Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
4838/24 Ansari Road, Daryaganj, New Delhi - 110002, India, Phone: +91-11-43574357, Fax: +91-11-43574314
B-3 EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi - 110 002, India
Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021 +91-11-23245672, Rel: +91-11-32558559, Fax: +91-11-23276490, +91-11-23245683
Offices in India
- Ahmedabad, Phone: Rel: +91-79-32988717, e-mail: email@example.com
- Bengaluru, Phone: Rel: +91-80-32714073, e-mail: firstname.lastname@example.org
- Chennai, Phone: Rel: +91-44-32972089, e-mail: email@example.com
- Hyderabad, Phone: Rel:+91-40-32940929, e-mail: firstname.lastname@example.org
- Kochi, Phone: +91-484-2395740, e-mail: email@example.com
- Kolkata, Phone: +91-33-22276415, e-mail: firstname.lastname@example.org
- Lucknow, Phone: +91-522-3040554, e-mail: email@example.com
- Mumbai, Phone: Rel: +91-22-32926896, e-mail: firstname.lastname@example.org
- Nagpur, Phone: Rel: +91-712-3245220, e-mail: email@example.com
Practical Approach to Ophthalmoscopic Retinal Diagnosis
© 2010, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 2010
Typeset at JPBMP typesetting unit
Printed at Ajanta OffsetPreface
Most books on the subject of retina are compilations on retinal diseases which then further describe the details of various signs seen ophthalmoscopically. However when we actually teach resident doctors about retina, we advise them to first observe and pick up retinal signs such as hemorrhages, exudates, edema, pigmentation, changes in the optic disk, etc. They are then encouraged to analyze and group the different signs observed to arrive at the possible diagnoses. We have been following this format of teaching for a number of years. The present book is an attempt to put this tried and tested methodology of teaching into book form. The book progresses from the stage of observed clinical signs as its starting point and goes on to organize the contents along the path to the diagnosis. In addition, concise information about important clinical disease entities is provided as background material in a different color print. The reader can refer to these according to his needs.
HOW TO USE THIS BOOK
In spite of the development of several advanced diagnostic tools, accurate clinical assessment remains the cornerstone in the diagnosis of lesions of the retina.
This book has been designed to help in the accurate identification of the signs observed and the scheme to be followed to reach a clinical diagnosis. The chapters have been segregated by the structure primarily involved by the lesion, i.e. the optic nerve, macula, retinal vasculature, the retina proper, peripheral retina or the vitreous.
Within the chapters the observations are grouped by the morphological features and color. The reader is encouraged to observe the lesions and identify the descriptive group most apt to the lesion being identified. The finer differentiating points within that group will clinch the identity of the lesion.
For example, if the lesion is found to involve the optic nerve the reader must turn to the chapter on optic nerve head. The lesion is then examined again and classified into one of the broad categories given in the chapter namely swollen optic nerve, pale optic nerve, excavated optic nerve or is there presence of anomalous tissue on the optic nerve or is it of an abnormal size. If the reader thinks that the optic nerve is swollen then the lesion is further categorized as whether the swollen optic nerve is hyperemic or pale and whether the involvement is bilateral or unilateral. If there is hyperemia and blurring of the disk margins, bilaterally, venous pulsations are elicited, the pupils are reacting normally, one should refer to the refractive status. A refractive error of +4.0D clinches the diagnosis as hypermetropic disks.
We gratefully acknowledge the help of Mr Nem Singh and Mr Jamsher Khan for painstakingly taking all the photographs. We thank our colleagues Dr Nishant Taneja, Dr Charu Tandon, Dr Uma Sridhar and Dr Reena Choudhry, Dr Umesh Bareja, Dr AS Lata for referring their patients and providing us unconditional support. We thank all our postgraduate students, especially Dr Navneet Mehrotra, for their curiosity and questioning, forcing us to improve our teaching methods. We are grateful to Dr Cyrus Shroff and Dr Shishir Narain for solving our problems from time to time and for providing rare photographs. We also acknowledge the help given by Dr Bhavna Sharma and Mr Sanjay Mishra for the electrophysiological data.
We acknowledge the steadfast support of our institutions ICARE Eye Hospital, NOIDA, UP, India, Shroff Eye Centre, Kailash Colony, New Delhi, India and Sitaram Bhartia Institute for Science and Research, New Delhi, India.
We thank Shri JP Vij, Chairman and Managing Director and Mr Tarun Duneja (Director-Publishing) of M/s Jaypee Brothers Medical Publishers for their support in the publication of the book. We are grateful to Ms Yashu Kapoor for formatting the entire book and Mr Manoj Pahuja for his help with the figures and illustrations.
Finally, we thank all our patients who gave us the opportunity to examine them.