9/7/2020 Disclosures: Common Optometry CooperVision Cases in “Mayberry” Maculogix IntegraSciences Lessons I Learned From These Cases Frances Bynum, OD COPE 65581-GO 1 2 Case 1: Opie Taylor Case 1: Opie Taylor Hit in the eye with air soft gun Hit in the eye with air soft gun VA: OD: 20/20 SLE: subconjunctival heme in the temporal corner Cornea: clear A/C: clear, no cells Posterior Pole: clear MHx: unremarkable Would you dilate this patient? (Grandmother brought child in) 3 4 Case 1: Opie Taylor Case 1: Opie Taylor Hit in the eye with air soft gun Hit in the eye with air soft gun Commotio retinae Commotio retinae (caused by blunt trauma to the eye) (caused by blunt trauma to the eye) Treatment: Treatment: usually none Prognosis: Prognosis: good, but look for choroidal rupture or RPE break Might use OCT to look for small break 5 6 1 9/7/2020 Case 1: Opie Taylor Case 1: Opie Taylor Hit in the eye with air soft gun Hit in the eye with air soft gun 7 8 Case 2: Barney Fife Case 2: Barney Fife Sudden spot in vision Sudden spot in vision CC: Sudden Spot in his vision this morning VA: OD: 20/20 OS: 20/20 IOP: 12/12 icare @ 8:12am MHx: HTN (uncontrolled at times) Meds: HTN OHx: Toric MF contacts, mild crossing changes consistent with HTN history DFE: heme @ disc 9 10 Case 2: Barney Fife Case 2: Barney Fife Sudden spot in vision Sudden spot in vision BP: 135/85 LA seated @ 8:15am BP: 135/85 LA seated @ 8:15am Management: ??? Management: ??? Upon further questioning……. Upon further questioning……. Reveals he noticed this after an “intimate moment” with wife this morning 11 12 2 9/7/2020 Case 2: Barney Fife Case 3: Aunt Bee Sudden spot in vision 85 WF CC: “I cannot see well out of my glasses” VA: OD: 20/25 OS: 20/30 MHx: (-) smoker; (+) high cholesterol; (+) HTN, controlled OHx: cataract sx 13 14 ARMD: dry, stage???? ARMD: dry, stage???? 15 16 ARMD: dry, stage???? ARMD: dry, stage???? 17 18 3 9/7/2020 Case 3: Aunt Bee Case 3: Aunt Bee Monitor vs Refer? Monitor vs Refer? Adaptdx: RI: >15min Recommend: no smoking, vitamins, diet 19 20 Case 3: Aunt Bee Case 3: Aunt Bee Monitor vs Refer? Monitor vs Refer? Adaptdx: RI: >15min Adaptdx: RI: >15min Recommend: no smoking, vitamins, diet Recommend: no smoking, vitamins, diet Refer: Retina Specialist confirmed dx: dry, severe Refer: Retina Specialist confirmed dx: dry, severe Challenges: new glasses? 21 22 Case 4: Otis Campbell “town drunk” Case 4: Otis Campbell “town drunk” VA: OS: 20/20 CC: white lesion in left eye x 1 week, (-) pain, (-) redness MHx: (+) breast cancer, decreased immune system due to chemotherapy Ohx: neg 23 24 4 9/7/2020 Case 4: Otis Campbell “town drunk” Case 4: Otis Campbell “town drunk” (+) rose Bengal stain and fluorescein stain f/u: size of lesion greatly reduced and (-) Rose Bengal stain Tx: Acyclovir 400 5x/day Trifluridine??? Decreased Acyclovir to bid amniotic membrane? Art tears Discussion: using Amniotic Membranes on HSK 25 26 Case 5: Gomer Pyle (mechanic) Case 5: Gomer Pyle (mechanic) VA: OD: 20/20 VA: OD: 20/20 CC: something in right eye X 2 days, grinding, not wearing safety rx CC: something in right eye X 2 days, grinding, not wearing safety rx MHx: neg MHx: neg OHx: neg OHx: neg SLE: metallic FB with rust ring SLE: metallic FB with rust ring Tx: Tx: removed with spud and alger brush 27 28 Case 5: Gomer Pyle (mechanic) Case 6: Andy Taylor (Sheriff) VA: OD: 20/20 VA: OD: 20/40 OS: 20/30 CC: something in right eye X 2 days, grinding, not wearing safety rx MHx: neg CC: while bending over this afternoon, vision suddenly changed in OS OHx: neg SLE: metallic FB with rust ring Verified that it was the left eye he noticed decreased in vision Tx: removed with spud and alger brush BCL vs Pressure Patch Drops: in office or Rx 29 30 5 9/7/2020 Case 6: Andy Taylor (Sheriff) Case 6: Andy Taylor (Sheriff) 31 32 Case 6: Andy Taylor (Sheriff) Case 6: Andy Taylor (Sheriff) 33 34 Case 6: Andy Taylor (Sheriff) Case 6: Andy Taylor (Sheriff) 35 36 6 9/7/2020 Case 6: Andy Taylor (Sheriff) Case 7: Clara (Aunt Bee’s friend) busy body, pie maker Importance of looking at both eyes! VA: OD: 20/50 OS: 20/60 (mild eccentric fixation) CC: vision not as clear Development of cataracts following laser procedures OHx: cataract sx (discussed findings prior to cat sx 4 years ago) DFE: What caused the hemes around buckle? Concern? Vitreous heme management 37 38 Case 7: Clara (Aunt Bee’s friend) Case 7: Clara (Aunt Bee’s friend) busy body, pie maker busy body, pie maker 39 40 Case 7: Clara (Aunt Bee’s friend) Case 7: Clara (Aunt Bee’s friend) busy body, pie maker busy body, pie maker Best Disease (Vitelliform macular dystrophy) Stage 1: previtelliform and initial development of retinal defects (3-15ys (symptoms may not develop until later) Stage 2: vitelliform stage, early egg yolk (typically ½ to 1 disc diameter) Stage 3-5: scrambled egg appearance May develop CNM Patients retain normal peripheral vision and dark adaptation Genetic disorder: BEST1 mutation, defect in this protein leads to accumulation of lipofusion 41 42 7 9/7/2020 Case 7: Clara (Aunt Bee’s friend) Case 8: Thelma (Barney’s girlfriend) Is this rare? “not if it is in your chair” VSP Srx Exam 61 YO WF CC: no changes in glasses or contacts Refuses optomap retinal screening VA: OD: 20/20 OS: 20/20 MHx: (+) HTN, controlled; reports recent blood work as good, cholesterol normal 43 44 Case 8: Thelma (Barney’s girlfriend) Case 8: Thelma (Barney’s girlfriend) 45 46 Case 8: Thelma (Barney’s girlfriend) Case 8: Thelma (Barney’s girlfriend) Refract first vs Slit Lamp Exam Would you have deferred refraction? 47 48 8 9/7/2020 Case 8: Thelma (Barney’s girlfriend) Case 8: Thelma (Barney’s girlfriend) Refract first vs Slit Lamp Exam Would you have deferred refraction? Would you bill photos to medical insurance? 49 50 Case 9: Floyd (Barber) Case 9: Floyd (Barber) “No good deed goes unpunished” VA: OD: 20/20 OS: HM CC: vision in my left eye not as clear MHx: neg Ohx: readers only 51 52 Case 9: Floyd (Barber) Case 10: Helen (Andy’s girlfriend) Refer Contact Lens Exam: VA: OD: 20/25 OS: 20/25 Realistic Expectations SLE: bilateral infiltrates DFE: unremarkable Resolved with steroids 53 54 9 9/7/2020 Case 10: Helen (Andy’s girlfriend) Case 10: Helen (Andy’s girlfriend) 55 56 Case 10: Helen (Andy’s girlfriend) Case 10: Helen (Andy’s girlfriend) 57 58 Case 10: Helen (Andy’s girlfriend) Misc cases: Loss of central vision OD No complaints in OS 59 60 10 9/7/2020 Misc cases: (CSC) Misc cases: (CSC) Bilateral ?? Bilateral ?? Fluid within the retinal layers Fluid within the retinal layers Type A personality Type A personality Associated factors: Steroids; nose sprays; pregnancy; stress 61 62 Misc cases: (CSC) Misc cases: (CSC) 63 64 11.