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Poster Presentations

122th Annual AOA Congress & 49th Annual AOSA Conference: Optometry’s Meeting®

June 19-23, 2019 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Screen #7 POSTER SESSION #1 Scientific Abstract Thursday, June 20 from 6- 6:30 p.m. Evaluation of Dynamic Amsler for Estimation of Visual Field in Low Vision Screen #1 Carlos Grandela, OD OD-Ocular Disease Co-Author(s) Electroretinographic Findings in Pityriasis Rubra Pilaris Tapuwa L. Chikwinya, OD, MPH Tracy Matchinski, OD, FAAO Laura Addy, OD Kara Crumbliss, OD, FAAO Co-Author(s) Kaila M. Osmotherly, O.D. Screen #8 OD-Ocular Disease Screen #2 Case Report Abstract An Atypical Case of Punctata Albescens OD-Ocular Disease Jeff Rabin, OD, MS, PHD Co-Author(s) Differentiating Subclinical , Peripheral Anjli Patel Retinoschisis, and White Without Pressure with Optical Melanie Cadavos, BS Coherence Tomography. Jacob Hansen, BS Jessica Haynes, OD Hiten Patel, BS Co-Author(s) Screen #9 Mohammad Rafieetary, OD OD-Ocular Disease Screen #3 Ocular Complications of Intraconal Cavernous Hemangioma Information Abstract Noor Abushagur, OD Reactivation of Herpes Zoster Co-Author(s) Tony Tran, OD student Jennifer Deakins, OD, FAOO Andrew Kemp, OD, FAAO Screen #4 OD-Ocular Disease Screen #10 OD-Ocular Disease A Case of Polypoidal Choroidal Vasculopathy - Utilizing advanced imaging modalities to appreciate the Pachychoroid Find the Culprit: A Case of Reversible Bilateral Visual Field Spectrum of Diseases Defect and Aripiprazole use Nathan Traxler, OD Karen Choi, OD

Screen #6 Screen #11 Scientific Abstract Scientific Abstract Prevalence of Visual Deficits and Dysfunctions associated Sustained IOP Control with Single or Multiple Trabecular with Traumatic Brain Injury (TBI): A Meta- Analyses Micro-Bypass Stents (iStent) Evaluated in Subjects with Open-Angle : 5 Year Outcomes Felix M Barker II OD MS Co-Author(s) Whitney Hauser, O.D. Natalya Merezhinskaya PhD Screen #12 Rita K Mallia OD MPA OD-Ocular Disease DoHwan Park PhD Daniel W Bryden PhD Spondylometaphyseal Dysplasia with Cone-Rod Dystrophy David A Eliason MD Kathryn Deliso, OD COL Mark E Reynolds MD MPH Andrew Morgenstern, OD

2 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Screen #13 Co-Author(s) Scientific Abstract Whitney Hauser, OD Accommodative Stabilization with use of NaturalVue Michael Christensen, OD Multifocal Contact Screen #3 Amber Zaunbrecher, OD Scientific Abstract Co-Author(s) Toric contact lens performance with digital devices Jennifer Dattolo, OD Anna-Kaye Logan, OD Screen # 14 Co-Author(s) OD-Ocular Disease Ananya Datta Syphilitic Kelsea Skidmore Chuan Hu, MD, OD Rebecca Hales, OD Erin S. Tomiyama, OD Moriah A. Chandler, OD Screen #15 Julia S. Benoit, PhD Scientific Abstract James S. Wolffsohn Pilot Study Assessing Patient Knowledge and Understanding of Their Diagnosis Screen #6 Scientific Abstract Karen Squier, OD, MS Durable IOP and medication reduction with iStent inject Screen # 16 (second-generation trabecular micro-bypass stent) in OD-Ocular Disease subjects with open-angle glaucoma on 1 preoperative Herpes Simplex Virus medication: 48-month outcomes Jacob Diedrich, OD Walter Whitley, OD, MBA, FAAO Screen #7 POSTER SESSION #1B BV-Biocular Vision Binocular Ramifications of Arteriovenous Malformation Thursday, June 20 from 6:30-7 p.m. Carlos Grandela, OD

Screen #1 Screen #8 Scientific Abstract BV-Biocular Vision The Effect of Video Educational Media on Anti-Reflective vs. Pathology in Pediatric Visual Loss: The Utility Spectacle Lens Coating and Patient Purchasing Decisions of Electrodiagnosis Laura Addy, OD Jeff Rabin, OD, MS, PHD Co-Author(s) Co-Author(s) Brianne Hobbs, OD, FAAO Emily Zediker, BS Alex Christensen Brian Hatch, BS Russell Gray Kelsey Crawford, BS Brandon Harr Rachna Patel, BS Jamison Langston Nancy Phan, BS

Screen #2 Screen #9 Scientific Abstract OD-Ocular Disease The Impact of Ocular Surface Disease Signs and Symptoms Treatment and Management of Multiple Evanescent White on Optical Remakes Dot Syndrome Alexis Smith, OD candidate Noor Abushagur, OD

3 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Co-Author(s) Jennifer Deakins, OD, FAOO POSTER SESSION #2 Andrew Kemp, OD, FAAO TOP 5 POSTER Screen #10 PRESENTATIONS OD-Ocular Disease Friday, June 21 from 9-10 a.m. When It’s Not Your Average Chronic Central Serous Chorioretinopathy Screen #1 Karen Choi, OD Screen #2 Screen #11 PC-Primary Care OD-Ocular Disease Clomiphene Citrate Induced Visual Palinopsia in Polycystic Panuveitis as Presenting Sign Leading to a Diagnosis of Ovary Syndrome Case Syphilis and HIV Breanne McGhee, OD, MEd, FAAO Ashley Toland, OD Screen # 3 Screen #12 OD-Ocular Disease OD-Ocular Disease Obscurities and Peculiarities- Bilateral Posterior Subcapsular Malignant Hypertension , Vitritis and Drusen as Presenting Signs Rashad Haddad, 4th year optometry student of Atypical Laine Higa, OD, FAAO Screen #13 Co-Author(s) PC-Primary Care Tina Choe A clinical case of Trigeminal Neuralgia Screen #4 Amal Mansoor, OD Scientific Abstract Screen #14 Reading Efficiency on Print vs. iPad Reading PC-Primary Care Amanda Lallensack Erythema Multiforme and Serum Sickness Co-Author(s) Jillian Nirenberg, OD Elizabeth Pallante Co-Author(s) Nicole DeMarco Roger Juarez, OD Melanie Nielsen Alicia Feis, OD Screen #15 OD-Ocular Disease Screen # 5 Scientific Abstract Coat’s Disease Comparison of the potential acuity meter, interferometer, and Mohit Adlakha, OD near super-pinhole in patients Screen #16 Janice McMahon, OD OD-Ocular Disease Co-Author(s) Orbital Pseudotumor Spectrum Disorder and Posterior Susan M. Ksiazek, MD in a Systemic Lupus Erythematosus Patient Christopher Borgman, OD

4 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

POSTER SESSION #2 Jonathan Jacesko, OD Friday, June 21, 2019 from 9-9:30 a.m. Screen #13 OD-Ocular Disease Screen #6 Symptoms Preceding Signs: Atypical Presentation of Central BV-Biocular Vision Retinal Artery Occlusion Neuro-Optometric Rehabilitation in a Patient with Visual Suzzane Li, OD, FAAO Perceptual Deficits Following an Acquired Brain Injury Co-Author(s) Danielle L. Weiler, OD, FAAO Angela Howell, OD Huey-Fen Song, OD, FAAO Co-Author(s) Lydia Luther, O.D. Candidate 2019 Screen #14 Scientific Abstract Screen #7 OD-Ocular Disease Innovation in Education - OCTaVIA - OCT VIsual Atlas iOS App Is it, or is it not, Pellucid Marginal Degeneration? A case series. Elena Biffi, OD Jami Parsons Malloy, OD Co-Author(s) Louis A. Frank, O.D., F.A.A.O. POSTER SESSION #2b Joseph Stamm, OD, FAAO Friday, June 21 from 9:30-10 a.m. Screen #8 CL-Contact Lens Screen #6 OD-Ocular Disease Orthokeratology for Control The Role of Imaging Techniques in the Case of Paracentral Leanne Leung, OD Acute Middle (PAMM) Screen #9 Stephanie He, OD OD-Ocular Disease Co-Author(s) Idiopathic Macular Hemorrhage Steven Ferrucci, OD, FAAO Brenda S. Yeh, OD, FAAO Kirsten Weitzel, Optometry Student Screen #7 Screen #10 OD-Ocular Disease OD-Ocular Disease PXE: A Complex Genetic Disorder Pellucid Marginal Degeneration Kellen Plomski, OD, MPH Christina Romano, BS Screen #8 Screen #11 Scientific Abstract A Case of Polypoidal Choroidal Vasculopathy - Utilizing advanced imaging modalities to appreciate the Pachychoroid Exploratory Data Analysis of Infant Patients Seen at an Spectrum of Diseases Academic-Based Urban Clinic from 2015 - 2018 Nathan Traxler, O.D. Tamara Petrosyan, OD Screen #9 Screen #12 PC-Primary Care OD-Ocular Disease Macular Pattern Dystrophies in Two Sisters Posterior Polymorphous (PPMD) Lori Gray, OD Kaitlyn Bishop, Optometry Student Co-Author(s)

5 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Screen #10 Screen #2 Scientific Abstract OD-Ocular Disease Readability of Wayfinding Signage at Midwestern Eye Institute Rethinking Risk for Hydroxychloroquine Maculopathy for the Low Vision Population Nicole Ethridge, OD Caitlin Jomoc, B.S. Co-Author(s)Brianne Hobbs, OD, FAAO Screen #3 Laura Addy, OD OD-Ocular Disease Vladimir Yevseyenkov, O.D., Ph.D. Emergent Giant Cell Arteritis Presenting as Unresolving Nicole Putnam, Ph.D. Unilateral Screen #11 Kimberly Skyles, OD OD-Ocular Disease Screen #4 Management of a Persistent Epithelial Defect in a Patient with Scientific Abstract Stevens-Johnson Syndromes/TENS 4-year outcomes of micro-invasive glaucoma surgery with Kathleen Prendergast, BS iStent inject (2nd generation trabecular micro-bypass stent) combined with topical prostaglandin Screen #12 OD-Ocular Disease Justin Schweitzer, OD Scleral Lenses Treatment Modality of Moderate to Severe Dry Screen #6 Scientific Abstract Herman Nijjar, Optometry (OD) Student A randomized pivotal clinical trial of iStent inject (second- Co-Author(s) generation trabecular micro-bypass stents) implanted in Louis A. Frank, O.D., F.A.A.O. conjunction with cataract surgery compared to cataract surgery alone Screen #13 OD-Ocular Disease Roberto Saenz, OD, MS, FAAO Orbital capillary hemangioma removal in a premature infant Screen #7 resulting in dragged optic disc Scientific Abstract Emily Crump, OD in May 2019 Review of a digital contact lens fitting support tool for Eye Care Professionals Screen #14 OD-Ocular Disease Jennifer Palombi, OD, FAAO Co-Author(s) Bilateral Papillitis Secondary to Neurosyphilis Amanda Bogers, BSc(EU), MCOptom, MBA Maneh Gevorgyan, student Dan Prest

Screen #8 POSTER SESSION #3 OD-Ocular Disease Roth Spots secondary to vitamin B-12 deficiency Friday, June 21, 2019 from 12-12:30 p.m. Adrian Kun, OD

Screen #1 Screen #9 OD-Ocular Disease Scientific Abstract Combating Dry Eye in a GP Lens Wearer with Ocular Primary Eye Care and Obstructive Sleep Apnea: An Rosacea Objective Neurologic Test of Eye Movements Demonstrates Baseline Dysfunction And Improvement With Treatment Tina Zhu, OD Co-Author(s) Lori Grover, OD PhD Robert Fintelmann, MD, FACS Co-Author(S) Florencia Yeh, OD, FAAO, FSLS Martina Mookadam, MD

6 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Michael L. Grover, DO Kiyavash Tebyanian, OD student Yu-Hui Chang, MPH, PhD Co-Author(s) Lanyu Mi Kathryn Deliso, OD James Parish, MD

Screen #10 PC-Primary Care POSTER SESSION #3B Using OCT-Angiography to Evaluate Retinal Vein Occlusions Friday, June 21 from 12:30-1 p.m. Pierce Kenworthy, OD, FAAO Screen #1 Screen #11 Scientific Abstract OD-Ocular Disease Interim results of a prospective, randomized phase 2 study Characteristic Imaging Findings in Acute Macular evaluating the safety and efficacy of Travoprost Intraocular Neuroretinopathy Implants Gabriel Fickett, OD Mitch Ibach, OD

Screen #12 Screen #2 Scientific Abstract PC-Primary Care Positive Predictive Value of Vision Screening Devices During Mild Vision Loss as the Sole Manifestation of a Meningioma Well-child Visits Brianne Hobbs, OD, FAAO Brittney Morales, OD Co-Author(s) Grace Liao, OD Screen #13 Kaila M. Osmotherly, O.D. Scientific Abstract Establishing an Open Access Clinic to Increase Compliance Screen #3 with Annual Diabetic Eye Exams OD-Ocular Disease Juan Ding, OD, PhD Pediatric Orbital Floor Fracture with Symptoms Mimicking Co-Author(s) Inferior Rectus Entrapment Manisha Anand, M.A., COA Kimberly Skyles, OD Shlomit Schaal, MD, PhD Screen #6 Screen #14 OD-Ocular Disease OD-Ocular Disease Toric Implantable Collamer Lens (ICL) implants in eyes Masquerades of Carotid Cavernous Fistula contraindicated for LASIK Eun-Young Ko, BSc Roberto Saenz, OD, MS, FAAO Co-Author(s) Screen #15 Anjli Patel OD-Ocular Disease Multiple Sclerosis: Making the Diagnosis when Atypical Screen #7 Findings are Present Scientific Abstract Jacqueline Molinda, OD Modern approach to assist toric lens fitting using a web- Co-Author(S) application William Denton, OD Jennifer Palombi, OD, FAAO Co-Author(s) Screen #16 Doerte Luensmann, PhD Dipl Ing (AO), FAAO OD-Ocular Disease Jill Woods, BSc(Hons), MCOptom, FAAO Stellate Nonhereditary Idiopathic Foveomacular Retinoschisis Shail Patel, BSc(Hons) MCOptom FBCLA

7 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Screen #8 Screen #14 Scientific Abstract PC-Primary Care Perception of Earliest Recommended Pediatric Eye Exam Continuous observation on Chinese children’s ocular axial Age by Health Professional Students length growth with the relationship to myopia development Eric Woo, OD Yining Shi, MD, PhD Co-Author(s) Screen #9 Yi Li, MD, PhD Scientific Abstract Improvement in Batting Performance through the Use of Screen #15 Stroboscopic OD-Ocular Disease Atypical Presentation of Idiopathic Intracranial Hypertension Matthew Roe, OD, FAAO Co-Author(s) Maciel Cruz, Doctor of Optometry Candidate Sarah Huff Co-Author(s) Sarah Thomas, OD Kathryn Deliso, OD

Screen #10 Screen #16 CL-Contact Lens OD-Ocular Disease Custom Scleral Lens Designs for Protection of Type I Boston West Nile Viral Retinitis vs APMPPE Keratoprosthesis Kristin Kosch, B.S. Melanie Frogozo, OD

Screen #11 POSTER SESSION #4 OD-Ocular Disease Friday, June 21, from 3-3:30 p.m. Management and Treatment of Chronic Central Serous Chorioretinopathy with Eplerenone Screen #1 Yuyeng Lor, Optometry Student BV-Biocular Vision Co-Author(s) Improving Stereopsis of an Adult with Intermittent Kathryn Deliso, OD Suppression Screen #12 Patrick Stark, OD Scientific Abstract Screen #2 The Effects of Over-the-Counter Topical Allergy Eye Drops on OD-Ocular Disease Soft Contact Lens Densitometry Lamellar Hole-Associated Epiretinal Proliferation Hera Ansari, OD candidate 2020 Co-Author(s) Jasmine Lynn, OD Emalea J. Deschamps, OD candidate 2020 Co-Author(s) Michael Schmalle, OD candidate 2020 Brenda S. Yeh, OD, FAAO Joshua Baker, OD Steven Ferrucci, OD, FAAO Grace Liao, OD Screen #3 Screen #13 OD-Ocular Disease OD-Ocular Disease Recurrent Non-arteritic Anterior Ischemic Optic Neuropathy Role of Supplements in Exacerbation of Central Serous Paige Small, Optometry Student Chorioretinopathy Co-Author(s) Nhat Nguyen, OD Kelly Schoorens, OD Co-Author(s) Heather McLeod, OD Screen #6 Scientific Abstract

8 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Evaluation of Two Toric Designs and Lens Stability Screen #13 Performance OD-Ocular Disease Jennifer Palombi, OD, FAAO Bilateral peri-papillary choroidal neovascularization Co-Author(s) membranes secondary to head drusen in a Ruben Velasquez, MSc FIACLE young patient Gary Orsborn, OD, MS, FAAO, FBCLA Raman Bhakhri, OD, FAAO Jose Vega, O.D. Co-Author(s) Screen #7 Patrick Yoshinaga, OD, MPH, FAAO LV-Low Vision Screen #14 CNS Lymphoma LV-Low Vision Maria Nguyen, OD Diagnosis and Low Vision Management of Occult Macular Dystrophy Screen #8 Information Abstract Maggie Man Ki Ho, OD, MS Co-Author(s) P.A.N.D.A.Scopic Vision - The Optometrists Role in Stephanie Schmiedecke Barbieri, O.D., F.A.A.O., Dipl. Low Identifying Pediatric Autoimmune Neuropsychiatric Syndrome Vision Megan Meus, OD Patricia C. Sanchez-Diaz, DVM, PhD, F.A.A.O. Jeff C. Rabin, O.D., M.S., Ph.D., F.A.A.O., Dipl. Vision Screen #9 Science Information Abstract Screen #15 Lessons of successful provision of ophthalmic equipment LV-Low Vision and supplies to optometry schools and sustainable clinics in developing countries: VOSH/International’s Technology Spectacle Prescribing Recommendations for Visually Transfer Program (TTP) Impaired Patients Tracy Matchinski, OD, FAAO Tyla Girouard, 4th year Optometry Student Co-Author(s) Maria A. Moreira, MSc Screen #16 David Stacy, OD OD-Ocular Disease Questionable Idiopathic Roth Spot in a Pediatric Patient Screen #10 Jared Reinert, OD Candidate Screen #11 Scientific Abstract Evaluating the visual performance of a daily disposable POSTER SESSION #4B multifocal lens, designed with two differently powered Friday, June 21, from 3:30-4 p.m. intermediate zones Gary Orsborn, OD, MS, FAAO, FBCLA Screen #1 Co-Author(s) OD-Ocular Disease Jill Woods, BSc(Hons), MCOptom, FAAO Jalaiah Varikooty, MSc, MBBS Presumed Diagnosis with Lyndon Jones, PhD, DSc, FCOptom, FAAO Coronary Computed Tomography Angiogram Justin Schaefers, BS Screen #12 LV-Low Vision Screen #2 Prescribing Pelli Prism for a Stroke Patient with a Bilateral OD-Ocular Disease Homonymous Visual Field Defect Differentiation between Herpes Zoster and Herpes Simplex Kimberly Skyles, OD Viruses

9 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Nhi Phan, OD Screen #13 Scientific Abstract Screen #3 OD-Ocular Disease The Effect of Social Support and Visual Function on Perceived Stress Vision Loss and Sensory due to Untreated Ocular Toxoplasmosis Tatevik Movsisyan, OD, MS Co-Author(s) Abby Small, Optometry Student San-San Cooley, OD, MS Rebecca Deffler, OD Screen #6 Frederick Davidorf, MD Scientific Abstract Bradley Dougherty, OD PhD Toric Implantable Collamer Lenses: Early United States Experience Screen # 14 LV-Low Vision Roberto Saenz, OD, MS, FAAO Co-Author(s) Diagnosis and Low Vision Management of Enhanced S Cone Hiten Patel, BS Syndrome in a Patient Showing Retinoschisis and Genetic Mutation in NR2E3. Screen #7 Maggie Man Ki Ho, OD, MS LV-Low Vision Co-Author(s) Beauty Parlor Syndrome: Beauty is Pain Stephanie Schmiedecke Barbieri, O.D., F.A.A.O., Dipl. Low Ashton Ehlers, OD Vision Patricia C. Sanchez-Diaz, DVM, PhD, F.A.A.O. Screen #8 Jeff C. Rabin, O.D., M.S., Ph.D., F.A.A.O., Dipl. Vision OD-Ocular Disease Science

Management of an Acute Traumatic After Being Hit Screen #15 in the Eye with a Padlock OD-Ocular Disease Inrava Khasnabish, B.Sc., O.D. Malignant or Benign? – But not a tumor. Screen #9 Elizabeth Nace, OD PC-Primary Care Co-Author(s) Life-saving paradigm shift in central retinal artery occlusion Moshe S. Roth, OD, FCOVD; management Andrea Yee, OD Co-Author(s) Sylvia Sparrow, OD

Screen #10 CL-Contact Lens Scleral Lens and Prism Management of Chronic Progressive External Ophthalmoplegia Rebecca Chung, OD

Screen #11 PC-Primary Care Optic Nerve Coloboma Eun Lee, MM

Screen #12

10 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

11 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

POSTER ABSTRACTS evidence of OP reduction due to vitamin A deficiency in humans and animal models; however, Case Report Abstract this is typically found in severe vitamin deficiency, Thursday, June 20, 2019 and when vitamin A levels returned to normal levels, OPs would be expected to return to 6-6:30 p.m. baseline. It is unclear if the proposed vitamin A metabolic changes thought to be involved in PRP OD-Ocular Disease pathogenesis were responsible for changes in our Electroretinographic Findings in Pityriasis patient’s ERG scotopic and OP amplitudes, or if a Rubra Pilaris generalized inflammatory state from the PRP contributed to reduced OPs. Eye care providers Pityriasis rubra pilaris (PRP) is a rare should be aware of potentially sight-limiting dermatological condition that results in that may be resultant of vitamin A hyperkeratotic papules and scaling erythemic deficiency in PRP. Electrodiagnostic testing is plaques. Systemic retinoids (vitamin A derivatives) recommended at initial diagnosis and throughout are often prescribed, as pathogenesis of PRP may and following vitamin A supplementation. be linked to vitamin A metabolism, and studies Author involving retinoids have shown some effectivity in Laura Addy, O.D. managing the uncomfortable skin manifestations. Co-Author(s) Classic electroretinogram (ERG) findings of vitamin Kaila M. Osmotherly, O.D. A deficiency consist of reduced rod and cone responses with normal implicit times. Limited Case Report Abstract studies also show ERG oscillatory potentials (OPs) to be a marker of vitamin A deficiency. Thursday, June 20, 2019 A 60-year-old female was referred for ERG 6-6:30 p.m. following diagnosis of PRP and subsequent vitamin A treatment. She had been prescribed retinoids for OD-Ocular Disease 4 months and denied or loss of vision. ERG scotopic amplitude was above an age- Differentiating Subclinical Retinal expected value OD and normal OS, the difference Detachment, Peripheral Retinoschisis, of which was attributed to prior peripheral retinal and White Without Pressure with Optical detachment OS. Multifocal ERG was also slightly Coherence Tomography reduced in amplitude at the central ring OS, though Subclinical retinal detachment (RD) is a term still in normal range OD and OS. Visual field and used to describe shallow RD in an asymptomatic optical coherence tomography were essentially patient. Typically originating from small retinal holes normal. One year later, scotopic ERG was reduced or breaks and progressing slowly, the condition is OU from the previous year but normal in amplitude. often found on routine examination. Conditions Unexpectedly, the ERG OPs were also diminished such as white without pressure and peripheral nearly 50% in amplitude OU from previous. Other retinoschisis are frequently mistaken as subclinical repeat testing and fundus appearance were RD. While subclinical RD will likely require unchanged. intervention, peripheral retinoschisis and white This case study is the first to our knowledge without pressure do not. Even more convoluted, documenting electroretinographic findings in a peripheral retinoschisis can progress to retinal patient with the rare condition PRP. There is limited

12 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

detachment resulting in a lesion that has Information Abstract components of each. A misdiagnosis of subclinical retinal detachment can result in an unnecessary Thursday, June 20, 2019 urgent referral, causing undue alarm for a patient. 6-6:30 p.m. While there are several fundus evaluation strategies that are beneficial in differentiating these Reactivation of Herpes Zoster conditions, optical coherence tomography (OCT) of the lesion in question can result in a definitive BackgroundVaricella zoster virus (VZV) causes diagnosis. As OCT scanning techniques are two major syndromes: one is varicella (chickenpox- generally performed to obtain information of the primary infection) and the other is zoster (shingles- macula or optic nerve, the technique used to reactivation). The average incubation period for obtain peripheral OCT with the Heidelberg varicella is 14 to 16 days after exposure to a Spectralis will be discussed. Testing limitations with varicella virus or a herpes zoster rash. The virus lies this strategy will also be discussed. dormant in the nerve tissue after an active infection (Case 1) A 43-year-old white female with history and the virus can reappear as shingles. Shingles of laser for retinal holes OD and lattice OS presents presents as lesions on only one side of the body for routine six-month follow up. Examination found and is limited to a specific dermatome. Prodromal questionable sub retinal fluid superiorly around symptoms include: headache followed by tingling, retinal hole and lattice, confirmed with peripheral itching, or sensitivity in the affected area. A rash OCT. (Case 2) A 67-year-old black female referred usually develops, followed by lesions that for retinal detachment with multiple breaks OS. On eventually blister over. Case summary: A 49-year- examination there was subclinical RD versus old Asian female presented with a chief complaint retinoschisis infratemporally OD. OCT confirmed of an itchy right eye with two papules on the right subclinical RD requiring laser retinopexy. (Case 3) A side of her face along with a rash on her lower 28-year-old black male patient referred for possible cheek that respect the vertical line. She reported RD OD. Examination and OCT confirms white no prior chicken pox infection and recalled without pressure. (Case 4) A 58-year-old black receiving vaccination for chicken pox 10 years ago. female referred for retinal hole OD. Examination Ocular involvement was not seen. This suggested and OCT confirms infratemporal retinoschisis that the maxillary division of the trigeminal nerve is combined with subclinical retinal detachment affected and corneal involvement is not expected. requiring laser retinopexy. (Case 5) A 53-year-old She was diagnosed with Herpes Zoster given the white male referred for retinoschisis vs. retinal fact that there was a rash and papule on one side detachment OS. Exam and OCT confirm of her face that respect the vertical line along with supratemporal bullous retinoschisis. symptoms of prodrome. Patient was given Valtrex This case series will demonstrate the utility of 1 gram TID po for 7 days. Conclusion: Sensory optical coherence tomography (OCT) in the nerve of the dorsal root ganglion harbors the evaluation of subclinical RD, retinoschisis and white herpes virus. If the nasociliary nerve of the without pressure and the OCT characteristics of ophthalmic branch of the trigeminal nerve is each. affected, this can lead to corneal involvement. Author Since this patient presented with lesions on the Jessica Haynes, O.D. cheek only, this suggested that the maxillary Co-Author(s) division V2 of the trigeminal nerve is involved, Mohammad Rafieetary, O.D. which includes the zygomatico-temporal nerve, zygomaticofacial nerve, and the infraorbital nerve. I

13 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

do not expect any corneal involvement but I expect conditions: AD (40.4%), CI (36.9%), VFL (17.7%), vesicles in the upper lips, zygomatic region, lower and VAL (0.0%). Meta-regression analyses revealed , upper labial mucosa, and the upper hard that VFL was significantly more prevalent in palate. Since there is no ocular involvement moderate-to-severe (29.6%) compared to mild TBI present in this case, the standard of care is to take (7.1%). Combined estimate for TBI-associated Valtrex 1 gram TID po for 7 days and return in one was 27.8% and the prevalence was week. highest less than 24 hours after injury. The Author observation that TBI-associated photophobia Tony Tran, OD student persists for a long time after injury was further supported by the prevalence rates from the studies Scientific Abstract with non-TBI controls. In these studies, the overall prevalence of photophobia in TBI patients (32.9%) Thursday, June 20, 2019 was higher than in control patients (9.6%). Risk 6-6:30 p.m. ratio estimates showed that immediately after TBI, patients are at >4.5 times greater risk of Prevalence of Visual Deficits and experiencing photophobia than non-TBI patients Dysfunctions associated with Traumatic Brain and that TBI patients were twice as likely to have Injury (TBI): A Meta- Analyses photophobia at 12 months after the traumatic event. Traumatic brain injury (TBI) is common—in Our meta-analyses demonstrate that TBI can 2013 alone, an estimated 2.8 million people in the affect the in different ways in many United States sustained a TBI1. Over 383, 947 TBI patients, and these effects can persist for a cases of TBI were reported in U.S. service long time. However, visual acuity, which is members since 2002. TBI is associated with assessed most frequently, is rarely affected. numerous co-morbidities, including visual deficits, Author dysfunctions and photophobia3,4. Retrospective Felix M Barker II, O.D., MS (1) studies show that 65% to 79% of TBI patients report subjective visual complaints5,6. We report Co-Author(s) here meta-analyses of available published data Natalya Merezhinskaya, Ph.D. (1) with estimated prevalence of five visual outcomes: Rita K Mallia, O.D., MPA (2) accommodative dysfunction (AD), convergence DoHwan Park, Ph.D. (3) insufficiency (CI), visual field loss (VFL), visual acuity Daniel W Bryden, Ph.D. (2) loss (VAL) and photophobia (PHP). David A Eliason, MD (1) Four databases were queried (PubMed, Col. Mark E Reynolds, MD, MPH (1) EMBASE, EBSCO, and Cochrane Library) for relevant literature using the terms: prevalence, 1 - DoD/VA Vision Center of Excellence (VCE), head injury, vision, and deficit/dysfunction for AD, Walter Reed National Military Medical Center, CI, VFL and VAL; for PHP, the terms head injury, Bethesda MD; PHP, and topic/scope for PHP were used. 2 - Contract personnel in support of VCE Database searches yielded 2,104 unique 3 - Department of Mathematics and Statistics publications related to AD, CI, VFL, and VAL; and University of Maryland Baltimore County 1,574 unique publications for PHP. Random-effects models yielded the following combined prevalence estimates for the four

