288 Optometry, Vol 81, No 6, June 2010

immediate diagnosis. Ascertaining the retinal layer locali-zation of lesions with SD OCT aides in the differentialdiagnosis of dots and spots and smudges.

Poster 42

Early, Pre-perimetric and ‘‘Slit’’ RNFL Defects DetectedWith Optomap� P200C

Jerome Sherman, O.D., Juliana E. Boneta, O.D.,Sanjeev Nath, M.D., and Marc Sherman, State University ofNew York State College of Optometry, New York, New York

Purpose: To determine whether the Optomap� P200C is use-ful in detecting retinal nerve fiber layer (RNFL) defects and toassess whether such defects correlate with documented struc-tural loss on GDx VCC and OCT and/or visual field loss.Methods: As part of an ongoing study, weekly retrospectivereview was performed of all Optomap� P200C imagestaken in one office where all patients are routinely imaged.

Composite images from patients (n51000) were alsoreviewed in the green laser separation. Charts of patientswith nerve fiber layer defects detected with P200C werethen reviewed to assess if there was concordant structural orfunctional loss. If RNFL assessment (with either GDx orOCT-Stratus or Spectralis) or visual fields (VFs) 24-2 SSwere not in the chart, the patient was recalled for thattesting. If the location of the RNFL loss predicted a fieldloss beyond 30�, 60-4 VFs were also obtained.Results: RNFL loss with the P200C in the absence of ob-vious cupping and pallor was found in 49 patients. GDxand/or OCT correlated in 82% (40/49 eyes) but some addi-tional defects on GDx (and occasionally on OCT) were notdetected by the examiner interpreting the P200C images.Corresponding field loss on the 24-2 was found in about69% (34/49 eyes) of the cases, but this increased when re-sults of the 60-4 were also included. Some narrow RNFLdefects detected with the P200C do not correlate withGDx, OCT, or visual fields. ‘‘Slits’’ in the RNFL, believedto be physiological, occur in the absence of correspondingGDx and OCT defects. In contrast to ‘‘authentic’’ RNFLdefects, slits were observed in nearly half of all eyes, aremore narrow than major retinal vessels, do not widen pe-ripherally, and do not reach the disc. In 9 patients, easilyobservable 1 DD wide RNFL defects 4 or 5 DDs fromthe optic nerve head tapered and became undetectable atthe disc. In 10 patients, the RNFL loss was caused by anonglaucomatous optic atrophy, such as LHON, AION, ordisc drusen.Conclusions: The Optomap� P200C, most often utilizedfor the detection of retinal abnormalities through an undi-lated pupil, appears useful in detecting RNFL defects.Moderate to large wedge defects correlate with RNFL re-duction with GDx and OCT and less often with visualfields. Narrow defects may be normal variants or mayrepresent very early loss. Follow-up examination includingdiagnostic tests of structure and function are recommendedto diagnose glaucoma as early as possible.

Poster 43

Hemifacial Spasm as an Unusual Manifestation ofPseudotumor Cerebri

Charles Druckman, O.D., and Thanh-Vi Nguyen, O.D.,Baltimore VAMC, Baltimore, Maryland

Background: Pseudotumor cerebri (PTC) is a diagnosisbased solely on exclusion. PTC is characterized by an in-creased intracranial pressure in absence of any intracranialmass or disease. The intracranial pressure of the cerebrospi-nal fluid is raised throughout the subarachnoid space withinvolvement of the optic disc leading to bilateral opticnerve edema. Patients may present with a wide rangeof neurological complaints, mostly headaches, but long-standing illness will begin to present with ocular symptoms.Most patients of pseudotumor cerebri are obese woman ofchildbearing age who may find their weight increasing re-gardless of exercise and diet.Case Summary: A 47-year-old black woman presented withblurry vision OS.OD. The patient history is notable foranemia, recent onset of weight regardless of exercise anddiet, and left-sided facial hemispasms. No headacheswere reported. Before examination, the patient had goneto her PCP and saw a neurologist who ordered MRIs andMRAs, all of which came back negative. Entering unaidedvisual acuities were 20/30 - and 20/20 OD and OS, respec-tively. Pupils were reactive and no APD was noted; colorvision was intact and IOP and SLE were unremarkable.Upon dilation, significant bilateral optic disc swelling andperipapillary flame hemorrhages were noted OU. A formalvisual field was obtained, which showed enlarged blind-spots OU. Once the diagnosis of bilateral optic disc swell-ing was made, the patient underwent workup once morewith an MRI to verify the absence of any intracranialmass or disease, and a lumbar puncture was performed toassess the intracranial pressure. The ICP was found to beelevated above 25cm H2O; the normal value. Upon treat-ment with oral Diamox, the typical treatment of PTC, ourpatient noted spontaneous resolution of her hemifacialspasm along with the bilateral disc edema.Conclusion: The final identification of this illness is by di-agnosis of exclusion and use of Dandy’s modified criteria.The increase CSF within the subarachnoid space mayhave led to the neurovascular compression, direct or sec-ondary, resulting in the hemifacial spasm with which ourpatient presented.

Poster 44

Optic Neuritis in an Operation Enduring FreedomVeteran With Multiple Sclerosis

Christopher Suhr, O.D., M.P.H., and Chelsea Bainter,O.D., Department of Veterans Affairs, New Port Richey,Florida

Background: Optic neuritis, a condition in which the opticnerve becomes inflamed, may be caused by an acute multi-ple sclerosis (MS) episode or relapse. We will discuss a