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Recommended: Diabetes
Report of case:
A ten years old boy was referred by Pediatrician for ocular assessment. He was a known case of DM since last two years being on insulin and the pediatrician was concerned about Diabetic Retinopathy, as the patient had a complaint of gradual visual decline over past two years. The patient was born to a 1st degree consanguineous cousin marriage, with a normal birth history. He had been diagnosed with DM at the age of eight, receiving insulin. The referral letter from pediatrician along with a recent HBA1C report was a telltale of good glycemic control. Moreover, the document reported an unremarkable systemic exam (afebrile patient with normal CVS, intact CNS, clear chest and soft abdomen)
His general health was good. He stepped into my office with a normal gait. The patient was well oriented to time and place.
His unaided and best-corrected visual acuities with a manifest refraction; +1.00DS/-0.25DC@180 OU, were 6/60 OU. He could not discern any of color vision plates on Ishihara color vision test. Confrontation visual fields to careful finger counting were constricted however, confrontation testing appeared to be unreliable as patient’s cooperation was poor during the entire exam. Extraocular motilities were full OU. Both pupils were equally round, however poorly responsive to light with no RAPD. Intraocular pressures measured 12mmHg OU.
Examination revealed bilateral Ocular adnexa and Anterior segments to within normal limits. Anterior chambers were quiet and deep OU. Dilated fundus examination revealed both vitreous clear OU. His both Optic Nerve heads were pale consistent with the clinical appearance of Optic Atrophy. Rest of fundus examination was unremarkable, including a well-defined Fovea, healthy maculae, ...
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Then, when she was finished reading, she stopped at a particular line and I wrote down her results. I also tested her other eye, which is her right eye, which had different results. After, she finished and I wrote her results down, I tested her vision field by sitting in front of her and placing my finger near her ear and she then told me when she saw my finger first. Next, I tested Jazmine Cooley’s oculomotor, trochlear, and abducens nerves by looking at the pupil of her eye and briefly shining a flashlight into her eyes asking her to look up, down, left, right, and side to side. Then, I repeated the same test, however, I did not use a flashlight this time, but I had her follow along to my clenched fist with my thumb held up.
Well how can you get it? Well it’s caused by damaged blood vessels in the tissue that the retina which is located at the back of the eye. When blood sugar levels are too high for extended periods of time, it can damage capillaries which are tiny blood vessels that supply blood to the retina. Over time these blood vessels begin to leak fluids and fats, causing edema. Then the vessels can close off which is called ischemia. These types of signs are non-proliferative diabetic retinopathy (“Diabetic Retinopathy Treatment,”2016).
Waardenburg Syndrome is a rare genetic disorder meaning that is caused by a mutation of genes. The disorder is classified as type I, II, III, or IV based on inheritance pattern and symptoms (Genetics 2013). Waardenburg Syndrome is an incurable disorder that is inherited from either one or both parents. If it came from one parent, it is an autosomal dominant pattern and if it came from both, it is known as an autosomal recessive pattern (Calendar 2013). Hearing loss, abnormalities with pigmentation of hair, eyes, and skin and other minor defects are some symptoms of Waardenburg Syndrome. There are many ways to diagnose the disorder and many treatments of the symptoms of it as well.
What? The patient is 65-year-old man Mr. John Douglas who is suffering from dysphagia and have been admitted to the surgical ward for insertion of a percutaneous endoscopic gastrostomy (PEG). Apart from that, he is a Type 1 diabetes patient and has weakness in his right leg and arm because of right-sided hemiplegia. He is thin in appearance and has stage 1 pressure sore on his right heel.
Stargardt disease is a genetic disease that is inherited as an autosomal recessive trait. The disease is inherited when both parents are carriers of the recessive gene. Parents are typically only carriers and are, therefore, unaffected; however, each of their offspring has a 25 percent change of inheriting the two copies of the Stargardt gene needed to cause the disease. Researchers have found that about 5 percent of the human population carry gene mutations causing inherited retinal disea...
Samaan, Zainab, Erin Hoh, and Glenda MacQueen. “Factitious Disorder Presenting as Type 1 Diabetes Mellitus” BMJ Case Reports (2009). ncbi.nlm.nih.gov/pmc/articles/PMC3027606/ Web. 12 Nov. 2013.
Type 1 diabetes has a genetic onset that often occurs in adolescence (Porth, 2005). It is an autoimmune disease in which the insulin-producing beta cells within the liver are destroyed (Dorman, 1993). This causes a deficiency in insulin secretion, which ultimately leads to high blood glucose levels, also referred to as hyperglycemia (Guthrie & Guthrie, 2004). The mechanism for insulin deficiency leading to hyperglycemia is described in more detail in the following section and in Figure 1.
Diabetes is a chronic disorder of metabolism characterized by a partial or complete deficiency of the hormone insulin. With this, there are metabolic adjustments that occur everywhere in the body. Specific to this child is Type One Diabetes. This is characterized by demolition of the pancreatic beta cells, which produce insulin. Because of this, it leads to complete insulin deficiency. Within Type One diabetes, there are two different forms. First there is immune-mediated deficiency, which typically results from an autoimmune destruction of the beta cells. The second type is called idiopathic type one, in which the cause is unknown. (Wong, Hockenberry, Wilson, 2015)
These types of damage are the result of damage to small vessels, referred to as microvascular disease, Diabetes also is an important factor in accelerating the hardening and narrowing of the arteries (atherosclerosis), leading to strokes, coronary heart disease, and other large blood vessel diseases. This is referred to as macrovascular disease” (Conrad Stöppler & Shiel Jr., 2016). Over time the kidneys may begin to fail, so the patient with have to have dialysis in order to filter their blood, since the kidneys have become damaged and are unable to do so properly, and eventually have to have a kidney transplant. The first sign of diabetes is starting to affect the eyesight is a person with diabetes will have to start wearing glasses, which has happened to my son approximately three years ago. He was diagnosed with Type 1 diabetes when he was two years old, he is now fifteen years old, and he has an insulin pump the doctor recommended this when he was five years old. The insulin pump works great for him, but we still monitor his glucose levels and watch his diet carefully, since another medical problem with juvenile diabetes is a risk of becoming overweight and eventually
He is admitted to the ward with the chief complain of pain at right lower quadrant of the abdomen for 8 hours prior to his admission.
On my mother’s side of the family Type-1 diabetes is prevalent and it isn’t entirely considered an inherited disease, but it has been proven to have some genetic factors that can be passed down. Diabetes is becoming an increasing problem in the United States with half of all Americans becoming either diabetic or pre-diabetic.
A number of medical risks are associated with type 1 diabetes. Many of them stem from damage to the tiny blood vessels in your eyes (called
My preparation for training in the field of optometry includes that of shadowing experience and employment by Dr. William Shaheen at the Eye Institute of Southeastern Michigan. Beginning in July of 2015 I was given the chance to follow and learn from Dr. Shaheen as he progressed through his daily routines. I have been fortunate enough to witness several procedures, including punctal plugs, lacrimal dilations, and my favorite the application of amniotic grafts for ocular surface issues. I learned to obtain photos of the macula and optic nerve using a Fundus camera and scans using an OCT machine. I was also fortunate enough to learn to administer both VEP and Pattern ERG Electrodiagnostic tests. Although I know what I have been exposed just scratches