14 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Scientific Abstract Dynamic Amsler testing showed an average 36.7+/-12.7⁰² with average percentage 58+/- Thursday, June 20, 2019 25.5%. 6-6:30 p.m. Data from this pilot study indicates inferior ability of Dynamic Amsler, Humphrey visual Evaluation of Dynamic Amsler for Estimation analyzer 30-2, Tangent Screen to replicate field of Visual Field in Low Vision area identified by Octopus perimetry in this patient population. The Dynamic Amsler performed The Dynamic Amsler technique has been used statistically higher than Tangent Screen in average by low-vision optometrists in assessing constricted area but not percentage, and higher than visual fields for decades without published Humphrey in percentage but not average area. comparison to other well-established field tests. Further testing in a larger sample is desirable to We hypothesized that Dynamic Amsler is non- confirm these results. inferior to Tangent Screen, Octopus perimetry, and Author Humphrey visual analyzer in testing patients with a Carlos Grandela, O.D. central visual field of 20 degrees or less. We Co-Author(s) conducted a prospective, randomized pilot study Tapuwa L. Chikwinya, O.D., MPH of nine patients to evaluate Dynamic Amsler in Tracy Matchinski, O.D., FAAO comparison with these well-known methods, with Kara Crumbliss, O.D., FAAO; Octopus perimeter as our standard. Patients with a comprehensive eye exam since Case Report Abstract November 2017, visual acuity of 20/70 or better, and a documented visual field of 20 degrees or Thursday, June 20, 2019 less were included in this study. Criteria for exclusion were: central , visual acuity of 6-6:30 p.m. 20/80 or worse, visual field greater than 20 OD-Ocular Disease degrees in diameter, inability to accurately perform visual field testing, or no comprehensive eye exam An Atypical Case of Retinitis Punctata since November 2017. After verifying visual acuity Albescens for eligibility, patients were tested with the Dynamic Amsler, Tangent Screen, Octopus perimeter, and Retinitis punctata albescens (RPA, prevalence Humphrey Visual Field 30-2. All testing was 1/800,000) is a rare variant of rod-cone dystrophy conducted in one visit, with randomized test order (retinitis pigmentosa or RP, prevalence 1/4000). and breaks to eliminate fatigue. Total area of field RPA is characterized by early onset of white for each test result was calculated in degrees deposits in the mid-peripheral fundi and nyctalopia. squared. Results from tests were analyzed as a Like fundus albipunctatus (FA), another early onset percentage of the area measured by the Octopus “white dot” syndrome, RPA involves a mutation in perimeter. the RLBP1 gene. Unlike FA, RPA eventually Octopus perimetry found an average area of includes pigment migration into the fundus often field 88.6+/-28.5⁰². Humphrey visual field 30-2 producing an RP-like appearance in elderly identified an average field of 26+/-23.8⁰² with an patients. We describe a presumed case of RPA average percentage of 10.7+/-8.3%. Tangent with late onset of symptoms and signs which may screen testing had an average area of 15.9+/-6⁰² have eluded early detection. and average percentage of 31.7+/-19.6%. A 57-YO Hispanic female was referred to our

15 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Visual Neurophysiology Service from a retinal Case Report Abstract specialist to assist in diagnosis of RP or a related condition. The patient reported difficulty driving and Thursday, June 20, 2019 seeing in dim settings which first began 9 years 6-6:30 p.m. ago. VA was 20/25 OD, OS with correction for hyperopic . Humphrey 120-point fields OD-Ocular Disease showed significant constriction to 20 degrees. Cone Contrast Test color testing (Innova Systems, Ocular Complications of Intraconal Inc.) showed moderate decreases in red, green Cavernous Hemangioma and blue cone sensitivity. Two color red-blue dark Cavernous hemangioma is a benign orbital adaptometry, conducted during the dark tumor, most commonly seen in middle-age adaptation phase of flash electroretinograms females. It is the most common orbital tumor in (ERGs), showed a 16X decrease in rod sensitivity adults and is thought to be a congenital vascular and an 8X decrease in cone sensitivity coupled malformation. with delayed dark adaptation. Scotopic (rod only) A 31-year-old black female presented with and maximum amplitude (rod and cone) flash decreased vision in the right eye. The vision loss ERGs were non-recordable OU. Photopic (cone slowly became more noticeable in the past year. only) single flash and 30 Hz flicker ERGs were non- The patient also noted long-standing proptosis of recordable as well. Multifocal ERGs (mfERGs), the right eye, which had progressively worsened which reflect cone and cone-bipolar responses this year during pregnancy. She had been referred from multiple retinal sites, showed significantly by her primary care doctor for a complete eye decreased focal ERGs compared to age-matched exam and MRI of the brain and orbits with and norms. Fundus evaluation revealed multiple white- without contrast. She states that there has been yellow fundus deposits as well as less frequent no associated pain, headaches, or areas of black pigmentation resembling RP. tinnitus. The patient has no pertinent medical Fundus appearance, impaired dark adaptation, history and is not taking any medications, though acquired color deficiency, decreased ERGs and she was currently nursing. Upon initial examination, constricted visual fields are consistent with RPA or the right eye had marked proptosis, a 2.25D a related condition. However, the late onset of hyperopic shift with a best-corrected visual acuity nyctalopia was unexpected. We referred the of 20/40. Her were full and patient for functional evaluation and genetic testing unrestricted. Her right optic nerve was swollen with in our Low Vision Service, the results of which will indistinct margins. The posterior pole had a be available soon. This case highlights the need for wrinkled appearance with choroidal folds inter-professional communication between retinal, noticeable near the macula. Her b-scan was electrophysiological and low vision specialists to consistent with a well-defined, retrobulbar mass optimize vision care. with anterior displacement of the and optic Author nerve head. Her visual field test showed few Jeff Rabin, O.D., MS, Ph.D. scattered, non-repeatable defects. All findings in Co-Author(s) the left eye were within normal limits. The patient’s Anjli Patel MRI impression noted the presence of a large, 2 by Melanie Cadavos, BS 2 by 2.7 cm lobulated, homogenously enhanced Jacob Hansen, BS intraconal mass in the right orbit. The mass is Hiten Patel, BS interposed between the optic nerve and right

16 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

inferior rectus. The optic nerve is elevated and of the visual field defects after termination of the displaced laterally. The most likely differential medication. diagnosis was a cavernous hemangioma. Surgical A 50-year-old white male presents with removal of the mass was recommended in order to constant “wobbling images” and difficulty relieve the pressure on the orbit and optic nerve. recognizing faces. His medical history consists of *internal/external photos, OCT, b-scan, visual field, depression, anxiety, insomnia and PTSD treated and MRI images available upon request. with Aripiprazole, Pregabalin and Quetiapine. Although observation is often appropriate for Uncorrected visual acuity fluctuated from 20/40 to most cases, the symptoms of the patient and size 20/25 in each eye. were normal without of the lesion in this case warranted surgery. afferent pupillary defect. The anterior segment and Cavernous hemangiomas are typically well dilated posterior segment findings were normal in encapsulated and relatively easy to remove. Visual both eyes. OCT imaging of the macula and optic prognosis is excellent and recurrence is rare unless nerve were also unremarkable. History of imaging the tumor is not completely excised. with MRI within 6 months revealed normal findings. Author Humphrey visual field testing demonstrated severe Noor Abushagur, O.D. bilateral constriction. The patient reported starting Co-Author(s) Aripiprazole approximately 2-3 months prior to the Jennifer Deakins, O.D., FAOO onset of his visual complaints. After careful review Andrew Kemp, O.D., FAAO; of medical treatment with the prescribing psychiatrist, the dosage of Aripiprazole was Case Report Abstract tapered then eventually discontinued. Sequential visual field testing and dilated fundus exams were Thursday, June 20, 2019 obtained over the course of 15 months, for careful 6-6:30 p.m. monitoring for any additional ocular pathology. Complete resolution of the visual field defects was OD-Ocular Disease demonstrated after the termination of Aripiprazole. Patients who are prescribed aripiprazole should Find the Culprit: A Case of Reversible Bilateral be properly educated on adverse effects. Other Visual Field Defect and Aripiprazole Use reported cases of ocular side effects with Aripiprazole (Abilify) is an atypical antipsychotic aripiprazole are blurred vision, transient myopia, medication commonly used to treat schizophrenia. and pigmentary chorioretinopathy. Although there It is also widely used as adjunctive therapy to treat is no established medical evidence, this case major depressive disorder. Despite the reduced risk shows a clear correlation of visual field changes of side effects in atypical vs. typical antipsychotics, with the use of Aripiprazole. the eye remains as one of the leading organs to Author manifest drug toxicity. It is important to follow a Karen Choi, O.D.; standard approach to monitor and be aware of potential ocular complications with the use of these agents, thereby allowing timely intervention to prevent permanent adverse visual sequelae. This case report will discuss a patient who developed severe visual field constriction during treatment with Aripiprazole, followed by complete resolution

17 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Scientific Abstract choroidal hemorrhage or effusion. C:D ratio remained stable through 5 years. Thursday, June 20, 2019 Outcomes through 5 years months following 6-6:30 p.m. single- or multiple-stent implantation as a standalone procedure demonstrated safe and Sustained IOP Control with Single or Multiple clinically meaningful IOP and medication reduction Trabecular Micro-Bypass Stents (iStent) in patients with OAG, with incrementally greater Evaluated in Subjects with Open-Angle benefits in eyes implanted with multiple stents. Glaucoma: 5 Year Outcomes Author Whitney Hauser, O.D. To assess IOP- and medication- reducing effects and safety of 1, 2 or 3 trabecular micro- Case Report Abstract bypass stents (iStent®) implanted in eyes with open-angle glaucoma (OAG) on topical glaucoma Thursday, June 20, 2019 medication. Subjects with OAG on 1 to 3 ocular 6-6:30 p.m. hypotensive medications were enrolled in this OD-Ocular Disease prospective, randomized study. Preoperative IOP was 18-30 mmHg on medication and 22-38 Spondylometaphyseal Dysplasia with Cone- mmHg following medication washout. Subjects Rod Dystrophy were randomized to undergo MIGS surgery with one, two or three iStent(s) as a standalone Spondylometaphyseal Dysplasia with Cone- procedure. Annual medication washout was Rod Dystrophy (SMD-CRD) is a rare autosomal- performed to assess unmedicated IOP. The study recessive disorder characterized by uniform assessed IOP and medication use, as well as skeletal abnormalities, short stature, lower limb standard safety parameters (i.e., BCVA, slit-lamp bowing, and cone-rod dystrophy. examination, gonioscopy findings, fundus/optic A 58-year-old Kenyan female presented for a nerve evaluation, and adverse events). low-vision evaluation referred from the state Preoperatively, mean medicated IOP ranged Commission for the Blind. She states she has a from 19.8-20.4 mmHg and post-washout IOP was longstanding history of photophobia and 25.0 Preoperatively, mean medicated IOP ranged decreased central vision and started wearing from 19.8-20.4 mmHg and post-washout IOP was glasses at age 5. She reports that both daytime 25.0-25.1 mmHg in the three groups. Through 5 and nighttime vision slowly declined until she was years postoperative, mean medicated IOP was in her early twenties, at which point she was told ≤18 mmHg in all 3 groups. A ≥20% reduction in there was nothing that could be done to improve unmedicated IOP was achieved in ~80% of multi- her vision. She moved to the United States one stent eyes and 31% of single-stent eyes. year ago and was seen by a local ophthalmologist Medication was needed in significantly more who diagnosed her with probable Cone Dystrophy, single-stent eyes (22 of 38 initial eyes) than eyes but she was not referred for genetic or with 2 or 3 stents (9 of 41 initial eyes, and 6 of 40 electrodiagnostic testing to confirm. She has 7 initial eyes, respectively). A high safety profile was siblings and 2 are short stature with similar vision observed with no reports of intra- or perioperative problems. Upon questioning family history, it complications. Importantly, there were no reports appears her parents were first cousins once of peripheral anterior synechiae, hypotony or removed. Physical evaluation demonstrated

18 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

profound short stature, shortened limbs, and impact of NaturalVue Multifocal (NVMF) center bowing of the legs. Best corrected acuities were distance 1-day contact lenses on the visual 20/150 OD and 20/300 OS. Entrance testing was system of pre-presbyopic patients with unremarkable apart from color deficiency in both accommodative disorders. eyes measured 4/14 OD and 3/14 OS with In this retrospective study, six non-presbyopic Ishihara. At the completion of the functional low- patients presented for annual eye exams with a vision evaluation, the patient inquired further primary complaint of blur at distance and near about the certainty and accuracy of her ocular while uncorrected. Patients were a mix of no diagnosis. A dilated exam was performed and correction or glasses correction for reading only. demonstrated hypopigmented focal macular No patients were previous contact lens wearers. changes and peripheral pigment clumping in both Complete eye exams included components of: eyes. She was referred to the Department of distance/near visual acuity, autorefraction, fused Inherited Retinal Disease for electrodiagnostic cross cylinder, near point of convergence, phorias testing, which revealed markedly decreased at distance and near, negative relative photopic and moderately decreased scotopic , positive relative ERGs, suggestive of cone-rod dystrophy. A accommodation, accommodative push up amps, diagnosis of Spondylometaphyseal Dysplasia with flipper bars, vergence ranges and a cycloplegic Cone-Rod Dystrophy was suggested and later exam of the ocular external and internal confirmed with genotyping revealing a defect in structures. All patients were fit with NVMF in each the PCYT1A gene. eye with insertion and removal training. Exams Clinical evidence of a retinal dystrophy can were performed on a digital acuity chart with elicit further testing (including electrodiagnostic variable letters. and genetic testing) in patients who may All patients experienced an improvement in demonstrate systemic findings suggesting a multi- both subjective and objective blur. Initial system syndrome. SMD-CRD is associated with uncorrected visual acuity varied between 20/25 recessive defects in the PCYT1A gene, and when and 20/30 OU and improved to 20/20 OU post suspected clinically can be confirmed with the treatment with the NVMF. Cycloplegic refraction Genetic Eye Disease Panel involving next- revealed all patients were low hyperopes. All generation sequencing of all known inherited patients reported improvements in: headache retinal disease genes. frequency, visual acuity fluxuations, length of Author comfortable reading time, and ability to translate Kathryn Deliso, O.D. from near to far. All patients accommodative systems Scientific Abstract experienced immediate enhanced stabilization demonstrated by improvement in NRA/PRA, push Thursday, June 20, 2019 up amps, near vergences and increased 6-6:30 p.m. subjective visual comfort with the use of NVMF. Contact lenses provide same-day treatment to Accommodative Stabilization with use of patients with accommodative dysfunction. NaturalVue Multifocal Contact Lens Understanding this is a small sample size, continued testing of like-symptom patients is Patient blur can be secondary to warranted for increased validity of current findings accommodation infacility, paresis or spasm. This and to address the actual mechanism of action retrospective case report series questions the that leads to the increase in visual stability.

19 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Additionally, expansion into vergence disorders and the retinal nerve fiber layer. Blood work was their reaction to the aspheric rapid plus power of ordered for the patient and the syphilis IgG/IgM AB the NVMF is merited. and RPR panel were reactive. The patient was Author treated with IV Penicillin G and followed up closely. Amber Zaunbrecher, O.D. Optic neuropathy can be caused by Co-Author(s) demyelination, inflammation, ischemia, infiltration, Jennifer Dattolo, O.D. compression, hereditary, as well as toxic/nutritional causes. It is essential that patients undergo careful Case Report Abstract clinical evaluation and diagnostic testing to find the underlying cause of the optic neuropathy. In cases Thursday, June 20, 2019 with a suspected etiology of syphilis, ordering 6-6:30 p.m. specific testing such as MHA, TPPA, IgG/IgM, and HIV status is imperative. Recognition of cases such OD-Ocular Disease as this not only has an effect on the visual prognosis of patients but the neurological Syphilitic Optic Neuropathy prognosis as well. Syphilis is caused by the bacteria Treponema Author pallidum and this bacterium can spread to the CNS Rebecca Hales, O.D. within days after exposure. Clinical manifestations can occur at any stage of the infection and can Scientific Abstract include asymptomatic neurosyphilis. The majority Thursday, June 20, 2019 of cases are reported in HIV-infected patients but the epidemiology is not well-defined. Systemic and 6-6:30 Pp.m. ocular involvement of syphilis can be described in three stages with the tertiary stages being the most Pilot Study Assessing Patient Knowledge and severe and involving the CNS. Understanding of Their Diagnosis A 76-year-old white male presented to the clinic Patient understanding of his or her diagnosis is complaining of in the left eye that had been one of the first steps to successful vision occurring for one week. He also noticed a black rehabilitation (1). Successful rehabilitation benefits line that looked like an EKG line and lasted about from a patient who is knowledgeable about their 10 seconds and did not recur. His systemic health condition and has a reasonable understanding of is significant for HIV, hypothyroidism and COPD. his or her prognosis (2). However, patients referred Ocular history includes , normal tension to a low-vision rehabilitation clinic have a variable glaucoma suspect, choroidal nevus of the left eye understanding of their vision loss and limited and early cataracts. Visual acuity was 20/40 in the understanding of prognosis, which influences right eye and 20/25-2 in the left eye. Pupils rehabilitation outcomes. The aim of this study was showed a mild apd in the left eye. On dilated to assess patient knowledge of their diagnosis and fundus examination the c/d ratio was 0.5 in the how patients learn about their ocular condition. right eye and 0.1 in the left eye with no appreciable A questionnaire was administered to 50 new cup. The left optic nerve head had significant patients in low-vision clinics pre- and post- low- swelling with hemorrhages and cotton wool spots. vision exam in an urban setting. Questions related Ancillary testing was performed and the OCT of the to understanding of their diagnosis as well as their optic nerve head showed correlating swelling of access to information about their diagnosis were

20 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

asked. other corneal layers, which can ultimately lead to Before their low-vision examination, 76% of blindness. patients reported they knew what the cause of A 59-year-old white female presented to the their vision loss was, however only 62% were able clinic complaining of discomfort, irritation and to name the condition correctly. Fourteen percent scratchiness OS that had been constant for the of participants felt their diagnosis had not been past 4 days. The patient also reported associated explained to them. After their low-vision symptoms of photophobia, watering and reduced examination, 98% felt confident in their ability to vision OS, and she denied any relieving factors. name their condition with 86% being correct. As The patient presented with corrected distance for resources to learn about their condition, exactly visual acuities of CF@1ft and NIPH OD with half of the participants did not have access to the reduction due to long-term history of optic atrophy, internet to research his or her visual diagnosis. Of and 20/50 with NIPH OS. Pupils were measured in those with internet access only 12 patients looked dim light at 4mm OD and 3mm OS with a mild up information about their vision loss online. Other APD OD. Slit lamp examination revealed two sources utilized were books, a family doctor, epithelial dendritic corneal ulcers OS. No stromal journals, a technician or an optometrist; however, involvement and no anterior chamber reaction only half of patients reported using those were observed. resources. This patient was diagnosed with Herpes This study suggests patients presenting to low- Simplex Virus keratitis OS based on the patient’s vision clinics for the purpose of rehabilitation may complaint and the clinical findings. The patient was require additional education regarding their prescribed oral Valtrex 500mg PO TID and 1gtt diagnosis. Additionally, attention to gaps in health Zirgan 5x/day OS. At the 2-day follow-up, there literacy in this population should be considered to was no observable improvement of the dendritic improve rehabilitation outcomes. corneal ulcers, so a BioDOptix amniotic membrane Author was inserted OS. One week following the initial Karen Squier, O.D., MS presentation, the dendritic corneal ulcers had completely resolved with no corneal scarring and Case Report Abstract vision improved to 20/30 OS. In cases in which there is no improvement of Thursday, June 20, 2019 HSV epithelial keratitis following topical treatment, 6-6:30p.m. an alternative treatment may be sought out to improve the rate of resolution. An amniotic OD-Ocular Disease membrane is a useful medical device to aid in the treatment of any corneal epithelial disease. The Herpes Simplex Virus Keratitis regenerative components of an amniotic The Herpes Simplex virus is one of the most membrane allow for it to be a beneficial option for common viruses that affects the human body. HSV keratitis because of its ability to reduce There are two types of the herpes simplex virus, inflammation, promote re-epithelialization, and with HSV type 1 affecting the oropharynx region of reduce corneal scarring. the body. HSV type 1 can manifest itself to the Author ocular surface and will most commonly cause Jacob Diedrich, O.D. epithelial keratitis. If not managed properly, the virus has the ability to cause further damage to

21 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Scientific Abstract purchases, with 75% of spectacles including ARC. The overall MWUEI ARC rate was 65% during the Thursday, June 20, 2019 study period, and the national rate was 61%. 6:30-7 p.m. This study demonstrates that a short video could positively impact patient purchasing The Effect of Video Educational Media on decisions. This intervention was easily Anti-Reflective Spectacle Lens Coating and implemented, well-received and generally effective. Patient Purchasing Decisions Subjective knowledge of ARC improved substantially. Better informed patients are more Patient education facilitates shared decision- informed consumers, making them more likely to making, improves satisfaction and empowers invest in a product that can improve visual function. patients to become advocates for their health. It’s possible that this methodology can be applied Proper education also can lead to increased to other health care topics to improve patient revenue potential in an optical setting by informing understanding and enhance overall well-being and patients how to optimize visual performance. This quality of life. study evaluated the impact of a novel educational Author video on spectacle antireflective coating (ARC) Laura Addy, O.D.; purchases. Co-Author(s) Subjects were selected among patients Brianne Hobbs, O.D., FAAO receiving a spectacle prescription during their Alex Christensen exam at the Midwestern University Eye Institute Russell Gray (MWUEI.) Subjects were given a brief survey Brandon Harr assessing current level of understanding of ARCs Jamison Langston using a five-point Likert Scale, and asking if ARC was used in their habitual spectacles. They then Scientific Abstract watched a two-minute video explaining the function and purpose of ARC. A follow-up survey Thursday, June 20, 2019 assessed knowledge of ARCs post-video viewing, and likelihood of purchase. Optical purchases were 6:30-7 p.m. tracked and the rate of ARC was compared to a The Impact of Ocular Surface Disease Signs random sample of controls from the same exam and Symptoms on Optical Remakes dates, and to a national average as reported by MWUEI’s primary lab. Dry eye disease (DED) is a chronic, progressive Among 40 subjects, 63% reported little to no condition that has been demonstrated to lead to knowledge of ARC prior to the video. After the reduced functional visual acuity. Patients video, this rate dropped to 0%, with 70% reporting complaining of reduced visual acuity with their very good to excellent knowledge. Converting to a spectacles may request an optical remake. DED 1-5 numerical scale, average understanding may be the cause of the reduced visual acuity improved from 2.2 to 3.9 points (p<0.001). Prior to rather than the optical quality of the spectacles. the video 39% were unsure if ARC was present on A pilot study was conducted to determine if their current spectacles. After the video, 78% said DED contributed to optical remakes. Thirty-seven they were either very likely or definitely would patients who requested optical remakes and 17 purchase ARC, with 0% who definitely would not control patients satisfied with their glasses at the purchase. This was consistent with actual time of dispense were enrolled in the study.

22 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Potential subjects were excluded for pregnancy or Participants, ages 20-38 years with -0.75 to nursing, diabetes, recent surgery, corneal surgery, -1.50D of astigmatism were enrolled in this double- or if they were younger than 18 years old. Pertinent masked, crossover study. Participants wore Alcon case history, demographic data, and Ocular Dailies Aqua Comfort Plus Sphere and Toric Surface Disease Index (OSDI) were collected from contact lenses in a randomized order. High and subjects. Initial and average non-invasive low contrast near LogMAR visual acuity was keratography break-up time (NIKBUT) were taken measured. Reading performance was assessed on subjects via the Oculus Keratograph 5M. After using two custom-made iPad applications; one one week, control subjects were called to utilized the Radner reading sentences test and determine if they were still satisfied with their calculated critical print size and optimal reading glasses. speed (ORS), while the other app used website Compared to participants satisfied with their articles and analyzed zoom and contrast glasses, participants who requested optical modifications as well as the distance at which the remakes showed significantly worse NIKBUT OD, iPad was held. Participants completed Near Acuity and worse NIKBUT OS (which approached Visual Questionnaires (NAVQ), and were asked significance). Participants who requested optical their preferred contact lens correction at the remakes showed worse OSDI than participants conclusion. satisfied with their glasses, but this result was not Thirty-four participants completed the study. statistically significant. Toric lens correction improved near high and low A larger sample size in future studies may shed contrast visual acuity by 0.5 to 1 full line more light on whether optical remakes are related (p<0.0001). This translated to reading to DED. performance, where participants also read about Author one line smaller text on the iPad (p=0.013). There Alexis Smith, OD candidate was no significant difference in ORS above Co-Author(s) threshold acuity (p=0.48). Participants increased Whitney Hauser, O.D. the zoom about 10% (p = 0.0039) and the contrast Michael Christensen, O.D. about 5% (p = 0.006) more with spherical compared to toric lenses during the reading Scientific Abstract articles functional vision test. Participants held the iPad at approximately the same distance, about 33 Thursday, June 20, 2019 cm (p=0.6304). Participants reported improved 6:30-7 p.m. satisfaction by the NAVQ (p=0.0002) and noticed the most benefit with tasks such as reading small Toric Contact Lens Performance with Digital print, reading labels/instructions, and conducting Devices near work. Eighty-five percent of participants preferred the toric contact lens correction (p < It is known that patients with low amounts of 0.0001). astigmatism may achieve better visual acuity with Participants were able to read smaller print size toric versus spherical soft contact lenses. Visual more comfortably, and preferred the toric lens demands today incorporate a significant amount of correction compared to the spherical equivalent time utilizing digital devices. This study measured lens correction. This study demonstrated realistic subjective and objective outcomes of astigmatic benefits of fitting toric lens designs for astigmatic patients wearing toric contact lenses using real- patients using digital devices. world digital devices. Author

23 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Anna-Kaye Logan, O.D. 1.5 mmHg and post-washout IOP was 24.4 ± 1.3 Co-Author(s) mmHg. Postoperative mean IOP was 13.2 mmHg Ananya Datta at M48 (representing a 32% and 46% reduction Kelsea Skidmore from medicated and washed-out baseline Chuan Hu, M.D., O.D. measures, respectively). IOP was observed to be Erin S. Tomiyama, O.D. 14.6 mmHg or lower at all timepoints assessed Moriah A. Chandler, O.D. through M48. At M48 95% of subjects achieved Julia S. Benoit, Ph.D. both an IOP ≤18 mmHg and a reduction of ≥20% James S. Wolffsohn on no medication compared to preoperative, unmedicated IOP. All but 3 subjects remained Scientific Abstract medication-free out to 48 months. An overall favorable safety profile was observed with no Thursday, June 20, 2019 intraoperative or device-related AEs. There were no 6:30-7 p.m. reports of peripheral anterior synechiae or hypotony. Best-corrected VA of 20/40 or better Durable IOP and Medication Reduction with was achieved in 93% of eyes. Optic nerve and iStent Inject (Second-generation Trabecular visual fields remained essentially unchanged at Micro-bypass Stent) in Subjects with M48 versus preoperative. Open-angle Glaucoma on 1 Preoperative Long-term outcomes from this study Medication: 48-month Outcomes demonstrate safe and sustained reduction of IOP in eyes with OAG following implantation with iStent Micro-invasive glaucoma surgery (MIGS) is inject stents performed as a standalone procedure. gaining popularity as an effective treatment for The study demonstrated that IOP reduction to ≤15 patients with glaucoma. This study evaluates the mmHg with elimination of medication can safely be safety and IOP-lowering efficacy of 2 second- achieved out to 48 months post-surgery. These generation trabecular micro-bypass stents (iStent findings of iStent inject show significant beneficial inject®) implanted as a standalone procedure in outcomes. subjects with open-angle glaucoma (OAG) not Author controlled on one ocular hypotensive medication. Walter Whitley, O.D., MBA, FAAO This is a prospective, single-arm study that enrolled subjects with OAG not controlled on a Case Report Abstract single ocular hypotensive medication whose preoperative IOP was 18-30 mmHg (medicated) Thursday, June 20, 2019 and 22-28 mmHg (after medication washout).1 Qualified subjects underwent implantation of 2 6:-6:30 p.m. iStent inject stents as a standalone procedure BV-Biocular Vision without concomitant cataract surgery. Assessments performed over the course of the Binocular Ramifications of Arteriovenous study included IOP, medication burden, adverse Malformation events, visual acuity, slit-lamp, gonioscopy, and fundus/optic nerve examinations. An Arteriovenous Malformation is an abnormal A total of 57 qualified subjects were enrolled in tangle of blood vessels in the central nervous this study and all completed 48 months of follow- system that forms without a capillary bed, allowing up. Preoperative mean medicated IOP was 19.5 ± direct exchange of blood from arteries to veins.

