302 Optometry, Vol 80, No 6, June 2009

Case Report: A 31-year-old Hispanic man presented with acomplaint of blurry vision in the right eye for 3 weeks. Healso complained of a headache before the decrease in vi-sion. Medical history was positive for increased cholesterol,nephrotic syndrome, and antithrombin III deficiency with aprevious pulmonary embolus. Prior renal biopsy showedmembranous nephropathy. Best-corrected acuities were fin-ger-counting at 6 feet O.D. and 20/25 1 2 O.S. Pupils,EOMs, and confrontation visual fields were normal. Gold-mann tonometry measured 14 mmHg O.D., O.S. Dilatedfundus examination revealed 4 1 ONH edema O.D. anda .45 round C/D O.S. with distinct margins. The maculashowed 41 edema O.D. and was flat O.S. There werehemes throughout the posterior pole and periphery O.D.The periphery was intact O.D. and O.S. Over the courseof the next year, the CRVO improved in the OD, but the pa-tient subsequently developed a low grade CRVO in the O.S.Conclusion: Although CRVO is a fairly common cause ofvision loss in those over age 50, it is a relatively uncommonfinding in younger individuals. Because of the potentiallyserious underlying health concerns, optometrists must befamiliar with causes of CRVO in the younger patient.This poster contains longitudinal fundus photography andOCT, the coagulation cascade, and laboratory testing.

Poster 36

Macular Schisis in a Patient in the Absence of OpticNerve Head Anomaly or Associated Retinal Pathology

Nektaria Mandadakis, O.D., and Andre Stanberry, O.D.,SUNY State College of Optometry, 33 West 42nd Street,New York, New York, 10036

Introduction: A macular schisis is commonly observed ineyes with optic disc pits. It represents a splitting of the ret-ina between the outer plexiform layer (OPL) and inner nu-clear layers (INL). Although the pathophysiology is notclearly understood, the clinical and Optical Coherence To-mography (OCT) picture may be the result of intraretinaledema causing detachment of the outer layer. Our case isa unique one of a macular schisis that developed in the ab-sence of any other ocular pathology.Case Summary: A 75-year-old Hispanic man complained ofreduced vision in his right eye, first noticed 2 months prior.The patient’s medical history was positive for hypertension,systemic lupus erythematosus, Parkinson’s disease, andprostate cancer 10 years in remission. Ocular history wasremarkable for a mild epiretinal membrane (ERM) O.S.and mild cataracts OU contributing to mildly reduced acu-ities: 20/25 O.D., 20/30 O.S. Current best-corrected acuitieswere 20/50 1 O.D., 20/30 O.S. Pupils were normal. Slitlamp examination showed stable cataracts OU. Funduscopyof the right eye revealed a healthy retina with the exceptionof a subtle retinal wrinkling nasal to the macula. The ERMin the left eye was stable. The optic nerves were healthywith a C/D ratio of 0.30, without any evidence of excava-tion or other abnormalities. The right eye had a significant

reduction in macular photo stress recovery. OCT examina-tion confirmed moderate macular edema with an overlyingmacular schisis extending from central macula to optic discO.D. A fluorescein angiography was performed thatshowed none to trace leakage corresponding to the areaof edema on the OCT. There were no signs of neovascular-ization or vascular compromise. The patient was treatedwith 3 series of Bevacizumab (Avastin�) injections. Al-though the macular edema is reduced, the macular schisisstill persists.Conclusion: Our patient had a macular schisis characteris-tically associated with optic disc pits, in the absence of suchfindings. Treatment of macular schisis associated with opticpits often includes vitrectomy, photocoagulation, and drain-age of subretinal fluid. Lacking vitreoretinal traction, anti-VEGF therapy was initiated in efforts to reduce the macularedema. The etiology in this case remains uncertain.

Poster 37

Correlation Between Optos Ultra Widefield Imaging andTraditional Diagnostic Methods in Glaucoma

Jerome Sherman, O.D., Hanish Patel, O.D., Sanjeev Nath,M.D., Juliana Boneta, O.D, Sharanjit Burmy, O.D., andDalia Layliev, B.A., SUNY State College of Optometry, 33West 42nd Street, New York, New York, 10036

Background: Detection of nerve fiber layer defects is veryhelpful in early diagnosis of glaucoma and nonglaucoma-tous optic neuropathy. If a screening procedure already inplace for retinal disorders can accomplish this, then retinaland optic nerve disorders can be detected simultaneouslywith the same procedure.Methods: A retrospective analysis of Optomap images fromthe initial 6-month installation of the P200C (n 5 700) wasperformed to determine visibility of retinal nerve fiber layerloss. Thirty-six eyes with a visible RNFL defect of at least 2vein diameters and no obvious cupping were identified.Charts were then reviewed for corresponding defects as re-corded with GDx and 24-2 VF. Patients with glaucomatousor pale discs as imaged with P200C were excluded.Results: RNFL loss detected on the P200C was correlatedwith a defect on the GDx deviation map or correspondingVF loss in 94% of patients. Optomap correlated with GDx de-fects in 83% of eyes and with visual field loss in 69%.Conclusion: A significant correlation was established be-tween RNFL loss visualized on the Optos P200C imagingsystem and GDx. Because Optomap is already widelyused for retinal screening, it can easily be a useful adjuvanttool in glaucoma screening. Although not specifically de-signed to measure RNFL loss, P200C is capable of showingsubtle defects that may be indicative of early glaucoma, be-fore the development of cupping. Viewing may be en-hanced by using the red free image channel. When lossof the nerve fiber layer is visible on the Optomap, it is sug-gested that further testing be performed. Visible RNFL lossthat was not correlated with GDx may represent a loss too

Poster Presentations 303

small to result in a GDx defect, and follow-up studies areunderway.

