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Week 4 SOCCEP QA SOCCEP Q/A Monday, April 13 Time Session Details Question Answer 9:00 – 10:00 AM Andrew Meagher, OD, When you get an artifact or a poor scan, I don’t think that is necessary and when FAAO do you recommend completely deleting you generate an actual report, you can Getting the Most Out of that scan from the database? select the scan you want to use and will have the signal strength number in Your Optic Nerve OCT parentheses next to it so you know you are choosing the right one, also when you generate a GPA which requires at least 3 OCTs, you can select the specific ones you want. You could always delete the bad scans to declutter but otherwise you have the option to select the correct one without deleting—hope that helps! What information does the OCT analyze Great question! To my knowledge, OCTs when calculating the symmetry utilize all the parameters to collect this percentage? Sometimes my average information. Specifically I found on thickness looks very symmetrical but Zeiss’s website what they deem as then I’m surprised by how low the asymmetry % is normal symmetry and have attached it to this response. There is also a useful article also on the topic and how that symmetry can vary greatly even in healthy eyes whether you look at total RNFL, clock hour and quadrant assessment —hope it helps! “Thus, the current study demonstrates that the statistical normal upper limit of right eye/left eye differences in mean RNFL thickness measured with Stratus OCT is between approximately 9 and 12 μm, depending on which eye is thicker and which algorithm is used for testing. When one expands this to measurements of RNFL thicknesses in quadrants and clock hours, the differences between eyes are much higher and, perhaps, not as useful to quantify and use clinically. The larger differences in quadrant and clock-hour measurements may be explained by several factors. First, the test-retest variability of clock-hour and quadrant measurements, even in the same eye on the same day by the same operator on the same instrument, has been found to be higher in these smaller areas than SOCCEP Q/A Monday, April 13 the mean RNFL thickness over the entire circumference.” Article link: https://www.ncbi.nlm.nih.gov/pmc/arti cles/PMC2646446/ What do you consider a clinically This question was asked from a previous significant decrease in RNFL thickness? lecture so I’ll share my response with you: “Great question! This is going to vary based on the OCT you are using. Each OCT has a micron resolution that varies (ie: Spectral domain>Time Domain) Once you know this resolution you then have to also consider signal strength (SS), a lower SS is going to yield a lower resolution, from what I’ve read in the literature this doesn’t truly make a difference until your SS goes below 7, with each decrease in SS the OCT loses roughly 2 microns of resolution. So there are a lot of artifacts to consider, the OCT our clinic uses, the Stratus, has 10 microns of resolution, so on a perfect scan the minimal change I’d see to consider progression is just that, 10 microns, but I tend to increase my personal parameters based on how the OCT measured other parameters, so if the disc area was measured vastly different between two scans then you aren’t comparing apples to apples anymore. Given this notion I tend to use 12-15 microns for the Stratus as my personal rule for progression, hope that helps! Below are the two sources I utilized to obtain this information for my presentation. I. https://www.ncbi.nlm.nih.gov/pmc/arti cles/PMC3170667/ II. SOCCEP Q/A Monday, April 13 https://www.reviewofophthalmology.c om/article/managing-glaucoma-with- oct-secrets-to-success" Hope that helps! What changes in RNFL values do you This question was asked from a previous lecture consider indicate glaucomatous so I’ll share my response with you: “Great question! This is going to vary based on the OCT progression and how did you decide on you are using. Each OCT has a micron resolution those values? that varies (ie: Spectral domain>Time Domain) Once you know this resolution you then have to also consider signal strength (SS), a lower SS is going to yield a lower resolution, from what I’ve read in the literature this doesn’t truly make a difference until your SS goes below 7, with each decrease in SS the OCT loses roughly 2 microns of resolution. So there are a lot of artifacts to consider, the OCT our clinic uses, the Stratus, has 10 microns of resolution, so on a perfect scan the minimal change I’d see to consider progression is just that, 10 microns, but I tend to increase my personal parameters based on how the OCT measured other parameters, so if the disc area was measured vastly different between two scans then you aren’t comparing apples to apples anymore. Given this notion I tend to use 12-15 microns for the Stratus as my personal rule for progression, hope that helps! Below are the two sources I utilized to obtain this information for my presentation. I. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3 170667/ II. https://www.reviewofophthalmology.com/article/ managing-glaucoma-with-oct-secrets-to-success" Hope that helps! I’ll also add that you want to ensure this matches any suggestive visual field defect, with that notion however know that the literature states you can lose up to 30-50% of RNFL before there is ANY visual field defect present, which is exactly where an OCT can play a great role in early detection 10:00 – 11:00 am Jeffrey Sterling, OD, Do you combine the topical and oral No. The herpetic Eye Disease Study FAAO Antivirals? showed no benefit to doing so. Its a Red Eye If there’s a trabculitis, would you I would likely start anti- consider anti-ocualhypertensives as well ocularhypertensive meds for any IOP or just start with anti-virals and see if over 30. In this case, you would also that alone brings the pressures down? most likely being adding a topical steroid as well. That will require more vigilance. For treating herpes Simplex Keratitis in a Zirgan over viroptic for faster re- patient, have you found the topical epithelialization. I also like it because it viroptic or zirgan to be more effective is thick and acts like a lubricating ung to compared to oral acyclovir or some extent. Zirgan, in my opinion, has valacyclovir? similar efficacy to the orals. But when SOCCEP Q/A Monday, April 13 doing orals, always give some lubricants drops or ointment to aid in managing discomfort. Hi, if there is deeper corneal involvement For stromal, I use orals and steroids. The in the stroma, what would your Tx plan amount of steroid should be be? Steroids? Oral antivirals for proportionate to amount of prophylaxis long-term? inflammation seen. And this can be altered upon follow up. A long taper of 10 weeks or so is recommended. Acyclovir 400mg bid po for prophylaxis when do you follow up after starting Probably around 3 days, depending on anti-virals? objective and subjective findings. For smaller dendrites, zirgan has often fixed the epithelium after just a few days and I can start reducing the taper sooner. Can we get contact info? [email protected] 11:00 – 12:00 pm Kelsey Jordan, OD, MS, Hello, post-PKP pts exhibit progressive Great question. I manage these patients FAAO endothelial cell loss, and a low by following them closely. Once I Managing the Irregular endothelial cell count may be achieve a final scleral lens fit that I am contraindicated for scleral lens wear due satisfied with, I will monitor the patient Cornea to risk of corneal edema and every 3 months for medical decompensation, so what is your management. In this patient’s case, his approach when it comes to managing vision is hand motion without a scleral these pts? lens – yet acheives 20/20 vision with a scleral lens. In this case, the patient is able to use both eyes providing him good binocularity and overall improved quality of life with scleral lens wear. I monitor these patients closely for any signs of complications and address them as they arise. 1:00 – 2:00 pm Sharon Park Keh, OD, how long do PK sutures usually stay in Great question! It will vary between FAAO for? patient and surgeons. Some A Family of Corectopia, interrupted sutures may be removed soon post-op and I’ve seen some KeratoConus, running sutures removed years after the MicroCornea Managed procedure. What we are concerned with Contacts about most are suture-related complications, e.g. loosened or ruptured sutures, which can lead to infection or graft failure. Sutures also can be removed strategically to normalize corneal shape. How do you choose a specific soft CLs Great question! It depends on the SOCCEP Q/A Monday, April 13 power & BC for piggyback fitting? REASON for piggyback fitting. In my mind, there are 2 major reasons I consider piggybacking – (1) comfort; (2) fit. If for comfort, a well-fit soft lens will work great with minimal power. If for fit, you can be strategic by using lens thickness (center vs. edge) to assist with your GP fitting. For example, if your GP alone exhibits too much central clearance, you may consider a high-plus soft lens underneath as this lens will be thicker centrally.
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