Page 83 - NAME OF CONDITION: REFRACTIVE ERRORS

 Rehabilitation

 Patient education
 Human resource development
 Documentation.

a)Clinical Diagnosis:
Diagnosis is mostly clinical. It requires good ophthalmic examination set up with
basic instruments such as slit lamp, 90D lenses, Indirect ophthalmoscope.

In its earliest stages, macular degeneration may cause the following symptoms:

 Blurry distance and/or reading vision;
 Distorted vision - straight lines will appear bent, crooked or irregular;
 Dark gray spots or blank spots in vision;
 Size of objects may appear different for each eye;
 Colours do not look the same for each eye.
The disease can be classified according to the stages mentioned earlier and steps for
prevention, treatment, rehabilitation or referral as required can be done.

b) Investigations:

Diagnostic tools such as slit lamp, indirect ophthalmoscope; procedures such as
fluorescein angiography, Indocyanine green angiography, autofluoroscence and optical
coherence tomography are used to obtain optimal diagnosis.
1. Amsler’s grid: is used to check macular vision and to detect any damage or disease
to the macula, which is located at the center of the retina. Basically, it is a grid that
consists of evenly spaced vertical and horizontal lines, resembling a piece of graph
paper, with a large dot in the middle. While staring or focusing at the dot, patient
will be asked if he sees any wavy lines or missing spaces. Any distortion in the

perception of the grid could indicate the presence of macular disease or
degeneration.
2. Fundus Fluorescein Angiography (FFA): This is a test involving photography of retina
after injecting fluorescein dye. This is usually performed to detect wet AMD. It helps
to decide the mode of treatment.
3. Indocyanine Green Angiography (ICG): This is another test done using injectable
dye. The helps to highlight the choroidal features well. As there is development of
choroidal neovascular membrane in AMD, ICG angiography has good diagnostic
value.

4. Optical Coherence Topography (OCT): OCT is a non-invasive, fast, non-contact
imaging technique which readily displays intra-retinal, subretinal and sub-RPE fluid,
but is limited in its imaging of the choroid due to poor penetration. Its role in CNV
detection has a good sensitivity and specificity.
c)Treatment:

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