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Home , Aniseikonia, Epiretinal membrane

7/13/18

Financial Disclosure: Nothing to Disclose Learning Objectives

Epiretinal 1. How is (ERM) best diagnosed? 2. How is ERM differentially diagnosed from central serous Membrane and cystoid ? 3. Which ERM cases can be monitored, and which will need surgical Update intervention? 4. What are the expected outcomes of macular peel microsurgery for ERM? Victoria Conference 2018 5. Which symptoms are expected to remain after successful James Kundart OD MEd FAAO FCOVD-A Images from surgery, and will need optical treatment? Cirrus OCT Pacific University College of Optometry

Case Study #1, First Visit: Case Study #1: Macular Cube OCT 2014 Macular Cube OCT, 2014

-6.00 SE OD, OS BP 175/113 BCVA BMI 23 20/60

OD, OS Images from Cirrus OCT

Images from Cirrus OCT

Case Study #1, Second Visit: Case Study #1: 10-2 Matrix Visual Fields 2014 Macular Cube OCT 2015

Images from Humphrey Matrix Images from Cirrus OCT

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BCVA 20/50 OD, OS Case Study #1, Third Visit: Macular Cube OCT Spring 2016

Case Study #1 5-Line Raster OCT 2015

BP 166/84

BMI 23 Images from Cirrus OCT BCVA 20/60 OD and OS Images from Cirrus OCT

Case Study #1: Case Study #1: Macular Cube OCT Spring 2016 5-Line Raster Macular OCT Spring 2016

Images from Cirrus OCT Images from Cirrus OCT

Case Study #1: Case Study #1: Corneal Topography and Macular Cube OCT Summer 2016 10-2 Matrix Visual Fields 2016

Images from Cirrus OCT Images from Medmont Topographer and Humphrey Matrix

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Case Study #1: Before ERM Peel/ Case Study #1: Post-Op Peel OS 5-Line Raster OCRT 2017

BCVA BCVA 20/50 20/70 OD, OS OD, OS

Images from Cirrus OCT

Case Study #1, Last Visit: Case Study #1: Post-Op Peel OS 10-2 Matrix Visual Fields and Summary

BCVA 20/50 OD, OS

BP 130/88, BMI 22

Other Causes of ERM: Other Causes of ERM: Adult-Offset Adult-Offset Coats’ Disease Pre-Op Coats’ Disease Post-Op (Peel/Vitrectomy)

• “(a) Color fundus photograph of the right eye of a 38-year- old man with epiretinal membrane along supertemporal arcade • (b) Ultra-wide-field color photograph showing exudation and telangiectatic vessels in temporal periphery.” • The patient was 20/25 OD with OD

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5678313/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5678313/

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Other Causes of ERM: Other Causes of ERM: Eales Disease

• (a) Fundus photograph and (b) fluorescein angiogram of a 22-year-old male with Eales disease Stage 3A and best-corrected visual acuity 0.1 showing fibrovascular proliferation at the disc • (c) spectral domain optical coherence tomography showed cystoid macular edema • (j) spectral domain optical coherence tomography showed epiretinal membrane and macular edema

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859602/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859602/

Epiretinal Membrane Differential Diagnoses: ERM DDx: Cystoid Macular Edema (CME) Cystoid Macular Edema (52 YOM and 13 YOF) Using NSAIDs Post- Surgery

http://www.ojoonline.org/article.asp?issn=0974- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5319126/ 620X;year=2012;volume=5;issue=3;spage=187;epage=188;aulast=Garoon

ERM DDx: Cystoid Macular Edema (CME) Where ERM Comes From: Do Steroids Help? Latanoprost, CME, and ERM

