CP.VP.63 Coding Implications Last Review Date: 12/2020 Revision Log
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Optic Disc Drusen in Differential Diagnosis of Optic Neuritis Optik Nörit Ayrıcı Tanısında Optik Disk Druzeni
DO I:10.4274/tnd.56514 Images in Clinical Neurology Optic Disc Drusen in Differential Diagnosis of Optic Neuritis Optik Nörit Ayrıcı Tanısında Optik Disk Druzeni Erkingül Shugaiv1, Elif Aksoy Güzeller2, Sait Alim2 1Tokat State Hospital, Clinic of Neurology, Tokat, Turkey 2Tokat State Hospital, Clinic of Diases Eye, Tokat, Turkey Optic disc drusen is a condition where a hyaline-like calcific object is accumulated on the optical nerve ending, often bilaterally (1). Its prevalence in the general population is 0.34-3.7%. It can be confused with optic papillitis since it blurs the papillary border at the bottom of the eye. Drusens can be seen as opacity in B-scan ultrasonography and computerized tomography (2). Optic disc drusens present with slowly progressing visual field defects. The 21-year-old patient who complained of blurry vision on both eyes did not have a history of disease. Her vision was blurry for the past 10 days, especially on the left side. There was no history of eyeball pain, headache, infection or trauma. Her vision was 0.2 on the right and 0.1 on the left side. The papillary borders were undefined on both sides in the examination of the base of Figure 1. Optic disc drusen on both sides: Discs are protruded due the eyes (Figure 1). Due to the slow clinical decline over 10 days, to the drusen and their borders are not clearly defined. cranial and spinal magnetic resonance imaging was conducted in order to address any possible demyelinating disease but did not produce any remarkable findings. After this, cranial and orbital tomography was conducted with the pre-diagnosis of optic disc drusen. -
Visual Field Test
EYE FACTS visual field test Your visual field refers to how much you can see around you, including objects in your peripheral (side) vision. This test produces a map of your field of vision. Visual field tests help your ophthalmologist (Eye M.D.) monitor any loss of vision and diagnose eye problems and disease. Visual field testing is used to monitor peripheral, or side, vision. HOW IS A VISUAL FIELD TEST PERFORMED? The test is performed with a large, bowl-shaped in- Normal visual field Severe visual loss strument called a perimeter. In order to test one eye at a time, one of your eyes is temporarily patched during the test. You will be seated and positioned comfortably in front of the perimeter and asked to look straight ahead at a fixed spot (the fixation target). The computer randomly flashes points of light around the bowl-shaped perimeter. When you see a light, press the indicator button. It is very important These grids are results of visual field tests.T he dark to always keep looking straight ahead. Do not move black shaded areas show where loss of vision has your eyes to look for the target; wait until it appears occurred. in your side vision. It is normal for some of the lights to be difficult to see. A delay in seeing a light does not necessarily mean your field of vision is damaged. If you need to rest during the test, tell the technician and they will pause the test until you are ready to continue. Your ophthalmologist will interpret the results of your test and discuss them with you. -
Optic Disc and Macular Vessel Density Measured by Optical
www.nature.com/scientificreports OPEN Optic Disc and Macular Vessel Density Measured by Optical Coherence Tomography Angiography in Open-Angle and Angle-Closure Glaucoma Tzu-Yu Hou1,2, Tung-Mei Kuang1,2, Yu-Chieh Ko1,2, Yu-Fan Chang1,2, Catherine Jui-Ling Liu1,2 & Mei-Ju Chen1,2* There is distinct pathogenesis between primary open-angle glaucoma (POAG) and primary angle- closure glaucoma (PACG). Although elevated intraocular pressure (IOP) is the major risk factor for glaucoma, non-IOP risk factors such as vascular abnormalities and lower systolic/diastolic perfusion pressure may play a role in the pathogenic process. This study aimed to compare the vessel density (VD) in the optic disc and macula using optical coherence tomography angiography (OCTA) between POAG and PACG eyes. Thirty-two POAG eyes, 30 PACG eyes, and 39 control eyes were included. All the optic disc VD parameters except the inside disc VD were signifcantly lower in glaucomatous eyes than in control eyes. Compared with PACG eyes, only the inferior temporal peripapillary VD was signifcantly lower in POAG eyes. The parafoveal VD was signifcantly lower in each quadrant in glaucomatous eyes than in control eyes. The central macular and parafoveal VD did not difer between POAG and PACG eyes. In conclusion, the inferior temporal peripapillary VD was signifcantly reduced in POAG eyes compared with PACG eyes, while PACG eyes showed a more evenly distributed reduction in the peripapillary VD. The distinct patterns of VD change may be associated with the diferent pathogenesis between POAG and PACG. Glaucoma is an optic neuropathy characterised by progressive loss of retinal ganglion cells and their axons accompanied by corresponding visual feld (VF) defects. -
Physical Eye Examination
Physical Eye Examination Kaevalin Lekhanont, MD Department of Ophthalmology Ramathibodi Hospp,ital, Mahidol Universit y Outline • Visual acuity (VA) testing – Distant VA test – Pinhole test – Near VA test • Visual field testing • Record and interpretations Outline • Penlight examination •Swingggping penli ght test • Direct ophthalmoscopy – Red reflex examination • Schiotz tonometry • RdditttiRecord and interpretations Conjunctiva, Sclera Retina Cornea Iris Retinal blood vessels Fovea Pupil AtAnteri or c ham ber Vitreous Aqueous humor Lens Optic nerve Trabecular meshwork Ciliary body Choriod and RPE Function evaluation • Visual function – Visual acuity test – Visual field test – Refraction • Motility function Anatomical evaluation Visual acuity test • Distant VA test • Near VA test Distance VA test Snellen’s chart • 20 ฟุตหรือ 6 เมตร • วัดที่ละขาง ตาขวากอนตาซาย • ออานทละตาานทีละตา แถวบนลงลแถวบนลงลางาง • บันทึกแถวลางสุดที่อานได Pinhole test VA with pinhole (PH) Refractive error emmetitropia myypopia hyperopia VA record 20/200 ผูปวยสามารถอานต ัวเลขทมี่ ี ขนาดใหญขนาดใหญพอทคนปกตพอที่คนปกติ สามารถอานไดจากท ี่ระยะ 200 ฟตฟุต แตแตผผปูปวยอานไดจากวยอานไดจาก ที่ระยะ 20 ฟุต 20/20 Distance VA test • ถาอานแถวบนสุดไไไมได ใหเดินเขาใกล chthart ทีละกาวจนอานได (10/200, 5/200) • Counting finger 2ft - 1ft - 1/2ft • Hand motion • Light projection • Light perception • No light perception (NLP) ETDRS Chart Most accurate Illiterate E chart For children age ≥ 3.5 year Near VA test Near chart •14 นวิ้ หรอื 33 เซนตเมตริ • วัดที่ละขาง ตาขวากอนตาซาย • อานทีละตา แถวบนลงลาง -
An Investigation of Visual Field Test Parameters in Glaucoma, Patterns Of
An investigation of visual field test parameters in glaucoma, patterns of visual field loss in diabetics and multispectral imaging of the optic nerve head in glaucoma A thesis submitted to The University of Manchester for the degree of Doctor of Philosophy in the Faculty of Medical and Human Sciences 2012 Yanfang Wang School of Medicine (Human Development) 1 CONTENTS Title page……………………………………………………………1 Contents……………………………………………………….........2 List of Tables………………………………………………………..9 List of Figures……………………………………………………..10 List of Abbreviations……………………………………………...14 Abstract …………………………………………………………...16 Declaration………………………………………………………...17 Copyright statement………………………………………………17 Acknowledgment……………………………………………...…..19 1. Rationale of the study…………………………………………..20 2. Glaucoma……………………………………………………….24 2.1- Classification of glaucoma……………………………………….........24 2.2 - Clinical assessment in glaucoma……………………………………..27 2.2.1- IOP measurement………………………………………………..27 2.2.2 - Examination of structural and functional loss in glaucoma….28 2.3 - Management…………………………………………………………..32 3. Visual field testing……………………………………………..33 3.1 - Stimuli and background……………………………………………...33 3.2 - Test strategies………………………………………………………….34 3.2.1 - Frequency-of-seeing (FOS) curve and threshold………………34 3.2.2 - Supra-threshold strategy………………………………………..36 2 3.2.3 - Threshold strategy……………………………………………….38 3.2.3.1 - Full threshold, Fastpac and SITA………………………….38 3.2.3.2 - 30-2, 24-2 and 10-2 stimulus distributions…………………41 3.3 - Interpretation of results……………………………………………...42 3.3.1 -
