SIMULATORS, ANATOMICAL MODELS AND CHARTS FOR CLINICAL SKILLS AND TRAINING
AR303/AR303-B
Eye Renopathy Trainer
Instrucon Manual & Eye Condions
Thank you for purchasing this AR303 Eye Renopathy Trainer. Please read this instrucon manual carefully and retain it for future reference.
Skills • Oers excellent ‘hands-on’ experience and pracce in the examinaon of eyes, and the use of an ophthalmoscope, with the emphasis on Diabec Renopathy • The model is now supplied with a completely new set of images idenfying condions and diseases of the rena. These are shown on a set of 28 interchangeable transparencies
Features • The slides for use in the Renopathy head can be placed in either the le or the right eye and are labelled accordingly
Safety and Precauons During use, the ophthalmoscope light must be switched o to avoid reecon on the slides. The head is open at the back for light to shine through from behind. Do not store the Eye Renopathy Trainer near heat or where it may experience extremes in temperature and humidity. Please treat the Trainer with the same care you would a paent.
Contents Parts and Conguraon
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During Use
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List of 28 Slides Showing Condions and Diseases of the Rena
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2
Parts and Conguraon
b
a
Front
a
Le Eye / Le Eye Slide Holder
b
Right Eye / Right Eye Slide Holder
b
a
Rear
Supplied With SPAR303
Set of 28 Slides
Oponal Extra ARR00002 Ophthalmoscope
If you require any replacement parts or oponal extras please contact our Sales Department, quong codes where applicable.
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During Use 1
a
b
a
2
4
b
Inserng Slides Ensure the work area is clean and dry. For opmal use, posion the Eye Renopathy Trainer where there is a good light source behind the head.
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Each of the 28 slides supplied can be used in both the le or right eye and are labelled accordingly. With the Eye Trainer head and numbered condion on the slide facing you: Insert Le Eye slides (Grey Side) into the
a
Le Eye Slide Holder.
Insert Right Eye slides (White Side) into the b Right Eye Slide Holder. When handling the slides, be sure to avoid touching the lm.
Using Ophthalmoscope 2
An ophthalmoscope (not included) may be used to view each slide condion.
During use, the ophthalmoscope light must be switched o to avoid reecon on the slides. The head is open at the back for light to shine through from behind.
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Slides Showing Condions & Diseases of the Rena Slide 1 The view is of the opc disc and temporal rena The main clinical features are: • Blot haemorrhages in the nasal macular area and superior temporal arcade • Hard exudates along the inferior temporal arcade • Micro-aneurysms at the macula area • Circinate exudates along the inferior temporal arcade The diagnosis is consistent with: BACKGROUND DIABETIC RETINOPATHY AND DIABETIC MACULOPATHY Comment: The macular area, as dened by a circle area centred on the fovea with its radius extending to the edge of the opc disc, has exudates in it. This makes the condion maculopathy. If the visual acuity was normal and there were Micro-aneurysms and haemorrhage only, then this would be Background Diabec Renopathy alone.
Slide 2 The view is of the opc disc and temporal rena (alignment marker is shown) The main clinical features are: • Mulple dot and blot haemorrhages • Coon wool spots (CWS) • Intra-renal micro-vascular abnormalies (IRMA) The diagnosis is consistent with: PRE PROLIFERATIVE DIABETIC RETINOPATHY Comment: Pre-proliferave Diabec Renopathy is characterised by renal ischaemia. CWS represent areas of focal renal ischaemia and IRMA are a pathological aempt at micro-revascularisaon. IRMAs are at and do not grow into the vitreous.