Poster 38

Use of Fluorophotometry to Evaluate in vivo ResidenceTime of Systane� Ultra Lubricant Eye Drops as Comparedto a Placebo Control

Justin R. Webb,1 Jerry R. Paugh,2 and Mike T. Christensen1

1Alcon Research LTD, Fort Worth, Texas, and 2SouthernCalifornia College of Optometry, Fullerton, California

Purpose: The aim of this study was to evaluate ocular sur-face retention time of a lubricant eye drop in dry eye pa-tients using fluorophotometry (Fluorotron Master;Ocumetrics, Inc.).Methods: This is a double masked, randomized, single eyecrossover study design with 25 targeted confirmed dry eyepatients. Patients are required to have 2 of the following atscreening: composite symptom score.5 (modified ScheinQuestionnaire); NaFl TFBUT , 7 sec; NaFl corneal stain-ing sum score.3 (NEI grid; 0-3/area, max 15 pts). Test eyeis the eye with the most rapid TFBUT. The test (PG/PEGbased tear) and control (saline) solutions were admixedwith a fluorescein-labeled dextran of w70,000 MW (at0.1% wt/vol) to reduce adsorption. Baseline intrinsic cor-neal fluorescence is measured followed by instillation ofone 25cmL drop of admixed solution per randomization inthe test eye. Measures are taken as rapidly as possible inthe initial 8 minutes, and then every 2 minutes thereafteruntil baseline signal is regained. The return to baseline isdefined as the time when the first of 3 consecutive fluores-cent values that are within 2 standard deviations of intrinsiccorneal fluorescence are noted. All visits are performed onthe same half day a minimum of 24 hours apart.Results: Preliminary, masked results show a statistical dif-ference (P 5 0.00076) in mean retention time of solution A(mean 5 30.02 min 1 13.5) versus solution B (mean 5

20.76 min 1 7.7). Mean age 5 49 yrs 1 9.2.Conclusions: This study was designed to determine if thereis a difference in ocular surface retention between the 2 testsolutions. The artificial tear test solution was formulated asa viscoelastic droppable gel to demonstrate that additionalprecorneal retention can be provided when compared witha saline control. Follow-up studies will compare variousmarketed tear retention times using this technique.

(Investigator is an employee of Alcon Research Ltd. Studyfunded by Alcon Research Ltd.)

Poster 39

Ocular Ischemic Syndrome

Meng Meng Xu, O.D., and Connie L. Chronister, O.D.,Pennsylvania College of Optometry at Salus University,1200 W. Godfrey Ave., Philadelphia, PA 19141

Background: Ocular ischemic syndrome develops in 5% ofpatients with internal carotid stenosis. It is usually seen inthe elderly and is associated with diabetes, hypertension,

stroke, and, less commonly, giant cell arthritis. Symptomsinclude decreased vision, ocular pain, and amaurosis fugax.Ocular signs include midperiphery dot/blot hemorrhages,dilated but nontortuous blood vessels, neovascularizationof the iris, the disc, and elsewhere.Case Report: A 56-year-old man presented to our emer-gency service with a painful swollen hyperemic left eye.He developed the symptoms while hospitalized for a stroke2 weeks before. His ocular history was remarkable for PRPOU for proliferative diabetic retinopathy. His presenting vi-sion was 20/50 O.D. and CF O.S. Biomicroscopy revealedgrade III cornea edema and dense rubeosis iridis O.S. Intra-ocular pressures were measured to be at 16 mmHg O.D.and 20 mmHg O.S. with Tonopen. Dilated fundoscopy, lim-ited by an uncooperative patient and a difficult viewthrough an inflamed anterior segment, demonstrated back-ground diabetic retinopathy O.D. and diffuse cotton-woolspots O.S. The patient was treated for the signs and symp-toms of proliferative diabetic retinopathy with rubeosis iri-des and corneal edema secondary to presumed anterior-segment ischemia. Topical prednisolone acetate 4 times aday and atropine twice a day O.S. were prescribed, andthe patient was promptly referred to retinology. The retinol-ogist confirmed our suspicion but was also able to obtain amore complete view of the fundus. Observing the classicsigns of carotid occlusive disease, testing was pursued torule out the possibility of ocular ischemic syndrome. Ca-rotid duplex imaging confirmed the diagnosis of ocular is-chemic syndrome and resulted in the appropriate treatmentof his rubeosis and retinopathy with PRP.Conclusion: Clearly, a patient may have more than one dis-ease. The partially correct diagnosis pertaining to the ante-rior segment inflammation allowed us to impart propertopical therapy, permitting the eye to partially recover, cre-ating an environment more conducive to retinal evaluation.Our prompt referral permitted the gathering of additionaldata uncovering the actual underlying cause. Here, we pre-sent a case in which circumstantial evidence and the diseaseprocess itself obscured our ability to gather complete dataleading to the appropriate but incomplete treatment of thepatient’s condition. We review ocular ischemic syndrome,its ocular and systemic findings, differential diagnosis,workup, and appropriate treatments.

Poster 40

SD OCT Imaging of the IS/OS Junction in a Wide Array ofDisorders of the Outer Retina

Jerome Sherman, O.D., Sanjeev Nath, M.D.,Richard Madonna, O.D, Juliana Boneta, O.D., andYuliya Bababekova, B.S., SUNY State College of Optometry,33 West 42nd Street, New York, New York, 10036

Background: The SD OCT affords double the resolution asthe traditional TD OCT and routinely tests more than 20times as many sections. Recent utilization of the SD OCThas demonstrated that the photoreceptor integrity line can