9/7/2020

Disclosures: Common Optometry

 CooperVision

Cases in “Mayberry”  Maculogix

 IntegraSciences Lessons I Learned From These Cases

Frances Bynum, OD

COPE 65581-GO

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Case 1: Opie Taylor Case 1: Opie Taylor Hit in the eye with air soft gun Hit in the eye with air soft gun

 VA: OD: 20/20

 SLE: subconjunctival heme in the temporal corner  Cornea: clear  A/C: clear, no cells  Posterior Pole: clear  MHx: unremarkable

 Would you dilate this patient?  (Grandmother brought child in)

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Case 1: Opie Taylor Case 1: Opie Taylor Hit in the eye with air soft gun Hit in the eye with air soft gun

 Commotio retinae  Commotio retinae

 (caused by blunt trauma to the eye)  (caused by blunt trauma to the eye)

 Treatment:  Treatment: usually none

 Prognosis:  Prognosis: good, but look for choroidal rupture or RPE break

 Might use OCT to look for small break

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Case 1: Opie Taylor Case 1: Opie Taylor Hit in the eye with air soft gun Hit in the eye with air soft gun

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Case 2: Barney Fife Case 2: Barney Fife Sudden spot in vision Sudden spot in vision

 CC: Sudden Spot in his vision this morning

 VA: OD: 20/20 OS: 20/20

 IOP: 12/12 icare @ 8:12am

 MHx: HTN (uncontrolled at times)

 Meds: HTN

 OHx: Toric MF contacts, mild crossing changes consistent with HTN history

 DFE: heme @ disc

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Case 2: Barney Fife Case 2: Barney Fife Sudden spot in vision Sudden spot in vision

 BP: 135/85 LA seated @ 8:15am  BP: 135/85 LA seated @ 8:15am

 Management: ???  Management: ???

 Upon further questioning…….  Upon further questioning……. Reveals he noticed this after an “intimate moment” with wife this morning

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Case 2: Barney Fife Case 3: Aunt Bee Sudden spot in vision

 85 WF

 CC: “I cannot see well out of my glasses”

 VA: OD: 20/25 OS: 20/30

 MHx: (-) smoker; (+) high cholesterol; (+) HTN, controlled

 OHx: cataract sx

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ARMD: dry, stage???? ARMD: dry, stage????

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ARMD: dry, stage???? ARMD: dry, stage????

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Case 3: Aunt Bee Case 3: Aunt Bee

 Monitor vs Refer?  Monitor vs Refer?

 Adaptdx: RI: >15min

 Recommend: no smoking, vitamins, diet

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Case 3: Aunt Bee Case 3: Aunt Bee

 Monitor vs Refer?  Monitor vs Refer?

 Adaptdx: RI: >15min  Adaptdx: RI: >15min

 Recommend: no smoking, vitamins, diet  Recommend: no smoking, vitamins, diet

 Refer: Retina Specialist confirmed dx: dry, severe  Refer: Retina Specialist confirmed dx: dry, severe

 Challenges: new glasses?

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Case 4: Otis Campbell “town drunk” Case 4: Otis Campbell “town drunk”

 VA: OS: 20/20

 CC: white lesion in left eye x 1 week, (-) pain, (-) redness

 MHx: (+) breast cancer, decreased immune system due to chemotherapy

 Ohx: neg

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Case 4: Otis Campbell “town drunk” Case 4: Otis Campbell “town drunk”

 (+) rose Bengal stain and fluorescein stain  f/u: size of lesion greatly reduced and (-) Rose Bengal stain

 Tx: Acyclovir 400 5x/day

 Trifluridine???  Decreased Acyclovir to bid

 amniotic membrane?

