EXTERNSHIP REPORT
ON
STUDENT CLINICAL WORK EXPERIENCE
@
SIGHTCARE SPECIALIST EYE CENTER, BENIN CITY
BY
AGHEDO PROGRESS
LSC1907073
DEPARTMENT OF OPTOMETRY
FACULTY OF LIFE SCIENCES
UNIVERSITY OF BENIN
JANUARY, 2025.
TABLE OF CONTENT
PAGE \* MERGEFORMAT 21
CASE 1: Case Report on a Patient with Bilateral Cataract, Retinal Detachment, Diabetic Macular
Oedema and Bilateral Vitreous Hemorrhage. -------------------------------------------------PAGE 3
CASE 2: Case Report of a Patient with Presbyopia and Myopic Astigmatism-----------PAGE 7
CASE 3: Case Report on the Follow Ups of a Patient with Bilateral Rhegmatogenous Retinal
Detachment-----------------------------------------------------------------------------------------PAGE 10
CASE 4: Case Report of a Patient with Hyperopic Astigmatism
Clinical Presentation. ----------------------------------------------------------------------------PAGE 17
CASE 5: Case Report on the Follow-Up of a Patient with Bilateral Glaucoma ----------PAGE 20
References ----------------------------------------------------------------------------PAGE 25
PAGE \* MERGEFORMAT 21
PATHOLOGICAL CASE
CASE 1: CASE REPORT ON A PATIENT WITH BILATERAL CATARACT, RETINAL
DETACHMENT, DIABETIC MACULAR OEDEMA AND BILATERAL VITREOUS
HEMORRHAGE.
CLINICAL PRESENTATION.
AGE-64 Yrs
GENDER- Male
CASE HISTORY
CC: The Patient complained of poor vision in both eyes which started about a year ago for OD
and a week ago for OS
POVHX: Patient was previously diagnosed of bilateral retinal detachment and hence referred
here for expert management.
PMHX: He is hypertensive and diabetic for over seven years
ALLERGIES: Nil
DRUG Hx: Anti-diabetics and anti-hypertensives
VISUAL ACUITY (UNAIDED) @ 6M
OD: HM @ Close to face
OS: 6/24-2
PINHOLE VA
OD: No Improvement OS: 6/24-1
TONOMETRY (icare Rebound) OD: 9mmHg OS: 12mmHg @10:15am
PAGE \* MERGEFORMAT 21
EXAMINATION
OD OS
Eyelids NAD NAD
Conjuctiva NAD NAD
Cornea Arcus sinelis Arcus sinelis
Pupil Fixed and irregular Round and reactive
Lens LO+++ LO++
VCDR Poor view Poor view
Macula Poor view Poor view
Both eyes were then dilated with tropicamide and the patient underwent OCT and B-SCAN (by
the consultant), thereafter went into the Consultant VitreoRetina Surgeon’s Office for further
examination.
DIAGNOSIS:
OD: COMPLICATED CATARACT + VITREOUS HEMORRHAGE + RETINAL
DETACHMENT
OS: CATARACT + VITREOUS HEMORRHAGE + DIABETIC MACULAR OEDEMA
PAGE \* MERGEFORMAT 21
TREATMENT PLAN:
OD: Complicated cataract surgery + PPV + EL + SOI LA
OS: Intravitreal anti-VEGF monthly x 3/12 stat
OD: SOR (later)
Gutt Nepafenac bd OD
Tabs Eye Cap i daily
CASE DISCUSSION
CATARACT
Cataract is a clouding of the lens in the eye, leading to a decrease in vision. It is a common
condition, particularly in older adults, and can affect one or both eyes. Cataracts develop
gradually and may cause symptoms such as blurry vision, glare, difficulty reading, and poor
night vision. The primary risk factors include aging, diabetes, smoking, excessive alcohol
consumption, and prolonged UV exposure. Treatment typically involves surgical removal of the
cloudy lens, followed by implantation of an artificial intraocular lens (IOL).
