362 Optometry, Vol 82, No 6, June 2011

the normative range. The patient was referred to a retinalspecialist for fluorescein angiography (FA) and possibletreatment. The examination and FA findings were consis-tent with IRVAN syndrome. Since retinal inflammatoryconditions are medically disqualifying for military person-nel, the patient was discharged from the U.S. Army.Conclusion: IRVAN syndrome is a rare condition with noknown cause; therefore an extensive medical history andworkup should be performed to rule out any associatedsystemic conditions. It is not clear whether immunosup-pressive agents provide beneficial therapy. However, treat-ment with panretinal laser photocoagulation early in thecourse of the disease can help preserve vision and preventdisease progression in cases of extensive peripheral ische-mia and retinal neovascularization.

Poster 37

Peripapillary Retinoschisis in High Myopia: A NovelClinical Entity Revealed by SD-OCT

Jerome Sherman, O.D., Samantha Slotnick, O.D.,Richard Madonna, O.D., Sanjeev Nath, M.D.,Raniah Hallal, and Dan Epshtein, State University of NewYork State College of Optometry, New York, New York

Background: Pathological myopia is the sixth leading causeof blindness in the U.S. In some cases, the etiology of thereduced vision and blindness is not obvious. Spectraldomain optical coherence tomography (SD-OCT) docu-ments many abnormalities such as various forms ofretinoschisis which are often invisible to ophthalmoscopy.Methods: A retrospective review of 600 eyes with OCTs thatcontained several sections through and around the optic nervehead. SD-OCTswere obtainedwith 1 of 4 systems (ZeissCirrus,Topcon 3D-OCT, Heidelberg Spectralis, Optovue RTVue).Results: A total of 19 eyes of the 600 reviewed exhibitedretinoschisis around the optic disc. 17 eyes were myopicwith refractive errors ranging from -5 to -18. The 18Dmyopic eye had a 360� PPRS which did not extend into themacula but appeared to be responsible for the visual acuity(VA) reduction to 10/400. The other 16 eyes had normal ornear normal VA. 8 of these 17 eyes had 1 or more zones ofvitreo-retinal traction (as revealed with SD-OCT) that maybe the etiology of the schisis. The splits were variable inlocation and often appeared to exist in several layers, mostoften seen in the inner and outer plexiform layers. One ofthe 2 eyes without myopia was a 4D hyperope (VA 20/40)with a PPRS that extended into the macula. The other wasan emmetropic eye with a Morning Glory-like congenitaldisc anomaly but with 20/20 VA. The 2 eyes withoutmyopia did not exhibit vitreal retinal traction. Most eyestested demonstrated field defects, most often enlargementof the blind spot. All 4 SD-OCT systems utilized were ableto document the PPRS.Conclusion: PPRS appears to be a clinical entity most oftenfound in high myopia. PPRS is generally invisible onophthalmoscopy but can be detected with SD-OCT images

around the optic disc. Scans through the macula often missthe PPRS. It remains to be determined whether vitrectomyis a viable option for PPRS with vitreal retinal traction incases that progress.(J.S. has lectured for Zeiss, Optos, Optovue, Topcon,

PHP, Centervue, Annidis Health Systems, Arctic DX, andNotal Vision.)

Poster 38

Does Serial Optos� Panoramic Imaging ImproveDifferential Diagnosis of Glaucomatous RNFL DefectsFrom Physiological RNFL ‘‘Slits’’?

Jerome Sherman, O.D., Sanjeev Nath, M.D.,Sarah MacIver, March Sherman, Juliana E. Boneta, O.D.,Dan Epshtein, Jeremy Whitney, and Samantha Slotnick,O.D., State University of New York State College ofOptometry, New York, New York

Background: Recently we demonstrated that Optos� Pano-ramic Imaging can document retinal nerve fiber layer(RNFL) defects in glaucoma and other optic neuropathieswith the P200C. In this study, we determined the preva-lence of such defects, both glaucomatous RNFL defectsand physiological RNFL ‘‘slits’’ and we determinedwhether serial imaging is helpful in the differentialdiagnosis.Methods: A prospective study of images from 500 consecutivepatients seen from January to October 2010 in a private practicesetting. A scale of assessing RNFL defects was established:Category (C) 1: defects that were nowider than retinal veins andthat did not fan out towards the periphery were classified aslikely physiological (‘‘slits’’). C2-5: Pathological (‘‘true’’) de-fects, were wider than retinal veins, and did fan out towards theperiphery (C2: subtle focal defects, up to C5: profound focal andwidespread.) Spectral domain optical coherence tomography(SD-OCT), andGDx, aswell as 24-2 SSVFand disc assessmentwere used to confirm the diagnosis. Previous Optos images(available in 290 patients) were also reviewed for progression.Results: Four-hundred and thirty-four of the 1,000 eyesreviewed had RNFL defects: 380 were C1 (slits). In 40 ofthese, confident placement into C1 (and not C2) was quitedifficult. Twenty-four were C2 (subtle) and 30 were C3-5(well-defined). In C3-5, all eyes showed defects on eitherOCT, GDx, or VF. In C2, 50% had corresponding defects.Twenty-one of the eyes in C2-5 had slits as well as truedefects. Follow-up Optos imaging was available in 24 of theeyes with true defects; 4 demonstrated apparent progression.These 4 eyeswere in 3 patientswho reported good compliancewith drops. Two of these eyes initially showed RNFL bundledefects with sharp borders, but the borders became less welldefined over follow-up. In C1 eyes, no slits appear to haveprogressed.Conclusions: RNFL defects can be imaged with OptosP200C. Slits were far more common than true defects.GDx, OCT, and VF defects showed a positive correlationwith increasing RNFL defect severity. All slits were stable on

Poster Presentations 363

serial imaging; some eyes with true defects progressed. Aswith fundus photography, serial imaging with Optos hasclinical utility.(Study funded by Optos.)

