relative survival rate is about 80For tumors that have spread beyond the eye the 5-year relative survival rate is about 15
Eye cancerDiagnosis of choroidal melanoma (CM)
4
Whites of Northern Europeans prone to CMCM is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma After excluding other causes a differential diagnosis can be made based on choroidal detachmentintraocular foreign body chronic angle closure glaucomaglaucoma hyphema neovascular glaucoma cavernous hemangioma vitreous hemorrhage hyphema ciliary body melanoma conjunctival melanoma and iris melanoma
Eye cancerMost common primary ocular tumor Melanoma
4
Management in AdultsDepending on the site and spread of the disease doctors may suggest radiation treatment surgery thermotherapy or intraocular injections Metastatic disease may be managed with liver-directed treatment options radiation and ablation Systemic therapies such as targeted chemo- and immunotherapies are also treatment options for appropriate patients
5 Saving vision through preventionGlobal Action Plan
It remains a shocking fact that 80 of visual impairments could have been prevented or treated The International Agency for the Prevention of Blindness (IAPB) has proposed a WHO-endorsed global action plan for preventing blindness (see Figure) This plan forms part of VISION 2020 The Right to Sight The long-term goal of VISION 2020 and other international plans are to rid the world of avoidable blindness and visual impairment
Creditsbull Articulate E-learning for the templatebull Wikimedia and freepikcom for imagesbull In addition to the Merck Professional Manual the
IAPB (see Prevention Infographic)and the Mayo Clinic some of the key sources are listed in the pdf
Adobe Acrobat Document
Uncorrected REsDiagnosis
4
c
Get the facts on testsDoctors determine how near or far you can see by looking at letters and symbols of different sizes on an eye chart eg a Snellen chart Refraction tests are done to determine levels of near- or far-sightedness in order to determine the correct prescription for glasses or contact lenses Gaps in peripheral vision are assessed with visual field tests Some people with retinal or optic nerve damage may be color bling and this condition can be determined with color vision tests
Uncorrected REsManagement
4
Treatment optionsGenerally refractive errors can be corrected with glasses contact lenses or refractive surgeries (eg LASIK) For instance early contact lens and spectacle interventions can reduce the rate of progression of myopia and these non-pharmacological interventions are also able to significantly reduce the burden of myopia Additionally pharmacotherapies that cause changes in the sclera show promising efficacies Laser in situ keratomileusis (LASIK) is one of the lens-based procedures that can be considered by appropriate patients
Eye cancerTumor types
4
c
The most common primary intraocular cancer in adults is melanomaEye cancer whether occurring as primary tumors in the immune-privileged eye or as secondary diseases that started somewhere else and spread to the eye is an umbrella term for a group of rare diseases that can also cause vision impairment Primary intraocular lymphoma a type of non-Hodgkin lymphoma can also occur in adults Cancers of the orbit and adnexa can develop from tissues such as muscle nerve and skin around the eyeball In children the most common primary intraocular cancer is retinoblastoma
Eye cancerSpread and lethality of eye cancer in the USA
4
Eye cancer is rare and can be lethal2810 new cancers (mainly melanomas) of the eye and orbit280 deaths from cancers of the eye and orbit 150 in men and 130 in women3 out of 4 people with eye melanoma survive for at least 5 yearsFor localized disease the 5-year relative survival rate is about 80For tumors that have spread beyond the eye the 5-year relative survival rate is about 15
Eye cancerDiagnosis of choroidal melanoma (CM)
4
Whites of Northern Europeans prone to CMCM is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma After excluding other causes a differential diagnosis can be made based on choroidal detachmentintraocular foreign body chronic angle closure glaucomaglaucoma hyphema neovascular glaucoma cavernous hemangioma vitreous hemorrhage hyphema ciliary body melanoma conjunctival melanoma and iris melanoma
Eye cancerMost common primary ocular tumor Melanoma
4
Management in AdultsDepending on the site and spread of the disease doctors may suggest radiation treatment surgery thermotherapy or intraocular injections Metastatic disease may be managed with liver-directed treatment options radiation and ablation Systemic therapies such as targeted chemo- and immunotherapies are also treatment options for appropriate patients
5 Saving vision through preventionGlobal Action Plan
It remains a shocking fact that 80 of visual impairments could have been prevented or treated The International Agency for the Prevention of Blindness (IAPB) has proposed a WHO-endorsed global action plan for preventing blindness (see Figure) This plan forms part of VISION 2020 The Right to Sight The long-term goal of VISION 2020 and other international plans are to rid the world of avoidable blindness and visual impairment
Creditsbull Articulate E-learning for the templatebull Wikimedia and freepikcom for imagesbull In addition to the Merck Professional Manual the
IAPB (see Prevention Infographic)and the Mayo Clinic some of the key sources are listed in the pdf
Adobe Acrobat Document
Uncorrected REsManagement
4
