OP9.4 | Posterior Segment Disorder Survey: Retinopathies, Detachment, Macular Disease, Dystrophy and Retinoblastoma — Summary & Reflection

KEY TAKEAWAYS

The posterior segment disorders covered in this module span five disease categories. Hypertensive retinopathy is graded KWB I-IV: grade I (arteriolar changes) → II (AV nipping) → III (haemorrhages, exudates, cotton-wool spots) → IV (grade III + papilloedema = hypertensive emergency). Eales disease causes peripheral periphlebitis with vitreous haemorrhage in young Indian men; treat active inflammation and laser ischaemic zones. ROP affects premature infants (<32 weeks); type 1 ROP is treated with laser or intravitreal anti-VEGF. Retinal detachment is rhegmatogenous (break-driven — PVD + myopia; most common, surgical emergency), tractional (PDR/ROP; membranes pull retina), or exudative (no break; treat underlying cause). CSR (young stressed men, steroid use) presents with monocular metamorphopsia and neurosensory detachment; most resolve in 3-4 months. CMO is a petaloid oedema pattern from multiple causes including post-operative, uveitic, and vascular. AMD: dry type has drusen + RPE atrophy (AREDS2 supplements for intermediate AMD); wet type has CNV — urgent anti-VEGF (ranibizumab, bevacizumab, aflibercept). Retinitis pigmentosa: bone-spicule pigmentation + arteriolar attenuation + waxy disc pallor + extinguished ERG; AR/AD/XLR inheritance; nyctalopia first, then tunnel vision; no cure. Retinoblastoma: leukocoria in a child under 5, RB1 gene, MUST refer same day — never biopsy, never reassure; life-threatening if orbital or CNS extension.

REFLECT

Reflect on the following:
- Why is a child with leukocoria sometimes reassured by primary care clinicians? What are the barriers — knowledge gaps, availability of equipment, time pressure — and how would you personally address these in your future practice?
- Retinitis pigmentosa is currently untreatable. How would you counsel a 25-year-old patient who has just received this diagnosis and is asking about the future of gene therapy and assistive technology?
- Consider the three types of retinal detachment. A general practitioner in a rural setting receives a patient with sudden onset floaters and a shadow in vision — what is the one examination they must attempt, and what is the appropriate referral action?
- AMD is the leading cause of blindness in the elderly in developed countries, while cataract leads in India. What does this difference tell us about the role of access to surgical care vs genetic/ageing factors in global patterns of blindness?