Websites on Loss of Vision

Dr Keith Barnard recommends websites relating to this week’s Clinical Review.

Website of the week
This site contains a wealth of information, some for patients, some for students and doctors. I have selected this particular part of the site because of the superb retinal images and the fact that there is a learning element to looking at them, as they are presented in the form of a quiz. The pictures all relate to diabetic retinopathy. The address given here takes you to the maculopathy page, and to access the considerably long list of other types of retinopathy you need to click on ‘photos and cases’ at the top of the page. The images are truly superb, and if you don’t believe me, take a look at this one, at The picture is not in colour, but if anything this enhances the detail that can be seen.

Diabetic retinopathy is something we are all likely to see more of in the future and it will contribute increasingly to visual loss, and that makes a visit to this site essential.

Why go there: superb images that also teach.
Downside: none.
Information from: University of Birmingham School of Medicine.

Assessing acute loss of vision
This PDF covers the assessment of sudden visual loss in six neatly laid out, uncrowded pages. I was taken aback by the number of possible causes, but the way the pathology is listed is a great help. The article divides the causes into four main groups: media opacities, retinal disease, optic nerve diseases and visual pathway disorders. And at the end are a couple more situations you might not think about – functional visual loss and acute discovery of a chronic loss, such as a previously unrecognised optic atrophy. Easy to print out, this makes a good teaching aid.

Why go there: makes it easy to remember.
Downside: no images.
Information from: Ivey Eye Institute, University of Western Ontario.

Visual field defects
There are at least eight types of visual field defect, and it’s not only difficult to remember them all, but also to decide on the causes of the various presentations. This article on the examination of the eye is useful in itself when dealing with vision loss, but if you scroll down you will find a table that lists the main types of visual field defect, describes them and explains the various possible causes.



Why go there: print off the table.
Downside: no diagrams.
Information from: The Merck Manual Professional.

Treatment for wet AMD
This one should get your hackles rising. It is a short article from a pharmaceutical business website that discusses the NICE decision to only allow the use of one form of anti-VEG-F drugs instead of the two currently available for the treatment of wet age-related macular degeneration. It makes interesting reading, as the NICE decision appears to mean that 80 per cent of patients with this condition in England and Wales will not get optimal treatment, whereas in Scotland both drugs are available. Now you might think that as this page has pharmaceutical industry backing, then they would say that, wouldn’t they? But the Royal National Institute for the Blind are right behind them, so that makes this carry much more weight. Something is seriously wrong here – what happened to all those pledges about ending ‘post-code prescribing’?


Why go there: make yourself angry.
Downside: almost as bad for the blood pressure as it is for AMD sufferers.
Information from: Pharmaceutical Business Review.
Address: Please click here

Information for patients
All the way from Australia comes this excellent patient leaflet that will help patients who are having surgery for retinal detachment or vitreous haemorrhage. Laser photocoagulation, cryopexy, scleral buckling procedures and vitrectomy are all discussed, and there is a useful section on coping after the operation, including such important questions as pain management, returning to normal activities and car driving. There are, most helpfully, a couple of decent colour drawings.

Why go there: well presented
Downside: none.
Information from: Royal Adelaide Hospital.


Dr Barnard is a former GP in Fareham, Hampshire

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