24 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

This tangle is thought to form during fetal Case Report Abstract development and may be asymptomatic for many years. Although rare (1 in 100,000), it can have Thursday, June 20, 2019 devastating effects. AVMs pose an increased risk 6:30-7 p.m. of aneurysms and hemorrhaging in the brain. Resulting symptoms include severe headaches, BV-Biocular Vision vomiting, seizures, severe pain, muscle weakness, paralysis, visual disturbances, mental confusion, Amblyopia vs. Pathology in Pediatric Visual and more. Loss: The Utility of Electrodiagnosis A 26-year-old black female presented for , or visual deprivation intermittent horizontal binocular diplopia and glare (e.g., unilateral monocular cataract) are that began in 2014 after a stroke. She reported a amblyogenic factors that often eventuate in history of Arteriovenous Malformation over the right decreased acuity (VA) and stereopsis. However, the cerebellum since birth that became symptomatic in etiology can be less clear, particularly if the 2012 with vomiting and headaches. She had since condition includes organic factors such as optic undergone multiple neurosurgeries for treatment nerve hypoplasia as well as failure to respond to and reported that the 2014 stroke was a amblyopia therapy. We describe a 5-year-old complication to her second surgery. The stroke female referred to our Visual Neurophysiology resulted in muscle weakness, poor mobility, verbal Service (VNS) to distinguish between amblyogenic difficulties, and diplopia that has and organic bases for decreased vision. improved but never fully resolved. She had A 5-year-old white female in good general previously been prescribed plano glasses with 10 health was referred from pediatric prism diopters of base out for the diplopia, but was to determine if decreased VA OD and lack of intolerant of the prism. Visual acuity was measured response to amblyopia therapy was due to at 20/20 OD,OS and 20/15 OU. She demonstrated undiagnosed pathology. The patient had moderate orthophoria at distance and near, full ocular motility, hyperopic astigmatism, which was not corrected 25” of stereo vision, accommodative amplitudes of until age two and her grandmother noted that prior 8 in each eye, and near point of convergence at to correction her right eye turned inward frequently, 4cm with recovery at 7cm. Vergence testing with indicating right early in life as the basis prism bar showed BO: x/14/8 and BI: x/0/2 at for her current decreased vision. Correction of the distance and BO: 10/14/8 and BI: 10/14/8 at near. hyperopia improved ocular alignment, resulting in Trial frame refraction was plano in both eyes, an intermittent right exotropia. However, the patient however diplopia resolved with use of 2-4pd BO has not responded to traditional amblyopia therapy OU. All other testing was unremarkable. and was referred with VA of: OD 20/125, OS This patient was prescribed 3pd BO OU in 20/50. Refraction revealed an improvement in plano glasses with photochromic and tint options vision OD to 20/70. While entering VA OS was for glare and then referred for a vision therapy 20/50+1 due to atropine penalization OS refraction evaluation. She was counseled on how therapy to to best VA was deferred. Gross stereopsis was strengthen vergence and accommodative skills present and cover test confirmed small angle would be beneficial and could reduce long-term intermittent exotropia OD. Visual evoked potentials reliance on prism. Therapy may also benefit further (VEPs), which assess central vision at the visual ocular symptoms of AVM. cortex, revealed decreased amplitude and delayed Author latency OD while OS was normal both consistent Carlos Grandela, O.D.

25 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

with amblyopia. Electroretinogram (ERG) cone prior. She also was experiencing associated flicker responses and ERG photopic negative headaches and light sensitivity. The patient had no responses, which measure cone, bipolar and pertinent medical history and was not taking any ganglion cell function, were normal and equal OU medications. Upon initial examination, the right eye providing evidence of normal retinal and optic had a best-corrected visual acuity of 20/50 with nerve function as expected in amblyopia. Sweep multiple, distinct, flat, gray-white lesions scattered VEPs across a range of pattern sizes showed throughout the . No holes, tears or comparable responses from each eye indicating detachments were noted. Fundus potential for improved vision OD with updated autofluorescence showed hyper-autofluorescence correction and continued amblyopia therapy corresponding to the retinal lesions. The optical emphasizing reward-based eye-hand coordination coherence tomography (OCT) of the macula tasks during patching. showed disruption of the photoreceptor integrity Electrodiagnosis helps eliminate organic bases line. The visual field showed an enlarged blind for visual loss in pediatric amblyopia. This case spot. All findings were normal in the left eye. Two also exemplifies the importance of inter- weeks later, the right eye had a best-corrected professional collaboration in patient care. visual acuity of 20/25 with very subtle gray-white Author lesions scattered throughout the retina. Fundus Jeff Rabin, O.D., MS, Ph.D. autofluorescence showed very subtle areas of Co-Author(s) hyper-autofluorescence. The OCT of the macula Emily Zediker, BS remained the same. The visual field no longer had Brian Hatch, BS an enlarged blind spot. All findings were normal in Kelsey Crawford, BS the left eye. Two months after the initial Rachna Patel, BS examination, both eyes had a best-corrected visual Nancy Phan, BS acuity of 20/20. The OCT of the macula was normal in both eyes. All further testing was Case Report Abstract unremarkable in both eyes and complete resolution was seen. Thursday, June 20, 2019 This case demonstrates resolution through 6:30-7 p.m. serial fundus photography paired with fundus autofluorescence of MEWDS. MEWDS is a self- OD-Ocular Disease limiting disease that resolves over several weeks without any treatment. Recurrence is rare and Treatment and Management of Multiple visual prognosis is excellent. Evanescent White Dot Syndrome Author Multiple Evanescent White Dot Syndrome Noor Abushagur, O.D. (MEWDS) is a rare, idiopathic disease most Co-Author(s) commonly seen unilaterally in middle-age females, Jennifer Deakins, O.D., FAOO and can sometimes present before a viral illness. It Andrew Kemp, O.D., FAAO can cause acute, painless vision loss, photopsia, color-vision changes, or visual field loss. A 30-year-old black female presented with sudden onset flashes of light in her temporal visual field of the right eye. The flashes began one week

26 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Case Report Abstract adjacent to the optic nerve. Retinal consultation confirmed OCT and examination findings of the Thursday, June 20, 2019 presence of peripapillary retinoschisis (PPRS) OU 6:30-7 p.m. and central serous chorioretinopathy OS. Fluorescein angiography showed late multifocal OD-Ocular Disease stippled leakage with no evidence of neovascularization. Micro-pulse grid laser was When It’s Not Your Average Chronic Central administered; the resolution of retinal edema Serous Chorioretinopathy remains continuously monitored. Fluticasone propionate (Flonase®, Central serous chorioretinopathy has been GlaxoSmithKline, Brentford, London), widely previously linked to the use of systemic available over-the-counter, represents an inhaled corticosteroids, altering ionic pump function and corticosteroid agent inhibiting phospholipase A2 blood-aqueous barrier permeability along the inflammatory cascades associated with allergic retinal pigment epithelium. Peripapillary rhinitis and sinusitis. Corticosteroids are utilized to retinoschisis is most commonly associated with help manage systemic inflammatory conditions congenital optic nerve anomalies and ranging from auto-immune and inflammatory glaucomatous optic neuropathy. Although the disease to surgical healing. Well documented pathophysiology behind PPRS remains unclear, adverse effects from corticosteroid use include environment factors should be considered as predilection for infection, hyperglycemia, ocular potential triggers for acquired PPRS. A temporal hypertension and central serous chorioretinopathy. relationship of therapy and similar retinal findings This case discusses a patient who presents with have been previously reported. Further PPRS and serous maculopathy after the use of investigation is indicated to elucidate the temporal intranasal corticosteroids. relationship and possible cause-effect. A 67-year-old male presented with complaints Author of a “green ring” in the center of his vision OS. Karen Choi, O.D.; Medical history includes hypertension, hyperlipidemia and seasonal allergies treated with Case Report Abstract Losartan, Amlodipine and Flonase. Best corrected Thursday, June 20, 2019 visual acuity (BCVA) was 20/20 in each eye. Pupils, confrontation fields, and ocular motility were all 6:30-7 p.m. unremarkable. Amsler grid revealed metamorphopsia in the central 5° of fixation OS. OD-Ocular Disease The patient had normotensive IOPs. Slit lamp Panuveitis as Presenting Sign Leading to a examination revealed a flat macula with mild retinal Diagnosis of Syphilis and HIV pigment epithelium (RPE) mottling OS, otherwise unremarkable ocular health OU. The patient was Syphilis, a sexually transmitted bacterial diagnosed with macular mottling OS and infection, is increasing in incidence worldwide. recommended to return at his annual exam. The Ocular manifestations are rare and represent a patient returned the following year with the same subtype of neurosyphilis. Syphilis is the most visual complaints. BCVA was 20/20 OD and common bacterial co-infection in HIV-positive reduced to 20/30 OS. Funduscopic examination patients, and the ocular manifestations of syphilis yielded and intraretinal thickening are often more severe in HIV-positive patients.

27 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Panuveitis has been reported to be the most Case Report Abstract common ocular manifestation of syphilis, especially in HIV-positive patients. Although the association Thursday, June 20, 2019 between , syphilis, and HIV is well- 6:30-7 p.m. documented, it is thought to be rare for uveitis to be the initial clinical sign leading to a syphilis and OD-Ocular Disease HIV diagnosis. In this case, a 31-year-old white female Malignant Hypertension presented complaining of floaters and decreased Malignant hypertension occurs when blood inferior vision in her right eye. She had visited the pressure exceeds 180/120, leading to damage of ER the week before for dizziness, loss of appetite, one or more organs in the body. This condition is fatigue, and a sore mouth and nose for the prior rare and only affects around 1% of people with three months. She also reported losing 120 high blood pressure but when manifests is pounds in the past year without trying. Ulcers on detrimental due to risk of stroke or death. There the tongue and nose were noted during the ER are many causes such as discontinuing blood exam. The ER physician initially diagnosed UTI and pressure medications, kidney failure, tumor of the possible thyroid problems. Upon ocular adrenal gland, and more. Dilated fundus examination, the patient was found to have examinations are a critical diagnostic element in panuveitis more severe in the right eye than the the diagnosis of malignant hypertension because left. Bloodwork was ordered to determine the of the classic appearance it will have with fundus cause of panuveitis. RPR, FTA-ABS, and VDRL evaluation, and optometrists should be aware of were reactive, and neurosyphilis was confirmed the significance in prompt diagnosis and treatment. with a lumbar puncture. HIV testing was ordered A 49-year-old new female patient came in as an following syphilis diagnosis, and the patient was emergency walk-in with a complaint of noticing a diagnosed with HIV with a normal CD4 count. The black spot in her vision in the left eye. It started a patient’s ocular signs and symptoms improved week ago and is ongoing. She also noticed that dramatically with IV penicillin treatment, and she she has been getting headaches, which started was scheduled to begin HAART treatment. around the same time and have been getting Although syphilis is a rare cause of uveitis, the gradually worse. Visual acuity was 20/30+2 in the incidence of syphilis is increasing. Optometrists right eye and 20/40 in the left eye with no should consider syphilis as an etiology of uveitis, improvement with pinhole in the left. Preliminary and remember that HIV is a common co-infection tests were all normal and anterior segment was in patients with syphilis. Ocular signs can be critical unremarkable. IOP was 16 mmHg for both eyes. in identifying the correct initial diagnoses and Fundus evaluation showed bilateral disc edema guiding proper ocular and systemic treatment. with scattered flamed-shaped hemorrhages, Author cotton wool spots, and arteriovenous nicking in Ashley Toland, O.D. both eyes. OCT of the macula revealed bilateral serous retinal detachment and OCT of the optic nerve agreed with edematous nerve appearance on fundus evaluation. Due to bilateral disc edema, blood pressure readings were measured and significantly elevated at 196/126. She was urgently referred to her primary care physician to manage

28 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

her blood pressure and to return for re-evaluation vision loss is described as a curtain that came over in 3 weeks. her vision when she woke up one year ago. It has Treatment of malignant hypertension is not happened since this occurrence. The patient emergent due to risks of irreversible damage but denies any flashes of light, floaters, discharge or must be done in a controlled setting as decreasing watering. Ocular manifestations include entering one’s blood pressure too fast can also cause VA of 20/20 OU, EOM OU (-) Diplopia (-) Pain, CVF damage. It is important for patients to see their FTFC OD, OS. Anterior and posterior segment internist for treatment. Patients with hypertension were unremarkable. Patient was educated on should have regular fundus examinations to condition and on possible length of duration. The monitor for sudden changes in retinal vasculature, patient began to become emotionally upset during lesions or edema. the exam and began to cry. She was referred to Author ambulatory care to see a nurse in primary care for Rashad Haddad, fourth-year optometry student pain-relieving medication secondary to emotionally unstable behavior due to trigeminal neuralgia. The Case Report Abstract patient was also given a neurological consult and will return to clinic after to perform a VF 24-2. Thursday, June 20, 2019 Patients with trigeminal neuralgia suffer from 6:30-7 p.m. chronic, persistent pain that may need to be treated with pain-reliving medication. Many times, PC-Primary Care the patient’s signs and symptoms are ignored because of lack of physical evidence. A diagnosis A Clinical Case of Trigeminal Neuralgia is based on the signs/symptoms, a patient history Trigeminal neuralgia is a chronic pain that and clinical evaluation including a neurological affects the trigeminal nerve. There are two types: consult. the classic form, which is a sudden sporadic shock Author that lasts for minutes, or an “atypical attack,” Amal Mansoor, O.D. described as a chronic stabbing pain. The trigeminal nerve is divided into three branches: the Case Report Abstract ophthalmic, mandibular and maxillary. Trigeminal Thursday, June 20, 20196:30-7 p.m. neuralgia can be caused by blood vessels pressing on the trigeminal nerve as it exits the brain stem, PC-Primary Care causing damage to the myelin sheath or caused by a tumor. Title: Erythema Multiforme and Serum A 62-year-old female complains of headache Sickness and chronic pain above her right eye that has Erythema Multiforme is a type IV persisted since an injury when she fell in the hypersensitivity reaction that can present with a summer of 2018. She states that the pain’s varying degree of severity. Symptoms can range severity is 8/10 and has not taken any medication. from a mild upper respiratory tract infection and The headache radiates from the back of head to rash to influenza-like symptoms. Over half of the behind her right eye. Patient has a history of cases of erythema mulitforme are related to schwannoma, sinus surgeries and Hashimoto’s medication use. Serum sickness is when the disease. The patient used a nasal spray, which immune system reacts to a medication that helped her sensation of “throbbing.” History of contains foreign proteins. Symptoms develop one

29 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

to three weeks after starting a medication and can Case Report Abstract present with fever, hives, itching, joint pain, joint swelling, swollen lymph nodes and rash. Both of Thursday, June 20, 2019 these conditions can have ocular side effects such 6:30-7 p.m. as blurred vision, sicca, and that can lead to scarring. OD-Ocular Disease A 2yo 3 month Hispanic female presented to her nurse practitioner with an internal hordeolum of Coat’s Disease her left inferior eyelid. She was treated with a Coat’s disease is an idiopathic retinal vascular course of Amoxicillin suspension, 400mg/5mL for disease thatinvolves telangiectasia and massive 10 days, the appropriate dose for her age and exudation. The exudation can be intraretinal and weight of 12kg (26lbs). The hordeolum did not subretinal, which can lead to exudative retinal completely heal after the 10-day treatment. She detachment. It is unilateral 80% of the time was then placed on a 10-day treatment of affecting mainly young males with no racial Amoxicillin + Clavulanic acid, 600mg/5mL predilection. Its clinical presentation involves suspension. On day 19 of antibiotic treatment, the unilateral vision loss strabismus and . patient developed “target-shaped” skin lesions on An 18-year-old Hispanic male presented to the her upper chest. The patient was brought to the clinic complaining of decrease in the vision from ER and diagnosed with erythema multiforme and right eye with onset of 3-4 weeks. He says that his serum sickness. All antibiotic medication was vision has always been 20/20 in both eyes during immediately stopped and she was placed on his school screenings. This was his first eye exam. Diphenhydramine HCL 12.5mg (Pediatric He denied any trauma/injuries or surgeries to his Benadryl), 5 mL every 6 hours, as well as Ibuprofen eyes. His system and ocular health was 100 mg every 4-6 hours for swollen joints as unremarkable as well as his family’s ocular and needed. Acetaminophen 160 mg every 6 hours, health history. Visual acuity was CF@5ft in the right was given as needed for fever. Her condition was eye and 20/20 in the left eye. Pupils showed 2+ monitored daily until it resolved. APD in the right eye. All other entrance testing was Hospitalization may be necessary to treat the unremarkable. On SLE, there was a noticeable sequelae of erythema multiforme when mucus leukocoria during retroillumination over right eye. membranes show signs of an inflammatory DFE showed massive exudation from 4-12 O’clock response. Systemic steroids are an option for with sectoral retinal detachment in the right eye. treatment, but there is some controversy in Left eye was unremarkable. The c/d ratio was literature as to when and how to use them. Most estimated to be 0.30 h/v for right and left eye. cases are self-limited and subside within two to Ancillary testing was done by doing a montage three weeks of onset. Symptoms from serum fundus photo of the right eye. Patient was referred sickness clear up in a few weeks with antihistamine to Boston Medical Center where cryotherapy was and NSAID treatment. done with 35 spots in the right eye. Time course of Author Coat’s disease was unclear, but presentation Jillian Nirenberg, O.D. suggests a degree of chronicity. Patient is being Co-Author(s) closely followed by retina specialist at Ophthalmic Roger Juarez, O.D. consultants of Boston. Coat’s disease has acute exacerbations followed by periods of quiescence. It tends to wax

30 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

and wane thus it is crucial for typically young involved eye. Given both the anterior and posterior children to get periodic eye exams. If caught early, segment findings, she was diagnosed with an blindness can be prevented, and disease can be orbital pseudotumor spectrum disorder. The slowed/halted from progressing. Patients with patient was started on 40 mg of prednisone with a coat’s disease in one eye should go through 10 mg/week taper over 1-month period until her extensive testing on the other eye including regular next rheumatology consult appointment DFE’s, extended fundus photography and FA approximately 1 month later. Full resolution of her should be implemented in follow-up care. ocular findings occurred within 1 week of initiation Author of oral prednisone. Mohit Adlakha, O.D. Prompt recognition of orbital pseudotumor spectrum clinical findings helped lead to this Case Report Abstract anterior and posterior scleritis diagnosis and appropriate treatment. Appropriate ocular workup Thursday, June 20, 2019 can help identify underlying clinical diagnosis 6:30-7 p.m. quickly, as in this case. Additionally, timely referral to a rheumatologist for continued medical OD-Ocular Disease management is important when a patient’s underlying systemic conditions, such as SLE in this Orbital Pseudotumor Spectrum Disorder and case, are less than ideally controlled. Posterior Scleritis in a Systemic Lupus Author Erythematosus Patient Christopher Borgman, O.D.; A 75-year-old AAF presented to our clinic with complaints of a red, swollen, irritated left eye that Case Report Abstract started approximately one month earlier. She denied any trauma, or recent ocular surgeries. Her Friday, June 21, 2019 medical history was positive for: hypertension, hypothyroidism, GERD, heart valve replacement, 9-10 a.m. and systemic lupus erythematosus (SLE). She PC-Primary Care reported she was seeing her primary care physician every 3 months, but had not seen her Clomiphene Citrate Induced Visual Palinopsia rheumatologist for her SLE in over a year because in Polycystic Ovary Syndrome Case of insurance complications. Current medications included: warfarin, hydroxychloroquine (400 mg Palinopsia is the occurrence of visual images daily), metoprolol, indapamide, losartan, and after the stimulus has been removed. The etiology lansoprazole. of palinopsia is unknown; however, it may be Entering visual acuity was 20/20 OD and 20/40 idiopathic or present secondary to cortical lesions, OS. External slit lamp examination revealed an seizures, or pharmaceutical drug therapy. Clomid edematous OS with mild temporal (clomiphene citrate) is an ovulatory stimulant used restriction of eye movement laterally OS. Dilated in infertile women. Visual side effects, including examination was WNL OD, but showed choroidal palinopsia, are rare. folds OS. Reflexive B-scan and posterior pole OCT A 32-year-old white female presented with imaging confirmed classic findings of posterior symptoms of constant “trailing after images” in scleritis with choroidal folds. And an orbital CT both eyes for 2 days duration. She denied scan showed diffuse scleral enhancement of the headaches, pain, photopsia and other associated

31 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

symptoms. She revealed a prior medical history of pigmented epithelium (RPE). Typically, RP presents polycystic ovary syndrome and initiated her as a clinical triad of bone spicule pigmentation, monthly treatments of oral Clomid (clomiphene waxy optic nerve pallor and arteriolar attenuation citrate) 100 mg daily less than one week ago. with symptoms of nyctalopia and visual field Ocular histories were unremarkable. Unaided constriction. Atypical, or variant forms of RP exist, acuities were 20/20 OD,OS. Normal pupillary, where typical clinical signs are absent making the extraocular motilities and color vision and diagnosis difficult or delayed. We present a case of intraocular pressures OU. Normal anterior and posterior subcapsular cataracts (PSC), vitirits, and posterior segment findings OU, respectively. —all bilateral—as presenting Humphrey visual field (24-2) and optical coherence signs of atypical RP. tomography (OCT) were reliable and showed no A 27-year-old white female presented for evidence of significant defects. She was instructed evaluation of blurry vision at distance and near with to return to her gynecologist to rule out toxicity. An her current glasses. She also reported difficulty MRI of the brain and orbits was ordered, which driving at night due to glare and bilateral floaters. yielded normal findings. The patient was diagnosed Medical history was unremarkable and the patient with probable clomiphene-citrate-induced visual denied any current use of medications. Best palinopsia. She was instructed to discontinue corrected visual acuity was 20/40-2 OD and clomiphene citrate immediately. Two months later, 20/40-2 OS. Automated perimetry was remarkable her palinoptic symptoms moderately improved but for peripheral constriction with a central island of did not completely resolve. vision bilaterally. All other entrance testing was Clomiphene-citrate-induced visual palinopsia is unremarkable. Full color vision was noted OD, OS. a rare side effect but may occur in cases of higher Slit lamp exam was remarkable for 2+ PSC OU. prescribed or cumulative dosages. A thorough Dilated examination was remarkable for 2+ vitritis case history, including medications, is essential for OU, indistinct optic disc margins OU, arteriolar ruling out potential ocular toxicity that may attenuation OU, and bone spicules in the mid- otherwise be overlooked if not asked. Drug periphery OU. A B-scan ultrasound was performed induction should be a diagnosis of exclusion. bilaterally confirming the presence of optic disc Author drusen OU. Severely abnormal multifocal Breanne McGhee, O.D., MEd, FAAO electroretinogram (ERG) with severely diminished central retinal cone dysfunction was found Case Report Abstract confirming the diagnosis of atypical RP. The patient was referred to a genetic counselor given her Friday, June 21, 2019 interest in having children. She has also been 9-10 a.m. scheduled with low vision to help with mobility and maximizing her remaining vision. Her cataracts will OD-Ocular Disease be removed at a later time. It is important that the eye care provider Obscurities and Peculiarities: Bilateral understand that variant forms of RP exist and can Posterior Subcapsular Cataracts, Vitritis and manifest differently than the clinical triad of findings. Optic Disc Drusen as Presenting Signs of Additionally, diagnosis and referral for genetic Atypical Retinitis Pigmentosa counseling and low vision services are key to ensuring a complete understanding of the Retinitis Pigmentosa (RP) is an inherited retinal condition and to maximize remaining vision in condition affecting the photoreceptors and retinal those affected.

32 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Author and overall time was slower on the iPad (31s vs. Laine Higa, O.D., FAAO 28s). Eye movements during reading did not differ Co-Author(s) between the iPad and paper. Comprehension Tina Choe scores did not differ between the reading sources, but subjects that read on the iPad first had higher Scientific Abstract comprehension scores. According to the survey, all subjects that prefer paper felt they would perform Friday, June 21, 2019 better with paper. 9-10 a.m. There is a significant difference in reading rate and overall speed between paper and digital Reading Efficiency on Print vs. iPad Reading devices. There was no significant difference in reading comprehension. Eye movements were not The prevalence of technology has shifted how significantly different, but fixation duration was students study. Some studies have shown significantly different. Further investigation is decreased reading speeds and accommodative warranted to determine if this holds true for other lag on some digital devices compared to paper digital devices and with longer passages. text. This study investigated reading Author comprehension, speed, and eye movement quality Amanda Lallensack while reading on a digital device, specifically an Co-Author(s) iPad, compared to paper copies. Elizabeth Pallante Thirty-one subjects completed a pre-exam Nicole DeMarco survey about study materials. Near VAs and CT Melanie Nielsen were taken for eligibility. To ensure consistency, the Alicia Feis, O.D. Harmon distance was utilized during the assessment. Subjects were randomly assigned to Scientific Abstract read the digital or paper copy first. Both passages were available in digital and paper forms and were Friday, June 21, 2019 also randomized. Two of the same passages were chosen, both of which were the highest grade level 9-10 a.m. (10) available for the Visagraph. They then Comparison of the Potential Acuity Meter, answered 10 yes or no comprehension questions. Interferometer, and Near Super-pinhole in A post-exam survey was given asking which Cataract Patients device they felt they performed better on. A paired t-test analysis was performed to compare digital Acuity achieved after cataract surgery may be versus paper copy reading efficiency between and lessened in the presence of macular disease or within subjects. other comorbidities. Potential vision tests allow the Fixations and regressions per 100 words were surgeon to set reasonable expectations. Current not statistically different between the iPad and research contains studies indicating reliability of a paper passages. Fixation duration was longer with single instrument when used to predict outcome, the iPad compared to the paper (p=0.03). Both or compares two instruments head to head. The reading rate (p=0.03) and total reading time purpose of this study was to assess the reliability (p=0.01) were statistically different between the of the potential acuity meter (PAM), laser iPad and paper. Subjects’ reading rates were lower interferometer (LI), and near pinhole (PH) as on the iPad (294wpm) than the paper (318wpm) screening tests to predict postoperative acuity in

33 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

cataract patients. developed a blood clot that moved to his heart, This prospective study used three potential lungs, and brain. He coded and was without vision tests to obtain preoperative acuity oxygen for several minutes. Once his condition measurements from 245 eyes and compare their stabilized, he was transferred to Encompass for values with final best corrected acuity recorded continued recovery and rehabilitation. During our one month post-cataract extraction. Testing initial vision consultation, with prompting from his necessitated some form of achievable Snellen wife, JF stated that during physical therapy the acuity. Subjects with comorbidities were not previous day, he had some trouble with copying excluded. images. He would often draw the mirror image of Each of the three predictive acuity tests the shape he was instructed to draw, and other significantly correlated with post op BVA. Each of times he would be wildly inaccurate with his the three methods is statistically similar. attempt at recreating the shape. Physical Postoperative prediction of acuity in cataract examination showed no abnormal anterior or patients is useful in setting an appropriate posterior segment findings, with the exception of a expectation of outcome for both patient and pre-existing left exotropia. With initial midline shift physician. Comorbidity including macular disease testing, JF drew a diagonal line from the top of the may need to be considered. Utilization of either line on the right to the bottom of the line on the left. PAM, LI, or PH in preoperative testing allows final He then drew well-planned and evenly spaced acuity to be predicted with reliability. vertical lines. During clock dial testing, he initially Author showed good planning skills by appropriately Janice McMahon, O.D. placing the 3, 6, and 9, but then began to fill in the Co-Author(s) circle with evenly spaced lines. Even with Susan M. Ksiazek, M.D. encouragement to place the rest of the numbers on the clock, JF continued drawing lines and did Case Report Abstract not appear to understand the directions. We coordinated care with his physical therapist and Friday, June 21, 2019 occupational therapist to incorporate visual 9–9:30 a.m. processing skills. At our 2nd assessment one week later, JF correctly drew a line down the center BV- during midline shift testing. The same instructions were given as previously, but at this exam he was Neuro-Optometric Rehabilitation in a Patient accurately able to interpret the test. with Visual Perceptual Deficits Following an This case demonstrates the importance of early Acquired Brain Injury intervention and coordinating care among different In America, someone has a stroke every 53 health professionals and educating different types seconds. We see the effects of brain injuries often of practitioners about the importance of during vision evaluations at Encompass Health, an incorporating the visual system into recovery. in-patient rehabilitation center in Jonesboro, Author Arkansas. Angela Howell, O.D. JF is a 41 year-old male who presented to Co-Author(s) Encompass Health for rehabilitation therapy. JF fell Lydia Luther, O.D. Candidate 2019 from a ladder and injured his back three weeks prior to our initial visit. During surgery, he

34 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Case Report Abstract classic band-like inferior thinning which is a characteristic of pellucid marginal degeneration. In Friday, June 21, 2019 inferior , the axial curvature map does 9–9:30 a.m. not display the true corneal shape. It is important to determine whether a crab claw topographic OD-Ocular Disease axial map illustrates a “true” pellucid marginal degeneration or an inferior keratoconus. PMD is a Is It, or Is It Not, Pellucid Marginal rare disease and many patients who present with a Degeneration? A Case Series. crab claw display on an axial map may in fact have Pellucid marginal degeneration (PMD) is a inferior keratoconus. The usage of Scheimpflug bilateral progressive ectatic corneal disorder imaging technology, such as the Pentacam, characterized by an inferior peripheral band of enables the clinician to make the accurate thinning extending from the 4 o’clock to 8 o’clock diagnosis and consider which treatment option is position on the with a 1- to 2-mm margin of most appropriate for the patient. normal cornea between the thinning and the Author limbus. Keratoconus is a condition in which the Jami Parsons Malloy, O.D. cornea assumes a conical shape due to thinning Co-Author(s) and protrusion. It is usually bilateral, non- Louis A. Frank, O.D., F.A.A.O. inflammatory, and asymmetric. The apex of the Joseph Stamm, O.D., FAAO; cone is typically decentered below the apex of the cornea with thinning coincident to corneal Case Report Abstract protrusion. When the apex of the cone is Friday, June 21, 2019 significantly inferiorly decentered, as in inferior keratoconus, a crab claw pattern may be seen on 9–9:30 a.m. axial map imaging which is possible to confuse with PMD. Prognosis and management of PMD CL-Contact Lens and keratoconus are different, and thus should be Orthokeratology for Myopia Control distinguished from each other. We report two patients referred to the Eye and Orthokeratology (OK) is an effective technique Vision Center for scleral contact lens fittings with for slowing myopia progression and reducing axial long-standing diagnoses of pellucid marginal length elongation in myopic children. Higher degeneration. In both cases, the patients had been degrees of myopia are associated with higher risk followed for many years with variable success in of retinal detachment, glaucoma, and cataracts soft contact lenses. In both cases, Pentacam due to increased axial length. Overnight OK lens images were obtained revealing irregular wear utilizes reverse geometry design rigid gas astigmatism with a classic crab claw axial permeable contact lenses that temporarily reshape curvature appearance, inferior anterior and the cornea to correct . posterior corneal elevation, and coincident corneal 8-year-old South Asian female presents for a thinning, but did not display the typical myopia evaluation and comprehensive eye tomographic appearance diagnostic of PMD. examination. Patient complains of constant blurred Many PMD cases reported in the literature vision in both eyes at distance with bifocals for the actually have corneal topographies compatible with past two months and states worsening of inferior keratoconus. These eyes do not show the symptoms. Patient was previously on atropine