Slide 3 The view is of the central fundus with the opc disc The main clinical features are: • New vessels on the disc • Haemorrhages • Exudates • Pre-renal brosis The diagnosis is consistent with: ADVANCED PROLIFERATIVE RETINOPATHY Comment: On-going ischaemia and increase in vaso-proliferave factors. The new vessels grow into the vitreous and are fragile leading to haemorrhage. As the haemorrhage organises, brous ssue reacon occurs oen resulng in renal tracon and detachment. 6
Slide 4 This view is of the opc disc and temporal rena The main clinical features are: • Mulple hard exudates in the macular area, some are circinate • Haemorrhages and Micro-aneurysms The diagnosis is consistent with: DIABETIC MACULOPATHY Comment: The visual acuity may be reduced depending on the locaon and macular oedema. Circinate hard exudates oen have Micro-aneurysms at their centre. The darker renal appearance is normal in an Asian or Afro-Caribbean paent.
Slide 5 This view is of the opc disc and temporal rena (alignment marker is shown) The main clinical features are: • Mulple laser scars with areas of hyper pigmentaon • Regressed new vessels at the disc with residual gliosis The diagnosis is consistent with: PAN RETINAL LASER PHOTOCOAGULATION Comment: The overall appearance suggests good response to management and stable renopathy. The paent will have reduced peripheral vision and a degree of night-blindness (compare with renis pigmentosa).
Slide 6 This view is of the posterior pole centred on the opc disc The main clinical features are: • Disc area is obscured • Poorly dened vasculature The diagnosis is consistent with: UNGRADABLE RETINOPATHY Comment: The suspicion of brovascular proliferaon at the disc and along the vascular arcade with traconal detachment is very strong. This would be a feature of advanced diabec eye disease. Clearly, urgent referral is indicated.
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Slides Showing Condions & Diseases of the Rena
(Connued)
Slide 7 The view is of the opc disc and temporal rena The main clinical features are: • Opc disc with uniform central cup with cup disc rao <0.5 and pink neurorenal rim • Renal vessels and macula look normal. This degree of darker redness in the central macular area is normal The diagnosis is consistent with: NORMAL FUNDUS Comment: Remember the classic sequence of looking at the rena: • Light reex for cataract, arcus, xanthelesma, conjuncva • Start at the opc disc • Superior temporal arcade and inferior temporal arcade • Macular area • Superior nasal arcade and inferior nasal arcade • Peripheral, clockwise sweep to look for peripheral lesions
Slide 8 The view is of the posterior pole centred on the opc disc The main clinical features are: • Large cup disc rao • Superior polar notching • Nasal displacement of central blood vessels The diagnosis is consistent with: GLAUCOMATOUS OPTIC DISC Comment: Glaucomatous damage and its extent is conrmed by visual elds and tomographic imaging techniques.
Slide 9 This view is of the opc disc and temporal rena The main clinical features are: • Disc margins are obscured and swollen and hyperaemic • Renal vessels show tortuosity The diagnosis is consistent with: PAPILLOEDEMA Comment: Spontaneous venous pulsaon may be absent, if present then Papilloedema is unlikely. Visual symptoms are absent in early stages. A space occupying lesion must be excluded urgently.
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Slide 10 This view is of the opc disc and temporal rena The main clinical features are: • Opc disc pallor with possible cupping • Large area of macular scarring The diagnosis is consistent with: OPTIC ATROPHY WITH MACULAR SCARRING (AND POSSIBLE GLAUCOMA) Comment: Age-related macular degeneraon would be the commonest cause of macular scarring.
Slide 11 This view is of the opc disc and surrounding rena The main clinical features are: • Disc margin and emerging vessels obscured by myelinated nerve bres along superior and nasal areas The diagnosis is consistent with: MYELINATED NERVE FIBRES Comment: This requires no further clinical aenon. On clinical examinaon the blind spot would be expected to be larger, but this would be very dicult to discern clinically.
Slide 12 This view is of the opc disc and temporal rena The main clinical features are: • Focal areas of atrophy of renal pigment • Drusens in the macular area The diagnosis is consistent with: DRY AGE RELATED MACULAR DEGENERATION Comment: Presence of haemorrhages and oedema in the macular area would suggest wet changes.