Treatment optionsGenerally refractive errors can be corrected with glasses contact lenses or refractive surgeries (eg LASIK) For instance early contact lens and spectacle interventions can reduce the rate of progression of myopia and these non-pharmacological interventions are also able to significantly reduce the burden of myopia Additionally pharmacotherapies that cause changes in the sclera show promising efficacies Laser in situ keratomileusis (LASIK) is one of the lens-based procedures that can be considered by appropriate patients
Eye cancerTumor types
4
c
The most common primary intraocular cancer in adults is melanomaEye cancer whether occurring as primary tumors in the immune-privileged eye or as secondary diseases that started somewhere else and spread to the eye is an umbrella term for a group of rare diseases that can also cause vision impairment Primary intraocular lymphoma a type of non-Hodgkin lymphoma can also occur in adults Cancers of the orbit and adnexa can develop from tissues such as muscle nerve and skin around the eyeball In children the most common primary intraocular cancer is retinoblastoma
Eye cancerSpread and lethality of eye cancer in the USA
4
Eye cancer is rare and can be lethal2810 new cancers (mainly melanomas) of the eye and orbit280 deaths from cancers of the eye and orbit 150 in men and 130 in women3 out of 4 people with eye melanoma survive for at least 5 yearsFor localized disease the 5-year relative survival rate is about 80For tumors that have spread beyond the eye the 5-year relative survival rate is about 15
Eye cancerDiagnosis of choroidal melanoma (CM)
4
Whites of Northern Europeans prone to CMCM is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma After excluding other causes a differential diagnosis can be made based on choroidal detachmentintraocular foreign body chronic angle closure glaucomaglaucoma hyphema neovascular glaucoma cavernous hemangioma vitreous hemorrhage hyphema ciliary body melanoma conjunctival melanoma and iris melanoma
Eye cancerMost common primary ocular tumor Melanoma
4
Management in AdultsDepending on the site and spread of the disease doctors may suggest radiation treatment surgery thermotherapy or intraocular injections Metastatic disease may be managed with liver-directed treatment options radiation and ablation Systemic therapies such as targeted chemo- and immunotherapies are also treatment options for appropriate patients
5 Saving vision through preventionGlobal Action Plan
It remains a shocking fact that 80 of visual impairments could have been prevented or treated The International Agency for the Prevention of Blindness (IAPB) has proposed a WHO-endorsed global action plan for preventing blindness (see Figure) This plan forms part of VISION 2020 The Right to Sight The long-term goal of VISION 2020 and other international plans are to rid the world of avoidable blindness and visual impairment
Creditsbull Articulate E-learning for the templatebull Wikimedia and freepikcom for imagesbull In addition to the Merck Professional Manual the
IAPB (see Prevention Infographic)and the Mayo Clinic some of the key sources are listed in the pdf
Adobe Acrobat Document
Eye cancerTumor types
4
c
The most common primary intraocular cancer in adults is melanomaEye cancer whether occurring as primary tumors in the immune-privileged eye or as secondary diseases that started somewhere else and spread to the eye is an umbrella term for a group of rare diseases that can also cause vision impairment Primary intraocular lymphoma a type of non-Hodgkin lymphoma can also occur in adults Cancers of the orbit and adnexa can develop from tissues such as muscle nerve and skin around the eyeball In children the most common primary intraocular cancer is retinoblastoma
Eye cancerSpread and lethality of eye cancer in the USA
4
Eye cancer is rare and can be lethal2810 new cancers (mainly melanomas) of the eye and orbit280 deaths from cancers of the eye and orbit 150 in men and 130 in women3 out of 4 people with eye melanoma survive for at least 5 yearsFor localized disease the 5-year relative survival rate is about 80For tumors that have spread beyond the eye the 5-year relative survival rate is about 15
Eye cancerDiagnosis of choroidal melanoma (CM)
4
Whites of Northern Europeans prone to CMCM is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma After excluding other causes a differential diagnosis can be made based on choroidal detachmentintraocular foreign body chronic angle closure glaucomaglaucoma hyphema neovascular glaucoma cavernous hemangioma vitreous hemorrhage hyphema ciliary body melanoma conjunctival melanoma and iris melanoma
Eye cancerMost common primary ocular tumor Melanoma
4
Management in AdultsDepending on the site and spread of the disease doctors may suggest radiation treatment surgery thermotherapy or intraocular injections Metastatic disease may be managed with liver-directed treatment options radiation and ablation Systemic therapies such as targeted chemo- and immunotherapies are also treatment options for appropriate patients
5 Saving vision through preventionGlobal Action Plan
It remains a shocking fact that 80 of visual impairments could have been prevented or treated The International Agency for the Prevention of Blindness (IAPB) has proposed a WHO-endorsed global action plan for preventing blindness (see Figure) This plan forms part of VISION 2020 The Right to Sight The long-term goal of VISION 2020 and other international plans are to rid the world of avoidable blindness and visual impairment
Creditsbull Articulate E-learning for the templatebull Wikimedia and freepikcom for imagesbull In addition to the Merck Professional Manual the
IAPB (see Prevention Infographic)and the Mayo Clinic some of the key sources are listed in the pdf
Adobe Acrobat Document
Eye cancerSpread and lethality of eye cancer in the USA
4