35 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

treatment and has a family history of high myopia. Case Report Abstract Corrected visual acuity is 20/200 in the right eye and 20/100-1 in the left eye at distance. Manifest Friday, June 21, 2019 refraction showed an increase of -1.50DS in the 9–9:30 a.m. right eye and -0.75DS in the left eye from a four- month-old prescription at her last eye exam. OD-Ocular Disease WaveNight lenses were designed using the patient’s topographical data. Patient returned with Idiopathic Macular Hemorrhage 20/30 in the right and left eye after one night of OK Idiopathic Macular Hemorrhage (IMH) usually wear. Patient presented with 20/20-2 in the right occurs in an otherwise healthy eye typically in eye and 20/25- in the left eye at the one-week female patients younger than 40 years old. The follow-up. Patient’s vision was stable at the one- exact pathogenesis of IMH is unclear and is poorly month follow-up and improved to 20/20 at the understood as its name suggests and it is a four-month-follow-up. Topography images diagnosis of exclusion. illustrated a defined bulls-eye and the lens A 25-year-old white female presented with a exhibited good centration and movement on both brown spot in her vision for the past three days. eyes. The patient will continue with OK nightly wear The patient reported no precipitating factors and and monitored for myopia progression through only took notice of the spot as she was looking at axial length, refraction, and corneal topography. a white screen on her phone. The patient’s ocular Orthokeratology is a safe and effective history was unremarkable except for a small approach for myopia control and is designed to amount of astigmatism, for which the patient wore provide clear unaided visual acuity. Myopia corrective lenses. The patient presented with no progression has become a critical public health significant past medical history and no family issue and eye care practitioners should become history of eye diseases. Visual acuity was 20/20- in proficient in fitting orthokeratology lenses to the right eye and 20/20 in the left eye. improve patients’ ocular health outcomes. This Supplementary testing of Amsler Grid revealed a patient was able to achieve better visual acuity and discoloration inferior to center in a tear drop shape myopia control with OK than spectacles and in the right eye with normal findings in the left eye. atropine. Long-term success of orthokeratology On dilated fundus exam, there was a dark fluid treatment warrants a proper lens fitting, filled area superior to the macula matching the conscientious compliance to contact lens hygiene shape the patient described on Amsler Grid. She and care regimen, and adherence to follow-up was initially diagnosed as having central serous examinations. retinopathy due to the location and fluid Author accumulation under the macula. However, on OCT Leanne Leung, O.D.; the fluid in question was not serous but rather had a trace amount of blood, making the fluid on the OCT appear hazy. Additional testing with a red-free fundus revealed the area in question was hypo- fluorescent due to the blood that was present. Her blood pressure was normal, and further blood work showed no evidence of any underlying diseases that could cause hemorrhages. The differential diagnosis for IMH is extensive

36 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

and includes: , hypertensive was unremarkable, including dilated ocular health. retinopathy, central serous retinopathy, valsalva Corneal topography revealed keratometry values of retinopathy idiopathic telangiectasia type 1, sickle 44.34@129/43.87@039 OD, and 46.88@034/ cell retinopathy, anemia, and Terson’s syndrome. 44.00X124 OS as well as a classic “kissing doves” For a conclusive diagnosis of Idiopathic Macular pattern in the left eye. Due to the suspicion for Hemorrhage, all possible etiologies must be ruled pellucid marginal degeneration, the patient was out. IMH can have spontaneous resolution that can referred to a corneal specialist for further evaluation occur within weeks to months. Patients are and treatment. Glasses were ordered in order to advised to avoid strenuous activities and correct the patient’s vision. anticoagulants that could interfere with the Pellucid Marginal Degeneration, although rare, resolution of the hemorrhage. can be easily mistaken for keratoconus given Author similar clinical appearances. Therefore, a good Kirsten Weitzel, Optometry Student; topography image is necessary in order to properly differentiate between the two conditions and give Case Report Abstract the proper diagnosis. There are many treatment options available; however, patients with pellucid Friday, June 21, 2019 can often be difficult to fit with traditional gas- 9–9:30 a.m. permeable contact lenses, so often patients will require scleral lenses or surgical intervention as the OD-Ocular Disease condition progresses. Some surgical options include penetrating keratoplasty and corneal cross- Pellucid Marginal Degeneration linking. Pellucid Marginal Degeneration is a progressive Author non-inflammatory disorder characterized by a Christina Romano, BS; peripheral band of thinning in the inferior cornea in a crescent shape. It is one of the corneal ectasias Scientific Abstract and has a similar case presentation to Friday, June 21, 2019 keratoconus. It is typically a bilateral condition, but can affect both eyes asymmetrically. Patients will 9–9:30 a.m. typically show high amounts of against the rule astigmatism and a classic “kissing doves” pattern Exploratory Data Analysis of Infant Patients on topography imaging. Seen at an Academic-Based Urban Clinic A 30-year-old black male presented with a from 2015 - 2018 complaint of distance blur OU. He denied any Vision disorders are the 4th most common other ocular symptoms and his last eye exam was disability in the U.S. and the most prevalent in 2015. He is unremarkable for any systemic or handicapping condition during childhood. ocular conditions. Corrected visual acuities were Untreated pediatric ocular and visual dysfunction 20/20 OD and 20/30 OS with a habitual such as uncorrected refractive error, amblyopia, prescription of -1.00sph OD and plano-0.75x110 strabismus, and ocular disease can lead to OS. Entrance testing was unremarkable. Refraction difficulties in development, education, social resulted in a prescription of -1.25-0.75x092 OD interaction, and potential permanent vision loss. and -1.25-3.00x112 OS, with a new corrected Early intervention and treatment improves visual acuity of 20/20 in both eyes. Ocular health treatment outcome and decreases treatment time

37 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

and so early comprehensive evaluation is critical. clinic within six months or less and one was Unfortunately, there is a lack of information in both referred to a neuro-ophthalmologist. parents and healthcare providers in the capacity to This exploratory study shows that a scant which an infant’s ocular and visual system can be number of infant patients are presenting and being evaluated by trained eye care providers and the referred to optometrists for comprehensive importance of a comprehensive ocular and visual evaluation and treatment. Evaluations in some of evaluation in infant patients. these infant patients lead to the diagnosis of ocular A retrospective record review was conducted and visual dysfunctions that needed follow up, on all infant patients presenting to the University treatment, and/or referral. Public outreach and Eye Center (UEC) during the period from January interdisciplinary education about the importance of 2015 to June 2018. Patients were included based eye exams in infants as well as the no cost on age at initial examination (12 months or less). InfantSEE program must be persistent. The following data was collected, where available, Author for each patient: age, sex, referral source, Tamara Petrosyan, O.D.; presenting complaint, birth and medical histories, family ocular history, entering visual acuity, Case Report Abstract binocularity, ocular motility, retinoscopy, anterior and posterior ocular health, need for follow up in Friday, June 21, 2019 less than six months, and if the patients returned 9-9:30 a.m. for their follow up appointment. A total of 88 infants were seen with 46 (52%) OD-Ocular Disease being male and 42 (48%) female with an average age of 6.25 months. Fifty-six (64%) were brought in Posterior Polymorphous Corneal Dystrophy by his or her parent without a referral from an (PPMD) outside provider, 15 (27%) of these patients Posterior Polymorphous Corneal Dystrophy is a presented with no chief complaint, 16 (29%) were rare autosomal dominant disease that is a type of concerned with strabismus, 11 (20%) had various inherited endothelial corneal dystrophy. PPMD ocular health concerns, six (11%) had a positive usually presents in the second to third decade of ocular family history, five (9%) had a suspected life. Patients can be asymptomatic and stable for obstructed tear duct, and three (5%) had vision many years, but this dystrophy may also be and tracking concerns. Only eight patients progressive, thereby making the patient mentioned the InfantSEE program as their incentive symptomatic. PPMD presents in one of three main for the visit. Thirty-two (36%) of the 88 total forms: vesicle-like lesions, band lesions, or diffuse patients were referred to the UEC, with the majority opacities. (21 or 24%) referred by an ophthalmologist for A 32-year-old male presented to the clinic for a scleral lens fitting following a comprehensive eye exam with complaint of blur at extraction. Of the 67 phakic patients, 60 were distance, especially at night in both eyes without evaluated for refractive error through retinoscopy correction. His last eye exam was two years ago with 21 showing myopic and 39 showing and he was last dilated in 2012. He had no other hyperopic refractive error with 38 instances of ocular complaints. Medical and ocular history were astigmatism. Ten (11%) patients were diagnosed unremarkable. Family medical and ocular history with strabismus and 24 (36%) of the phakic were also unremarkable. The patient’s unaided patients had a positive ocular health finding. Of the visual acuities were 20/25 OD and 20/20-2 OS, 67 phakic patients, 29 were asked to return to

38 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

but he corrected to 20/20 in each eye. Intraocular vision loss. The presence of CRAO should prompt pressures were within normal limits at 12 mmHg immediate referral to a stroke center for evaluation. OD and 13 mmHg OS. Slit lamp biomicroscopy The visual prognosis is poor with no effective revealed a horizontal band lesion consistent with therapy to date that restores retinal function. The PPMD in the right eye. The lesions spanned the following is an atypical presentation of CRAO. entire horizontal length of the cornea OD; the OS 73-year-old male was referred by ER for acute cornea was unremarkable, as were all other visual disturbance in the left eye noted upon anterior segment findings. A dilated fundus exam awakening. PMH: extensive coronary artery was also unremarkable. disease, atrial fibrillation, myocardial infarction, and This autosomal-dominant disorder was not mitral valve insufficiency with prosthetic valve on present at the last eye exam two years ago, so Warfarin and Plavix. Due to GI surgery 1 month monitoring of this condition periodically is prior, bridge anticoagulation resulted in sub- important. This disease can be progressive, which therapeutic INR. At the initial visit, BCVA was results in corneal edema, decreased visual acuity, 20/25-1 OD, 20/150-1 OS. However, there was no photophobia, foreign body sensation, and APD, CVF were FTFC OD/OS, slit lamp, DFE and increased intraocular pressure leading to OCT were unremarkable OU. Given PMH and glaucoma. In severe cases, surgical intervention symptoms, stroke work-up was recommended. with penetrating keratoplasty may even be During his hospital admission for observation and required. In this case, the patient was work-up, there was further decrease in vision OS. asymptomatic, the IOPs were normotensive, and This exam revealed CF at 5’ OS, 3+ APD OS, the band lesion was not significantly impacting cherry red spot on DFE OS and perimacular vision, so the patient did not require treatment. He thickening on OCT OS. Anterior chamber was instructed to return to the clinic in one year for paracentesis was performed same day by retinal monitoring. specialist, but further reduction in vision was noted Author at 1-week follow-up (HM OS). The cherry red spot Kaitlyn Bishop, optometry student persisted until 3-month follow-up when DFE Co-Author(s) revealed vascular attenuation and OCT showed Jonathan Jacesko, O.D. diffuse perimacular thinning, vision was mildly improved at the visit to CF at 3’. Case Report Abstract Patients with CRAO typically present with acute painless decrease in vision accompanied by signs Friday, June 21, 2019 of retinal ischemia such as thromboembolus and 9–9:30 a.m. cherry red spot. This case illustrates that visual symptoms of CRAO may precede retinal findings OD-Ocular Disease despite the retina’s high sensitivity to ischemia. This case also highlights the significant effects of Symptoms Preceding Signs: Atypical subtherapeutic anticoagulation therapy which may Presentation of Central Retinal Artery precipitate thromboembolic events such as CRAO Occlusion in the case. Central retinal artery occlusion (CRAO) is a well- Author recognized, relatively common ophthalmic and Suzzane Li, O.D., FAAO medical emergency requiring immediate attention Co-Author(s) as it is equivalent to a cerebral stroke. Patients Danielle L. Weiler, O.D., FAAO usually present with sudden, painless unilateral Huey-Fen Song, O.D., FAAO

39 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Scientific Abstract conditions, by increasing the effectiveness and efficiency of diagnosis. Friday, June 21, 2019 With the support derived from the AOF/ 9-9:30 a.m. Johnson & Johnson Vision Care, Inc. 2016 Innovation in Education Grant, we developed the Innovation in Education - OCTaVIA - OCT first-of-its-kind OCT reference iOS app, named VIsual Atlas iOS App OCTaVIA (Optical Coherence Tomography VIsual Atlas). The app was launched to the Apple Store The widespread availability of Optical on Nov. 1, 2018, and is currently available for free Coherence Tomography (OCT) has revolutionized for iPhone and iPad. The app is intended to allow diagnostic approaches to retinal pathology by users to search for a specific ocular disease by allowing for microstructural characterization of name, or by keywords describing a specific OCT disease processes, leading to improved differential finding in ocular diseases. It also provides eye care diagnosis. While often extremely valuable in clinical professionals with normal OCT reference material practice, OCT imaging requires training and and corresponding OCT with Fundus Photography expertise in order to benefit diagnostic images for multiple retinal disease conditions, as effectiveness and efficiency. Specifically, well as a brief disease-specific description of OCT pathognomonic imaging patterns and findings images, high-yield key considerations and useful must be recognized and placed in the correct links to aid in the differential diagnosis. clinical context in order to arrive at a diagnostic Participants of the study were current OD4 conclusion. Students who are approaching OCT students from New England College of Optometry imaging from a beginner’s standpoint are often (NECO) who successfully completed NECO’s overwhelmed by the amount and complexities of Clinical Ocular Imaging Topics course taught in the data provided, and therefore turn to reference summer of their OD3 year (Summer 2017). materials to support the diagnostic process. Participants had to be able to use web-based Currently available resources (textbooks, articles, computer programs (such as Moodle) and have web-based references), while comprehensive, are electronic devices (such as iPhone), as well as own often too in-depth to be of immediate assistance. an iOS device (iPhone or iPad) that was used for Furthermore, their use is often too logistically the study. All communication and testing/surveys cumbersome for daily clinical teaching/ practice were done online. The study received IRB approval (e.g., requiring the physical availability of books or from NECO Institutional Review Board (IRB) in May a computer to access digital material). A dedicated 2018. The study consisted of two short online smartphone/tablet app presenting well-annotated surveys (6 questions each) and one 20-question OCT reference images by diagnosis in a clear, OCT image interpretation test, all available to the succinct manner would overcome these participants via the Moodle program 1. OCT Topic challenges. Although there is an abundance of Familiarity Survey: a brief survey consisting of 6 smartphone/tablet apps, there is little in regards to questions aimed at quantifying OCT topic familiarity OCT data review. Such an app would represent a prior to testing with one additional question for valuable tool for learners familiarizing themselves intervention arm only representing a self-screen of with the clinical applications of OCT to retinal ability to use the smartphone app; 2. OCT Image disorders. This proposal sought to clarify whether Interpretation Test: a 20-question OCT Image the novel smartphone/tablet app can assist Interpretation test depicting retinal pathological learners (specifically optometry students) in conditions of clinical relevance; and 3. Satisfaction diagnosing common retinal pathological Survey: a 5-question satisfaction survey with one

40 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

additional question about the type of sources used correct answers in the test group versus 50% by a participant to answer OCT Image correct in the control group). Multivariable analyses Interpretation Test. A total of 28 participants were confirmed that this systematic difference in test randomized to answer the 20-question test using performance was independent of age, gender, as diagnostic support either: 1) conventional GPA, and self-reported familiarity on OCT. Basic reference material, including OCT books, internet OCT knowledge (as assessed by the OCT Topic references and personal notes (control group, n = Familiarity Survey) and daily use of OCT in clinical 14); 2) the dedicated iPhone/iPad smartphone/ practice were also independently associated with tablet app OCTaVIA for personal use (intervention performance on the diagnostic challenge test. We group, n = 14). After completion of OCT topic also found that participants using the OCTaVIA app familiarity survey, students were asked to complete demonstrated significantly higher level of within 4 weeks the individual portion of the study to satisfaction across all surveyed questions, provide a diagnostic interpretation for 20 OCT compared to those who used conventional images, depicting retinal pathological conditions of reference material (all p-values for comparison < clinical relevance. These included (but were not 0.05). Satisfaction rate (on the scale of 1 to 5 with limited to (macular drusen, , 5 being the most satisfied) amongst students in the choroidal neovascularization, RPE migration, control group averaged around 2.6 whereas cystoid macular edema, central serous, RPE satisfaction rate amongst students in the test detachment, macular hole, pseudo-hole, group was 4.6 (all p-values for comparison < 0.05). vitreomacular traction, epiretinal membrane, The support derived from the AOF/Johnson & exudates, cotton wool spot, Best’s Vitelliform Johnson Vision Care, Inc. 2016 Innovation in macular dystrophy, retinitis pigmentosa, cone Education Grant was crucial to further the research dystrophy, solar maculopathy, choroidal nevus, into the application of new technologies to crystalline maculopathy and plaquenil maculopathy. optometric education. The grant allowed us to This web-based portal kept track of answers and develop the first-of-its-kind OCT reference iOS time from initial viewing of images to diagnosis for app, named OCTaVIA, that consisted of normal each question individually. Students were able to OCT reference material and corresponding OCT complete the images’ review over multiple sessions with Fundus Photography images for dozens of by saving their work progress, thus maximizing retinal disease conditions. This innovative teaching comfort. module resulted in higher satisfaction rates among We found no differences in age, gender and NECO students, as well as 20% better test GPA when comparing students randomized to use accuracy on diagnosing retinal pathological of conventional reference material (control group) conditions. This study provides a clear example for with those randomized to utilize the OCTaVIA app creating tangible learning gains through the (test group), all p-values for comparison > 0.05. integration of educational technology in optometric There were also no differences in OCT usage education. patterns, self-reported familiarity with OCT in Author general, or in performance in a three-question test Elena Biffi, O.D. of basic OCT knowledge (all p-values for comparison > 0.05) between the two groups. In univariable analysis participants randomized to use the app scored significantly higher on the 20-question diagnostic challenge test than those who used conventional reference material (70%

41 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Case Report Abstract macula OD in the deep inner retina scan (IPL-OPL). There was normal arteriolar fill with no signs of Friday, June 21, 2019 ischemia OS. Both eyes showed within normal 9:30–10 a.m. outer retina (OPL-Bruchs) and scans. Because PAMM typically presents with OD-Ocular Disease paracentral and unremarkable or mild fundus findings on clinical examination, the use of The Role of Imaging Techniques in the Case SD-OCT and OCT-A are crucial. These ancillary of Paracentral Acute Middle Maculopathy tests have gained significant momentum in recent (PAMM) years in aiding clinicians with diagnosis, treatment, Paracentral acute middle maculopathy (PAMM) and management of many posterior segment is a relatively novel disease with a predilection for conditions. This case explores the development of older men with systemic vascular disorders or PAMM and how vital imaging techniques are in retinal vascular disease, such as diabetes, detecting a disease process that is often hypertension, sickle cell anemia, and retinal vein overlooked or misdiagnosed. and artery occlusions. While the exact etiology is Author unknown, it is often preceded by an event Stephanie He, O.D. triggering retinal capillary vasospasm, which Co-Author(s) ultimately causes ischemic injury to the Steven Ferrucci, O.D., FAAO microvasculature at the level of the INL and OPL. Brenda S. Yeh, O.D., FAAO Therefore, on acute presentation, a hyper-reflective band of OPL can be detected on spectral-domain Case Report Abstract optical coherence tomography (SD-OCT) with Friday, June 21, 2019 subsequent thinning of the INL upon resolution correlating with the area of ischemia. 9:30 – 10 a.m. This case explores a 75-year old male who experienced a retinal migraine in the right eye. OD-Ocular Disease Upon resolution of the migraine attack he was left PXE: A Complex Genetic Disorder with a dark spot in his vision. The patient did not seek any additional care until four months later Pseudoexfoliation (PXE) is a generalized when he presented to the eye clinic. Best systemic disorder of elastin formation resulting in corrected visual acuity was 20/20 in both eyes with the deposition of fine, gray-white, dandruff-like unremarkable entrance testing and anterior material on the lens capsule, , and anterior segment evaluation. On fundus examination there segment structures. Ocular concerns of PXE was a small area of faint hypopigmentation nasal to include secondary glaucoma and complications the fovea in the right eye. With the use of SD-OCT during cataract surgery. PXE is a systemic an area of general retinal attenuation with condition, also involving the skin, heart and lungs. moderate macular pucker was observed in the PXE can occur in all ethnicities but has a right eye. Optical coherence tomographic prevalence up to 25% in specific Scandinavian and angiography (OCT-A) revealed normal arteriolar fill South African populations. Patients generally in the en face superficial inner retina scan (ILM-IPL) present >50 years of age, women>men. The with one small area, approximately one-disc genetics of PXE have been mapped to diameter, of non-perfusion superior nasal to the chromosome 15q24 (LOXL1 gene). Research has

42 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

linked PXE prevalence to genetics predispositions Case Report Abstract combined with environmental stresses such as oxidation, ischemia and mechanical stresses, Friday, June 21, 2019 making PXE a complex genetic disorder. 9:30–10 a.m. A 70-year-old male presents to clinic for a complete eye exam. The patient did not have a OD-Ocular Disease primary complaint at this visit as his vision was stable. The patient’s ocular history was positive for A Case of Polypoidal Choroidal Vasculopathy cataracts, ERM OD and PXE OS. The patient’s - Utilizing Advanced Imaging Modalities to systemic health was positive for Hypertension, Appreciate the Pachychoroid Spectrum of Dysrhythmia, Asthma, PTSD, Hyperlipidemia and Diseases Rheumatic Fever as a child. Visual acuity was Polypoidal choroidal vasculopathy (PCV) is a 20/20-1 OD and 20/20-2 OS. Intraocular was form of type 1 neovascularization characterized by 14mmHg OD and 12mmHg OS, similar to multiple shallow irregular pigment epithelial historical IOP’s. Dilated exam revealed unilateral detachments (PED) in the absence of drusen. The PXE OS, +1 Nuclear sclerotic cataracts OU, 0.3 recently described pachychoroidal spectrum of CD ratio OU and otherwise unremarkable findings. diseases are macular conditions that share Patient was previously considered a glaucoma choroidal variations of increased thickness and suspect, hence performing historical OCT, IOP, VF dilated vasculature (often referred as and pachymetry testing. However, no glaucoma pachyvessels). PCV, along with central serous development has yet to present. chorioretinopathy (CSC), pachychoroid pigment This patient’s presentation of PXE is a red flag epitheliopathy (PPE), and pachychoroid for systemic conditions. Additional examination neovasculopathy (PNV) currently comprise the would be necessary to determine if PXE could be described pachychoroid spectrum. Imaging correlated with this patients’ systemic modalities such as enhanced depth imaging presentations of cardiac and lung issues. Some optical coherence tomography (EDI-OCT) and research suggests that there is no correlation fundus autofluorescence (FAF) allow for precise between PXE and asthma. Genetic research choroidal thickness measurements and improved suggests environment stresses take advantage of visualization of choroidal composition and genetic deficiencies to spike inflammatory assessments of RPE health. mediators affecting fibrotic assembly processes. A 55-year-old white male presented with a This results in a dysregulated protein cross linking complaint of a bilateral decrease in vision process eventually leading to degradation and worsening for one week. Health history was aggregations. While this patient did not have any unremarkable and patient denied use of any serious manifestations from his PXE, it remains topical, oral, or nasal steroids. Ocular health history possible for his disorder to progress under an included only refractive error and . Best influence from environmental stresses. corrected visual acuities were OD 20/20 and OS Author 20/20- with no significant refractive change. Kellen Plomski, O.D., MPH Extraocular muscles were full and pupils were equal, round, and reactive to light with no APD. Anterior segment findings were all normal. Intraocular pressure measured via Goldmann were 16 mmHg OD and 17 mmHg OS. Dilated

43 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

funduscopic exam revealed 0.25 C/D ratio OU. their forties and fifties. Subfoveal serous detachments were observed Our first patient is a 36-year-old white female without evidence of a choroidal neovascular who presented for a routine eye exam with no membrane. Multiple scattered shallow focal PEDs complaints. During our patient’s visual examination, were observed in the posterior pole of both eyes we were unable to correct her vision to a crisp and imaged with fundus photography. FAF imaging 20/20. On Amsler grid, she described a ¼ inch ring revealed irregular mottled hyperautoflorescence in of distortion surrounding the center dot of the grid. both maculas. Peripheral retinal findings were Slit lamp examination was normal with the unremarkable. Macular OCTs including EDI-OCT exception of her maculae. The macula of each eye line scans were also obtained. OCT line scans demonstrated macular pigment changes in a ring- confirmed serous fluid OU. Increased subfoveal like pattern. There was no edema, hemorrhage or choroidal thickness was measured at 426 microns exudate OU. Peripheral retinal anatomy was OD and 462 microns OS and dilated outer normal OD. There were two small areas of lattice choroidal vessels were present in both eyes. degeneration inferior OS, one with a small retinal Patient was referred to retina for an indocyanine hole unrelated to the macular condition. There green angiography (ICG) for confirmation of PCV were no bone spicules in either retina. Once this diagnosis. condition was observed in our patient a series of Advancements in imaging such as EDI-OCT diagnostic tests were performed including ocular and FAF aid in the differentiation of PCV and other coherence tomography, fundus autofluorescence, pachychoroid spectrum conditions. Distinction is (ERG), multifocal ERG, and critical to avoid mismanagement, as observation fundus photography. Then, a thorough eye rather than surgical intervention is often indicated assessment was performed on her immediate in pachychoroid cases. family. Neither her parents nor her 28-year-old Author brother exhibited any of the same characteristics. Nathan Traxler, O.D.; However, upon examination her 39-year-old sister demonstrated early macular RPE abnormalities in Case Report Abstract only her left eye. In the case of the 39-year-old, this was very mild with no other signs or symptoms. Friday, June 21, 2019 Pattern dystrophies are often difficult to 9:30–10 a.m. diagnose as they can masquerade as one another. Numerous advanced testing procedures can assist PC-Primary Care in the diagnosis of these diseases. Although these conditions are rare, it is vital that we determine Macular Pattern Dystrophies in Two Sisters how to stop the progression of these diseases and Dystrophies primarily involving the retinal preserve the vision for these patients. Gene pigment epithelium (RPE) often have a genetic therapies, while they have many significant origin. Pattern dystrophies specifically are often challenges, possess the best prognosis for these autosomal dominant and can present with a wide patients. variety of appearances. Patients with pattern Author dystrophies are typically expected to have good Lori Gray, O.D.; vision, but in some cases, they experience a slow decline of their central vision. This group of diseases typically present in patients who are in

44 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Scientific Abstract Recommended low vision sign-to-background contrast values of the LVDC were met in 2 of 9 Friday, June 21, 2019 (22.2%) signs. Recommended low vision character 9:30–10 a.m. contrast values of the LVDC were met in 1 of 11 (9.1%) signs. Recommended illuminance values of Readability of Wayfinding Signage at the IES for normal-sighted and for low vision Midwestern Eye Institute for the Low Vision populations were met in 11 of 14 (78.6%) and 7 of Population 14 (50.0%) signs, respectively. Although signs may be approved by ADA It is essential for low vision patients to have the Standards, they may not be sufficient for the low ability to comfortably navigate the clinical setting vision population to use in essential, daily and access their doctors. This is often wayfinding. Re-evaluating the parameters, such as accomplished by using common, wayfinding contrast and illuminance, that are included in signage posted in and around the building; signage standards would facilitate improved however, the requirements laid out by Americans navigation and healthcare accessibility. With Disabilities Act (ADA) Standards fail to Author address factors that are fundamental to visual Caitlin Jomoc, B.S. function, including contrast and illumination. The Co-Author(s)Brianne Hobbs, O.D., FAAO Low Vision Design Committee (LVDC) and the Laura Addy, O.D. Illuminating Engineering Society (IES) have Vladimir Yevseyenkov, O.D., Ph.D. suggested values of contrast and illuminance for Nicole Putnam, Ph.D.; low vision individuals, but these are not incorporated as set standards. Midwestern Case Report Abstract University Eye Institute was surveyed to determine if ADA-approved signage is sufficient for the Friday, June 21, 2019 wayfinding ability of the low vision population. Fourteen interior and exterior signs at the 9:30–10 a.m. Midwestern University Eye Institute were assessed. OD-Ocular Disease A digital caliper was used to confirm that ADA Standards were met, including character width, Management of a Persistent Epithelial height, stroke thickness, spacing, and font style. Defect in a Patient with Stevens-Johnson Luminance was measured using a portable Syndromes/TENS photometer. From this, luminance contrast was calculated using the Michelson equation. Stevens-Johnson Syndrome (SJS) is a reaction Illuminance was measured using a portable digital of the body to a drug, virus, bacteria, etc. which illuminometer. Luminance and illuminance attacks the eyes and other mucous membranes. measurements for each sign were taken within a Toxic epidermal necrolysis (TENS) is considered one-hour window of the same day. Measurements when more than 30% of the skin is detached. One- were compared to recommended contrast and third of SJS cases will develop early ocular illuminance values suggested by the LVDC and involvement, leading to chronic ocular sequelae IES, respectively. Certain sign types, such as non- with lasting visual impairments. One ocular sequela mounted signs, were not included in LVDC that can occur is a persistent epithelial defect recommendations and, therefore, were not (PED). A PED is a corneal abrasion that has lasted assessed for contrast. more than two weeks. This occurs when there is a