Poster 39

Peripheral Retinal Vascular Disorders Detected, Treated,and Monitored With Optomap fa as Compared toSpectralis FA

Juliana E. Boneta, Jerome Sherman, O.D., Karl E. Waite,M.D., Sanjeev Nath, M.D., and Michael D. Bennett, M.D.,State University of New York State College of Optometry,New York, New York

Background: Standard fundus cameras are not ideal forcapturing images of the far peripheral retina. Two systemsare available which do, and both can also be used forfundus fluorescein angiography (FA). In this study, wecompare image quality and field of view obtained withboth Optos� Optomap fa and Spectralis� FA in myriadperipheral retina vascular disorders both pre and posttreatment.Methods: A retrospective review of 100 eyes of 50 patientswith peripheral retinal vascular disorders who were imagedwith both Optomap fa and Spectralis FA during the sameclinical session at 2 facilities equipped with both technolo-gies. Early phase angiography images were obtained withSpectralis FA then mid to late stage images were capturedwith the Optomap fa system. Far peripheral lesions imagedwith Optomap fa were then attempted to be imaged withSpectralis FA. The 50 patients included 5 with proliferativesickle cell retinopathy (PSR), 2 with coats disease, 2 withlupus vasculopathy, 1 with ROP, 1 with autosomal reces-sive hypercoagulopathy with temporal avascular zones, 2Eales disease with mid- and far peripheral lesions, 1 withperipheral phlebitis in MS, 1 with Stage 4 IRVAN, 2with ‘‘papillophlebitis’’ with peripheral vasculopathy inthe ‘‘normal eye,’’ and several with AV anastomosis. Alsoincluded were patients with peripheral findings in diabeticretinopathy, hypertensive retinopathy, and various veinocclusions.Results: Both systems were able to obtain high qualityimages of perfused retina, zones of avascularity and areasof leakage in the posterior pole and extending to theequator. The Spectralis FA appeared to have an advantagein the posterior pole but identical, early phase images werenot available with the Optomap fa for direct comparison.Optomap fa images documented significantly more lesionsanterior to the equator in all 4 quadrants than did the Spec-tralis FA. This was especially true in PSR. Post-treatmentimages of far peripheral lesions were also obtainable withOptomap fa but far more difficult (if not impossible) to ob-tain with Spectralis.Conclusions: Neither technology is ideal in all cases. Useof both in most disorders yields more clinically usefuldata than either alone. In disorders with peripheral

pathology, such as PSR, Optomap fa reveals more anteriorlesions.

Poster 40

Comparison of RNFL Assessment With the Optos� P200and 200Dx

Jerome Sherman, O.D., Sarah MacIver, O.D.,Marc Sherman, and Samantha Slotnick, O.D.,State University of New York State College of Optometry,New York, New York

Background: Thousands of clinicians utilize the Optos�

panoramic ophthalmoscopy systems to detect retinal abnor-malities. These same images contain information about theretinal nerve fiber layer (RNFL) which is virtually alwaysneglected; perhaps because the original P200 did not imagethe RNFL effectively and consistently.Methods: Images (OU) of 50 consecutive patients fromboth systems were reviewed retrospectively. A trainedobserver evaluated the RNFL (using green separation) onimage quality (Q) and RNFL integrity (N). Q was gradedon a scale of 1-4: 1 5 poor overall view of RNFL; 4 5well-defined RNFL in at least 1 clock hour. N was gradedon a scale of 1-5: 1 5 profound loss; 5 5 normal RNFL. N% 3 indicates a probable pathological defect. A clinicaldiagnosis based on dilated fundus exam and on GDx,optical coherence tomography, and/or VF was used toconfirm the presence of a pathological defect.Results: According to the grading scale, the 200DX yieldedhigher quality RNFL images; Q R 3 was found in 78 of100 200DX and in 55 of 100 P2 images. In many P200 im-ages, artifacts obscured the RNFL off the disc, reducing Q.Both systems generally had higher Q in superior RNFLthan inferior RNFL. Pathological defects (N % 3) werefound in 39 of 100 200DX and 36 of 100 P200 images.Where N % 3, correspondence with diagnosis was foundin 33 (84.6%) 200DX and 23 (63%) P200 images.Conclusions: In this direct comparison study, 200DXRNFL images were of higher quality than P200. The circu-lar polarizer in the 200DX results in a more uniform qualityimage translating to greater visibility of the RNFL. The200DX was thus better at accurately detecting pathologicalRNFL defects than the P200. The image quality producedby the linear polarizer in the P200 limits its ability to detectpathological RNFL defects.(Study funded by Optos.)

Poster 41

The Pseudotumor Cerebri That Wasn’t

Juliana Yuen Tsz Lam, O.D., Cariboo Eye Care Clinic,Williams Lake, British Columbia

Background: Pseudotumor cerebri, also known as idiopathicintracranial hypertension, is predominantly seen in obese, orsomewhat overweight, women of childbearing age.