VITREOUS HEMORRHAGE
Vitreous hemorrhage refers to bleeding into the vitreous humor, the gel-like substance that fills
the eye between the lens and the retina. It can occur as a result of various eye conditions, often
involving retinal damage or abnormalities. The blood may obscure vision and lead to symptoms
like sudden vision loss, floaters, or a red or hazy appearance in the visual field. Causes of
vitreous hemorrhage include: diabetic retinopathy, retinal tears or detachment, age-related
macular degeneration, trauma and retinal vein occlusion . It presents with symptoms such as
sudden onset of blurry vision or vision loss, floaters, a reddish or hazy appearance in the field of
view. Diagnosis involves a comprehensive eye examination including dilated fundoscopy, OCT
and B-Scan Ultrasonography. Treatment depends on the underlying cause. In some cases, the
hemorrhage may resolve on its own, but if the bleeding is severe or persistent, surgery (e.g.,
vitrectomy) may be needed to remove the blood and repair any retinal damage. Laser therapy
may also be used for conditions like diabetic retinopathy.
PAGE \* MERGEFORMAT 21
DIABETIC MACULAR OEDEMA
Diabetic macular oedema (DME) is a common complication of diabetic retinopathy, occurring
when high blood sugar levels damage the blood vessels in the retina, causing them to leak fluid
into the macula—the central part of the retina responsible for sharp, detailed vision. This fluid
accumulation leads to swelling, blurred vision, and can severely impair central vision if
untreated. DME results from chronic hyperglycemia, which weakens the retinal blood vessels,
causing them to become leaky. In addition, the abnormal growth of new, fragile blood vessels
(neovascularization) can contribute to fluid leakage into the macula. Symptoms include: Blurred
or distorted central vision, Difficulty seeing fine details, Colors may appear washed out and in
severe cases, vision loss can occur if left untreated. DME is diagnosed by: dilated fundoscopy,
OCT and fluorescein angiography. Treatment options for DME aim to reduce swelling and
prevent further damage and this include: Anti-VEGF injections, laser therapy and tight blood
sugar control.
RETINAL DETACHMENT
Retinal detachment is a serious eye condition where the retina, the light-sensitive layer at the
back of the eye, becomes separated from its underlying support tissue. This detachment disrupts
the retina's ability to function properly, leading to vision loss if not treated promptly. There are
three types of retinal detachment viz Rhegmatogenous retinal detachment, exudative retinal
detachment and tractional retinal. Rhegmatogenous retinal detachment is the most common type,
caused by a tear or hole in the retina that allows fluid from the vitreous cavity to seep underneath
and pull the retina away. Exudative retinal detachment occurs when fluid accumulates beneath
the retina due to inflammation, injury, or vascular abnormalities, without any retinal tear or hole
while Tractional retinal detachment results from scar tissue on the retina pulling it away, often
seen in advanced diabetic retinopathy.
The causes and risk factors include: Age-related changes (vitreous syneresis), trauma, diabetic
retinopathy, family history and high myopia. Symptoms include: Sudden onset of flashes of light
or floaters in the vision, curtain-like shadow or loss of peripheral vision and Blurred or reduced
central vision, especially as the detachment progresses.
Retinal detachment is diagnosed through a comprehensive eye exam, often involving:
fundoscopy, OCT and B-Scan ultrasonography. Prompt treatment is crucial to preserve vision.
Options include: laser surgery (photocoagulation), cryopexy, vitrectomy and pneumatic
retinopexy. The success of treatment largely depends on how quickly the detachment is
diagnosed and treated. Early intervention can preserve or restore vision, but if left untreated,
retinal detachment can lead to permanent blindness.
PAGE \* MERGEFORMAT 21
REFRACTIVE CASE
CASE 2: CASE REPORT OF A PATIENT WITH PRESBYOPIA AND MYOPIC
ASTIGMATISM
CLINICAL PRESENTATION.
AGE- 61 Yrs
GENDER- Female
BP- 91/62mmHg @9:20am
CASE HISTORY
CC: The Patient complained of inability to read tiny prints.
POVHX: She was diagnosed of complicated cataract and retinal detachment (OD) about six
months ago.
