Prepared by:Muhd Ariff b Mahdzub

GRADUAL 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 problemI. Unilateral OR bilateralII. Painfull or painlessIII. Blurred vision? (whole field, close,

distance or both).IV. 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 history

Ask for systemic conditions/duration/compliance to medI. Endocrine/metabolic (Diabetes mellitus)II. HTNIII. HyperthyriodismIV. hyperlipidimia

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

1. Visual acuity. (Note whether this improves using a pinhole)

2. 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 macula

3. Use 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 vision

Glaucoma Cystoid mascular oedema

Refractive error Diabetic retinopathy

Cataract Retinitis pigmentosa

ARMD (Age-Related Macular degeneration)

Drug

Treatment

It is treated by prescribing suitable correcting spherical convex lenses.

From: Basic opthalmology 4th edition, page 51