Bass – Glaucomatous-Type Field Loss Not Due to Glaucoma
Glaucoma on the Brain! Glaucomatous-Type Yes, we see lots of glaucoma Field Loss Not Due to Not every field that looks like glaucoma is due to glaucoma! Glaucoma If you misdiagnose glaucoma, you could miss other sight-threatening and life-threatening Sherry J. Bass, OD, FAAO disorders SUNY College of Optometry New York, NY Types of Glaucomatous Visual Field Defects Paracentral Defects Nasal Step Defects Arcuate and Bjerrum Defects Altitudinal Defects Peripheral Field Constriction to Tunnel Fields 1 Visual Field Defects in Very Early Glaucoma Paracentral loss Early superior/inferior temporal RNFL and rim loss: short axons Arcuate defects above or below the papillomacular bundle Arcuate field loss in the nasal field close to fixation Superotemporal notch Visual Field Defects in Early Glaucoma Nasal step More widespread RNFL loss and rim loss in the inferior or superior temporal rim tissue : longer axons Loss stops abruptly at the horizontal raphae “Step” pattern 2 Visual Field Defects in Moderate Glaucoma Arcuate scotoma- Bjerrum scotoma Focal notches in the inferior and/or superior rim tissue that reach the edge of the disc Denser field defects Follow an arcuate pattern connected to the blind spot 3 Visual Field Defects in Advanced Glaucoma End-Stage Glaucoma Dense Altitudinal Loss Progressive loss of superior or inferior rim tissue Non-Glaucomatous Etiology of End-Stage Glaucoma Paracentral Field Loss Peripheral constriction Hereditary macular Loss of temporal rim tissue diseases Temporal “islands” Stargardt’s macular due -
Visual Field & Otc Tests Care Instructions
DR. CAROLYN ANDERSON EYE SURGERY CARE INSTRUCTIONS VISUAL FIELD & OTC TESTS To ensure the health of your Visual Field Test eye(s), please read this information sheet carefully. Your visual field is the entire area that you can see when the eye is forward, including your peripheral vision. As most of us use two eyes, the overlapping fields allow you to see in an arc of 180 degrees. Certain diseases can cause a loss of visual field, and unless If you need to cancel your the defect is extensive, you will not be aware of it. appointment, please let us know as soon as possible at The Humphrey Field Analyzer 2 uses a computer-controlled, projected beam of light to 604.530.6838. map the visual field, which is then compared by a computer against a database of normal readings. The Visual Field test results are plotted on paper, extending about 90 degrees If you have any questions or to the temple side, and 60 degrees to the nose side. Dr. Anderson will examine the Visual concerns, please speak with Field results, and from the type and location of the defect (if any) can tell where in Dr. Anderson. the visual system the problem may lie. The field test is also used to monitor possible progression of diseases like glaucoma and can indicate if more intensive therapy (if any) is needed. The test is done by a technician and takes approximately 30 minutes. Drops are not generally used, so your vision should not be affected. Appointment date: Time: Optical Coherence Tomographer (OCT) Test The Optical Coherence Tomographer is a type of scanning laser ophthalmoscope, which uses a low-powered laser and a computer to build up a three-dimensional picture of the optic nerve, macula, and other structures in the back of the eye. -
IQI 17 Acute Stroke Mortality Rate