PMHX: Nil
ALLERGIES: Nil
DRUG Hx: Gutt Beoptic-N, Gutt Dorzolamide, Tabs Eye Cap.
VISUAL ACUITY (UNAIDED) @ 6M
OD: NLP PH: No improvement
OS: 6/60-2 PH: 6/36
VISUAL ACUITY (UNAIDED) @ 40CM
OD: N36 OS: N36 OU: N36
TONOMETRY (icare Rebound) OD: 6mmHg OS: 17mmHg @10:25am
PAGE \* MERGEFORMAT 21
EXAMINATION
OD OS
Eyelids NAD NAD
Conjuctiva NAD NAD
Cornea Clear Clear
Pupil Miotic and fixed Reactive
Lens LO+++ LO++
VCDR Poor view 0.9
Macula Poor view NAD
Automated refraction results
OD: No reading
OS: -3.75DS/-2.75DC x 162
Subjective refraction results
OD: No improvement with lenses
OS: -3.75DS/-1.00DC x 180 (6/18-1) ADD +3.00DS (N6)
PLAN
GIVE GLASSES
Gutt. Dorzolamide + timolo bd (OS)
Gutt. Latanoprost nocte (OS)
Tab. EyeCap i daily
Tabs Optic nerve ii daily
PAGE \* MERGEFORMAT 21
CASE DISCUSSION
PRESBYOPIA
Presbyopia is an age-related condition in which the eye's ability to focus on near objects
gradually decreases. It typically begins around age 40 and worsens with age, as the lens of the
eye becomes less flexible and the muscles controlling the lens lose their ability to change its
shape. This results in difficulty reading small print or seeing objects up close, especially in low
light conditions. Symptoms include: Difficulty reading small text or seeing objects up close, Eye
strain or headaches when focusing on near tasks and the need to hold reading material at arm’s
length to see it clearly. Presbyopia is diagnosed through a standard eye exam, which includes
tests of visual acuity and the ability to focus at various distances. Treatment options include:
prescription of reading glasses, bifocals or progressive lenses and contact lenses.
MYOPIC ASTIGMATISM
Myopic astigmatism is a type of refractive error where the eye has both myopia
(nearsightedness) and astigmatism. In this condition, the eye's cornea or lens is not perfectly
spherical, causing light to focus unevenly on the retina. As a result, objects at both near and far
distances appear blurry. In myopic astigmatism, the myopia causes blurry vision at a distance,
while the astigmatism causes overall distortion or blurring, both for near and far objects.
Symptoms include: Blurry or distorted vision at all distances, Eye strain or discomfort and
Headaches, particularly after visual tasks like reading or using a computer.
Myopic astigmatism is diagnosed through a comprehensive eye exam, including a refraction test
and keratometry to measure the curvature of the cornea. Management options include:
prescription of glasses to correct both myopia and astigmatism, toric lenses and refractive
surgery (e.g LASIK).
PAGE \* MERGEFORMAT 21
FOLLOW-UP CASE
CASE 3: CASE REPORT ON THE FOLLOW UPs OF A PATIENT WITH BILATERAL
RHEGMATOGENOUS RETINAL DETACHMENT
FIRST DATE OF APPEARANCE: 21ST OCTOBER, 2024.
CLINICAL PRESENTATION.
AGE-69 Yrs
GENDER- Male
BP- 114/78mmHg @8:18am
RBS- 147mg/dl @ 8:21am
CASE HISTORY
CC: The Patient complained of poor vision in both eyes (OU), (OD>OS) after cataract surgery
which started x7 years ago (OD) and about a month ago (OS).
POVHX: Patient had cataract surgery in his right eye over 7 years ago but since then he has not
been seeing with that eye. He had a cataract surgery in left eye @ Maxiview eye clinic about two
months ago. Subsequently, he started observing deterioration in vision and was diagnosed of
retinal detachment and was thus referred for expert intervention.
PMHX: Nil
ALLERGIES: Nil
DRUG Hx: Tabs Prednisolone, Gutt Flubiprofen, Caps Indomethacin, Gutt Ofloxacin +
Dexamethasone.