 Art tears

 Discussion: using Amniotic Membranes on HSK

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Case 5: Gomer Pyle (mechanic) Case 5: Gomer Pyle (mechanic)

 VA: OD: 20/20  VA: OD: 20/20

 CC: something in right eye X 2 days, grinding, not wearing safety rx  CC: something in right eye X 2 days, grinding, not wearing safety rx

 MHx: neg  MHx: neg

 OHx: neg  OHx: neg

 SLE: metallic FB with rust ring  SLE: metallic FB with rust ring

 Tx:  Tx: removed with spud and alger brush

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Case 5: Gomer Pyle (mechanic) Case 6: Andy Taylor (Sheriff)

 VA: OD: 20/20  VA: OD: 20/40 OS: 20/30

 CC: something in right eye X 2 days, grinding, not wearing safety rx

 MHx: neg  CC: while bending over this afternoon, vision suddenly changed in OS

 OHx: neg

 SLE: metallic FB with rust ring  Verified that it was the left eye he noticed decreased in vision

 Tx: removed with spud and alger brush

 BCL vs Pressure Patch

 Drops: in office or Rx

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Case 6: Andy Taylor (Sheriff) Case 6: Andy Taylor (Sheriff)

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Case 6: Andy Taylor (Sheriff) Case 6: Andy Taylor (Sheriff)

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Case 6: Andy Taylor (Sheriff) Case 6: Andy Taylor (Sheriff)

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Case 6: Andy Taylor (Sheriff) Case 7: Clara (Aunt Bee’s friend) busy body, pie maker

 Importance of looking at both eyes!  VA: OD: 20/50 OS: 20/60 (mild eccentric fixation)

 CC: vision not as clear

 Development of cataracts following laser procedures  OHx: cataract sx (discussed findings prior to cat sx 4 years ago)

 DFE:

 What caused the hemes around buckle? Concern?

 Vitreous heme management

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Case 7: Clara (Aunt Bee’s friend) Case 7: Clara (Aunt Bee’s friend) busy body, pie maker busy body, pie maker

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Case 7: Clara (Aunt Bee’s friend) Case 7: Clara (Aunt Bee’s friend) busy body, pie maker busy body, pie maker

 Best Disease (Vitelliform macular dystrophy)

 Stage 1: previtelliform and initial development of retinal defects (3-15ys (symptoms may not develop until later)

 Stage 2: vitelliform stage, early egg yolk (typically ½ to 1 disc diameter)

 Stage 3-5: scrambled egg appearance

 May develop CNM

 Patients retain normal peripheral vision and dark adaptation

 Genetic disorder: BEST1 mutation, defect in this protein leads to accumulation of lipofusion

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Case 7: Clara (Aunt Bee’s friend) Case 8: Thelma (Barney’s girlfriend)

Is this rare? “not if it is in your chair”  VSP Srx Exam

 61 YO WF

 CC: no changes in glasses or contacts

 Refuses optomap retinal screening

 VA: OD: 20/20 OS: 20/20

 MHx: (+) HTN, controlled; reports recent blood work as good, cholesterol normal

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Case 8: Thelma (Barney’s girlfriend) Case 8: Thelma (Barney’s girlfriend)

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Case 8: Thelma (Barney’s girlfriend) Case 8: Thelma (Barney’s girlfriend)

 Refract first vs Slit Lamp Exam

 Would you have deferred refraction?

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Case 8: Thelma (Barney’s girlfriend) Case 8: Thelma (Barney’s girlfriend)

 Refract first vs Slit Lamp Exam

 Would you have deferred refraction?

 Would you bill photos to medical insurance?

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Case 9: Floyd (Barber) Case 9: Floyd (Barber)

“No good deed goes unpunished”

 VA: OD: 20/20 OS: HM

 CC: vision in my left eye not as clear

 MHx: neg

 Ohx: readers only

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Case 9: Floyd (Barber) Case 10: Helen (Andy’s girlfriend)

 Refer  Contact Lens Exam:

 VA: OD: 20/25 OS: 20/25

 Realistic Expectations  SLE: bilateral infiltrates

 DFE: unremarkable

 Resolved with steroids

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Case 10: Helen (Andy’s girlfriend) Case 10: Helen (Andy’s girlfriend)

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Case 10: Helen (Andy’s girlfriend) Case 10: Helen (Andy’s girlfriend)

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Case 10: Helen (Andy’s girlfriend) Misc cases:

 Loss of central vision OD

 No complaints in OS

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Misc cases: (CSC) Misc cases: (CSC)

 Bilateral ??  Bilateral ??

 Fluid within the retinal layers  Fluid within the retinal layers

 Type A personality  Type A personality

 Associated factors:

 Steroids; nose sprays; pregnancy; stress

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Misc cases: (CSC) Misc cases: (CSC)

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