Optical coherence tomography images of A. Optical coherence tomography of right eye cystoid macular edema (CME) before latanoprost administration. No pathology is detected. • Top: Preoperative and postoperative B. Seven months after treatment with findings of definite CME preservative free latanoprost optical coherence tomography in right eye revealed cystoid macular • Middle: Preoperative and postoperative edema with well-defined, intraretinal cystic areas findings of probable CME of low reflectivity in the macula with serous retinal • Bottom: Preoperative and postoperative detachment () findings of possible C. Two months after latanoprost discontinuation CME optical coherence tomography demonstrated complete resolution of cystoid macular edema

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5636715/ A subtle epiretinal membrane is noted

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ERM DDx: Does Latanoprost Cause CME? (after cataract surgery OD)

Niacin and CME

https://www.ncbi.nlm.nih.gov/pmc/articles/P MC5360021/pdf/13104_2017_Article_2448.pdf http://www.hindawi.com/journals/criopm/2013/713061/

ERM DDx: Microcystic Macular Edema ERM DDx: Microcystic Macular Edema (MME)

• An example of a normal compared with the retina of a patient with MME. (A) A normal retina from a healthy control subject • The pseudo-colored surface image is the infrared surface photo; the vertical stacked gray image an OCT B-scan • (B) Optical coherence tomography image taken from a 76-year-old woman with a 3- year history of AMD, for which she received regular injections with ranibizumab and bevacizumab • At time of imaging, her best corrected VA OS was 0.7 (20/30)

http://iovs.arvojournals.org/article.aspx?articleid=2190200 http://iovs.arvojournals.org/article.aspx?articleid=2190200

ERM DDx: Microcystic Macular Edema (MME) ERM DDx: Microcystic Macular Edema

• Representative OCT images of patients with MME from the • (D) Microcystic macular edema in clinical spectrum are shown a 58-year-old female patient with • The infrared surface photo and OCT image are presented to the a newly diagnosed pucker in the left and the manually segmented INL to the right right eye (VA OD 0.2 or 20/100) (A) Microcystic macular edema in the right eye of a 70-year-old male patient with a history of proliferative • Again, there were multiple treated with panretinal photocoagulation (VA OD 0.3 or 20/60) hyperreflective spots in the inner (B) Optical coherence tomography image showing MME 8 months retinal layers after occlusion of the vena temporalis superior OD in a 66-year- old female patient (VA OD 0.7 or 20/30) • (E) Microcystic macular edema 3 months after vitrectomy, in a 71- • Microcystic macular edema was located in the temporal year-old female patient with a superior quadrant of the inner 3-mm EDTRS grid in the left • However, INL thickening extended to the periphery. In addition, eye (VA OS 0.05 or 20/400) hyperreflective spots were observed in all inner retinal layers

http://iovs.arvojournals.org/article.aspx?articleid=2190200 http://iovs.arvojournals.org/article.aspx?articleid=2190200

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ERM DDx: Microcystic Macular Edema ERM DDx: Microcystic Macular Edema Propensity for the Nasal/Temporal Quadrants

• Microcystic macular edema in a patient with multiple • Most frequently, MME sclerosis and a history of and branch retinal vein occlusion in the right eye was observed in patients • This 55-year-old female patient was diagnosed with with ARMD (27.1%) clinical definite MS in 1992 followed by patients • Magnetic resonance imaging showed multiple with preceding periventricular brain lesions, and spinal T2 ophthalmic surgery hyperintense lesions (20.3%) or presence of • In 2001, she experienced one episode of optic neuritis OD; coincidentally, an occlusion of the vena temporalis an epiretinal membrane superior was found (VA 0.4 or 20/50) (18.8%)

http://iovs.arvojournals.org/article.aspx?articleid=2190200 http://iovs.arvojournals.org/article.aspx?articleid=2190200

Last ERM DDx: Case Study #2 Case Study #2: Head OCT

• A 62-year-old male first reported to our clinic with a chief concern was a larger image size OS • The patient had no history of of any sort • There was a history of blunt trauma to the right nasal canthus almost 40 years Images from Cirrus OCT previously • The patient reported that he was generally healthy with a history of hay fever

https://journals.lww.com/optvissci/Abstract/2018/03000/ Retinal_Nerve_Fiber_Layer_Thickness_in_Various.11.aspx

