www.goodhope.nhs.uk/departments/eyedept/ ==== Home / Admin Other conditions Contact dept / Personnel Web site feedback Secretaries Appointments Eye drop enquiries Links for students Online eye text book About this site Contents Contents Children/Othoptic clinic Contact lenses Rehabilitation & coping with poor sight Low vision clinic Magnifiers Glaucoma Professionals Letters for professionals Professionals: rubeotic Professionals: ang closure Professionals: POAG Trab audit 2008 What is glaucoma? Drops for glaucoma Intraocular hypertension Low tension glaucoma Pre-perimetric glaucoma Rubeotic glaucoma Acute angle closure Chronic angle closure Animations Glaucoma animation Progression simulation Rubeotic glaucoma Rubeotic glaucoma animation Angle closure, Narrow angle, Laser iridotomies Laser iridotomy animation SLT laser animation Visual fields Trabeculectomy Trabeculectomy animation Students: Cases Case 1 Case 2 Case 3 Case 4 Case 5 Case 6 case 7 case 8 case 9 case 10 case 11 Macula Cases 1 for students 2 hard drusen Central Serous Retinopathy 4 CCNV (wet ARMD) 5 Occult CCNV 6 Soft drusen Pre-macula haem Bests 10 PDT 11 rip 12 CNV 13 CSR & PED 14 Dry/Occult 15 polypoidal 16 myopic early CNV 17 macula hole 18 more fluid with oct 19 fluid reaccumulates 20 peds & nsd 21 AOFVD 22 AOFVD/ERM 23 speckles 24 VMT 25 ERM 26 Juvenile retinoschisis 27 early classic ARMD pathology & treatment Understanding macular degeneration Are you at risk? Coping: poor sight in one eye Coping with poor sight: hints animations etc Diagram: link Large diagram 1 Large diagram 2 Animation more detail lucentis dry ARMD hard drusen soft drusen geographic AOFMD ERM VMT macula hole wet Lucentis/Avastin treatment Occult type 1, PED Occult type 2 Classic myopic Rip Polypoidal RAP extensive subfoveal haemorrhage Peripapillary CNV VMC professionals CSR none-ARMD macula ERM VMT macular hole Juvenile macular dystrophies PFT parafoveal telangiecasia Magnifiers Rehabilitation & local services Low Vision Clinic RNIB link Procedures Your first visit Fluorescein angiogram & photography Laser Refraction (test for spectacles) Orthoptic/squint examination Minor lid surgery, cyst etc Diabetes Lifestyle Alcohol Smoking How to prevent retinopathy Type 2 diabetes (diet/tablets) Insulin users Types of retinopathy Blood pressure Cholesterol, prevention etc Other retinopathy issues Driving Other problems Allergic conjunctivitis Blepharitis Cataracts Cataract surgery animation Cataract surgery at Good Hope Chalazion, styes, eyelid Dry & sore eyes Herpes simplex keratitis (cornea) Naevi Links/other problems Central serous retinopathy Migraine Posterior vitreous detachment Stroke / TIA corneal ulcers Recurrent corneal abrasions Retinal vein blockage/occlusion Squints & Lazy eyes Thyroid eye disease Watery eyes, adult Watery eyes in children

Classic neovascular ARMD (also called ‘classic CNV’)

Some dry types of macular degeneration progress to form this type of wet ARMD. It is very difficult to predict whose dry ARMD will progress, but the risk factors include those mentioned above (soft drusen, high blood pressure, smoking, poor diet, lack of exercise). When blood vessels grow under the macula, this is termed choroidal neovascularisation (CNV or CCNV). When the new vessels are seen easily on a fluorescein angiogram, they are called 'classic CNV': They look like a net of blood vessels. Photo (case 12) When a doctor looks in the retina looks elevated, there may be tiny haemorrhages, a grey area, or exudaes. This photo is a severe case. In milder cases vision may still be good. The condition may develop over days or weeks, with increasing distortion or blurred central vision. If this process is mild you can still read, but if it becomes severe reading with any magnifier is impossible. Treatment, if possible, includes the anti_VEGF drugs Avastin & Lucentis. Laser PDT  may help in addition. If you notice the symptoms (central vision becoming distorted or blurred, sometimes like looking through water) you should have your eye checked with an OCT scan: see distortion.. This is usually a very serious type of macular degeneration, serious because it can cause very poor sight. It never blinds in the sense that you cannot see light and dark, but in its serious form it can damage the central vision so you can only see fingers or even the movements of hands. Once again, the side vision will normally be good, so you should always be able to walk around the house. The CNV grow at 20�/day, reaching 3000 � in 6 months. They can be extremely difficult to see in early stages. Small membranes gain, on average, 5 lines of vision with the Lucentis. The biggest problem is detecting them early, and much work ('Replacing the Amsler Grid")   is being carried out to detect early membranres. OCT is essential to diagnose the condition early. The condition is occasionally unresponsive to treatment. Surgery/other treatment

New vessels growing under the central retina in a 'classic' pattern: PDT treatment may help enlarge   ARMD progression rate and relative risk of smoking see geographic neovascular active smoking x 3.4 x 2.5 passive smoking x 2   photos / ffa same patient 3 months after pdt another classic same patient other eye...disciform scar CNV due to sarcoid membrane other healthy eye (thanks to Ajith Kumar/BMEC) treatment with PDT

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