VISUAL ACUITY (UNAIDED) @ 6M
OD: NLP
OS: 6/60-2
PINHOLE VA
PAGE \* MERGEFORMAT 21
OD: No Improvement OS: 6/60+2
TONOMETRY (icare Rebound) OD: 13mmHg OS: 21mmHg @9:01am
EXAMINATION
OD OS
Eyelids NAD NAD
Conjuctiva NAD NAD
Cornea Arcus sinelis Arcus sinelis
Pupil Distorted and unreactive Distorted and unreactive
Lens AC IOL insitu PC IOL insitu
VCDR Poor view Poor view
Macula Poor view RD??
Subjective Refraction Results
OD: No Improvement with lenses
OS: +1.50DS -2.00DC x 090 (6/60-1) ADD +3.00DS (N36)
Both eyes were then dilated with tropicamide and the patient underwent B-SCAN(by the
consultant), thereafter went into the Consultant VitreoRetina Surgeon’s Office
PAGE \* MERGEFORMAT 21
B-SCAN RESULT FOR OS and OD respectively
DIAGNOSIS: BILATERAL RHEGMATOGENOUS RETINAL DETACHMENT
TREATMENT PLAN:
Left PPV+ PFCL + EL + SOL ↓LA
Guarded Prognosis Explained
Gutt Nepafenac bd OS
Tabs Eye Cap 1 Daily
SECOND DATE OF APPEARANCE (SURGERY DAY) 21ST NOVEMBER, 2024.
BP: 145/85mmHg @8:42am
RBS: 145mg/dL @ 9:05am
Pulse rate: 78bpm
CC: Patient came for scheduled procedure (LEFT PPV + PFCL + EL + SOI ↓LA)
VISUAL ACUITY (UNAIDED) @ 6M
OD: NLP
PAGE \* MERGEFORMAT 21
OS: CF @ 2m
PINHOLE VA: No Improvement (OU)
TONOMETRY (icare Rebound) OD: 12mgHg OS: 18mmHg @9:12am
The Patient’s left eye was dilated with appamide + amethocaine
Consent was taken
The Surgery was done
TREATMENT PLAN:
Compulsory Facedown position for 7 days (which must be adhered to)
Tabs. Acetazolamide 500mg stat
Tabs Rabeprazole 20mg bd x 5/7
Tabs Gestid ii bd x 2/52
Tabs Ciprofloxacin 500mg bd x 5/7
Tabs Pcm ii tds x 3/7
Tabs Vit.C ii tds x 2/52
Tabs diclofenac 50mg bd x 5/7
Patient was scheduled to come the next day for post-operative care.
THIRD DATE OF APPEARANCE (1ST DAY POST-OP) 22ND NOVEMBER, 2024.
BP: 125/81mmHg @9:03am
Pulse rate: 71bpm
The patient came for post-operative care after the surgery (Pars Plana Vitrectomy and SOI) in the
left eye. The patch on his eye was removed and his eye cleaned properly with a Sterilized Gauze.
Thereafter his visual acuity was taken.
His distant visual acuity post operatively in the left eye was: CF@ 2.5m which indicated an
improvement in his vision beyond that of his pre-operative appearance. IOP was 11mmHg (OD)
and 19mmHg (OS) @10:05am. External examination revealed no abnormalities.
PLAN
PAGE \* MERGEFORMAT 21
The following drugs were prescribed to be taken along with the medications prescribed the
previous day:
• Gutt. Prednisolone 2hourly OS
• Gutt. Moxifloxacin 1hourly OS
• Gutt. Maxi-Tears tds OS
• Oc. Beoptic-N nocte OS
• Gutt. Brimonidine + timolol tds OS
The patient was then scheduled for one week post-operative care.
FOURTH DATE OF APPEARANCE (ONE WEEK POST-OP) SATURDAY 28TH
NOVEMBER, 2024.