Case Study #2: Optic Nerve Head OCT Case Study #2: Optic Nerve and RNFL Compare OD to OS

Images from Cirrus OCT

Images from Cirrus OCT

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Case Study #2: Optic Nerve OCT Case Study #2: Retinal Nerve Fiber Layer OCT

Images from Cirrus OCT

Images from Cirrus OCT

Case Study #2: Nerve Fiber Layer Analysis Case Study #2: Optic Nerve OCT Summary

Images from Cirrus OCT Images from Cirrus OCT

Case Study #2: Matrix N-30-5 Case Study #2: Screener is Unremarkable 24-2 SITA Standard Visual Fields

• Why did we run a frequency-doubling visual field screening? • There are two reasons: both related to cranial nerves • Which two nerves were we checking with his screening field?

Images from Humphrey Matrix

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Case Study #2: Case Study #2: Assessment & Initial Plan Pachymetry with Ant Seg OCT

http://cdn.iofferphoto.com/img3/item/568/007/701/o_xalatan- http://opticaldiagnostics.com/info/aniseikonia.html eye-drops-latanoprost-0-005-anti--3932.jpg Images from Cirrus OCT

Case Study #2, Second Visit: Case Study #2: Macular OCT OD and OS Contact Telescope and New discovery

https://www.flonase.com/allergies/is- http://gogadgetplus.blogspot.com/2014/02/ flonase-a-nasal-steroid-spray/ terminator-telescopic-contact-lens.html Images from Cirrus OCT

Case Study #2, Visit 1: Macular OCT OU Case Study #2, Second Visit: Macular OCT OD

Images from Cirrus OCT Images from Cirrus OCT

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Case Study #2, Visit 2: Macular OCT OS Case Study #2: Macular OCT OD and OS

Images from Cirrus OCT Images from Cirrus OCT

Case Study #2: Case Study #2: What’s Your Diagnosis OS? Macular OCT 5-Line Raster

Images from Cirrus OCT Images from Cirrus OCT

Case Study #2 Dx: Case Study #2: Macular OCT OD and OS Central Serous Retinopathy (CSR) OS

Images from Cirrus OCT Images from Cirrus OCT

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Summary: Epiretinal Membrane Questions? Thank You!

• Epiretinal membrane can be concurrent and confused with: James Kundart OD MEd • , like Coats’ and Eales FAAO FCOVD-A • Cystoid and Microcystic Macular Edema Professor, Pacific • Central Serous Retinopathy University College of • Systemic hypertension leads to some of Optometry these conditions, but not necessarily ERM 3D Performance Clinic, • is a presenting and residual symptom, uniquely treated by optometry Beaverton, Oregon • ERM causes , magnify the fellow [email protected] http://iovs.arvojournals.org/a eye rticle.aspx?articleid=2458795

Additional References

1. Xiao W, Chen X, Yan W, Zhu Z, He M Prevalence and risk factors of epiretinal membranes: a systematic review and meta-analysis of population-based studies. BMJ Open. 2017 Sep 25;7(9):e014644. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5623383/ 2. Shen Z, Duan X, Wang F, Wang N, Peng Y, Liu DT, Peng X, Li S, Liang Y. Prevalence and risk factors of posterior vitreous detachment in a Chinese adult population: the Handan eye study. BMC Ophthalmol. 2013 Jul 16;13(1):33. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726418/ 3. Daruich A, Matet A, Dirani A, Bousquet E, Zhao M, Farman N, Jaisser F, Behar- Cohen F. Central serous chorioretinopathy: Recent findings and new physiopathology hypothesis. Prog Retin Eye Res. 2015 Sep;48:82-118. https://www.sciencedirect.com/science/article/pii/S1350946215000336?via% 3Dihub

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