Gradual loss of vision (opthalmology)

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GRADUAL LOSS OF VISION

Prepared by:Muhd Ariff b MahdzubGRADUAL LOSS OF VISION

Introduction Patients with gradual loss of vision present with chronic, slowly progressive loss of vision which is generally painless.Visual loss is usually bilateral, but may occur asymmetrically, and happens over weeks to years. Poor vision in one eye may only be noticed when the patient closes the other eye, and thus may be reported to be sudden in onset in some cases.

General History TakingGradual Loss Vision

Patient age(younger/older)The nature of the problemUnilateral OR bilateralPainfull or painlessBlurred vision? (whole field, close, distance or both).Restricted visual field? (often noted following difficulties in driving/ daily activity

Progression: 1. Ask whether there has been a slow and steady decline or whether there have been step-wise drops in visual acuity, or Any associated symptoms. (eg: pain, redness, or visual phenomena - eg, haloes or flashes of light).Any precipitating factors (Specifically ask about whether vision is better in the day or at night).Hx trauma

Medical historyAsk for systemic conditions/duration/compliance to medEndocrine/metabolic (Diabetes mellitus)HTNHyperthyriodismhyperlipidimia

Cont.Medication - some drugs may be toxic to the eye or precipitate acute angle-closure glaucoma.Family history - it is helpful to know about atopy, diabetes, thyroid disease, certain malignancies and any hereditary syndromes.Social history -; eg, a metal worker

Physical examination

Visual acuity. (Note whether this improves using a pinhole)Red reflex using opthalmoscope. - Media opacity (appears black against the red reflex) suggests a corneal, lens or vitreous problem. - Media clear, it is more likely to be a retinal or optic nerve disorder.Do a functional testing of visual field, pupils (RAPD), optic nerve and maculaUse an Amsler grid to look for distortion of straight lines - if present, this indicates serious macular pathology and needs urgent referral.

Primary care assessment of patients with gradual loss of vision

CAUSES

The common causes of gradual loss of visionGlaucoma Cystoid mascular oedema Refractive errorDiabetic retinopathy Cataract Retinitis pigmentosaARMD (Age-Related Macular degeneration)Drug

TreatmentIt is treated by prescribing suitable correcting spherical convex lenses.

From: Basic opthalmology 4th edition, page 51