AHRQ Quality Indicators™ (AHRQ QI™) ICD-10-CM/PCS Specification v2021 Inpatient Quality Indicator 17 (IQI 17) Acute Stroke Mortality Rate July 2021 Hospital-Level Indicator Type of Score: Rate Prepared by: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services www.qualityindicators.ahrq.gov DESCRIPTION In-hospital deaths per 1,000 hospital discharges with a principal diagnosis of acute stroke for patients ages 18 years and older. Includes metrics for discharges grouped by type of stroke. Excludes transfers to another hospital, cases admitted from a hospice facility, and obstetric discharges. [NOTE: The software provides the rate per hospital discharge. However, common practice reports the measure as per 1,000 discharges. The user must multiply the rate obtained from the software by 1,000 to report in-hospital deaths per 1,000 hospital discharges.] Stratification of Indicator The indicator is stratified into three groups by the type of stroke: Cases are assigned to strata according to a hierarchy based on risk of mortality, with cases being assigned to the stratum with the highest mortality for which the case qualifies. In the case of Stroke Mortality the current hierarchy is as follows: Strata hierarchy (listed from highest mortality to lowest mortality): 1) Intracerebral hemorrhage 2) Subarachnoid hemorrhage 3) Ischemic stroke Strata are mutually exclusive. If a discharge qualifies for more than one stratum, it will be assigned to the stratum with the highest risk of mortality (Intracerebral hemorrhage, Subarachnoid hemorrhage, Ischemic stroke). July 2021 1 of 7 AHRQ QI™ ICD-10-CM/PCS Specification v2021 IQI 17 Acute Stroke Mortality Rate www.qualityindicators.ahrq.gov NUMERATOR Overall Number of deaths (DISP=20) among cases meeting the inclusion and exclusion rules for the denominator. -
Posterior Uveitis Signs
Uveitis unplugged: sorting out infectious uveitis Hobart 2017 Peter McCluskey Save Sight Institute Sydney Eye Hospital Sydney Medical School University of Sydney Sydney Australia No financial or proprietary interest in any material discussed Immunosuppression for IED The fundamental principle for managing uveitis: Is the disease: infective inflammatory neoplastic What is the worst, most acute threat to vision this could be? Immunosuppression for IED The fundamental principle for managing uveitis: Is the disease: infective inflammatory neoplastic What is the worst, most acute threat to vision this could be? usually infection! Common Causes of Uveitis in Sydney 2015 Idiopathic 505 (50%) • idiopathic 424 Infective 203 (20%) • Fuchs 26 • Herpetic 105 • WDS 55 - anterior 83 - posterior 22 Inflammatory 358 (35%) • HLA B27 188 TB 40 (+systemic B27) 46 • • Toxoplasmosis 38 • sarcoid 56 • syphilis 10 (25) • Behcets 18 4 Assessing the patient with uveitis How do I sort this out??? • clinical assessment + carefully selected tests • clinical assessment is the key investigation • critical to take as comprehensive a history and review of systems as possible plus • thorough careful complete examination of each eye Sorting out Uveitis: anterior uveitis signs Anterior Uveitis Signs: • comprehensive a history and systems review • there are some unofficial “rules” can’t diagnose anterior uveitis without a normal fundus on dilated exam • anterior uveitis: mostly non specific signs • KPs, iris and pupil: useful clues Sorting out Uveitis: posterior uveitis -
A Case of Cerebral Granuloma and Optic Papillitis Due to Brucella Sp
Hindawi Case Reports in Infectious Diseases Volume 2020, Article ID 5216249, 3 pages https://doi.org/10.1155/2020/5216249 Case Report A Case of Cerebral Granuloma and Optic Papillitis due to Brucella sp. A. Chiappe-Gonzalez 1,2 and A Solano-Loza2 1Hospital Nacional Dos de Mayo, Lima, Peru 2Cl´ınica Angloamericana, San Isidro, Peru Correspondence should be addressed to A. Chiappe-Gonzalez; [email protected] Received 21 December 2019; Revised 18 April 2020; Accepted 29 June 2020; Published 18 July 2020 Academic Editor: Larry M. Bush Copyright © 2020 A. Chiappe-Gonzalez and A Solano-Loza. ,is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We document a case of a 24-year-old woman who presented with cerebral granuloma and optic papillitis associated to Brucella sp. infection, whose diagnosis was made with a brain biopsy and serology tests, with clinical improvement following specific antibiotic therapy. ,e patient was followed up for over a year without evidence of relapse. 1. Introduction Seven months prior to presentation, she had been eval- uated for this complaint; a head computed tomography (CT) Brucellosis is a common zoonotic infection in many angiography was performed which showed a hypodense, right countries, including Mediterranean and Middle Eastern occipital lesion with ill-defined borders and peripheral con- countries. In Peru, the prevalence of brucellosis has been trast enhancement (Figure 1); the study was followed by a poorly documented, with higher frequency in the cities of brain magnetic resonance imaging (MRI), which confirmed Lima, Callao, and Ica probably due to the informal goat the presence of a solid cortical formation of about 0.7 cen- farming in these regions. -