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Slides Showing Condions & Diseases of the Rena
(Connued)
Slide 13 This view is of the opc disc and temporal rena The main clinical features are: • Mulple renal haemorrhages • Venous dilataon The diagnosis is consistent with: MULTIPLE RETINAL HAEMORRHAGES Comment: Hyperviscosity states (polycythemia, Waldenstrom’s macro-globulinaemia, myeloma) can lead to venous dilataon and haemorrhages. Thrombocytopenia and other bleeding diatheses are other possibilies.
Slide 14 This view is of the posterior pole centred on the opc disc The main clinical features are: • Large opc disc • Marked peripapillary choriorenal atrophy The diagnosis is consistent with: HIGH MYOPIA Comment: Areas of choriorenal atrophy in the macular area are not uncommon in highly myopic paents.
Slide 15 This view is of the opc disc and temporal rena The main clinical features are: • Focal narrowing of arterioles • Changes at arterio-venous crossings along inferotemporal arcade (A-V nipping) The diagnosis is consistent with: HYPERTENSIVE RETINOPATHY: GRADE 2 Comment: Absence of haemorrhages (ame shaped) and disc swelling suggest early changes or chronic hypertension. The grading system can be summarised as follows: • Micro-aneurysms are rare in Hypertensive Renopathy without diabetes mellitus • Grade 1: Arteriolar narrowing • Grade 2: Arterio-venous nipping • Grade 3: Exudates, Haemorrhages, Coon wools spots • Grade 4: Papilloedema
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Slide 16 This view is of the opc disc and temporal rena The main clinical features are: • Pigmented clumps in macular area with chorio-renal atrophy and scarring. Pallor of the opc disc is noted indicang atrophy The diagnosis is consistent with: MACULAR SCAR (TOXOPLASMOSIS) Comment: The cat is a denive host for Toxoplasma gondii. This is a usually a quiescent lesion oen discovered incidently when a child is assessed for impaired vision. An acve lesion may show an inammatory focus with a vitreous haze adjacent to a previous scar and vasculis. There may be associated anterior uveis.
Slide 17 This view is of the temporal rena The main clinical features are: • Area of bullous rena showing area of elevaon with uid The diagnosis is consistent with: RETINAL DETACHMENT Comment: In the absence of idenable break and trauma the possibility of choroidal metastasis should be considered. Clearly urgent referral is indicated.
Slide 18 This view is of the peripheral rena The main clinical features are: • Green-grey at asymptomac lesion with detectable but not sharp borders • Presence of surface drusen • Areas of atrophy within the lesion The diagnosis is consistent with: CHOROIDAL NAEVUS Comment: In view of large size >5mm, it is worth monitoring for a period. If there is a change in size then further invesgaon is indicated.
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Slides Showing Condions & Diseases of the Rena
(Connued)
Slide 19 This view is of the opc disc and temporal rena The main clinical features are: • Dense white areas along vessels with vasculis along temporal arcade The diagnosis is consistent with: CYTOMEGALOVIRUS RETINITIS Comment: The spread of vasculis can be relentless from periphery to the disc along renal vessels. Haemorrhages may be present in fulminang cases.
Slide 20 This view is of the opc disc and temporal rena The main clinical features are: • Papilloedema • Totuosity and dilataon of all branches of the central renal vein • Renal haemorrhages: ame shaped, dot and blot in all quadrants • Coon wool spots (CWS) The diagnosis is consistent with: CENTRAL RETINAL VEIN OCCLUSION (CRVO) Comment: The presence of CWS would suggest signicant ischaemic element carrying poor prognosis. Space-occupying lesions in the cerebrum and hyperviscosity have to be excluded. Hypertension alone can cause CRVO.
Slide 21 This view is of the temporal rena and temporal opc disc The main clinical features are: • Aenuaon of arteries and veins • The pale temporal edge of the opc disc is shown • Central ‘cherry red spot’ with surrounding pale rena The diagnosis is consistent with: CENTRAL RETINAL ARTERY OCCLUSION (CRAO) Comment: Poor prognosis due to renal infarcon. Renal cloudiness of pale rena would disappear aer a few weeks. Aenuated vessels would remain and consecuve opc atrophy would be evident. The cherry-red spot is seen because the macular arterial supply from the choroid can remain intact. Oen there is a band of neural ssue that is not rendered ischaemia by the CRAO, this is seen if there is an adequate cilio-renal artery supply.