BP: 120/69mmHg @8:43am
Pulse rate: 80bpm
CC: One week post-op
VISUAL ACUITY (UNAIDED) @ 6M
OD: NLP
OS: 6/36+1
PINHOLE VA: No Improvement (OU)
TONOMETRY (icare Rebound) OD: 10mmHg OS: 32mmHg @8:50am
DOCTOR’S COMMENT: Patient is responding well to treatment.
TREATMENT PLAN:
• Gutt. Prednisolone 6x daily OS
PAGE \* MERGEFORMAT 21
• Gutt. Moxifloxacin 6x daily OS
• Gutt. Maxi-Tears tds OS
• Oc. Beoptic-N nocte OS
• Gutt. Brimonidine + brinzolamide qds OS
• Gutt Homatropine bd OS
The patient was then scheduled for follow up in 3/52.
CASE DISCUSSION ON RHEGMATOGENOUS RETINAL DETACHMENT
Rhegmatogenous retinal detachment (RRD) occurs when a tear in the retina allows fluid from
the vitreous to accumulate beneath it, separating the neurosensory retina from the retinal
pigment epithelium. This condition is sight-threatening and primarily affects individuals aged
40-70, with symptoms including flashes of light, floaters, and a "curtain" effect in vision.
Risk factors include aging, trauma, high myopia, previous eye surgery.
Early diagnosis and surgical intervention are crucial for preserving vision, especially if the
macula remains attached, as outcomes are better in such cases. Rhegmatogenous retinal
detachment is diagnosed using a comprehensive eye exam, including: dilated fundus
examination, OCT and B-Scan ultrasonography. Treatment options include: laser surgery
(photocoagulation), cryopexy, vitrectomy and pneumatic retinopexy.
PAGE \* MERGEFORMAT 21
REFRACTIVE CASE
CASE 4: CASE REPORT OF A PATIENT WITH HYPEROPIC ASTIGMATISM
CLINICAL PRESENTATION.
AGE- 32 Yrs
GENDER- Male
CASE HISTORY
CC: The Patient complained of blurry vision at far and moderate sensitivity to light.
POVHX: He has used glasses before but his former glasses got broken.
PMHX: Nil
ALLERGIES: Nil
DRUG Hx: Nil.
VISUAL ACUITY (UNAIDED) @ 6M
OD: 6/9 PH: 6/6-2
OS: 6/9 PH: 6/6-1
VISUAL ACUITY (UNAIDED) @ 40CM
OD: N5 OS: N5
PAGE \* MERGEFORMAT 21
EXAMINATION
OD OS
Eyelids NAD NAD
Conjuctiva NAD NAD
Cornea Clear Clear
Pupil PERRLA PERRLA
Lens Clear Clear
VCDR 0.4 0.3
Macula NAD NAD
Automated refraction results
OD: +3.75DS/-1.50DC x 165
OS: +4.50DS/-1.75DC x 163
Subjective refraction results
OD: +2.00DS/-0.75DC x 180 (6/5) N5
OS: +1.50DS/-1.75DC x 180 (6/5) N5
DIAGNOSIS: HYPEROPIC ASTIGMATISM
PLAN
To get photochromic/ Blue-cut lens
PAGE \* MERGEFORMAT 21
CASE DISCUSSION ON HYPEROPIC ASTIGMATISM
Hyperopic astigmatism is a type of refractive error that combines hyperopia (farsightedness) and
astigmatism. In this condition, the eye experiences two visual problems (hyperopia and
astigmatism) simultaneously. In hyperopia, the eyeball is too short or the cornea has too little
curvature, causing light entering the eye to focus behind the retina. As a result, people with
hyperopia have difficulty seeing close objects clearly, though they may see distant objects more
clearly. Astigmatism occurs when the cornea or lens is irregularly shaped, often more like a
football than a round ball. This irregular shape causes light to focus on multiple points in the
retina instead of just one, resulting in distorted or blurred vision at all distances.
Symptoms of hyperopia astigmatism include: Blurry or distorted vision, particularly for near
objects, Blurry or distorted vision, particularly for near objects and Headaches or discomfort
during tasks that require focusing on small details or near objects. Hyperopic astigmatism is
diagnosed through a comprehensive eye exam, which may include: refraction and keratometry.