45 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

failure in the corneal mechanisms in order to the ocular surface and tears, characterized by promote healing. Typical treatments for this long- insufficient tear production or impaired tear stability, lasting abrasion include ointment, antibiotic drops, ocular surface inflammation, and neurosensory bandage contact lens, debridement, tarsorrhaphy, abnormalities. Since dry eye is associated with and amniotic membranes. various causes, treatment modalities differ A 58-year-old Middle Eastern male with a depending on severity and form. Treatment is history of SJS/TENS presents with a persistent aimed at either restoring or maintaining the tear film epithelial defect (PED) OS since 12/2017. No and ocular surface health, ranging from improvement has been made with amniotic supplemental lubrication to immunomodulating cytokine extract drops, autologous serum, artificial therapy. Another treatment modality that is proving tears, ointment, bandage contact lens, and to be successful for moderate to severe dry eye is tarsorrhaphy. He is also experiencing constant scleral contact lenses. severe dry eye OS with no relief with drops.He is In this case, a 48-year-old Hispanic female interested in being treated with Prosthetic presented for contact lens examination and fitting, Replacement of the Ocular Surface Ecosystem after no success with soft lenses due to chronic, (PROSE) OS after his tarsorrhaphy is removed. moderate dry eye and having multiple unsuccessful PROSE is a specialty scleral lens and was made dry eye treatments. Scleral contact lenses were with Boston XO2 material to optimize oxygen selected as the treatment modality to provide dry permeability. The PROSE device is indicated for eye relief and clear vision at distance and near. The support of the ocular surface in patients with SJS/ patient was initially fit with a Custom Stable Elite TENS that have failed with other treatment diagnostic lens, with a base curve of 7.85, modalities as well as to aid in the healing process diameter of 15.8mm, central thickness of 400 of a PED. This patient was seen at the clinic every microns and prescription of -2.00 SPH in both day regarding the abrasion. The patient was eyes. With adjustment to the prescription and educated to sleep in the lens at nighttime to fitting, the final lenses were Custom Stable Aurora facilitate healing. In less than one month, the defect multifocal lenses with a prescription of -6.00 SPH had healed. OD and -4.50 SPH OS and add power of +3.00; Scleral lenses (including PROSE) are viable best corrected to 20/20 OD and 20/100 OS for treatment options in order to heal a persistent distance, and 20/25 OD and 20/100 OS for near. epithelial defect. Note that decreased acuity in the left eye is Author secondary to toxoplasmosis scars. The patient Kathleen Prendergast, BS; reported contact lens wear of nine to 10 hours per day for seven days per week, with significant Case Report Abstract improvement in dryness symptoms OU, using re- wetting drops about one to three times per day, as Friday, June 21, 2019 needed. 9:30–10 a.m. Scleral lenses are designed to have complete clearance of the cornea and a large diameter to OD-Ocular Disease allow vaulting of the lens across the entire corneal surface forming a fluid reservoir that continuously Scleral Lenses: Treatment Modality of bathes and hydrates the corneal surface,. hence Moderate to Severe Dry Eye Disease providing optimal vision and comfort. These lenses Dry eye disease is a multifactorial disorder of are commonly used for the management of corneal ectasias, but the scope of treatment can be

46 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

expanded to include ocular surface disease as and OD was unable to be determined due to the well. superior temporal dragging of the optic nerve Author head. The surgical procedure to remove the Herman Nijjar, Optometry Student hemangioma resulted in a dragged optic nerve Co-Author(s) head that has caused a large anisometropic Louis A. Frank, O.D., F.A.A.O. refractive error, resulting in amblyopia OD. Amblyopia is the most common ocular Case Report Abstract complication of periocular and orbital capillary hemangiomas in infants. If it is suspected that Friday, June 21, 2019 amblyopia will occur secondary to the capillary 9:30 –10 a.m. hemangioma, removal via medication or surgery should be initiated. When the tumor is intraorbital, OD-Ocular Disease methods such as ultrasonography, CT, MRI, or angiography can be used to determine the location Orbital Capillary Hemangioma Removal in a of the tumor. Ocular surgery in infants carries Premature Infant Resulting in Dragged Optic possible complications, including large amounts of Disc blood loss and unintended excision of surrounding Capillary hemangiomas are the most common orbital structures. The risks and benefits of ocular eyelid and orbit tumor in childhood with a surgery to remove the capillary hemangiomas is prevalence of one in 10 births. These tumors are weighed in order to determine the proper treatment more prevalent in females and an increased to decrease the risk of amblyopia. incidence is seen in premature infants. The majority Author of capillary hemangiomas are benign lesions that Emily Crump, O.D. in May 2019; often resolve on their own, however some may indicate a systemic syndrome or can cause Case Report Abstract amblyopia due to strabismus, visual deprivation or Friday, June 21, 2019 anisometropia. If the tumor is causing an obstruction of the visual axis, or large enough that 9:30–10 a.m. it depresses the infant , it can cause significant amblyopia and should be treated OD-Ocular Disease promptly. Lesions can be treated with oral Bilateral Papillitis Secondary to Neurosyphilis medications, laser therapy, steroid injection or surgical excision. Syphilis is caused by spirochete bacterium A 24-year-old female presents complaining of Treponema pallidum. It is a sexually transmitted blurry vision at distance with her glasses. Patient disease and is most often seen in homosexual was born 2.5 months premature and had a males. Syphilis is difficult to diagnose due to multi- capillary hemangioma behind her right eye system symptoms. For this reason the disease is removed at one month of age. The patient stated known as “the great pretender.” Syphilis is divided that she was patched as a child. Her BCVA was into different stages: primary, secondary, latent and 20/30 OD and 20/20 OS with a refraction of -5.00- tertiary. Tertiary stage is very serious and can 5.25x 008 OD and -4.00-3.00x 178 OS. All present as neurosyphilis which means there is an entrance testing was unremarkable. On dilated invasion of nervous system by the spirochete. fundus examination the cup to disc OS was 0.3 Neurosyphilis can cause variety of symptoms such

47 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

as headaches, loss of coordination, paresis, Case Report Abstract dementia and ocular complications. A 63-year-old homosexual male presents to Friday, June 21, 201912–12:30 PM clinic complaining of blurry vision in both eyes OD-Ocular Disease since he had an acute kidney failure about three weeks ago. Patient described vision as if he was Combating Dry Eye in a GP Lens Wearer with looking through a plastic bag and seeing patches Ocular Rosacea of black spots that move around. Patient denied flashes, pain, and diplopia. Patient’s systemic It has been shown that the number one reason health was positive for HIV, benign essential for contact lens (CL) dropout is discomfort. hypertension, nephrotic syndrome, fibromyalgia, Patients with symptomatic dry eye are even more and PTSD. Patient’s ocular history was significant susceptible to discomfort with CL wear. These for in the left eye, double patients also regularly experience burning, stinging, vision, and hemorrhagic posterior vitreous and blurred visual acuity (VA) secondary to poor CL detachment. Patient’s presenting visual acuity was wettability. In 2017, Tangible Science developed a 20/20-2 in the right eye and 20/40 with no hydrophilic compound called HydraPEG that improvement on pinhole in the left eye. Extraocular bonded specifically to the surface gas permeable muscles, pupils, confrontational fields, and color (GP) CLs to increase wettability and lubricity and testing was unremarkable. Anterior segment decrease protein/lipid deposition. Intense pulsed testing was also unremarkable. Upon dilated light (IPL) was FDA approved in 1995 to fundus exam, significant bilateral optic nerve dermatologically treat telangiectatic blood vessels swelling was seen. OCT of the optic nerve was in conditions such as acne rosacea. A few years performed which showed corresponding swelling later, studies were being published about the of the retinal nerve fiber layer. Patient’s initial significant improvement of dry eye symptoms with sedimentation rate was extremely elevated. Lab IPL in patients with meibomian gland dysfunction testing came back positive for RPR and secondary to ocular rosacea. This case highlights a quantiferon gold. PPD testing and chest X-ray corneal GP lens patient with a history of end-of- were negative. MRI was unremarkable. Patient was day CL discomfort experiencing a notable treated with IV Penicillin G for 14 days. Patient was improvement in her CL comfort after coating her already on Doluntegravir and Emtricitabine/ GP lenses with HydraPEG and completing four IPL tenofovir for HIV. treatments. Papillitis can be caused by many conditions; A 54-year-old white female presents with a however, there are diagnostic tests that can assist history of significant dry eye wishing to return to in finding the right etiology. In case of syphilis, tests full-time GP wear. She has been on a variety of dry such as RPR, VDRL, FTA-Abs, TP-PA, MHA-TP, eye disease (DED) treatments including Restasis, dark field microscopy, EIA and MFI can be ordered. Lipiflow, fish oil tablets, warm compresses, and It is crucial to detect even mildest papillitis cases artificial tears. Her medical history was significant as they may be life threatening. for a recent diagnosis of acne rosacea, for which it Author was recommended she undergo IPL treatments. Maneh Gevorgyan, Optometry Student; She was diagnosed with concomitant ocular rosacea in-office. HydraPEG was applied to her GP CLs and the patient reported she was able to return to an eight-hour wear schedule. For further symptom relief and cosmetic reasons related to her

48 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

ocular rosacea, she underwent the monthly IPL This finding, alongside central visual field loss on treatments. Following four sessions of IPL, her screening visual fields, warranted further testing. Standardized Patient Evaluation of Eye Dryness One week later, a macula OCT was performed (SPEED) score improved from 9/28 to 13/28. showing a decreased foveal contour with a classic Patient has also begun to downsize her dry eye “flying saucer” appearance. A 10-2 Humphrey management regimen. visual field revealed bilateral paracentral scotomas. Dry eye disease is a condition that affects a Fundus autofluorescence confirmed a parafoveal large population of patients to some degree. ring of speckled hypoautofluorescence, left eye HydraPEG and IPL are both viable additions to more progressed than right. Ishihara color testing your clinical arsenal to combat dry eye in contact revealed a decrease in sensitivity. TG’s PCP was lens wearers. promptly notified and the patient was taken off Author hydroxychloroquine. At a three-month and six- Tina Zhu, O.D. month follow-up examination, no evidence of Co-Author(s) progression was noted. Robert Fintelmann, M.D., FACS This case represents the importance of Florencia Yeh, O.D., FAAO, FSLS awareness of the changing guidelines of HCQ retinopathy management. Due to the finding that Case Report Abstract risk of toxicity of HCQ is greater than originally believed, the American Academy of Ophthalmology Friday, June 21, 201912–12:30 p.m. (AAO) updated the guidelines in 2016, which will OD-Ocular Disease be explored in this poster. TG, according to reported weight, was taking approximately 5.70 Rethinking Risk for Hydroxychloroquine mg/kg/d of Plaquenil. The typical 400mg a day Maculopathy dosing may be inappropriate for patients of lower weight. Past studies show that progression of Hydroxychloroquine sulfate (HCQ) is an retinopathy typically occurs in moderate-severe antimalarial agent often used for the treatment of cases rather than mild or subclinical ones. At this autoimmune disease. It is well documented that time, no progression after discontinuation has been use of HCQ can cause toxic maculopathy. The risk noted despite the original maculopathy classfied at factors for maculopathy include daily dose a moderate-severe stage. >5.0mg/kg/d, cumulative dose, renal/liver disease, Author tamoxifen use, age, and underlying retinal disease. Nicole Ethridge, O.D.; This type of toxic maculopathy is not reversible. TG, a 62-year-old white female, presented with Case Report Abstract complaints of mildly blurred vision at all distances in her left eye. Her systemic history was positive for Friday, June 21, 201912–12:30 p.m. hypertension, hyperthyroidism, and systemic lupus erythematosus (SLE). Medications taken include OD-Ocular Disease HCQ (200mg BID; 20 years), trospium, Emergent Giant Cell Arteritis Presenting as levothyroxine, lisinopril, and simvastatin. Refraction Unresolving Unilateral Conjunctivitis yielded best corrected visual acuity of 20/20 in both eyes. Upon fundus examination, a granular Giant Cell Arteritis (GCA) is a vision-threatening depigmentation of the RPE of the macula was vasculitis which affects medium to large arteries noted in both eyes, left slightly greater than right. including the ophthalmic and ciliary arteries that

49 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

supply the eye. Sudden vision loss due to arteritic the likelihood of a negative outcome. ischemic optic neuropathy (AION) is a common Author initial manifestation of GCA. This, along with the Kimberly Skyles, O.D.; high probability of permanent vision loss and the potentially life-threatening nature, makes the Scientific Abstract identification and diagnosis of GCA one of the most critical in the scope of optometry. Vision loss Friday, June 21, 2019 in GCA typically presents along with other classic 12–12:30 p.m. symptoms including temporal headache, scalp tenderness, and jaw claudication. This is an Four-year Outcomes of Micro-invasive atypical case of early GCA presenting as an Glaucoma Ssurgery with iStent Inject (2nd unresolving unilateral conjunctivitis. generation trabecular micro-bypass stent) A 65-year-old white male was referred by his Combined with Topical Prostaglandin primary care physician for a presumed unresolving unilateral conjunctivitis, OS, after being Micro-invasive glaucoma surgery (MIGS) is unresponsive to Polytrim drops for two weeks. gaining popularity as an effective treatment for Upon presentation, he reported worsening patients with glaucoma. Combining trabecular redness, irritation, and pressure behind the eye micro-bypass stents and a prostaglandin targets which extended temporally. No vision loss, two different outflow pathways, the conventional photophobia, jaw claudication, headache, or scalp and the uveoscleral outflow pathways. This study tenderness were reported. VAs were pinholed to evaluated the safety and IOP-lowering efficacy of 20/40 OD and 20/25 OS. IOPs, confrontations, iStent inject® (2nd generation trabecular micro- ocular motility and pupils were normal and slit lamp bypass stents) implanted as a standalone exam revealed only injection and chemosis. A DFE procedure in subjects with open-angle glaucoma and fundus photo were then performed, revealing (OAG) on two ocular hypotensive medications. papillary edema, OS, at which point GCA became This prospective study enrolled 53 subjects the principal differential diagnosis. Stat bloodwork with OAG on two ocular hypotensive medications revealed elevated ESR and CRP and the diagnosis and with IOP of 18-30 mmHg (medicated) and 22- of GCA was later confirmed through temporal 38 mmHg (following medication washout). Two artery biopsy. After a chain of referrals, the patient iStent inject devices were implanted as a was started on oral prednisone which fully resolved standalone procedure, and topical travoprost was the condition, with best-corrected VAs of 20/20 in started on postoperative Day 1. Assessments both eyes. performed over the course of the study included This presentation of emerging GCA without the IOP, medication usage, adverse events, visual classic signs and symptoms of sudden vision loss, acuity, slit-lamp, gonioscopy, and fundus copy. jaw claudication, or temporal headache is atypical. Annual medication washout was performed. It was key in this case to identify a posterior Postoperative safety and efficacy evaluation segment problem although it presented like a through five years is currently underway. simple conjunctivitis. This condition could have All 53 subjects enrolled in the study completed been sight- or even life-threatening had it not been follow-up out to 49 months. Mean medicated IOP for the referral to an optometrist. In addition, if the at M48 is 13.1 mmHg compared to 19.7 mmHg prescription of oral steroids was under the scope preoperative (34% reduction). Mean unmedicated of practice of optometry in Washington state, this IOP at M49 is 17.7 mmHg compared to 24.9 patient could have been treated sooner, decreasing mmHg preoperative. Postoperative mean IOP on

50 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

travoprost remained at or below 13.1 mmHg at all cataract surgery compared to cataract surgery timepoints assessed through M48. 91% of alone in subjects with mild to moderate open-angle subjects achieved IOP of ≤ 18 mmHg on 1 glaucoma (OAG). medication; 81% achieved IOP ≤ 15 mmHg. All This was a two-year prospective, randomized, eyes underwent uncomplicated implantation of concurrently controlled, parallel groups, multicenter iStent inject with no significant postoperative trial that enrolled subjects ≥45 years diagnosed adverse events reported including no reports of with mild to moderate OAG on 1-3 medications hypotony, peripheral anterior synechiae or with a cataract eligible for surgery. Baseline post- choroidal hemorrhage or effusion. Visual acuity, washout mean diurnal IOP of 21-36 mmHg was C/D ratio, and visual field remained stable through required in the study eye. Qualified subjects were M48. randomized to implantation with 2 iStent inject In this study, patients with OAG not controlled devices in conjunction with cataract surgery on two topical ocular hypotensive medications (treatment group) or cataract surgery alone (control demonstrated safe and sustained clinically group). Annual medication washouts were meaningful IOP and medication reduction through performed. Key study assessments included: IOP, four years after standalone implantation of two BCVA, pachymetry, VF, specular microscopy, iStent inject trabecular micro-bypass stents in biomicroscopy, gonioscopy, funduscopy, and conjunction with postoperative topical travoprost. adverse events. The findings from this study demonstrated the A total of 505 subjects were randomized in a beneficial outcomes of iStent inject implantation 1:3 ratio to either the control (N=118) or treatment combined with a postoperative prostaglandin as a (N=387) group. Subject accountability at Month 24 treatment for patients with OAG on more than a was 96%. At M24, 75.8% of treatment eyes vs. single medication. 61.9% of control eyes achieved ≥ 20% reduction Author from baseline in unmedicated IOP (difference = Justin Schweitzer, O.D.; 13.9%; p = 0.003). Mean reduction in unmedicated IOP from baseline was greater in treatment eyes Scientific Abstract (7.0 ± 4.0 mmHg) than control eyes (5.4 ± 3.7 mmHg; p < 0.001). Eighty-four percent (84%) of Friday, June 21, 2019 iStent inject subjects were medication-free at 12-12:30 p.m. postoperative Month 23. Overall the safety profile of the treatment group was favorable and similar to A Randomized Pivotal Clinical Trial of iStent that of the control group throughout the 2-year Inject (Second-generation Trabecular Micro- follow-up. Notably there were no reports of bypass Stents) Implanted in Conjunction choroidal hemorrhage or effusion, corneal with Cataract Surgery Compared to Cataract decompensation, or significant hyphema. Surgery Alone Clinically and statistically greater reductions in IOP without medication were achieved after iStent Micro-invasive glaucoma surgery (MIGS) with inject implantation in combination with cataract trabecular micro-bypass stents is gaining surgery vs. cataract surgery alone, with excellent popularity as an effective treatment for patients safety observed through 2 years. with open-angle glaucoma. This US IDE pivotal trial Author aimed to evaluate the effectiveness and safety of Roberto Saenz, O.D., MS, FAAO the second-generation trabecular micro-bypass stents (iStent inject®) implanted in conjunction with

51 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Scientific Abstract This novel analysis highlights that ECPs utilise the digital tool to support fitting of toric and Friday, June 21, 2019 multifocal CLs. Repeated use suggest that the app 12–12:30 PM benefits their success in practice and that more support in needed when fitting multifocal Review of a Digital Contact Lens Ffitting compared to toric CLs. Further analysis of ECP Ssupport Tool for Eye Care Professionals satisfaction in using the OptiExpert tool is desired to understand how this can further help their Since the digital revolution, several apps have needs. been developed to support eye care professionals Author (ECP) during contact lens (CL) practice. A Jennifer Palombi, O.., FAAO multifunctional app and website tool, available Co-Author(s) since 2014 (OptiExpert, CooperVision), is one Amanda Bogers, BSc(EU), MCOptom, MBA example, available in 79 countries and 15 Dan Prest; languages worldwide, and provides multifocal and toric calculators to support their prescribing and Case Report Abstract fitting. The purpose of this study was to understand how ECPs use the tool. Friday, June 21, 201912–12:30 p.m. Two months of data (November and December 2018) on usage of the app were collated on OD-Ocular Disease country, duration of visit, use of fitting calculators Roth Spots Secondary to Vitamin B-12 and other educational tools. Deficiency There were a total of 72,355 sessions by 36,542 users which was 1.98 sessions per user Roth spots are retinal hemorrhages with a with an average session duration of three minutes. characteristic white center—composed of fibrin— 61.1% of ECPs were returning users. The UK has seen in conditions which cause retinal blood vessel the most sessions (16,384) and users (7,877) damage typically due to endothelial cell followed by Germany (9,701 sessions and 4,920 dysfunction. Common causative conditions users) and the recently launched USA (6,982 include, but are not limited to: bacterial sessions and 4,902 users). The app is accessed endocarditis, diabetes, leukemia, and anemia. predominantly by desktop (53.6%) and mobile Despite occurring secondary to a systemic (40.0%). Globally, ECPs used both the toric condition, patients with Roth spots may be calculators (60.3% by session, 68.2% by user) and asymptomatic. multifocal calculators (36.0% by session and A 65-year-old black male diagnosed with angle 46.8% by user) for fitting advice in addition to recession versus open angle glaucoma in the right sourcing product information. U.S. practitioners eye, open angle glaucoma suspect in the left eye, demonstrated similar trends with both the toric presented for a six-month eye evaluation. His (65.05% by session, 68.78% by user) and treatment regimen included: Travatan Z 1 gtt multifocal (31.63% by session and 39.47% by nightly and Simbrinza 1 gtt every 8 hours in both user) calculators. Considering U.S. prescribing eyes. He had a medical history significant for trend data by CL design, the use of the multifocal chronic hepatitis C, interferon treatment, lung calculator in comparison to that for torics is over cancer, and cocaine/alcohol/opioid dependence. indexed since toric CLs are prescribed nearly two- During the dilated fundus exam a Roth spot was and-a-half times more than multifocals. noted in the right eye in addition to two cotton

52 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

wool spots, and one cotton wool spot in the left comorbidities. One of the most common sleep eye. Fundus photos were taken to document the disorders is obstructive sleep apnea, or OSA. findings and the patient was questioned further Clinical evaluation of suspected OSA is reliant upon about his medical history. The patient denied subjective reports of excessive daytime sleepiness, history of heart problems, autoimmune diseases, snoring or witnessed apnea. These require hypertension, diabetes, HIV, and intravenous drug questioning of patient recognition or bed partner use. He was referred to his primary care physician recall, either which may be inaccurate or with the exam findings for further analysis. The unavailable. Although clinical guidelines suggest primary care physician ordered updated blood utilizing reports of excessive sleepiness as the testing and found that the B-12 deficiency, and preferred method to target OSA suspects for history of alcohol abuse, caused an increase in further evaluation, this does not always reliably PLT. He was treated with vitamin B-12 1,000 mcg differentiate those patients with or without OSA. In intramuscular daily for one week, then once a addition, existing OSA clinical guidelines do not month, then maintenance. The Roth spot and take into account the visual system and associated cotton wool spots resolved at the follow-up eye risks from OSA to vision and overall health. Direct evaluation three months later. measurement of impaired brain function caused by Presence of Roth spots require further testing sleep deprivation and hypoxia has the potential to to evaluate the underlying condition which is augment clinicians’ suspicion of disease and causing the hemorrhage(s). Despite not affecting objectively assist in patient risk stratification and vision in most cases, Roth spots present a serious early intervention. The King-Devick Test (KDT) in concern to systemic health and require association with Mayo Clinic is a rapid number coordination with the primary care physician for naming test used in baseline assessments and blood work and additional lab testing. Failure to do remove from play decisions for concussion. It is an so can result in serious complications including objective physical measure of neurologic function, death. Once the underlying condition is found and allowing assessment in a quick, easily administered treated Roth spots will resolve without targeted manner. Rapid number naming requires saccades, treatment. attention, and language, as well as other areas Author involved in reading. It evaluates function of the Adrian Kun, O.D.; brainstem, cerebellum, and cerebral cortex. Abnormalities in saccadic eye movements have Scientific Abstract been shown to be associated with sleep deprivation, hypoxia and cognitive impairment- Friday, June 21, 2019 issues frequently found in OSA patients. Prior work 12–12:30 p.m. has demonstrated significant KDT time differences related to neurologic conditions such as dementia Primary Eye Care and Obstructive Sleep and Parkinson disease. The test is effective at Apnea: An Objective Neurologic Test of detecting acute hypoxic impairment, even at early Eye Movements Demonstrates Baseline pre-symptomatic stages, so has promise in OSA Dysfunction And Improvement With Treatment where patients may have with repeated hypoxic events. The KDT has been utilized in a few small There is long-standing evidence to support the studies of sleep restricted or deprived subjects but association between sleep disorders and a variety had not been utilized previously in OSA suspect of diseases and conditions including neurologic patients. Our objective was to obtain baseline KDT disorders, ophthalmic diseases, and other times for patients suspected of OSA presenting to

53 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

the Mayo Clinic Arizona Sleep Lab. We OSA. Early detection of OSA can reduce the risk of hypothesized correlation between slower KDT associated health conditions including times (i.e. worse function) and greater severity of cardiovascular disease, hypertension, cognitive OSA. We also hypothesized that OSA patients who impairment, obesity, and metabolic abnormalities. adhered to continuous positive airway pressure From a visual system standpoint, OSA is (CPAP) treatment would demonstrate improvement associated with glaucoma, floppy eyelid syndrome in brain function as measured by decreased KDT (FES), , corneal ulceration, times compared to baseline. nonarthritic ischemic optic neuropathy (NAION), Study dates January 30 to July 31, 2018. age-related (AMD), diabetic Subjects were referred for initial evaluation of Sleep retinopathy, , central serous Disordered Breathing concerns. OSA severities chorioretinopathy, and keratoconus. Administration were defined by Apnea Hypopnea Index (AHI) of the KDT as a quick and objective physical results, with ≥ 15 considered at least moderate measure of neurologic function using eye OSA. The KDT is an objective physical measure of movements is shown to identify baseline brain function that assesses eye movement and abnormalities in patient with OSA. In addition, was chosen due to ease of use and rapid significant neurologic improvement is achieved administration. We estimated correlation between after patients are treated with CPAP. Use of KDT is KDT time and AHI and compared mean KDT time indicated to augment clinicians’ risk stratification, between patients with and without moderate OSA. clinical decision making, and timely primary care For the OSA subgroup, we evaluated for potential management decisions for patients with and/or at improvement in KDT after intervention with CPAP risk for OSA. Findings from this study also reinforce treatment. the 2016 National Academies of Sciences, Sixty subjects were enrolled. We found that 35 Engineering, and Medicine report highlighting the of 60 subjects (58.3%) had OSA with an AHI ≥ 15. value of primary eye care in health care and Initial analyses noted no significant KDT time opportunity for doctors of optometry to further differences between subjects based on OSA assist in improving population health outcomes. severity. However, after excluding three subjects Author who had baseline neurologic illness, adjusted Lori Grover, O.D., Ph.D. analyses demonstrated that mean KDT time was Co-Author(S) significantly prolonged for patients with moderate Martina Mookadam, M.D. or greater OSA (AHI ≥ 15) as compared to those Michael L. Grover, D.O. with mild or no sleep apnea (AHI <15); 63.4 Yu-Hui Chang, MPH, Ph.D. seconds versus 55.7 seconds, p= 0.03, 95%CI Lanyu Mi (58.9-67.8). CPAP treated subjects demonstrated James Parish, M.D.; significantly improved KDT test times; 63.5 seconds mean pretreatment vs. 55.6 posttreatment; -6.6 seconds mean difference, p=0.02, 95%CI (-12.0, -1.13). Targeted assessment of eye movements is quickly emerging as an objective clinical measure of patient neurological function associated with a myriad of specific conditions and diseases. Doctors of optometry are well positioned to play a key role in reducing the negative health impacts of

54 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Case Report Abstract Author Pierce Kenworthy, O.D., FAAO; Friday, June 21, 201912–12:30 p.m. PC-Primary Care Case Report Abstract Using OCT-Angiography to Evaluate Retinal Friday, June 21, 201912–12:30 p.m. Vein Occlusions OD-Ocular Disease A 57-year-old black female patient presented Characteristic Imaging Findings in Acute for a chief complaint of blurry vision in the left eye Macular Neuroretinopathy which she could localize as being worse nasally. She thought she may have scratched her left eye Acute Macular Neuroretinopathy results in the at work doing construction about two weeks ago, sudden onset of paracentral scotomas affecting which is when the blur started. one or both eyes. Fixation is spared, but the The patient explained that she was having scotomas tend to persist indefinitely. Affected ‘cloudy’ vision in the left eye which was worse in individuals tend to be generally healthy young the morning. Her BCVA was 20/30 on examination. women who often report a flu-like illness prior to All anterior segment findings were normal and not the onset of symptoms. The etiology is unknown, indicative of any ocular trauma at work. A dilated though a vascular etiology is thought to be likely. fundus exam was performed, which revealed a There is no known disease-modifying intervention. branch retinal vein occlusion in the left eye with A systemically-healthy 30-year-old white female macular thickening visualized on OCT. An with a history of migraine aura and low myopia additional OCT-Angiography was accomplished presented for evaluation of a paracentral blind spot which was able to localize the exact location of the in the vision of her left eye which she had noticed occlusion. Consistent with the statistics which acutely 10 days earlier. The blind spot affected an suggest that 80 % are temporal, this patient had a area immediately below fixation, was persistent, superior temporal BRVO. OCT Angiography was and stable since first noted. She denied any other instructive to show the reduction in blood flow in visual symptoms. Two weeks before noticing the the area of occlusion. It does have limitations too blind spot she had experienced a few days of which include motion artifact and artifacts from the malaise, nausea, and vomiting.Upon examination, blood as well. The IS-OS Ellipsoid En Face image her vision was found to be 20/20 OD, OS. Her is particularly helpful at localizing the occlusion. evaluation, confrontation fields, extraocular This case illustrates a classic example of a motilities, and intraocular pressure were branch retinal vein occlusion, but includes a newer unremarkable. Amsler grid and Humphrey Visual way of visualizing this disorder. OCT Angiography Field testing revealed an inferior, paracentral is being utilized in many settings, but is particularly scotoma. Slit lamp and fundus examination were helpful in detecting early macular degeneration, unremarkable. OCT testing was performed and diabetic changes and occlusive events in the revealed minimal superior perifoveal thinning OS retina. This case specifically shows a recent BRVO, corresponding to the scotoma. The en face but comparison can be made in the setting of an infrared image revealed dark petalloid lesions in the old BRVO in which fundoscopy may reveal a same retinal location. One month after ‘normal’ appearing retina, but on further presentation, her symptoms and exam were investigation, OCT-A reveals a much more stable. At follow-up three, seven, and 13 mos after complete history. initial presentation her symptoms were stable with