Eye cancer is rare and can be lethal2810 new cancers (mainly melanomas) of the eye and orbit280 deaths from cancers of the eye and orbit 150 in men and 130 in women3 out of 4 people with eye melanoma survive for at least 5 yearsFor localized disease the 5-year relative survival rate is about 80For tumors that have spread beyond the eye the 5-year relative survival rate is about 15
Eye cancerDiagnosis of choroidal melanoma (CM)
4
Whites of Northern Europeans prone to CMCM is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma After excluding other causes a differential diagnosis can be made based on choroidal detachmentintraocular foreign body chronic angle closure glaucomaglaucoma hyphema neovascular glaucoma cavernous hemangioma vitreous hemorrhage hyphema ciliary body melanoma conjunctival melanoma and iris melanoma
Eye cancerMost common primary ocular tumor Melanoma
4
Management in AdultsDepending on the site and spread of the disease doctors may suggest radiation treatment surgery thermotherapy or intraocular injections Metastatic disease may be managed with liver-directed treatment options radiation and ablation Systemic therapies such as targeted chemo- and immunotherapies are also treatment options for appropriate patients
5 Saving vision through preventionGlobal Action Plan
It remains a shocking fact that 80 of visual impairments could have been prevented or treated The International Agency for the Prevention of Blindness (IAPB) has proposed a WHO-endorsed global action plan for preventing blindness (see Figure) This plan forms part of VISION 2020 The Right to Sight The long-term goal of VISION 2020 and other international plans are to rid the world of avoidable blindness and visual impairment
Creditsbull Articulate E-learning for the templatebull Wikimedia and freepikcom for imagesbull In addition to the Merck Professional Manual the
IAPB (see Prevention Infographic)and the Mayo Clinic some of the key sources are listed in the pdf
Adobe Acrobat Document
Eye cancerDiagnosis of choroidal melanoma (CM)
4
Whites of Northern Europeans prone to CMCM is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma After excluding other causes a differential diagnosis can be made based on choroidal detachmentintraocular foreign body chronic angle closure glaucomaglaucoma hyphema neovascular glaucoma cavernous hemangioma vitreous hemorrhage hyphema ciliary body melanoma conjunctival melanoma and iris melanoma
Eye cancerMost common primary ocular tumor Melanoma
4
Management in AdultsDepending on the site and spread of the disease doctors may suggest radiation treatment surgery thermotherapy or intraocular injections Metastatic disease may be managed with liver-directed treatment options radiation and ablation Systemic therapies such as targeted chemo- and immunotherapies are also treatment options for appropriate patients
5 Saving vision through preventionGlobal Action Plan
It remains a shocking fact that 80 of visual impairments could have been prevented or treated The International Agency for the Prevention of Blindness (IAPB) has proposed a WHO-endorsed global action plan for preventing blindness (see Figure) This plan forms part of VISION 2020 The Right to Sight The long-term goal of VISION 2020 and other international plans are to rid the world of avoidable blindness and visual impairment
Creditsbull Articulate E-learning for the templatebull Wikimedia and freepikcom for imagesbull In addition to the Merck Professional Manual the
IAPB (see Prevention Infographic)and the Mayo Clinic some of the key sources are listed in the pdf
Adobe Acrobat Document
Eye cancerMost common primary ocular tumor Melanoma
4
Management in AdultsDepending on the site and spread of the disease doctors may suggest radiation treatment surgery thermotherapy or intraocular injections Metastatic disease may be managed with liver-directed treatment options radiation and ablation Systemic therapies such as targeted chemo- and immunotherapies are also treatment options for appropriate patients
5 Saving vision through preventionGlobal Action Plan
It remains a shocking fact that 80 of visual impairments could have been prevented or treated The International Agency for the Prevention of Blindness (IAPB) has proposed a WHO-endorsed global action plan for preventing blindness (see Figure) This plan forms part of VISION 2020 The Right to Sight The long-term goal of VISION 2020 and other international plans are to rid the world of avoidable blindness and visual impairment
Creditsbull Articulate E-learning for the templatebull Wikimedia and freepikcom for imagesbull In addition to the Merck Professional Manual the
IAPB (see Prevention Infographic)and the Mayo Clinic some of the key sources are listed in the pdf
Adobe Acrobat Document
5 Saving vision through preventionGlobal Action Plan
It remains a shocking fact that 80 of visual impairments could have been prevented or treated The International Agency for the Prevention of Blindness (IAPB) has proposed a WHO-endorsed global action plan for preventing blindness (see Figure) This plan forms part of VISION 2020 The Right to Sight The long-term goal of VISION 2020 and other international plans are to rid the world of avoidable blindness and visual impairment
Creditsbull Articulate E-learning for the templatebull Wikimedia and freepikcom for imagesbull In addition to the Merck Professional Manual the
IAPB (see Prevention Infographic)and the Mayo Clinic some of the key sources are listed in the pdf
Adobe Acrobat Document
Creditsbull Articulate E-learning for the templatebull Wikimedia and freepikcom for imagesbull In addition to the Merck Professional Manual the
IAPB (see Prevention Infographic)and the Mayo Clinic some of the key sources are listed in the pdf
Adobe Acrobat Document