The treatment for hyperopic astigmatism generally includes: prescription of corrective lenses to
address both the farsightedness and the astigmatism and refractive surgery (e.g LASIK or PRK).
PAGE \* MERGEFORMAT 21
PATHOLOGICAL CASE
CASE 5: CASE REPORT ON THE FOLLOW UP OF A PATIENT WITH BILATERAL
GLAUCOMA
FIRST DAY OF APPEARANCE (29TH OCTOBER, 2024)
CLINICAL PRESENTATION.
AGE-50 Yrs
GENDER- Male
CASE HISTORY
CC: The Patient presented with a chief complain of needing a second opinion about the state of
his both eyes.
A/C: Cloudy vision (OS), left sided headache.
POVHX: He had laser in his left eye earlier this year and about ten years ago. He has also had
trabeculectomy in left eye about four weeks ago but there was no improvement in vision.
PMHX: Diabetes and Hypertension
ALLERGIES: Drugs that ends with “lol” (e.g timolol) and diamox
DRUG Hx: Gutt Misopt, Gutt Diclofenac, Gutt Ciprofloxacin, Gutt Brimonidine and Gutt
Moxifloxcin.
VISUAL ACUITY (UNAIDED) @ 6M
OD: 6/36-1
OS: [email protected]
PINHOLE VA
OD: 6/9+2 OS: No Improvement
PAGE \* MERGEFORMAT 21
VISUAL ACUITY (AIDED) @ 6M (Rx: -2.50DS ADD +2.00)
TONOMETRY (icare Rebound) OD: 14mmHg OS: 42mmHg @12:55pm
EXAMINATION
OD OS
Eyelids NAD NAD
Conjuctiva NAD NAD
Cornea NAD NAD
Pupil Reactive Reactive
Lens NAD Poor view
VCDR 0.7 Poor view
Macula NAD Poor view
AutoRefraction Results
OD: -3.00DS/ -0.50DC x 138
OS: No reading
Subjective Refraction Results
OD: -2.75DS/ -0.50DC X 90 (6/5) ADD +2.50DS (N5)
OS: No Improvement with lenses
His right eye was then dilated with tropicamide and the patient underwent OCT and B-SCAN
PAGE \* MERGEFORMAT 21
(by the consultant), thereafter went into the Consultant VitreoRetina Surgeon’s Office for further
examination.
B-SCAN RESULT FOR OS and OD respectively
DILATED FUNDOSCOPY WITH VOLKS LENS FINDINGS:
OD: GLAUCOMA
OS: GLAUCOMA (? SECONDARY) + POSTERIOR SYNECHIAE + POST
TRABECULECTOMY
PLAN
TSCPC in a post trabec eye (OS)
Gaurded to poor prognosis explained to the patient
The TSCPC procedure was done that same day.
Thereafter, the following medications were prescribed:
Gutt Dorzolamide tds OS
Gutt Brimonidine qds OS
Gutt Diclofenac tds OS
Gutt Latanoprost nocte OD
Gutt Dorzolamide bd OD
Tabs Eye Cap i daily
Tabs Optic Nerve ii daily
PAGE \* MERGEFORMAT 21
Gutt Dexamethasone + Ciprofloxacin tds OS
The patient was scheduled to come for follow up care the next day.
SECOND DATE OF APPEARANCE (30TH OCTOBER, 2024)
VISUAL ACUITY (UNAIDED) @ 6M
OD: 6/24
OS: 6/36
PINHOLE VA
OD: 6/9+2 OS: 6/24-2
TONOMETRY (icare Rebound) OD: 13mmHg OS: 7mmHg @10:20pm
PLAN
Discontinue Gutt Dorzolamide OS
Gutt Brimonidine tds OS
Gutt Diclofenac tds OS
Gutt Latanoprost nocte OD
Gutt Dorzolamide bd OD
Tabs Eye Cap i daily
Tabs Optic Nerve ii daily
The patient was then scheduled for follow up in 2/52
CASE DISCUSSION ON GLAUCOMA
Glaucoma is a group of eye diseases characterized by damage to the optic nerve, often associated
with increased intraocular pressure (IOP). The optic nerve is responsible for transmitting visual
information from the retina to the brain, and its damage can lead to irreversible vision loss.