55 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

partial resolution of OCT findings. a cycloplegic refraction. Based on visual acuity and Considering its rarity, there is much that AAPOS prescribing guidelines, glasses were given remains unknown about Acute Macular if visual acuity in the amblyopic eye was worse Neuroretinopathy. The differential diagnosis for the than 20/40, interocular difference was greater than condition includes Multiple Evanescent White Dot 2 Snellen lines, > 1.00 D difference between eyes Syndrome and Acute Posterior Multifocal Placoid in spherical equivalent, >1.50 D difference between Pigment Epitheliopathy. Thankfully, the eyes in astigmatism in any meridian, or myopia or characteristic dark petalloid perifoveal lesions hyperopia > than 3 diopters. Subjective cycloplegic noted on infrared imaging (such as the en face refractions were compared with Retinomax K plus imaging from OCT instrumentation) as well as the 3 measurements. The devices for failed vision outer-retinal changes noted on OCT allow the screenings were assessed for positive predictive practitioner to quickly and accurately make the value and confidence intervals. Devices utilized in diagnosis. While there is no viable treatment at this this study were the Iscreen, SPOT, GoCheckKids time, patients can be reassured that the condition application, and PlusOptiX. Outcomes were is not progressive and practical visual limitation is compared with the previous failed vision screening uncommon. report. Author There were 232 pediatric participants with Gabriel Fickett, O.D.; referral to the practice as a result of a failed vision screening at a well-child exam. The positive Scientific Abstract predictive values (PPVs) of 69.5% for Iscreen, 40.5% for SPOT, 30.0% for PlusOptiX, and 7.7% Friday, June 21, 2019 for GoCheckkids were found. The overall 12–12:30 PM confidence interval is 95%. The only screening device with a confidence interval greater than 50% Positive Predictive Value of Vision Screening was the Iscreen device. Devices During Well-child Visits In this study, it was determined certain photoscreening devices can reliably screen for Photoscreening devices are widely used in refractive and strabismic risk factors that can lead primary care physician offices. Failed vision to amblyopia. Certain devices are considerably screenings result in referral for possible more reliable and have a higher positive predictive amblyogenic risk factors. The variety of value. photoscreening devices has raised concerns Author regarding reliability and positive predictive value. Brittney Morales, O.D.; The purpose of this study is to assess the positive predictive value assessment of failed vision Scientific Abstract screenings referred from 2015 to current. This is a masked prospective cohort study of Friday, June 21, 2019 photoscreening referrals with known screening data. 12–12:30 p.m. Patients with a failed vision screening by a Establishing an Open Access Clinic to photoscreening device were referred to a pediatric Increase Compliance with Annual Diabetic eye care practice for comprehensive eye exam, Eye Exams extraocular motility assessment, and refraction measurements. All failed vision screenings received Diabetic retinopathy is the leading cause of

56 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

blindness among working-age Americans. Annual diabetic patients, improving compliance with diabetic eye exams are recommended to screen annual diabetic eye exams, allowing early detection for diabetic retinopathy, but only about 30% are of diabetic eye disease, and increase in patient compliant with this nationally. The compliance rate satisfaction. within UMass Memorial Health Care, the largest Author health care system in Central Massachusetts, was Juan Ding, O.D., Ph.D. 22% prior to the present pilot study. Previously Co-Author(s) patients were referred to Hahnemann Eye Center, Manisha Anand, M.A., COA an off-site campus, where no-show rate was high. Shlomit Schaal, M.D., Ph.D.; Our goal was to establish a satellite eye clinic at the main university campus allowing same-day Case Report Abstract access to eye exams for diabetic patients, and to investigate whether increased access to care will Friday, June 21, 201912–12:30 p.m. have an impact on screening rates for diabetic OD-Ocular Disease retinopathy. A new optometry clinic was established next to Masquerades of Carotid Cavernous Fistula the Diabetes Center of Excellence at the university campus. Number of patients seen, types of Carotid cavernous fistula (CCF) results from an pathologies discovered, no-show rates, number of abnormal connection between the cavernous sinus scheduled visits versus walk-in visits, patient and the carotid arterial system. CCFs are classified satisfaction and percentage of compliance with as direct or dural depending on where the annual eye exams were measured. abnormal communication lies. CCFs are caused by The university campus optometry clinic has either trauma or are idiopathic. Clinical triad of been operating full-time since 09/2018, accepting conjunctival chemosis, pulsatile proptosis, and an both scheduled and walk-in patients. From ocular bruit. However, due to the subtle and September to December 2018, 930 patients were varying presentation of signs and symptoms, they examined. Walk-in patients comprised of 8% of all can often be misdiagnosed. Prompt diagnosis is patients seen. No-show rate at this clinic was 8.5 important as early treatment has a high success %, markedly lower than that for the same providers rate and prevents vision loss. at Hahnemann (~ 25% out of 710 total patients A 65-year-old white female presented with lid seen). A subset of 104 patients were referred to swelling OU that started onemonth ago after a Hahnemann for management of diabetic sinus infection. She finished oral antibiotics and retinopathy (34%), glaucoma (27%), cataract used Maxitrol drops bid x one week with no (18%), age-related macular degeneration (4%), and improvement. She denied eye pain, itching, and miscellaneous (21%). Preliminary surveys indicate injury. Systemic health is significant for patients seen at this clinic are highly satisfied, with hypertension, hyperlipidemia, depression, and 86 % preferring this location (and the rest showing arthritis. Ocular history of meibomian gland no preference between the two locations). For dysfunction, cataracts, and choroidal nevus OD. some providers, the compliance with annual eye Family history of thyroid disease in her sister. Visual exams have increased to 95%, which reflected in acuity of 20/20 OD, 20/30 OS. Entrance testing an increase in Accountable Care Organization unremarkable. Slit lamp exam reveals conjunctival (ACO) profitability. chemosis OS>OD, diagnosed with viral We have shown that an optometry clinic in the conjunctivitis. At two-week follow-up, presented hospital setting may provide convenient access to with horizontal binocular diplopia and blur OS.

57 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Abduction deficit OS led to diagnosis of left cranial vision, and hearing loss lead to an early diagnosis nerve 6 palsy. Ancillary testing revealed normal of multiple sclerosis. exophthalmometry and blood work for thyroid A 36-year-old black woman presented to the stimulating hormone, thyroxine, and triiothyronine. emergency department with complaints of right Computed tomography (CT) scan revealed sided headache and right eye blurred vision for enlarged superior ophthalmic vein OS>OD. Based four days. She also reported muffled hearing in her on clinical findings and labs, diagnosed with right ear for over six months. A CT was performed carotid cavernous fistula, confirmed with CT and determined unremarkable. She was then angiography. Coil embolization surgery performed referred to the optometry clinic to evaluate her OS. At 1-month follow-up, presented for new complaint of worsening unilateral central vision loss onset diplopia and cranial nerve 6 palsy OD. Coil and photophobia. Entering visual acuities were OD: embolization surgery performed OD, complete 20/80 and OS: 20/20. Pupil, CVF, and EOM testing resolution of diplopia at 6-month follow-up. was normal. Anterior and posterior segment In the early stages of CCF, it can often be examination was unremarkable. Macular OCT and misdiagnosed as conjunctivitis and asymmetric GCA were unremarkable. A large central scotoma glaucoma due to the subtle presentation. CCF can was noted on Amsler grid testing. Medical history mimic orbital diseases including thyroid eye was significant for tinnitus, vertigo, vitamin D3 disease and idiopathic orbital inflammatory deficiency, generalized anxiety disorder, and PTSD. syndrome. Prompt diagnosis is important as Two weeks later the unilateral vision loss persisted. delayed diagnosis puts the vision at risk usually Entering visual acuities were OD: 20/100+2 and from glaucoma, ischemic optic neuropathy or OS: 20/20. New findings included a slow response chorioretinal dysfunction. Definitive diagnosis to light OD on pupil testing and pain on right gaze requires arteriography. Prognosis varies from on EOM testing. All other findings were stable from complete to incomplete resolution after treatment. the initial exam. An MRI was ordered but found Author inconclusive. Neurology was consulted and a Eun-Young Ko, BSc; lumbar puncture was performed that returned positive for oligoclonal bands. Additional ocular Case Report Abstract testing preformed at follow up included a visual field in which a nasal OD was noted, Friday, June 21, 201912–12:30 p.m. impaired color vision on Ishihara, and GCA with OD-Ocular Disease nasal thinning. Benefits of early diagnosis and treatment of Multiple Sclerosis: Making the Diagnosis multiple sclerosis have been well documented. when Atypical Findings are Present Unfortunately, diagnosis can be delayed or complicated by atypical features. This patients’ is often a presenting unilateral complaints of headache, missing vision manifestation of multiple sclerosis. When presented and difficulty hearing combined with absence of classically the link between optic neuritis and pain on eye movement prompted a thorough multiple sclerosis is quite clear. However, when diagnostic evaluation that resulted in a diagnosis of atypical features are present a more investigative multiple sclerosis. diagnostic workup is required. This case features Author typical and atypical clinical findings, diagnostic Jacqueline Molinda, O.D. testing to rule out differential diagnosis, and co- Co-Author(S) management with neurology for a patient whose William Denton, O.D.; initial complaint of right sided headache, blurred 58 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Case Report Abstract patients with reduced visual acuity. This is due to accelerated diffusion of serous fluid from the retina Friday, June 21, 201912–12:30 p.m. to the vitreous. Even though no active OD-Ocular Disease management is required, caution should be employed prior to cataract surgery since there has Stellate Nonhereditary Idiopathic been reported cases of complications, including Foveomacular Retinoschisis retinal detachment following cataract surgery. Author Stellate nonhereditary idiopathic foveomacular Kiyavash Tebyanian, Optometry Student retinoschisis (SNIFR) is a rare condition which is Co-Author(s) most commonly unilateral. Although bilateral Kathryn Deliso, O.D.; presentation is possible, is it not as common. SNIFR is due to a separation of neurosensory Scientific Abstract retina at the level of the with lesser involvement of outer nuclear layer. Patients Friday, June 21, 2019 with SNIFR usually have little to no symptoms with mild reduction in visual acuity. Although infrequent, 12:30-1 p.m. there have been some reported cases of subretinal Interim Results of a Prospective, Randomized fluid and subsequent retinal detachment with Phase 2 Study Evaluating the Safety and reduced visual acuity due to SNIFR. Efficacy of Travoprost Intraocular Implants A 61-year-old white male presents for cataract evaluation with blurry vision OD>OS which started The iDose is a novel sustained-release 2+ years ago with constant presentation and travoprost implant under development as a gradual onset affecting both near and far vision. treatment option for glaucoma. This US IND phase Patient’s medical history include: type II diabetes, 2 study evaluated the safety and efficacy of two hypertension, anxiety, COPD, depression, acid Travoprost Intraocular Implants, one with a fast- reflux, and elevated lipids. Past ocular history elution rate and one with a slow-elution rate includes: refractive error, vitreomacular adhesion (referred to as iDose-slow and iDose-fast) OD, cataract OU. Patient’s BCVA are 20/60 OD, compared to Timolol Ophthalmic Solution, 0.5%, in 20/30 OS. EOMS, Pupils, CVF are all within normal subjects with OAG or OHT, either on no ocular limits. Anterior slit lamp examination is remarkable hypotensive medication or using up to 3 for 2+ nuclear sclerosis with 1-2+ cortical changes medications. OU. Dilated fundus examination is remarkable for This is a prospective, randomized, double- stellated appearance at the macular area OD masked, active-controlled, parallel-group, otherwise unremarkable. OCT scans of the right multicenter US IND phase 2 trial. The study macula reveals retinoschisis at the level of outer enrolled phakic or pseudophakic subjects ages plexiform layer. A diagnosis of SNIFR was ≥18 years diagnosed with mild to moderate OAG discussed with the patient. Patient was referred to or OHT on 0 to 3 medications, with a baseline a retina specialist for clearance prior to cataract mean diurnal IOP of 21-36 mmHg in the study eye surgery as patients with SNIFR are at risk for retinal (a washout was required for subjects on ocular detachment following surgery. hypotensive medication(s)). Qualified subjects were Patients with SNIFR require no active randomized (1:1:1) to implantation with iDose-fast management. Pars plana vitrectomy with ILM peel or iDose-slow as a standalone procedure, or has shown success in a limited sample size of treatment with topical timolol BID. Key study

59 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

assessments include: BCVA, pachymetry, VF, I, II, III based on characteristics of the tumor and it endothelial cell density, biomicroscopy, gonioscopy, is this categorization which aids in determining the funduscopy, and AEs. treatment plan. Visual changes may be a symptom A total of 154 subjects were randomized to the of meningiomas, especially if the tumor affects the study: iDose-slow (n=54), iDose-fast (n=51), timolol optic nerve sheath, the cavernous sinus, or the (n=49). All subjects completed the 12-week follow- parasellar region. up visit (with a subset completing 1 year). Per A 61-year-old female presented with mild vision study design, continued follow-up is planned loss in the left eye and reported that she had been through 3 years. Initial efficacy was demonstrated experiencing blur at all distances for the past 1-2 through Week 12 with all 3 study groups achieving months. The patient denied any accompanying at least 30% IOP reduction. An excellent safety neurological symptoms. The patient’s BCVA was profile was observed with no reports of hyperemia, 20/20 OD and 20/30-1 OS. The patient also intraoperative or serious ocular AEs in the iDose reported metamorphopsia OS upon Amsler grid groups. testing. Color vision testing, macula OCT, and The interim results of this prospective RNFL OCT were performed. Moderate NFL randomized double-masked phase 2 trial thinning was present bilaterally. Upon return visit, demonstrate initial efficacy of both the iDose-fast stereoscopic fundus photos, fundus and iDose-slow implants out to 12 weeks with at autofluorescence and threshold visual field testing least 30% IOP reduction. An excellent safety profile was conducted which revealed a deep central was observed with no hyperemia, intraoperative or scotoma with adjacent mid-peripheral reduction. serious ocular AEs reported to date in either of the An MRI of the brain and orbits was ordered. iDose groups. Travoprost Intraocular Implants Neuroimaging revealed a meningioma in the left (iDose) showed favorable initial efficacy and safety parasellar region, extending into the left optic canal in this study. The iDose implant has the potential to and the cavernous sinus. Due to the size and change the treatment paradigm in glaucoma. location of the tumor, in addition to the patient’s Author reduced visual function, the neurologist proceeded Mitch Ibach, O.D. with a modified orbitozygomatic craniotomy for resection of the tumor. The pathology analysis of Case Report Abstract the tumor classified it as Grade I. Following the resection, the patient suffered from reduced vision Friday, June 21, 2019 in the left eye and diplopia upon left gaze which 12:30- 1 p.m. gradually improved. In patients with unexplained vision loss, even if PC-Primary Care the loss is mild, a space-occupying lesion must be excluded. Visual symptoms may be the initial sign Mild Vision Loss as the Sole Manifestation of of a meningioma, and the degree of visual function a Meningioma loss may help determine the appropriate treatment Meningiomas are the most common primary course. Visual loss may also occur as a result of brain tumors. Although usually benign, these tumor resection, and optometrists may play an tumors may cause significant morbidity due to their important role in detection and the post-operative location in the central nervous system. The World management of these patients. Health Organization has generated a classification Author system in which meningiomas are assigned Grade Brianne Hobbs, OD, FAAO Co-Author(s)

60 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Grace Liao, OD the course of action that will result in the best Kaila M. Osmotherly, O.D. outcome for our patients. In the case of a possible inferior rectus entrapment in a pediatric patient, a Case Report Abstract decision on whether surgical treatment is warranted should be made quickly. As the Friday, June 21, 2019 presenting history and symptoms have a high 12:30-1 p.m. positive predictive value for inferior rectus entrapment, it was important that I recommend an OD-Ocular Disease immediate CT scan to then determine if surgery was needed. This is an unusual case as the CT Pediatric Orbital Floor Fracture with scan ruled out muscle entrapment, though it Symptoms Mimicking Inferior Rectus presented with the typical signs. This patient did Entrapment not have to undergo surgery as treatment and, at As the structurally weakest area of the orbit, the last follow-up, continues to improve. orbital floor is the most likely area to sustain Author fractures due to trauma. Orbital floor fractures with Kimberly Skyles, O.D. entrapment of the inferior rectus muscle are more common in pediatric patients and typically cause Case Report Abstract symptoms of binocular diplopia, upward gaze Friday, June 21, 201912:30-1 p.m. restriction, pain on eye movement, nausea and vomiting. This is a case of orbital floor fracture in a OD-Ocular Disease pediatric patient presenting with the typical symptoms of, but without, muscle entrapment. Toric Implantable Collamer Lens (ICL) MP, a 9-year-old male on a soccer trip from Implants in Eyes Contraindicated for LASIK Canada, presented with binocular diplopia, a Traditionally, corneal conditions such, as restriction of upward eye movement, and pain on keratoconus, corneal scarring, or histories of downward eye movement after being kicked in the herpes simplex were contraindications for LASIK. left eye the previous day. The diplopia was present With the Visian Toric Implantable Collamer Lens directly following the incident while pain, (toric ICL, STAAR surgical) gaining FDA approval in photophobia, nausea and vomiting presented later. 2018, patients with myopic astigmatism and VAs were 20/20 OD/OS, pupil response was corneal abnormalities potentially have an option to normal. EOMs were restricted OS in all superior improve their uncorrected visual acuity (UCVA) with gazes with pain on inferior gaze. All structures on toric ICLs.Three patients with myopic astigmatism DFE were normal. An orbital floor fracture with ranging in age from 33 to 36 years old were muscle involvement was highly suspected. Photos implanted with toric ICL from November 2018 to were taken and the patient was referred for an January 2019. Each patient had previously been orbital CT scan at the nearest hospital. The patient told they were not candidates for LASIK. Pre- had a CT done in Canada the next day, which operative best corrected visual acuity, mean revealed a left orbital floor fracture without muscle spherical equivalent, sphere, and cylinder were entrapment. After follow-up by email one month measured preoperatively, and at one day and one later, all symptoms had improved except upward month visits. motion, which had not fully recovered. TH had stable keratoconus with a pre-operative It is our responsibility as optometrists to plan manifest of -5.50-2.00x001 in the right eye and

61 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

-5.00-1.25x 147 in the left eye with BCVA of 20/20 the OptiExpert online lens-fitting app. in both eyes. One-day status post toric ICLs, Two DDSH toric lenses; stenfilcon A and UCVA was 20/25 in the right eye and 20/20- in the somofilcon A (both from CooperVision) were fit to left eye. The UCVA in both eyes was unchanged at 54 and 37 habitual lens wearers, respectively. The one-month post-operatively. The BCVA one-month investigator followed the manufacturer’s fitting post-operative was 20/20 in both eyes. TH, who guides and the final lens prescription (Investigator- elected to have implantation of a toric ICL, had a Rx) was determined based on the over-refraction corneal scar in the left eye and had a preoperative and lens rotation. Participants wore these lenses BCVA of 20/80 with a manifest refraction of -4.00- for approximately one week. In a retro-analysis the 4.00x 166. At one-day post-operative, the UCVA subjective refraction data and back vertex distance and BCVA was 20/50 and at one-month post- were entered in the online app to determine the operative, the UCVA and BCVA was 20/25. CV recommended Rx (App-Rx). Fitting results from had a history of and was both approaches were compared using Pearson correctable to 20/15-2 pre-operative in the right correlation analysis. To determine how closely the eye with a manifest refraction of -3.50-3.75x175. results matched for each lens type, different criteria The left eye was also correctable to 20/15-2 with a for sph (±0.25, ±0.50D), cyl (±0.00DC) and axis manifest refraction of -3.25-4.00x006. One-day (±10, ±20degrees) were applied to calculate the post-operatively the patient had UCVA of 20/15 in percentage of matching fitting results. the right eye and 20/25 in the left eye. At the one- A high correlation was found for both toric lens month post-operative visit, the UCVA and BCVA types in respect to sph, cyl and axis between the was 20/15-2 and 20/15-2 OU. Investigator-Rx and the App-Rx (stenfilcon A r Implantation of the Visian Toric ICL can be an >0.92, somofilcon A r >0.97). For criteria sph effective option for improving uncorrected visual ±0.25D, cyl ±0.00DC, axis ±10, the lens acuity in patients who were previously non- prescriptions from both methods matched in 82% candidates for LASIK. of eyes with stenfilcon A and 75% of eyes in Author somofilcon A. For criteria sph ±0.50D, cyl Roberto Saenz, O.D., MS, FAAO ±0.00DC, axis ±20 the Investigator-Rx and the Co-Author(s) App-Rx matched in 91% (stenfilcon A) and 92% Anjli Patel; (somofilcon A) of eyes respectively. The lens cylinder power was correctly calculated by the App Scientific Abstract in all eyes, except for three eyes when fitted with somofilcon A and one eye when fitted stenfilcon A. Friday, June 21, 2019 The performance of the toric DDSH lenses was 12:30-1 p.m. very predictable, resulting in a high level of agreement between the fitting app and the Modern Approach to Assist Toric Lens-fitting investigator dispensed lens. The OptiExpert app Using a Web Application can confidently be used as a clinical tool to aid toric lens-fitting success. To optimize patient chair time, online apps are Author available to recommend contact lens prescriptions Jennifer Palombi, O.D., FAAO based on the subjective refraction. This study is Co-Author(s) comparing fitting results with toric daily disposable Doerte Luensmann, Ph.D. Dipl Ing (AO), FAAO silicone hydrogel (DDSH) lenses using traditional Jill Woods, BSc(Hons), MCOptom, FAAO fitting guides to the prescriptions recommended by Shail Patel, BSc(Hons) MCOptom FBCLA

62 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Scientific Abstract asymptomatic/low-risk pediatric patients to occur at 6 to 12 months of age. Only 22% of all HPS Friday, June 21, 2019 surveyed chose the appropriate earliest age of 6 12:30-1 p.m. months with 22.9% choosing 12 months. As future health care providers who may have significant Perception of Earliest Recommended interactions with families and patients of infants, it Pediatric Eye Exam Age by Health is important that we educate them on the Professional Students appropriate age for the first eye examination as well as the no-cost public service program, Health care is moving toward an increase in InfantSEE, that is available to all. interprofessional collaborative practice (ICP) as a Author goal of enhancing quality of care. One method of Eric Woo, O.D. improving quality of care is for other health care professionals to understand some of the Scientific Abstract fundamentals of other professions. For example, parents may ask other health care professionals Friday, June 21, 2019 when pediatric patients should have their first eye examination. To our knowledge, there are no 12:30-1 p.m. studies examining the understanding of the earliest Improvement in Batting Performance through age of eye examinations by other health care the Use of Stroboscopic Glasses professional students (HPS). The purpose of this study was to determine various HPS with no formal Stroboscopic technology is commonly used in education on optometry at what earliest age they sports-vision-therapy protocols to help athletes believe the first eye examination should occur. improve their performance in competition. A total of 441 students ages 20 to 45 However, minimal research has been performed to (M=24.25, SD=±3.35) years completed an optional determine the impact that stroboscopic technology paper survey. The survey was distributed in a has on athletic ability alone. This pilot study single course given to first-year osteopathic explored the direct effect of stroboscopic glasses medicine, dental medicine, and pharmacy students on batting performance with increasing pitch in the winter quarter of 2015 at Midwestern speeds. University at Downers Grove, Illinois. Without Sixteen athletes capable of hitting pitches at external aids, HPS were given 5 minutes to answer speeds greater than 60 mph were selected to questions including: “What is the earliest participate in two sessions separated by one week recommended age for an eye examination for an at a batting cage. Participants were randomized asymptomatic/risk-free pediatric patient?” followed into a control and study group. Each session by 5 items to choose from. consisted of 25 pitches at a simulated 45 mph A total of 13.83% of students believed at birth speed for warm-up, followed by a 15-minute break was the earliest recommended age with 22% at 6 to simulate the time between at-bats. Pitch speeds months, 22.9% at 12 months, 23.36% at 24 began at a simulated speed of 60 mph, with a 5 months, and 17.91% at 36 months. mph increase after two consecutive hits and a 5 The American Optometric Association’s mph decrease with every miss until a total of five evidence-based clinical practice guideline, misses were recorded. The first session served as Comprehensive Pediatric Eye and Vision a baseline for both groups in order to account for a Examination, recommends the first eye exam of learning curve. During the second session, the

63 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

participants in the study group were asked to wear over the keratoprosthesis. The bandage contact Senaptec Strobe Glasses during the 25-pitch lens provides hydration and enhances device warm-up. retention by preventing complications such as Of the 16 participants, 15 completed the study. dellen, epithelial defects, and corneal melt. High When comparing sessions 1 and 2 in the strobe postoperative astigmatism is common after corneal glasses group, significant differences were noted in transplantation. Depending on how the BKPro the number of hits during warm-up (-3.71, transplant is sutured, irregular scleral astigmatism p=0.0293), maximum speed hit (7.86mph, may also result, making it difficult to fit standard p=0.0333), and average speed (5.05mph, soft lenses. In such cases, custom scleral contact p=0.0323). There was no significant difference in lenses should be considered as an alternative the total number of hits in those wearing the strobe choice for protection. glasses (3.20, p=0.1489). There was no significant This case report refers to two patients who difference in these same four categories as underwent unilateral BKPro transplantation. The measured in the control group, suggesting that no first patient had a history of multiple failed PKP learning curve was present (0, p=1; 4.38mph, transplants from Mooren’s ulcer. The second p=0.0639; 2.65mph, p=0.0982; 1.63, p= 0.3348, patient had multiple failed PKP transplants from respectively). glaucoma. A traditional soft bandage contact lens Our results in this pilot study suggest that using was not successful due to large amounts of stroboscopic glasses during batting warm-up may residual irregular scleral astigmatism after BKPro result in an improved ability to hit faster pitches. transplantation. Instead, a custom scleral lens However, further research with more participants is prosthetic cover shell was created in order to necessary to determine if strobe glasses protect the BKPro transplant. This custom scleral consistently improve performance. lens wwas designed using impression and Author software-based technology in order to align with Matthew Roe, O.D., FAAO the highly irregular scleral shape. The follow-up Co-Author(s) period was six months for all patients. Both BKPro Sarah Huff transplants experienced no complications at this Sarah Thomas, O.D. time. Custom scleral designs should be considered Case Report Abstract for protective bandage contact lenses in cases of high irregular scleral astigmatism after BKPro Friday, June 21, 2019 transplantation. 12:30–1 p.m. Author Melanie Frogozo, O.D.; CL-Contact Lens Custom Scleral Lens Designs for Protection of Type I Boston Keratoprosthesis The type I Boston Keratoprosthesis (BKPro) is indicated for patients with refractory corneal blindness and poor prognosis for penetrating keratoplasty (PKP). Postoperative care traditionally requires a protective soft bandage contact lens

64 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Case Report Abstract improvement in the structure of his retina after multiple follow-up visits. Friday, June 21, 2019 Central serous chorioretinopathy is a condition 12:30-1 p.m. that is not fully understood, which can make it difficult to treat. Current treatment for CSCR OD-Ocular Disease includes observation, stress reduction, discontinuation of steroids, and laser Management and Treatment of Chronic photocoagulation. Eplerenone is a Central Serous Chorioretinopathy with mineralocorticoid receptor antagonist that has Eplerenone been found to be a potential treatment choice for Central serous chorioretinopathy (CSCR) is an chronic cases of CSCR. Eplerenone is beneficial idiopathic condition in which the fluid from the because it is a less invasive mode of treatment choroid leaks into subretinal space causing fluid while still providing a faster resolution of central build-up between neurosensory retina and the serous chorioretinopathy. retinal pigment epithelium. This accumulation of Author fluid can cause changes to the vision manifesting Yuyeng Lor, optometry student as metamorphopsia, hyperopic shifts, and Co-Author(s) scotomas. The pathophysiology of CSCR has not Kathryn Deliso, O.D. been definitely identified, but there are theories that RPE dysfunction may be the underlying etiology. Scientific Abstract A 58-year-old male presented to the clinic Friday, June 21, 2019 complaining of a distortion of his vision in the left eye that started about two weeks ago. The 12:30–1 p.m. patient’s ocular history was significant for moderate primary open-angle glaucoma status post selective The Effects of Over-the-Counter Topical laser trabeculoplasty in both eyes. In addition, the Allergy Eye Drops on Soft Contact Lens patient reported a history of long-term inhaled Densitometry steroid use, but mentioned he discontinued the Widespread availability of over-the-counter steroid about a year ago. Upon examination, the (OTC) ophthalmic medications allow patients to visual acuity was 20/20 in the right eye and 20/30 self-treat certain conditions without consulting an in the left eye. On dilated fundus examination, the eyecare provider, but many may not follow left eye was significant for subretinal elevation in guidelines provided on the label. Patients who the macula. Ancillary testing was performed and continue contact lens wear may experience visual the optical coherence tomography revealed changes due to the absorptive properties of soft shallow subneurosensory fluid in the macula of the lenses. This study examines the effects of five OTC left eye. To further support the diagnosis of central allergy drops on the optical clarity of soft contact serous chorioretinopathy, fluorescein angiography lenses using the OCULUS Pentacam®. was performed and demonstrated a smokestack Five OTC ophthalmic allergy medications and leakage in the left eye. The patient was observed saline control (Nortech Labs isotonic eye-wash) for six weeks and upon follow-up was found to were included in the study: Alaway, Visine-A, have no improvement structurally or functionally. Equate Eye Allergy Relief, Similasan Allergy Eye He was then prescribed 25 mg of oral Eplerenone Relief, and Natural Ophthalmics Allergy twice a day and found to have a progressive Desensitization. The lenses used for all trials were