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Slide 22 This view is of the opc disc and surrounding rena The main clinical features are: • Yellow orange refracle bodies at an arterial bifurcaon (12 o’clock on the opc disc) The diagnosis is consistent with: RETINAL ARTERY CHOLESTEROL EMBOLI (HOLLENHORST PLAQUE) Comment: Frequently asymptomac as it rarely causes signicant obstrucon of the arteriole unlike calcic emboli. Fibrinoplatelet emboli cause transient renal ischaemic aacks (amaurosis fugax) which may occasionally be complete.
Slide 23 This view is of the mid peripheral rena The main clinical features are: • Mulple bony spicule renal pigmentaon scaered in the periphery of the rena The diagnosis is consistent with: RETINITIS PIGMENTOSA Comment: The associated history of night blindness and family history is oen posive. The opc disc may show waxy pallor with aenuaon of vessels.
Slide 24 This view is of the opc disc and surrounding rena The main clinical features are: • Linear reddish-brown lesions with irregular edges beneath the normal renal vessels. This represents breaks in Bruch’s membrane and visualisaon of the choroidal circulaon • Peripheral focal chorio renal scars may be present The diagnosis is consistent with: ANGIOID STREAKS Comment: Bruch’s membrane is mainly elasn. The condion is associated with connecve ssue disorders. This includes: pseudoxanthoma elascum, Ehlers-Danlos syndrome, Marfan’s syndrome, rarely Paget’s disease, acromegaly and certain haemoglobinopathies.
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Slides Showing Condions & Diseases of the Rena
(Connued)
Slide 25 This view is of the peripheral rena The main clinical features are: • Elevated dome shaped grey mass The diagnosis is consistent with: MALIGNANT MELANOMA Comment: A secondary renal detachment may be present. Urgent referral indicated.
Slide 26 This view is of the opc disc and surrounding rena The main clinical features are: • Flat pigmented lesion involving inferior aspect of the opc disc The diagnosis is consistent with: BENIGN DISC NAEVUS Comment: Oen dicult to disnguish from malignancy. If in doubt seek a specialist opinion.
Slide 27 This view is of the opc disc and temporal rena The main clinical features are: • Large macular haemorrhage in the pre renal area The diagnosis is consistent with: MACULAR HAEMORRHAGE Comment: Sudden severe intrathoracic or abdominal pressure can lead to this feature. Macular degeneraon and Diabec Renopathy can be considered in presence of addional features. A pre-renal haemorrhage with a uid level can be seen in some paents with subarachnoid haemorrhage. Small areas of haemorrhage adjacent to blood vessels are seen in bacterial endocardis (Roth’s spots).
Slide 28 This view is of the opc disc and temporal rena The main clinical features are: • Pale yellow appearance of vessels in a creamy renal background The diagnosis is consistent with: LIPAEMIA RETINALIS Comment: This is associated with hypertriglyceridaemia and hypercholesterolaemia. This is occasionally encountered in lipid disorders, poorly controlled diabetes and alcoholism. 14
The images of the eye condions supplied are the copyright of Adam,Rouilly Limited. They are for sole use with the AR303 Eye Renopathy Trainer. These images may not be copied, sold, displayed or reproduced in any format without the prior consent of Adam,Rouilly Limited.
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Adam,Rouilly has over 90 year’s experience in providing quality medical models and simulators. Should you require any further informaon please contact our Sales Department who will be pleased to help with your enquiry. Adam,Rouilly Limited Castle Road Eurolink Business Park Singbourne Kent United Kingdom ME10 3AG
T: +44(0)1795 471378 F: +44(0)1795 479787 E:
[email protected] www.adam-rouilly.co.uk
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