Glaucoma is one of the leading causes of blindness worldwide, and it often progresses without
noticeable symptoms until significant vision loss has occurred.Glaucoma can be categorized into
PAGE \* MERGEFORMAT 21
different types, with open-angle glaucoma and closed-angle glaucoma being the most common
forms. Open-angle glaucoma results from impaired drainage of aqueous humor in the eye,
leading to a gradual increase in intraocular pressure and optic nerve damage. On the other hand,
closed-angle glaucoma involves a sudden blockage of the eye's drainage canals, causing a rapid
rise in intraocular pressure and more severe symptoms like eye pain, blurred vision, and nausea.
Risk factors for glaucoma include high internal eye pressure, age over 55, certain ethnic
backgrounds like Black, Asian, or Hispanic heritage, family history of glaucoma, medical
conditions such as diabetes and high blood pressure, extreme nearsightedness or farsightedness,
and prolonged use of certain medications like eye drops. Early detection through regular eye
examinations is crucial for managing glaucoma effectively and preventing irreversible vision
loss.
Treatment options include medications to reduce intraocular pressure, laser treatments, and
surgeries like trabeculectomy or shunt implantation to improve fluid drainage from the eye. It's
essential for individuals at risk of glaucoma to undergo routine screenings to detect the condition
early and initiate appropriate management to preserve vision.
PAGE \* MERGEFORMAT 21
REFERENCES
American Academy of Ophthalmology (AAO). "Cataracts." AAO.org. Link
American Diabetes Association (2020). "Diabetic Retinopathy and Macular Edema." Diabetes
Care, 43(1), 147-157.
Bourne, R. R. A., et al. (2013). "Causes of vision impairment and blindness in a cohort of elderly
individuals in the United Kingdom." Eye, 27(1), 122-130.
Brown, D. M., et al. (2019). "Diabetic Macular Edema: Pathophysiology and Treatment."
Journal of Clinical Medicine, 8(12), 2111.
Fazzini, J. (2012). "Refractive Surgery: Principles and Techniques." Springer.
Fong, D. S., et al. (2009). "Retinal Vascular Disease and Vitreous Hemorrhage." Ophthalmology
Clinics of North America, 22(4), 491-500.
Heijl, A., et al. (2002). "Reduction of intraocular pressure and glaucoma progression: results
from the Early Manifest Glaucoma Trial." Archives of Ophthalmology, 120(10), 1268-1279.
Lambert, J. W., & Schein, O. D. (2006). Cataracts: diagnosis and management. American Family
Physician, 73(2), 271-276.
Norrby, S. (2008). "Presbyopia: A Review." Clinical and Experimental Optometry, 91(2), 109-
119.
Quigley, H. A., & Broman, A. T. (2006). "The number of people with glaucoma worldwide in
2010 and 2020." British Journal of Ophthalmology, 90(3), 262-267.
Reinstein, D. Z., & Archer, T. J. (2008). "Astigmatism and its Management." Eye & Contact
Lens, 34(3), 149-155.
Sadda, S. R., & Schwartz, S. G. (2019). "Vitreous hemorrhage: diagnosis and management."
Retina Today, 8(6), 22-28.
Schwartz, S. G., & Flynn, H. W. (2017). "Surgical Management of Retinal Detachment."
Ophthalmology Clinics of North America, 30(1), 51-62.
Smith, R. T., & Sadda, S. R. (2019). "Retinal Detachment: Pathophysiology, Diagnosis, and
Management." Journal of Clinical Ophthalmology, 43(2), 295-303.
PAGE \* MERGEFORMAT 21
Weiner, A. L., & McCulley, J. P. (2003). "Management of Presbyopia." Ophthalmology Clinics
of North America, 16(4), 591-599.
PAGE \* MERGEFORMAT 21