65 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Alcon’s Dailies AquaComfort Plus Toric (-4.25- Case Report Abstract 1.75x180). Lenses were assigned to a solution and divided into 1-minute, 5-minute, or 10-minute Friday, June 21, 2019 subgroups for a total of five trials. Each lens was 12:30-1 p.m. placed in a well with solution, soaked for the required time, then mounted on a calibration arm in OD-Ocular Disease front of the Pentacam to measure its optical density via densitometry. Each lens received three Role of Supplements in Exacerbation of scans in succession. Statistical analysis was Central Serous Chorioretinopathy performed using ANOVA with SPSS to compare This case report will overview potential causes two individual variables: densitometry and time. of central serous chorioretinopathy (CSCR). All the While no statistical significance was found reviewed compounds are supplements, which may across time domains, statistically significant have caused them to be overlooked when differences between average densitometry values managing central serous retinopathy. were found for the following: Alaway vs Visine-A A 44-year-old Asian man had been complaining (p=0.025), Alaway vs Equate (p=0.01), Alaway vs. of metamorphopsia in the right eye for the past Control (p=0.007), Visine-A vs. Similasan week. OcHx: “Fluid” in the left eye 3 years ago, (p=0.028), Equate vs. Similasan (p=0.001), Equate treated with eye drops and laser therapy. Medical vs. Natural Ophthalmics (p=0.009), Similasan vs. History: unremarkable. Meds: creatine Control (p=0.008), and Natural Ophthalmics vs. supplements beginning 2 weeks prior. Pertinent Control (p=0.059). Alaway, Similasan, and Natural findings: Clinical VA sc: 20/25 OD. 20/20 OS (-) Ophthalmics averaged lower values between 11.4 APD, OU. All other clinical testing unremarkable. and 12.27, while Visine-A and Equate averaged Physical OD: 1 DD central elevation with higher values between 12.3 and 13.53. The pigmentary changes in the macula, inferior control’s average densitometry was 12.97. temporal chorioretinal scar. All other physical Previous studies have explored densitometry as findings unremarkable. Laboratory studies OCT 5 a function of corneal clarity. In this study, Line Raster: neurosensory retina detachment. ophthalmic allergy medications absorbed by soft Photos: pigmentary changes surrounding central lenses have varying effects on optical density: elevation. Treatment: Discontinue all supplements, Alaway, Similasan, and Natural Ophthalmics were Monitor in 6 weeks. associated with lower optical densities, while Case reports reveal an association between Visine-A and Equate were associated with higher CSCR with deer antler spray and Ephedra, optical densities. supplements that increase testosterone. Ephedra Author is an alpha and beta adrenergic agonist, which Hera Ansari, Optometry Student also increases norepinephrine release. Deer antler Co-Author(s) supplements are believed to have high levels of Emalea J. Deschamps, Optometry Student testosterone, though not fully studied. Creatine is Michael Schmalle, Optometry Student linked to increased testosterone, which raises Joshua Baker, O.D. cortisol in the body, which has been linked to Grace Liao, O.D.; CSCR. Sudden changes in hormones may elicit CSCR in individuals who are already susceptible to the condition. Increased cortisol secondary to testosterone may be the driving force behind

66 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

CSCR. Supplements should not be taken without for 3 years and 38 (6.9%) more than 4 years. A considering overall health. Further studies are total of 22.5% had no increase of axial length, needed to determine the association between 19.7% with AL increase about 0.1-0.2mm, 17.3% common OTC supplements and the retina. with 0.2-0.3mm, 16.8% with 0.3-0.4mm and Specific questioning about supplements can assist 21.0% with 0.4-0.5mm increase. Only 2.6% had in pinpointing factors that can lead to development AL increase more than 0.5mm. of CSCR in patients. It is also important to Before 7 years old they had no hyperopic remember that patients don’t always tell a full story. buffering, showing the about -0.50D mild minus With America becoming more health conscience, refractive status while their axial length elongating supplements are being utilized more with unknown to over 23mm. With the 0.26mm average increase potential side effects. It is our role as optometrists of the axial length, their myopic progression kept to consider this in our practice. More studies adding at -1.00D speed. Chinese children’ ocular should be performed to outline safety profile. elongation speed is faster than the average speed Author (0.26mm per year to 0.1mm) under 15 years old, Nhat Nguyen, O.D. correspondingly with their myopic refraction Co-Author(s) deteriorating before 13 years (-1.00D per year to Heather McLeod, O.D. -0.25D). Their ocular axial length reached to over 25mm. Corneal flatting to 42D in average Case Report Abstract compensated for their refractive error lower 1 to 2D diopter, that is latent myopia. Friday, June 21, 2019 Author 12:30-1 p.m. Yining Shi, M.D., Ph.D. Co-Author(s) PC-Primary Care Yi Li, M.D., Ph.D.

Continuous Observation on Chinese Case Report Abstract Children’s Ocular Axial Length Growth with the Relationship to Myopia Development Friday, June 21, 2019 To observe the Chinese children’s myopic 12:30–1 p.m. development with ocular axial length growth and other relevant factors. OD-Ocular Disease Patients with refractive errors visited our clinic Atypical Presentation of Idiopathic since 2009. A total of 547 patients under 20 years Intracranial Hypertension old were enrolled in sequence, including 298 boys (54.5%) and 247 girls (45.2%). And their bio- Idiopathic Intracranial Hypertension (IIH), or parameters were recorded, including visual acuity, Pseudotumor Cerebri, is an intracranial process intraocular pressure, ocular axial length, height, that can lead to edema of the optic nerve, diplopia, etc. Of 562 had taken more than twice exams, with transient obstructions of vision, visual field defects the average 3 times, at 8 months average interval. and loss of color vision. General symptoms include We followed them up and recorded their bio- headaches, nausea, and tinnitus. IIH has been parameters up to 9.9 years. Among 547 cases, associated with obesity, women of child-bearing 238 (43.5%) revisited our office within one year, years and use of certain medications but cannot 170 (31.1%) followed up for 2 years, 101(18.5%) be excluded when a patient without associated

67 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

risks presents with bilateral optic nerve edema. Case Report Abstract A 62-year-old male of normal weight presents complaining of transient visual disturbances for the Friday, June 21, 2019 past few months described as a darkening of 12:30-1 p.m. vision in the left eye for about five minutes. He denied headaches, weight loss, jaw claudication, OD-Ocular Disease scalp tenderness or fatigue. He denied floaters and flashes of light. His best corrected acuity was OD West Nile Viral Retinitis vs. APMPPE 20/25 and OS 20/20. Visual field showed overall West Nile Virus is a mosquito-borne, single- depression without specific neurological loss. stringed RNA flavivirus, belonging to the Japanese Anterior segment evaluation was noncontributory. encephalitis virus antigenic complex. Side effects Posterior segment evaluation revealed asymmetric of the virus can include fever, headache, fatigue, bilateral disc edema OS>OD. Blood pressure skin rash and retro-orbital pain, and in severe measured 165/94, but vascular changes and/or cases meningitis, encephalitis or poliomyelitis. macular edema associated with hypertensive Ocular involvement can include unique patterns of retinopathy were not present on evaluation. Urgent multifocal chorioretinal lesions, and cause imaging and blood work including investigation of complaints of floaters or decreased vision. neuroretinitis due to Bartonella, Syphilis, Lyme, Unfortunately, there is currently no established Tuberculosis were ordered and returned within treatment for the virus. Acute Posterior Multifocal normative values. After all other possible causes Placoid Pigment Epitheliopathy (APMPPE) typically were exhausted, a lumbar puncture was performed affects young to middle-age men, and causes a to rule out meningitis and to investigate the sudden onset of bilateral, sometimes asymmetric, possibility of elevated intracranial pressure. CSF blurred vision. Clinical signs include anterior uveitis, evaluation revealed an elevated opening pressure mild vitreous infiltration and one-half disc diameter of 290mm and the patient was diagnosed with IIH. lesions (possibly swollen RPE cells) that are pale, Treatment was initiated with oral Diamox 250 mg focal and deep within the neuroretina. twice a day PO with co-management with A 51-year-old Hispanic male presents for neurology. sudden onset blurred vision and spots seen in both IIH is a diagnosis of exclusion. Although certain eyes. The patient was previously hospitalized for medication such as tetracyclines, contraceptives, West Nile Virus encephalitis 3 weeks prior to Synthroid and Accutane have shown associations examination. The patient’s ocular and medical with IIH, the etiology is unknown. Those with disc history are otherwise unremarkable. Uncorrected edema should first be evaluated for life-threatening visual acuities are 20/30 in both eyes, with no conditions such as malignant hypertension and improvement on PH in the right eye, and PH compressive lesions, but patients with IIH may improvement to 20/20- in the left eye. Examination present with asymmetric disc edema and may not revealed an anterior chamber reaction in both fit textbook descriptions of being overweight, eyes, mild vitritis of both eyes, and multifocal female or of child bearing years. retinitis of the right eye. The patient was prescribed Author Pred Forte ophthalmic suspension 1 gtt QID OU, Maciel Cruz, Optometry Student and instructed to RTC in 1 week for follow up. Co-Author(s) It is undetermined whether the patient’s Kathryn Deliso, O.D.; panuveitis was secondary to the previous encounter with West Nile Virus, or caused by

68 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

APMPPE. Both potential etiologies are self-limiting, demand was changed. After 10 in-office vision though an ophthalmic steroid can improve therapy visits, the patient was able to perform symptoms and vision more rapidly. When it comes prism bar vergences without suppression and to white dot syndromes, it is important to consider measurements were taken for the first time. the demographics, systemic symptoms, laterality, Randot local stereopsis measured at 40 seconds. dilated fundus findings, and additional testing The Howard-Dolman stereopsis instrument found (OCT, ICG, FA, Photos) to aid in diagnosis and approximately 40 seconds at distance. At the end management plans. of the 17th vision therapy session, no exotropia Author was elicited at distance or near and in no position Kristin Kosch, B.S. of gazes during 9 gaze cover test. Randot local stereopsis at near was 25 seconds and global Case Report Abstract stereopsis was 40 seconds at near. The patient achieved 5.8 seconds of arc at distance with the Friday, June 21, 2019 Howard-Dolman instrument. Convergence ranges 3-3:30 p.m. before diplopia were 28 prism diopters at distance and 36 prism diopters at near. BV-Biocular Vision The patient was extremely satisfied and pleased with the results of his therapy. He has Improving Stereopsis of an Adult with great control of his ocular alignment and noted Intermittent Suppression significant improvement with binocularity, thus Adult patients can appreciate significant contributing to improved visual comfort and improvement in their binocularity with proper function. He was able to meet his goal and instructional guidance during structured in-office exceeded it, and his case is a testament to what vision therapy. A 28-year-old white male was can be accomplished, even with adult patients, referred for evaluation and was diagnosed with a with proper motivation. non-comitant V-syndrome left exotropia with Author suppression worse at distance than near. He Patrick Stark, O.D. wanted to improve suppression in the left eye and overall stereopsis. Magnitude of intermittent left Case Report Abstract exotropia with 9 gaze cover test ranged from 10 to Friday, June 21, 2019 20 prism diopters at near. Stereopsis with Randot measured 50 seconds in primary gaze, 140 3-3:30 p.m. seconds in up gaze, and 30 seconds in down gaze. Vergence ranges were unreliable due to OD-Ocular Disease suppression. Lamellar Hole-associated Epiretinal In-office vision therapy began focusing on anti- Proliferation suppression in the left eye. Initially, the patient could not fuse the Quoits vectogram target. With a Lamellar hole-associated epiretinal proliferation combination of weekly in-office and home vision (LHEP) is characterized as a thick, mound-like, therapy exercises, on the third week, the patient homogenous layer of medium reflectivity on SD- could successfully fuse the quoits vectogram OCT, that lies on the epiretinal surface at the without suppression or diplopia. However, he was margins of lamellar macular holes (LMH). LHEP is unable to keep the target fused when vergence reportedly present in 20-44% of all eyes with LMH.

69 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

The etiology of LHEP is controversial. Many Brenda S. Yeh, O.D., FAAO theorize that it originates from Muller cell migration Steven Ferrucci, O.D., FAAO and proliferation; while others propose the vitreous cortex as its origin. Unlike conventional epiretinal membranes (ERM), LHEP does not exert traction Case Report Abstract on the retinal surface. Friday, June 21, 2019 A 93-year-old white male presented with a chief complaint of blurry vision. Ocular history was 3-3:30 p.m. significant for dry age-related macular degeneration (AMD) OU, glaucoma suspect OU, OD-Ocular Disease pseudophakia OU, and strabismic amblyopia OS. Recurrent Non-arteritic Anterior Ischemic Medical history included diabetes, hypertension Optic Neuropathy and cardiovascular disease. BCVA was 20/50 OD and CF at 2 ft OS. Macular examination showed Non-arteritic anterior ischemic optic neuropathy scattered confluent drusen OD and large (NAAION) is characterized by swelling of the optic geographic atrophy OS. In addition to the AMD nerve head due to underlying systemic vascular findings, OCT revealed a partial thickness foveal disease, such as hypertension, diabetes or defect with disruption of the ellipsoid zone and a hypercholesterolemia. Other controversial thick, mound like material at the retinal surface OD. contributory factors are obstructive sleep apnea, Based on these findings, the patient was smoking and use of phosphodiesterase inhibitors. diagnosed with LHEP OD. After discussion with NAAION represents an infarction of the anterior the patient, it was decided that surgery was not portion of the optic nerve involving branches of the indicated and he will be monitored periodically. posterior ciliary arteries leaving the optic nerve LHEP is a newly described entity and is head edematous and hyperemic. frequently mistaken for ERM, hence it is important A 53-year-old white male presented with a for optometrists to be familiar with the condition complaint of sudden and painless visual field loss and its implications. Generally, LMH with LHEP of the left eye. The patient denied: jaw claudication, have significantly lower mean BCVA, greater temporal pain, fatigue and malaise. Entrance external LMH diameter, thinner center foveal testing was remarkable for positive afferent thickness, and greater disruption of ellipsoid zone, pupillary defect (APD) and constriction of the compared to LMH without LHEP. Management inferior nasal visual field by confrontation left eye. includes monitoring or surgical treatment, the latter Dilated examination revealed an edematous and being somewhat controversial. Most studies have hyperemic disc superior nasally with splinter found that LHEP does not influence the natural hemorrhages. Less than two months later the progression or visual prognosis of LMH with or patient returned with complaints of field loss now without surgery. However, a few studies have involving the superior portion of the left eye. Again, reported worsening of anatomic features and post- entrance testing was remarkable for positive APD operative BCVA. Therefore, surgery should be and constriction of the superior and inferior nasal limited to visually symptomatic patients who report visual fields by confrontation of the left eye. Dilated significant visual decline. examination revealed a similar appearance to the Author previous exam but now involving the inferior aspect Jasmine Lynn, O.D. of the optic nerve. Co-Author(s) Because NAAION is not inflammatory in nature,

70 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

it is not treated with corticosteroids like the arteritic rotational recovery, (measured 1 minute after presentation. There is no widely accepted rotating the lens 450 temporally), were evaluated at treatment for NAAION, therefore managing the dispensing and 2 weeks. Subjective responses patient’s underlying systemic conditions with the were collected using a 0-10 scale. patient’s primary care provider is essential. Once A total of 44 subjects completed the study, NAAION has occurred in one eye, there is a 15- ages 18 to 40 (mean ± SD, 25.0 ± 7.2 years). No 24% chance of involvement of the fellow eye over statistical difference was found between lenses for five years. It is rare for it to reoccur in the same logMAR distance visual acuity on dispensing and eye, and in this unfortunate case the patient was after 2 weeks’ wear (p>0.05 both). Comfort on subject to this unusual circumstance despite best insertion was similar at dispensing (p>0.05) but efforts to manage his systemic risk factors by design A was rated significantly higher than design adjusting his blood pressure medication to avoid B for initial comfort at 2 weeks (9.0 ± 1.0 vs. 8.3 ± nighttime dosing and having him re-evaluated for 1.6, p = 0.033). At 2 weeks, design A ratings were his CPAP machine. It is important to understand significantly higher than design B for lens stability that a diagnosis of NAAION is not only about the (9.2 ± 1.1 vs. 8.7 ± 1.0, p<0.05), and vision patient’s vision, but also the overall health of the satisfaction (9.1 ± 1.1 vs. 8.5 ± 1.1, p<0.05). patient due to the vasculopathic risk factors that Orientation position was similar between lenses on underlie the etiology. dispensing (1.30 ± 3.10 vs. 2.60 ± 3.10, p = Author 0.083), but a significant difference was found at 2 Paige Small, Optometry Student weeks with design A lenses showing better Co-Author(s) orientation than design B (1.40 ± 2.90 vs. 2.80 ± Kelly Schoorens, O.D. 3.50, p = 0.026). A higher proportion of design A than design B lenses returned to within 100 of Scientific Abstract primary gaze orientation, after manually displacing the lens 450 temporally, at dispensing (97.7% vs. Friday, June 21, 2019 11.4%, p<0.001) and after 2 weeks wear (95.5% 3-3:30 p.m. vs. 20.5%, p<0.001). Lens stabilization design of soft toric contact Evaluation of Two Toric Designs and Lens lenses is important for fitting success and to Stability Performance provide optimum vision satisfaction specially in patients with astigmatism. Contact lens manufacturers incorporate Author different stabilization designs in toric soft contact Jennifer Palombi, O.D., FAAO lenses that affect orientation stability and rotation in Co-Author(s) dynamic situations and subsequent vision Ruben Velasquez, MSc FIACLE performance. This study sought to investigate the Gary Orsborn, O.D., MS, FAAO, FBCLA clinical performance and subjective acceptance of Jose Vega, O.D. two silicone hydrogel toric contact lenses with different stabilization designs (design A: uniform horizontal ISO thickness, fanfilcon A, and design B: eyelid stabilized design, senofilcon A). A 2-week crossover, randomized, double- masked dispensing study was conducted at a single site. Visual acuity, lens orientation and

71 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Case Report Abstract Lymphoma in the brainstem will cause oculomotor dysfunction. The circuits for Friday, June 21, 2019 supranuclear control of eye movements will be 3-3:30 p.m. affected. Functions such as horizontal eye movements, vertical eye movements, and LV-Low Vision vergence eye movements will be abnormal. A lesion to the MLF will affect the nerve signals to the CNS Lymphoma medial rectus and cause internuclear Lymphoma of the central nervous system ophthalmoplegia. Because the lymphoma was in accounts for about 3% of primary brain tumors. the pons, midbrain and cerebellum, multiple Recently, it has been attributed in part to the pathways are affected. Currently, the median increase of human immunodeficiency virus. It survival rate of a CNS lymphoma is 4 years. arises from B lymphocytes and commonly growth Author occurs adjacent to ventricles. Chemotherapy and Maria Nguyen, O.D. radiation therapy is effective in controlling growth of tumor for several years. Radiation therapy may Information Abstract have ocular side effects that resemble diabetic Friday, June 21, 2019 retinopathy. A 46-year-old white male presented to the clinic 3-3:30 p.m. for an acquired brain-injury-specific eye exam. He is wheelchair bound and accompanied by his P.A.N.D.A. Scopic Vision: The Optometrist’s caregiver. Patient has a history of CNS lymphoma Role in Identifying Pediatric Autoimmune diagnosed in 2016. He was treated with several Neuropsychiatric Syndrome rounds of IV steroids with some improvements for This presentation will educate doctors of masses in pons, midbrain and cerebellum. He had optometry about their role in PANS/PANDAS biopsy and is currently undergoing chemotherapy (Pediatric Autoimmune Neuropsychiatric and radiation therapy. His systemic health is Syndrome). Optometrists are potentially ‘first significant for hypertension, hyperlipidemia, and responders’ in the identification and early diagnosis PTSD. Patient had complaints of photophobia, of this condition. This treatable disorder is diplopia and postural dizziness. He reported that estimated to affect 1 in 200 children. In a poll taken the diplopia has decreased over time. His last eye of parents whose children were later diagnosed, an exam was in 2011. His visual acuity was 20/40+2 overwhelming majority responded that their eye in the right eye and 20/30-1 in the left eye. Patient care professional either dismissed or overlooked had dysconjugate gaze and difficulty with left gaze the ocular signs and symptoms involved. This fixation with large overshoots. He is exophoric with informational poster will demonstrate the neuro- a slight right . On DFE, the retina had ocular manifestations of the disorder and provide scattered dot blot hemorrhages and cotton wool clinical guidance to the practitioner in specialized spots in both eyes. The macula had edema and testing. A greater understanding by the optometrist hard exudates in both eyes. He does not have will hopefully lead to a proper, prompt diagnosis history of diabetes. His last HbA1C was 5% in that will provide a more favorable outcome for the 2017. The differentials are either diabetic or child. Recovery is possible if treated early and radiation retinopathy. The patient was referred to a appropriately. Optometrists must be aware of their retinal specialist for further evaluation. role as a ‘first responder’.

72 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Author clinics, and developing optometry schools in many Megan Meus, O.D. countries including Peru, Nicaragua, Trinidad and Tobago, Haiti, Guatemala, Mexico, Colombia, El Information Abstract Salvador, Argentina, Malawi, Dominican Republic, Nepal and Ghana. Since 2005, the VOSH TTP Friday, June 21, 2019 data management system, network of recipients 3-3:30 p.m. and criteria of impact keeps evolving and important lessons can be drawn on the value delivered by Lessons of Successful Provision of these donations. Ophthalmic Equipment and Supplies to The mission of VOSH TTP is to collect, repair Optometry Schools and Sustainable Clinics in and refurbish donated, used optometric equipment Developing Countries: VOSH/International’s in the United States, and place it at schools of Technology Transfer Program (TTP) optometry and clinics in developing countries. VOSH TTP has seen a growth in the donation of VOSH (Volunteer Optometric Services to and request for good, usable optometric Humanity) recognizes that functional equipment examination equipment. There are important and supplies must be available for a student to be lessons of success and impact generated by the properly trained, and for a clinic to properly program such as better training of optometry examine and care for patients. Our mission to bring students and better equipped VOSH-affiliated vision to all is achieved by supporting sustainable clinics worldwide, but also challenges to consider eye clinics, optometry schools and optometric for its growth. educators wherever there is insufficient or Author unaffordable eye care. Ophthalmic instruments and Tracy Matchinski, O.D., FAAO equipment play an essential role in achieving this. Co-Author(s) The VOSH TTP Program collects, repairs and Maria A. Moreira, MSc refurbishes donated ophthalmic instruments and David Stacy, O.D. equipment, and then sends them to schools and clinics in need. Important lessons on eye health Scientific Abstract technology management are summarized here. Donated equipment is solicited on our website Friday, June 21, 2019 and at various optometric meetings. Details about the donated equipment are gathered through an 3-3:30 p.m. on-line system. In our warehouse, accepted items Evaluating the Visual Performance of a Daily are repaired or refurbished, and then inventoried. Disposable Multifocal Lens, Designed with Response to equipment requests prioritize Two Differently Powered Intermediate Zones those affiliated with a VOSH chapter or a developing school or university. The TTP Visual performance with multifocal contact Committee monthly meetings evaluate donations lenses (MFCL) can vary with add-power and lens and requests and consider where the items will be design. The modern digital-device lifestyle used, maintenance, customs and transportation. demands the ability to see at various intermediate VOSH TTP has seen an increasing number of distances. This study evaluated the visual donated items of optometric equipment, new performance of a daily disposable, silicone frames and lenses. This has allowed VOSH TTP to hydrogel (somofilcon A), multifocal lens (DDMF) provide equipment and supplies to VOSH-affiliated with a centre near design, which incorporates two

73 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

differently powered intermediate zones. Jill Woods, BSc(Hons), MCOptom, FAAO This study refitted habitual MFCL wearers, who Jalaiah Varikooty, MSc, MBBS were wearing lenses as prescribed by their eye Lyndon Jones, Ph.D., DSc, FCOptom, FAAO care professionals, with a DDMF. Subjects were masked to lens brand and wore the DDMF for 2 Case Report Abstract weeks. After 2 weeks, logMAR acuity was measured at four working distances (WDs) - Friday, June 21, 2019 distance (DV), long-intermediate (LI=1.5m), short- 3-3:30 p.m. intermediate (SI=0.75m), and near (NV= 0.4m). Subjects also rated their experience by grading the LV-Low Vision vision clarity for specific tasks as one of three options: exceeded expectations, met expectations Prescribing Pelli Prism for a Stroke Patient or fell short of expectations. with a Bilateral Homonymous Visual Field Forty-eight subjects completed the study. Defect Habitual MFCLs spanned market-representative A bilateral homonymous visual field defect can brands of reusable and DDMF lenses. At the be detrimental to a patient’s quality of life. Although 2-week visit, mean binocular logMAR acuities at rehabilitation and therapy techniques may help the four WDs were good with the DDMF: DV improve a visual field defect, it is unlikely to result in -0.040.09, LI -0.110.11, SI -0.100.09 and a full recovery. A Pelli prism is an optical method of NV 0.020.09. Ratings of vision clarity were providing a patient with awareness of objects in significantly better for DDMF than with habitual their missing peripheral field for increased safety lenses for tasks conducted at LI (91.7% vs. 87.5% and quality of life. In this case, a Pelli prism was reported exceeded or met expectations (E/M), used to help a patient with a bilateral left p=0.013), SI (85.4% vs. 77.1% reported E/M, homonymous visual field defect. p=0.042), NV (83.3% vs. 56.2%, reported E/M A 61-year-old male presented for his annual p=0.001), but not statistically different at DV eye exam three months after having had a stroke (81.2% vs. 72.9% reported E/M, p=0.068). that resulted in the complete loss of his left visual Significantly more subjects preferred the DDMF field. He reported a significant decrease in his over habitual lenses for vision clarity at LI (43.7% quality of life since then and was looking for vs. 12.5%, p=0.040) and for SI (43.7% vs. 12.5%, anything that could improve his functionality p=0.040), whereas the differences for DV and NV despite the assertion from other doctors that were not significant (DV: 39.6% vs. 33.4%, nothing could be done. At his exam, the patient p=0.771; NV: 41.6% vs. 16.7%, p=0.111). was educated on the use and benefits of Pelli This design of multifocal lens provided good prisms. The patient returned for an evaluation and vision, both for acuity measured in-office, as well after a Fresnel prism trial over his current glasses, as in real-world experience. In particular, subjective single-vision lenses with Pelli prisms on the left eye ratings and preferences for long-intermediate and were ordered. 4Forty prism diopter base out short-intermediate distances were all better than prisms were placed above and below the line of subjects’ habitual MFCLs. These results suggest sight 12mm apart over the left eye, the eye on the the somofilcon A multifocal lens provides a range side of the deficient visual field. The placement and of focus suited to a modern digital lifestyle. orientation of the prisms brings images from the Author missing left visual field into the patient’s field of Gary Orsborn, O.D., MS, FAAO, FBCLA view. The patient then has awareness of any Co-Author(s)

74 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

objects to his left and he can direct his attention to Feinbloom chart. External examination, entrance them if needed by turning his head and bringing testing, and slit lamp examination were them into his functional field of vision. After some unremarkable. Intraocular pressures were 12 adaptation, the patient reported greater mmHg OD/OS. Fundus examination revealed functionality and a great improvement in his quality bilateral disc drusen with RPE hyperplasia and of life. intraretinal fluid extending into the macula OU. This is an important case in which optometry Fundus auto-fluorescence imaging (FAF) revealed was able to help improve this patient’s life after large amounts of hypo-AF surrounded by hyper AF other doctors asserted there was nothing that extending from the fovea to the peripapillary area could be done to improve his situation. Using Pelli OU. SD-OCT scans OD/OS revealed elevation of prisms, we were able to increase this patient’s the optic nerve head confirming optic nerve head functional range of vision and help him get the drusen. The scans also revealed bilateral choroidal most of his remaining visual field. neo-vascular membranes with adjacent intraretinal Author fluid temporal to the optic nerve head OD/OS. Kimberly Skyles, O.D. Anti-VEGF treatments were initiated with only minor improvement in the patient’s acuity. Case Report Abstract Although very rare, this case report demonstrates the importance of considering Friday, June 21, 2019 CNVM in younger patients who present with disc 3-3:30 p.m. drusen and reduced vision. For unknown reasons, many of the patients in the literature who are OD-Ocular Disease diagnosed with this condition are children or young adults. Clinicians should be cognizant of these Bilateral Peri-papillary Choroidal findings as an early diagnosis can allow for prompt Neovascularization Membranes Secondary to treatment and possible visual recovery. Optic Nerve Head Drusen in a Young Patient Author Optic nerve head drusen (ONHD) are congenital Raman Bhakhri, O.D., FAAO multi-lobed calcific protein deposits that are Co-Author(s) thought to be secondary to a disturbance in axonal Patrick Yoshinaga, O.D., MPH, FAAO metabolism with slowed axoplasmic flow. Buried early in life, they become more superficial and Case Report Abstract visible as the patient ages. Although most patients Friday, June 21, 2019 are asymptomatic, visual acuity and visual field loss can occur. Rare complications, especially in 3-3:30 p.m. younger patients, can include choroidal neovascular membranes (CNVM), which can lead LV-Low Vision to visual acuity and visual field loss. This case Diagnosis and Low Vision Management of highlights the development of bilateral CNVM in a Occult Macular Dystrophy young patient with SD-OCT and FAF aiding in the diagnosis. Occult macular dystrophy (OMD) has a broad A 19-year-old female presented with reduced range of age onset and was first reported in the vision in both eyes. Best-corrected distance visual literature in 1989. While the genetics of OMD is acuity was 20/360 OD and 20/450 OS with a complex, heterozygous ‘retinitis pigmentosa 1-like

