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Ok. We, we have some people joining you. Move it. Not fine. Ok. I'll just wait um, a few seconds for some more people to join and then I'll make a start. Mm. Ok. Right. So, hi, everyone and thank you for joining us today. My name is Gabby and I am the educational lead at. So this week we will be focusing on um ophthalmology, um specifically blurred vision. Um I'm really excited to have you all with us. Um, today I am joined by Karen and Tim, both final year medical students at Plymouth University to make the um, session as engaging as possible, will be releasing polls throughout. Um, these are completely anonymous. So we really encourage you to participate actively. Um, there aren't that many people on the session today. So please don't be embarrassed at all about getting the answers wrong. It's purely for your learning. Um, at the end of the session, we'll share a feedback form. Um, if you complete this, you'll receive a certificate of attendance and exclusive discount codes for Teach me surgery past the MRC S additionally. Um, the session is being recorded, the recording and slides will be shared on our metal page in a couple of hours after the session. So please keep an eye out for that. Um We're also excited to share that um an exclusive question bank and other resources will be available on our learning portal. So please be sure to check out our website to access them. If you create a free membership account with us, you'll automatically receive a discount code for 10% off medics, anatomy flash cards, surgery, flash cards, and um knowledge bundle. We also have an exciting opportunity for all our attendees. Two lucky people will win free access to the ki Medics surgical flash cards and the ki medics ay stations um to enter simply complete the Google form at the end of um recession and enter the unique code that will provide the the more sessions you attend, the higher chances of winning. So please be sure to stay until the end of today's session and attend our other sessions as well. We'd also like to thank our partners G medics, the MD more than skin deep meal, teach me surgery and pass the Mr S Sorry CS. Um Finally, we have a quick announcement. Um Yeah, so this teaching series is coming to a close soon and after our final week um on pediatric surgery, we will still be on medal. Um We'll be moving all our fu future sessions to career book. This includes our upcoming national conference and series focused on preparing you for foundation yet one, which we'll be really looking forward to. So keep an eye out on our socials for any updates. Um and to keep you guys in the loop and then without further ado, I want to hand it over to Karen and Tim. Perfect. Thank you very much. Um So I'm trying to quickly share my slides again because they stopped working briefly. Uh There we go. Can you see that? Yes, we can see them. Perfect. So, today's session is on blurred vision. There's a couple of different pathologies and things we'll be covering. Um And my name's Karen. I'm one of the, one of the tutors for today. I've got Tim as well. Hi, my name is Tim. Um I'm gonna be sharing his power, powerpoints and er discussing three sections together. So, thank you to our partners again, the list. Uh and for today's learning objectives, um we're gonna understand the anatomy of the vitreous humor and the retina, including its layers and the neurovasculature that supplies it. We're gonna also explain the anatomy of the optic nerve as it enters the orbit and the vasculature that runs along it to supply the retina. We're going to describe the presentations of pathologies in this vasculature and that includes things like diabetes, disease, um and its associated retinopathy, central retinal artery occlusions and vein occlusions. And there's a couple of other presentations er, that we're going to look at. Um these include retinal detachment er vitreous hemorrhage A RMD, which we'll talk a bit more about later, um glaucoma and hypertensive retinopathy as well. And we'll talk a bit about the management of these acute and chronic conditions. We're gonna also describe the importance of the red reflex in infants and as you might know that relates to retinoblastoma, so we'll talk a bit about that as well. And we're gonna understand the pathophysiology, risk factors, diagnosis and management of cataracts, including some of this postoperative care and why it's important. So, the vitreous humor is a sort of call this uh gel like substance er that fills the space between the lens and the retina. And it's um it's also known as sort of the, the, the po the posterior chamber or vitreous chamber is, is essentially what it fills up as well. That's the other terms that you might hear that uh relate to it. It's composed mostly of water um along some sort of collagen sugars or um electrolytes and proteins and things like that. So, not too important aspect of it, but it does have an important role and it has a couple of roles. Actually. Um the main one would be sort of maintaining the round shape of the eye from the inside. So keeping it the shape that it is um but it also helps with vision clarity and light transmission to the retina. It also helps absorb any unexpected disturbances or trauma. So, if you do get trauma to the eye. This fluid can help absorb that. Um it supports the lens and also it pushes the lens and keeps it in place. And it also holds the layers of the retina in place as well. So pushes the lens forward at the front and then pushes the retina at the back. So it keeps everything where it's supposed to be when it comes to the retina. Uh it's essentially the very back of the eye. Um And the innermost layer of the eyes is the retina and it's used for um essentially picking up images that you'll see with your eyes. Um because it detects light essentially and it's composed of two layers. Um The pigmented outer layer and the neuro uh inner layer which you can see on the top left diagram there, the pigmented layer is formed by a single layer of cells attached to the choroid and it supports the choroid in absorbing light. It does continue around the sort of whole inner surface of the eye. Uh as you can see on that top left image again, um which the other layer the neural lay doesn't and we'll talk a bit more about that now. So the neuro layer consists of the photoreceptors, which you'll be aware of, you know, sort of cones and rods and different cells are involved in that and may essentially detect light. Um So that is the essentially why it's called the neuro layer because it, it detects signals. And as I was saying before, unlike the pigmented layer, this does not cover the whole of the inner eye surface. It often referred to as the optic part of the retina. So you might hear that turn throwing around sometimes. Um and this is what's seen during ophthalmoscopy as well. So you can't actually see the outer parts of the pigmented ly, you can only see um this section of the, the retina when you do ophthalmoscopy. And at the center of the retina is the macular, which is a yellow and highly pigmented area. And this contains a depression called the fovea centralis. Um For anyone that doesn't know what the fovea centralis is, it's essentially a really high concentration of light detecting cells and is thus responsible for high vis acute, acute vision. So the most important part of your vision there is another important structure which you can see on the, the diagram on the bottom left. Um And that is the optic disc, essentially what this is is where the optic nerve enters the retina. And thus, it doesn't actually have any light protecting cells. So you can actually test for this um when you test for your blind spot because that part of the eye can't see actually pick up any images. So it your brain kind of tricks you in some ways to to fill that gap when it comes to neurovasculature of the retina. Um It's not actually too complex I know that image, there does look a bit uh overwhelming at first, but there are only a few important arteries and veins to be aware of. And the eyeball itself receives most of its arterial supply via the ophthalmic artery which branches off the internal carotid um and divides into many different branches. And that includes the central retinal artery which supplies the internal surf surface of the retina and therefore, occlusion of that artery will quickly result in blindness. But there's also the anterior and posterior ciliary arteries which make up the choroidal vascular system and supplies the outer part of the retina as well. When it comes to venous drainage of the eyeball, this is carried out by the superior and inferior.