Myelin Oligodendrocyte Glycoprotein-Igg-Positive Recurrent Bilateral Optic Papillitis with Serous Retinal Detachment: a Case Report
doi: 10.2169/internalmedicine.9840-17 Intern Med Advance Publication http://internmed.jp 【 CASE REPORT 】 Myelin Oligodendrocyte Glycoprotein-IgG-positive Recurrent Bilateral Optic Papillitis with Serous Retinal Detachment: A Case Report Tomoya Kon 1, Hiroki Hikichi 1, Tatsuya Ueno 1, Chieko Suzuki 1, Jinichi Nunomura 1, Kimihiko Kaneko 2, Toshiyuki Takahashi 2,3, Ichiro Nakashima 2 and Masahiko Tomiyama 1 Abstract: Autoantibodies against myelin oligodendrocyte glycoprotein (MOG-IgG) have been detected in inflamma- tory demyelinating central nervous system diseases. A 30-year-old woman had blurred vision, marked optic nerve disc swelling, serous retinal detachment at the macular on optic coherence tomography, and MOG-IgG seropositivity. The patient was thought to have optic papillitis associated with MOG-IgG. Her symptoms rap- idly improved after high-dose methylprednisolone therapy. We hypothesize that serous retinal detachment was secondary, arising from optic papillitis. This is the first report of the concurrence of optic papillitis with MOG-IgG and serous retinal detachment. MOG-IgG should be tested in patients with marked optic disc swelling. Key words: IgA nephropathy, MOG, myelin oligodendrocyte glycoprotein, optic neuritis, optic papillitis, serous retinal detachment (Intern Med Advance Publication) (DOI: 10.2169/internalmedicine.9840-17) inflammatory diseases, such as Vogt-Koyanagi-Harada dis- Introduction ease, sarcoidosis, and Behçet’s disease, disrupt the blood- retinal barrier, resulting in the development of serous retinal Autoantibodies against myelin oligodendrocyte glycopro- detachment (4, 5). However, to our knowledge, serous reti- tein (MOG-IgG) have been detected in patients with central nal detachment in a patient with MOG-IgG-positive optic nervous system demyelinating diseases, including acute dis- neuritis has not been reported to date. -
Ophthalmology Ophthalomolgy
Ophthalmology Ophthalomolgy Description ICD10-CM Documentation Tips Description ICD10-CM Documentation Tips Cataracts Code Tip Glaucoma Code Tip Cortical age-related cataract, right eye H25.011 Right, left, or bilateral; Presenile, Open angle with borderline H40.011 Suspect, Open angle, Primary senile, traumatic, complicated; findings, low risk, right eye angle closure; type; acute vs., specific type (cortical, anterior or chronic; mild, moderate, severe, Cortical age-related cataract, left eye H25.012 Open angle with borderline H40.012 posterior subcapsular polar, etc) indeterminate findings, low risk, left eye Cortical age-related cataract, bilateral eye H25.013 Open angle with borderline H40.013 findings, low risk, bilateral eye Anterior subcapsular polar age-related H25.031 Anatomical narrow angle, right H40.031 cataract,right eye eye Anterior subcapsular polar age-related H25.032 Anatomical narrow angle, right H40.032 cataract, left eye eye Anterior subcapsular polar age-related H25.033 Anatomical narrow angle, H40.033 cataract, bilateral bilateral Age-related nuclear cataract, right eye H25.11 Primary open-angle H40.11x2 glaucoma, moderate stage Age-related nuclear cataract, left eye H25.12 Globe Rupture Code Tip Age-related nuclear cataract, bilateral eye H25.13 Penetrating wound without S05.62xS Contusion vs. laceration; If foreign body of left eyeball, laceration, with or without sequela prolapsed or loss of intraocular tissue; penetrating wound, with or Combined forms of age-related cataract, H25.811 Contusion of eyeball and