75 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

1’ (RP1L1) missense variants have been linked to evaluation. This will aid to enhance her quality of this retinal dystrophy. OMD is characterized by life, maintain her independence, and assist her with visual acuity reduction from macular dysfunction. It interprofessional referrals. is named occult because the dysfunction is hidden Author by normal funduscopic examination, full-field Maggie Man Ki Ho, O.D., MS electroretinograms (ERG), and fluorescein Co-Author(s) angiograms (FA). However, focal macular, Stephanie Schmiedecke Barbieri, O.D., F.A.A.O., multifocal ERG, and optical coherence tomography Dipl. Low Vision (OCT) can reveal the dysfunction. This case report Patricia C. Sanchez-Diaz, DVM, Ph.D., F.A.A.O. describes the diagnosis, genetic testing, and low- Jeff C. Rabin, O.D., M.S., Ph.D., F.A.A.O., Dipl. vision management of OMD. Vision Science VG, a 42-year-old Hispanic female, presented to clinic due to failing her driver’s license renewal. Case Report Abstract Her chief complaint was unexplained progressive central vision reduction for the right eye (OD) and Friday, June 21, 2019 left eye (OS) over the past two years. Her ocular 3-3:30 p.m. and medical history were unremarkable and her family history was non-contributory. Her visual LV-Low Vision acuity was 20/60 OD, OS at distance with a minimal prescription and 20/50 OD, OS at near Spectacle Prescribing Recommendations for with +1.50 effective ADD. The fundus and full field Visually Impaired Patients ERG were within normal limits (WNL) in both eyes There is great importance in proper spectacle (OU). A multifocal ERG showed borderline prescribing and lens design recommendations for amplitudes foveally OU. The fundus all populations, particularly those with low vision or autofluorescence (FAF) showed a mottled other visual impairments. As with any patient, a appearance with small areas of granular thorough refraction is the first step in spectacle hyperfluorescence and OCT macular thinning OU. prescribing. Many practitioners, however, do not OCT angiography of the posterior pole showed 1 understand the impact improper lens design vessel loop with a few areas of nonperfusion and a recommendations can have on the field of view microaneurysm. A visual field (VF) demonstrated and usable vision of patients with impairments. scattered central defects and a psychogenic Case 1: A 65-year-old male presents with left component was ruled out with the tangent field. homonymous hemianopia secondary to cerebellar The genetic testing revealed a heterozygous stroke. At last visit, patient had press-on Peli pathogenic missense mutation in RP1L1. This prisms placed on existing pair of distance glasses. genetic change is known to cause OMD with His prescription was updated, and he was to trial reduced penetrance and variable expressivity. prisms with current prescription and return with Through a visual functioning questionnaire, we new distance and near-only glasses to have Peli anticipated that she may benefit from telescopes, prisms placed. Patient presented to clinic with microscopes, magnifiers, filters and driving progressive lenses in a small frame, complaining of rehabilitation services. worsening symptoms and expecting to have the OMD is rare and difficult to diagnose without Peli prisms placed on the new glasses. rigorous testing. Nonetheless, there is no standard Unfortunately, the prisms are not compatible with a treatment for OMD. Our next step in management progressive lens design, and the patient had to is to perform an extended functional, low-vision

76 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

exchange the glasses and return with a new pair Behcet’s disease, hypertension, lupus and HIV. It is for placement. Case 2: A 67-year-old white female nearly exclusively an incidental finding and is only presents with a complaint of decreased vision for associated with visual symptoms when there is one year secondary to wet ARMD. Entering macular involvement. Due to its underlying acuities OD:20/160 OS: 20/40, with OD:+2.00 systemic causes, a binocular presentation is most -0.50 x100 OS:+2.25 -0.50 x100. Retinoscopy common. and trial frame refraction resulted in acuities of A 13-year-old black male presented for an OD:20/32 OS:20/32 with a prescription of annual eye exam, denying any visual or ocular OD:+1.25 -0.75 x035 OS:+1.75 -0.50 x135. complaints or changes. The patient’s systemic Careful retinoscopy, and trial frame refraction history was unremarkable except for seasonal should be implemented in all patients with visual allergies. His entering uncorrected visual acuity impairments. It is important to trial frame any was 20/20 in both eyes. All other entrance testing updated spectacle prescriptions in order to was unremarkable. The patient had a minimal determine if the visually impaired patient can refractive error and spectacle correction was not appreciate an improvement in their usable vision. recommended. His anterior segment was The trial frame prescription can also help determine remarkable for mild racial melanosis of both eyes if the changes impact the patient’s mobility or but otherwise noncontributory. The patient and spatial orientation. Additionally, certain lens designs parent initially deferred dilation, and during can decrease vision further in patients with visual undilated fundus examination a single Roth spot impairments. It is important to specify lens design was observed in the left eye nasal to the optic on the prescription of patients who may be nerve. Upon this finding, the patient was dilated, impacted by such variations. fundus photos were taken and an extensive fundus Author examination was performed. The patient was Tyla Girouard, fourth-year optometry student immediately scheduled for a complete blood count with his pediatrician to investigate the possibility of Case Report Abstract a systemic correlation or diagnosis of Leukemia. The blood work results returned within normal Friday, June 21, 2019 range and the pediatrician referred the patient to 3-3:30 p.m. ophthalmology for a second opinion where he reported no Roth spots on fundus examination, OD-Ocular Disease approximately two months after our initial examination. Questionable Idiopathic Roth Spot in a While it is possible this patient had an isolated, Pediatric Patient idiopathic Roth spot there is little literature detailing Roth spots are small intraretinal flame an idiopathic cause. For this reason it is extremely hemorrhages with a pale white or yellow center important to rule out all systemic associations. most likely composed of coagulated fibrin or While the patient’s initial blood work ruled out all platelets at the site of the vessel rupture due to systemic associations, it is still unwise to assume underlying vessel endothelial dysfunction. Originally an idiopathic cause and careful follow-up is considered pathognomonic for bacterial recommended. endocarditis, Roth spots are now a non-specific Author finding associated with several underlying systemic Jared Reinert, causes including leukemia, diabetes, anemia,

77 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Case Report Abstract determined stenosis of the left internal carotid artery to be greater than 80%, and a carotid Friday, June 21, 2019 endarterectomy surgical consult was scheduled. 3:30-4 p.m. Ocular ischemic syndrome is an ocular manifestation of severe vascular stenosis and OD-Ocular Disease requires follow-up with a vascular specialist. A carotid Doppler is standard of care in presumed Presumed Ocular Ischemic Syndrome ocular ischemic cases to determine the amount of Diagnosis with Coronary Computed stenosis of the internal carotid artery. When Tomography Angiogram Doppler is unavailable or inconclusive, CTA may be Ocular Ischemic Syndrome (OIS) is a set of used to evaluate carotid occlusion. Treatment for findings observed in patients with severe vascular OIS often requires a carotid endarterectomy to stenosis, specifically of the internal carotid artery. restore blood flow to the carotid, and urgent Characterized by stenosis >80%, OIS has many referral is mandated when OIS is suspected. manifestations within the eye. Most notably, Author unilateral mid-peripheral hemorrhages are Justin Schaefers, BS hallmarks of this condition. A 71-year-old white male presented to the clinic Case Report Abstract for an annual eye exam, with his only complaint Friday, June 21, 2019 being new floaters in the left eye. His last eye exam was 2 years ago, where he was diagnosed a 3:30-4 p.m. glaucoma suspect due to an increased cup to disc ratio. Systemic medical history included OD-Ocular Disease hypertension and type II diabetes with a recent A1c Differentiation Between Herpes Zoster and of 6.1.Best corrected visual acuity was 20/25 in Herpes Simplex Viruses the right eye and 20/20- in the left eye. Entrance testing and Biomicroscopy were unremarkable. The patient had mixed symptoms of variable IOP was 16/19 via applanation and gonioscopy pain with foreign body sensation in one eye, which was open and unremarkable. Dilated fundus exam correlated more with herpes simplex, plus a revealed moderate cupping with minimal prodrome of fever, headache and malaise, which asymmetry between optic discs. The retina of the was usually associated more often with herpes right eye was without hemorrhages or exudates. zoster. There was no macupapular skin eruption Fundus examination of the left eye revealed and no Hutchinson’s sign. Positive signs involved numerous mid-peripheral intraretinal hemorrhages corneal staining and grade 3 cells in the anterior extending into posterior pole, with one perifoveal chamber. Corneal vesicles found in early simplex hemorrhage. The macula was flat without macular infections have similar appearance to edema. A referral was made to the vascular pseudodendrites in zoster infections. The patient surgical department for a carotid artery imaging. was already taking Valcyclovir 400mg twice a day The carotid Doppler was determined inconclusive directed by the PCP for long-term management. due to a significant amount of plaque blocking the The addition of Ganciclovir five times a day for 21 scan. A coronary computed tomography days was to treat the corneal involvement. Once angiogram (CTA) was also ordered to determine the cornea was healed, the introduction of the amount of stenosis. The vascular surgical team prednisolone acetate 1% four times a day was to

78 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

treat the anterior chamber reaction. After 2 weeks, A 65-year-old Liberian female presents for her signs and symptoms resolved. first eye exam. The patient complains of eye If this presentation was herpes simplex irritation and states that the left eye has a fleshy infection, vesicles would eventually develop into growth over the nasal aspect of the cornea, which dendritic or geographical ulcers without additional has caused the eye to turn outward and has topical anti-viral drops. Topical steroid for significantly reduced her vision. The patient states concurrent anterior chamber reaction is that she only developed an eye turn in her late contraindicated unless the corneal surface is thirties after head trauma, which made her eye red healed. In contrast, if this presentation was herpes and painful, progressing to vision loss and eye zoster infection, vesicular ulceration and crusting or turn. Ocular examination is significant for dry eye of Hutchinson’s sign would develop without further both eyes, a three-millimeter nasal left intervention. The later the onset of treatment, the eye, a constant large angle left exotropia and greater the prevalence and severity of post- extensive chorioretinal atrophy of the left eye. The herpetic neuralgia. Therefore, prompt initiation of chorioretinal atrophy in the left eye extends from treatment was important even though it was the superior border of the optic nerve head, difficult to definitively determine whether this was a through the superior arcade out to the periphery, herpes simplex or zoster infection. with a linear band of fibrosis. The atrophy of the Author macular and paramacular region is circular. These Nhi Phan, O.D. fundus findings are consistent with untreated, inactive toxoplasmosis. Case Report Abstract Pain, decreased vision, or the appearance of a associated with ocular toxoplasmosis often Friday, June 21, 2019 prompts a person to seek medical attention. With 3:30-4 p.m. proper diagnosis, treatment can be initiated to treat the infection, relieve symptoms and prevent vision OD-Ocular Disease loss. Medical consult for systemic evaluation is also necessary. For this patient, the undiagnosed Vision Loss and Sensory Exotropia due to toxoplasmosis caused extensive retinal damage, Untreated Ocular Toxoplasmosis resulting in a sensory exotropia and permanent Ocular toxoplasmosis occurs as a vision loss. The visual outcome for this patient consequence of the obligate intracellular parasite could have been very different with optometric Toxoplasma gondii and is most often acquired by intervention during initial active infection. consuming undercooked meat. Infection can Author cause floaters, decreased vision, photophobia, Abby Small, Optometry Student uveitis and retinochoroiditis. Poorer prognosis is associated with larger lesions, recurrence, and proximity to the fovea. It is estimated that about one-third of humans are chronically infected with T. gondii, however manifestation of disease varies. Epidemiologic data show that risk of infection is significantly greater in people with compromised immune systems; patients with advanced age, HIV/AIDS, or during pregnancy.

79 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Case Report Abstract right posterior inferior cerebellar artery distribution (PICA). MRA neck and CTA head neck: Irregularity Friday, June 21, 2019 preforaminal right vertebral artery, no flow-limiting 3:30-4 p.m. stenosis, right artery terminates in PICA. • ESR and CRP: within normal limits LV-Low Vision Management: • Occlusion of left eye for “diplopia” relief. Beauty Parlor Syndrome: Beauty is Pain Current occlusion via opaque contact lens. Option An 85-year-old white female with complaint of to try Bangerter foil/eye patch. “not being able to see well or walk properly”. • Suspect combination of sensory, mechanical, and neurological (). Defer to • Initial symptoms April 2018 while at the hair strabismus surgeon regarding surgery. salon. • Continue care with PCP and Cardiologist • After shampoo became extremely dizzy and • Refer to OT/PT for rehabilitation unable to walk. She had to bend down and crawl The vertebrobasilar arterial system is located over the curb and into her car. within the posterior circulation of the brain and • Reports change in vision, numbness, tingling supplies blood, oxygen and nutrients to the in feet, vertigo, loss of balance and coordination. brainstem, occipital lobe, and cerebellum. • Presented to ENT for vertigo and proceeded Vertebrobasilar insufficiency results from an to see 10 additional doctors within different interruption blood flow due to mechanical specialties without a diagnosis to her knowledge. compression of the vertebral artery during Ocular history: Pseudophakic OU. Scleral prolonged hyperextension. Most importantly, don’t buckle with vitrectomy due to a rhegmatogenous ignore acute stroke symptoms and know when to retinal detachment with a secondary macular admit. hole OS (1990s). Peripheral retinal laser for tear OD Author (1990s). Meibomian gland dysfunction. Medical Ashton Ehlers, O.D. history: Hypertension, dyslipidemia, carotid disease with stent. Medications: losartan, rosuvastatin, Case Report Abstract vitamin D, low-dose aspirin. NKDA. Social history: Friday, June 21, 2019 retired librarian, married with four children. • Best corrected acuity: OD 20/20 OS 20/500 3:30-4 p.m. • EOM: -1 underaction LLR, LMR. -3 underaction LSR OD-Ocular Disease • Cover test (Krimsky): 25pd CLXT; 20pd Management of an Acute Traumatic Hyphema CLHypoT After Being Hit in the Eye with a Padlock • Visual field: full OD, grossly full OS • Pupils: Round, normal reactivity OD. Irregular A hyphema is the presence of blood in the surgical pupil, (+)RAPD OS. anterior chamber (AC), typically present after blunt • Intraocular pressure: 13mmHg OD, 7mmHg trauma has occurred, following intraocular surgery, OS• Posterior segment: 0.4R OD normal rnfl, 0.7R or spontaneously in persons on blood thinners. OS diffuse optic atrophy, scleral buckle with Long-term complications of hyphemas include chorioretinal scarring OS. (-) OU. elevated intraocular pressure (IOP), peripheral • MRI with and without contrast: Infarction of anterior synechiae, optic atrophy, corneal blood

80 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

staining, secondary glaucoma, and impairment to Case Report Abstract accommodative function. Common presentation may include a history of blunt trauma, use of blood Friday, June 21, 2019 thinners, genetic predisposition to platelet or 3:30-4 p.m. thrombin disorders. The management of traumatic hyphemas are time-sensitive. It is imperative to PC-Primary Care have the patient elevate their head during the healing process in addition to prescribing a Life-saving Paradigm Shift in Central Retinal cycloplegic for comfort and a steroid to reduce Artery Occlusion Management inflammation and manage any secondary iritis that Central retinal artery occlusions (CRAO) are may manifest. In the instance of an acutely rare; they occur in approximately 1-2 of every elevated IOP, a beta-blocker is the appropriate 100,000 patients with increasing incidence with management of choice as it will not promote age. Data from 2016 revealed that only one-third of inflammation like a prostaglandin analog. practitioners referred patients with an acute CRAO A 16-year-old male presented with a history of for immediate stroke evaluation at the emergency blunt trauma: a lock bounced off the ground and department. Recent literature has shown that the hit him in the eye. He complained of pain, watering risk of having a subsequent cerebrovascular and photophobia. The patient’s systemic health accident (CVA) or myocardial infarction (MI) was unremarkable, he denied any possibility of following a CRAO is equivalent to having had a Sickle-Cell trait or clotting disorders, and his previous MI or transient ischemic attack. medication list was unremarkable. Entrance testing Furthermore, the highest risk period for a CVA or was unremarkable and uncorrected visual acuity MI following an ischemic event occurs during the was 20/20- in both eyes. Anterior segment exam first 1-2 weeks after the incident. This poster of the left eye was remarkable for moderate bulbar highlights the importance of the updated injection, mild endothelial blood staining from the recommendations for patients who present with an AC, 3-4+ red blood cells in the AC in addition to a acute CRAO. 1.5mm hyphema. IOP via Goldmann applanation A 74-year-old Hispanic female presented with tonometry was measured at 18 mm Hg OD and 28 sudden decreased vision of the left eye that mm Hg OS. 4-mirror gonioscopy revealed a occurred 3 days prior. The patient’s last eye superior temporal angle bleed. With daily follow-up examination was 5 years ago. Pertinent ocular the hyphema had been reducing in size and IOP history included cataract extraction with PCIOL in was under good control until day 7 post-injury the left eye 5 years ago. Pertinent medical history where IOP spiked to 48 mm Hg OS. Combigan TID included hypertension, insulin-dependent type 2 OS was started for IOP management until the diabetes, congestive heart failure, and hyphema had resolved completely 2 weeks hyperlipidemia. All systemic conditions were following initial presentation. controlled with medications, with the exception of Prompt management of a traumatic hyphema hyperlipidemia, which was being monitored. is essential in procuring optimal visual outcome in Pertinent examination findings included visual patients. With the use of a cycloplegic, steroid, and acuity of HM (PHNI) and retinal “whitening” with a IOP-lowering agent, long-term visual reduction can “cherry-red spot” on fundoscopy OS. Our patient be avoided. was sent and admitted to the ER on the same day, Author and underwent a full stroke evaluation. Her testing Inrava Khasnabish, B.Sc., O.D. revealed no evidence of giant cell arteritis, an acute

81 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

MI or CVA; however, she was found to have diplopia, which required differing amount of prism coronary artery disease and worsening left correction in spectacles for various distances. Her ventricular hypertrophy with a severely reduced medications included amitriptyline, albuterol and ejection fraction. The patient underwent surgical vitamin B supplements. Palate paralysis, implantation of a loop recording device and was pharyngeal dysphagia, and sleep-related prescribed dual antiplatelet therapy as well as hypoventilation were some of her systemic cholesterol medication with close follow-up in comorbidities. cardiology. Her ocular health continues to be Her spectacle-corrected distance visual acuities monitored by optometry for neovascularization of were 20/40 OD and OS. Anterior segment exam the iris, angle and retina. revealed inferior corneal scarring with superficial Patient education and proper follow-up care to inferonasal neovascularization OU with marked monitor overall systemic and ocular health are of epithelial irregularity OS>OD. Due to her critical importance for patients with central retinal incomplete blink and lid closure, scleral lenses artery occlusions. Timely referral of these patients were indicated to protect her from further to the emergency department for a stroke breakdown with continued exposure. Custom evaluation can be a life-saving endeavor. Stable scleral lenses (Valley Contax, Springfield, Author OR) were successfully fit OU with BCVA of 20/30 Andrea Yee, O.D. OD and OS. RJ reported excellent comfort and Co-Author(s) superior vision in the lenses OU; however, wear Sylvia Sparrow, O.D. time was limited by the diplopia. Plano-powered spectacles with prism correction over her scleral Case Report Abstract lenses were recommended. The diplopia at distance was fully resolved with a total of 3BO and Friday, June 21, 2019 2BU OS but could not be fully resolved in any 3:30-4 p.m. prism amount at near. Consequently, RJ declined prism correction at near, instead opting to continue CL-Contact Lens reading monocularly as she had been doing in her habitual spectacles. Scleral Lens and Prism Management Patients with CPEO suffer from diplopia and of Chronic Progressive External constant ocular surface exposure due to Ophthalmoplegia secondary to orbicularis muscle RJ, a 50-year-old female, was referred for a dry weakness and iatrogenic causes like ptosis repair. eye and medical contact lens evaluation by Neuro- Scleral lens therapy provides all-day ocular Ophthalmology for severe exposure protection and optimizes vision by masking corneal keratoconjunctivitis OU secondary to chronic irregularities from exposure-related scarring. Over- progressive external ophthalmoplegia (CPEO) due spectacles with prism correction are advised to to mitochondrial myopathy, diagnosed at age 18. most accurately treat the evolving degrees and Her ocular history was significant for ptosis OU, directions of ocular misalignment induced by this which improved after undergoing frontalis sling progressive condition. repair OU but resulted in lagophthalmos OU. She Author was very symptomatic for dryness despite frequent Rebecca Chung, O.D. artificial tears and taping her at night. She reported longstanding vertical and horizontal

82 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

Case Report Abstract Most congenital optic disc anomalies are not associated with progressive vision loss. Hence, no Friday, June 21, 2019 treatment is usually required. However, in cases of 3:30-4 p.m. amblyopia or with decreased vision, polycarbonate protective lenses may be required. Furthermore, PC-Primary Care basal encephalocele can occur in any of the dysplasia thus proper education, monitoring, Optic Nerve Coloboma genetic testing, and evaluation are essential with Optic nerve coloboma is a category of optic nerve colobomas. dysplasia in which the optic disc appears abnormal Author due to incomplete closure of the embryonic fissure. Eun Lee, MM It is usually located inferonasally and often associated with other ocular colobomas. It may be Scientific Abstract associated with fatal systemic defects including Friday, June 21, 2019 basal encephalocele, congenital heart defects, double aortic arch, transposition of the great 3:30-4 p.m. vessels, coarctation of the aorta, and intracranial carotid anomalies. The Effect of Social Support and Visual An 8-year-old Hispanic female presents with Function on Perceived Stress father to the eye clinic due to unsatisfactory Age-related macular degeneration (AMD) has performance during eye screening evaluation at the been found to be associated with psychological school. Father reports patient has had trouble stress. Previous investigation has found that social seeing the board at the school. Father reports the support as measured by the Enriched Social child was full-term and no complication with birth. Support Inventory (ESSI) and self-reported visual Patient’s entrance DVA was 20/20 OD and OS. function as measured by the Impact of Vision Medical, surgical histories as well as medications Impairment survey (IVI), separately, are significant and allergies were noncontributory and indicators of perceived stress (as measured by the unremarkable. Aside from the slight reduction in Perceived Stress Scale). However, these two stereo examination, all other entrance testing was surveys share some common themes (e.g., the unremarkable. Refractory status was minimal at ability to get common tasks completed). The -0.50DS for each eye. Dilated anterior segment purpose of this study was to determine whether and posterior segment for right eye was both social support and self-reported visual unremarkable. Anterior segment for left eye was function each contribute to the ability to predict unremarkable. Dilated posterior segment for left perceived stress when included in the same eye showed optic nerve coloboma. The coloboma predictive model. of the left optic nerve was encroaching upon Participants were recruited from The Ohio State macula area sparing of fovea. Due to congenital University Department of Ophthalmology retina dysplasia, education to family members was the service. A correlation analysis was used to most important part of assuring them about risk investigate whether social support and visual and prognosis of this condition. It was also function were strongly related to each other. encouraged to have all family members receive a Additionally, multiple regression analysis was used comprehensive eye exam along with genetic to investigate whether both social support and self- testing. reported visual function are significant indicators of

83 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

stress when analyzed together. Rasch analysis was Case Report Abstract used to score surveys and generate summary scores for each person. Friday, June 21, 2019 There were a total of 163 subjects with AMD 3-3:30 p.m. (mean age ±SD of 81±9 years) participated. Fifty-three percent were female. Mean better-eye LV-Low Vision visual ETDRS letter score acuity was 61±19 (approximately 20/60). Social support and self- Diagnosis and Low Vision Management of reported visual function were weakly but Occult Macular Dystrophy significantly correlated with one another (Pearson Occult macular dystrophy (OMD) has a broad correlation coefficient=0.22, P=0.006). Both range of age onset and was first reported in the measures were significantly related to perceived literature in 1989. While the genetics of OMD is stress (P<0.001 for the ESSI and P=0.049 for the complex, heterozygous ‘retinitis pigmentosa 1-like IVI) when included together in a multiple regression 1’ (RP1L1) missense variants have been linked to model that also accounted for age, sex and this retinal dystrophy. OMD is characterized by whether the patient was alone while completing visual acuity reduction from macular dysfunction. It the surveys, indicating that each construct is named occult because the dysfunction is hidden provides unique information about perceived stress by normal funduscopic examination, full-field levels in patients with AMD. electroretinograms (ERG), and fluorescein Social support and self-reported visual function angiograms (FA). However, focal macular, were both shown to be related to perceived stress multifocal ERG, and optical coherence tomography levels in patients with AMD. These findings may be (OCT) can reveal the dysfunction. This case report useful in clinical practice in the planning of describes the diagnosis, genetic testing, and low- interventions to improve psychological and other vision management of OMD. outcomes in low-vision rehabilitation by addressing VG, a 42-year-old Hispanic female, presented deficits in social support or ability to complete to clinic due to failing her driver’s license renewal. visual tasks. Her chief complaint was unexplained progressive Author central vision reduction for the right eye (OD) and Tatevik Movsisyan, O.D., MS left eye (OS) over the past two years. Her ocular Co-Author(s) and medical history were unremarkable and her San-San Cooley, O.D., MS family history was non-contributory. Her visual Rebecca Deffler, O.D. acuity was 20/60 OD, OS at distance with a Frederick Davidorf, M.D. minimal prescription and 20/50 OD, OS at near Bradley Dougherty, O.D. Ph.D. with +1.50 effective ADD. The fundus and full field ERG were within normal limits (WNL) in both eyes (OU). A multifocal ERG showed borderline amplitudes foveally OU. The fundus autofluorescence (FAF) showed a mottled appearance with small areas of granular hyperfluorescence and OCT macular thinning OU. OCT angiography of the posterior pole showed 1 vessel loop with a few areas of nonperfusion and a microaneurysm. A visual field (VF) demonstrated

84 Poster Presentations Optometry’s Meeting® • St. Louis, MO • June 19-23, 2019

scattered central defects and a psychogenic revealed mildly elevated blood pressure of 158/81, component was ruled out with the tangent field. a left homonymous hemianopia—denser below, The genetic testing revealed a heterozygous limited pupil reactivity OS, and stage 4 pathogenic missense mutation in RP1L1. This characterized by bilateral genetic change is known to cause OMD with disc edema, retinal hemorrhages, and cotton wool reduced penetrance and variable expressivity. spots. Management: With the current presentation, Through a visual functioning questionnaire, we it was important for the patient’s health to stabilize anticipated that she may benefit from telescopes, prior to evaluation for vision therapy. Coordination microscopes, magnifiers, filters and driving of care with the neurologist gave the consensus rehabilitation services. that there were no indications of increased OMD is rare and difficult to diagnose without intracranial pressure and the disc edema was likely rigorous testing. Nonetheless, there is no standard the result of hypertensive crisis. The patient was treatment for OMD. Our next step in management seen 1 month after the initial visit for repeat visual is to perform an extended functional, low-vision field testing and an Optomap retinal exam. At this evaluation. This will aid to enhance her quality of visit the field defect was stable but the retinopathy life, maintain her independence, and assist her with had worsened, despite improved blood pressure interprofessional referrals. and blood glucose levels. Further discussion with Author the neurologist led to a repeat neurological study Maggie Man Ki Ho, O.D., MS that demonstrated a second, silent stroke. Co-Author(s) Appropriate adjustments were made to the Stephanie Schmiedecke Barbieri, O.D., F.A.A.O., patient’s medications, and at a 1-month follow-up Dipl. Low Vision the retinal evaluation showed improvements in the Patricia C. Sanchez-Diaz, DVM, Ph.D., F.A.A.O. retinal appearance. Jeff C. Rabin, O.D., M.S., Ph.D., F.A.A.O., Dipl. It is not currently known which medications are Vision Science most effective against MHT due to the low incidence of cases. Retinal evaluation allows Case Report Abstract insight into the state of microvascular changes and end organ damage. Therefore, it is likely a good Friday, June 21, 2019 indicator of if the systemic medications are working 3:30-4 p.m. properly. The purpose of the case report is to suggest close follow-up of MHT patients in order OD-Ocular Disease to ensure that systemic medical treatment is having the desired effects. Malignant or Benign? But Not a Tumor Author The case: A 57-year-old white male reported to Elizabeth Nace, O.D. the clinic for an ocular health exam and evaluation Co-Author(s) for candidacy of vision therapy. He had suffered Moshe S. Roth, O.D., FCOVD; from a stroke 3 weeks prior that affected his left visual field, the visual acuity in his left eye, and resulted in visual hallucinations. His medical history was significant for hypertension, diabetes and hypercholesterolemia, for which he was appropriately medicated at this time. Examination

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