Poster Presentations 313

myopic and astigmatic correction, best-corrected acuitieswere 20/25- O.D. and 20/20 O.S. IOP was 36 O.D., 34 O.S.Gonioscopy found angles open to ciliary body, flat ap-proach, and 1’ pigment and iris processes OU, and noapparent abnormalities. Dilated fundus examination founda .9 cup O.D. with very limited rim tissue remaining,especially superiorly, and .75 O.S. with no pallor in eithereye. Humphrey 24-2 visual field indicated a dense completeinferior altitudinal defect O.D., and no glaucomatousdefects O.S. JOAG was diagnosed, and Travatan qhs OU,Timolol 0.5% twice a day OU, and a referral for surgicalassessment were pursued. At the surgical evaluation, IOPwas 16 O.D., 14 O.S., and all other findings were con-firmed. A surgical course was not pursued and medicaltherapy was maintained using Travatan qhs OU, andTimolol was changed to Cosopt twice a day OU with a 1-month follow-up scheduled. Treating a patient with JOAGmay present unique challenges depending on the age ofpresentation because of differences in side effect andefficacy profiles for children. Medical therapy alone isoften insufficient in controlling IOP. Among the surgicalchoices, trabeculectomy is most typically performed inJOAG. The underlying pathophysiology of JOAG is notfully known; however, several genes and other molecularcomponents have been linked to its development. Thismolecular and genetic research is paramount in predictivediagnosis and treatment for high-risk, asymptomatic indi-viduals. In this case, no other family members had glau-coma diagnosed, and genetic screening was not considered;however, the family was counseled on the importance of allimmediate family members receiving a dilated eye exam-ination.

Other

Poster 64

Ocular Manifestations of Arnold-Chiari I Malformation:A Case Presentation

Kathryn Thompson, O.D., Salem Veterans Medical Center,Eye Clinic, 1970 Roanoke Blvd., Salem, Virginia 24153

Background: Arnold Chiari I malformation is considered tobe a congenital malformation, characterized by the down-ward displacement of the cerebellar tonsils beneath theforamen magnum into the cervical spinal canal. This herni-ation of the cerebellar tonsils may obstruct normal circulationof cerebral spinal fluid, causing intracranial hypertensionwith symptoms such as blurred vision, headaches, backpain, nausea/vomiting, and oscillopsia.Clinical Case: A 32-year-old woman presented to her localemergency room with complaint of acute diplopia, blurredvision, and increased frequency and intensity of her mi-grainelike headaches. Bilateral papilledema was observed,

along with unilateral abducens nerve and facial nerve pare-sis. Radiologic studies showed an Arnold-Chiari I malfor-mation, prompting an obstruction in circulation ofcerebral spinal fluid. Opening pressure by lumbar measured420 mm H2O, causing hydrocephalus and papilledema.The patient was treated with acetazolamide, with subse-quent improvement in papilledema, headaches, and cranialnerve function.Discussion: Although precipitated by a congenital deforma-tion, Arnold-Chiari I malformation is usually diagnosed in ad-olescents or adults, whereas other types are present earlier inlife. Arnold-Chiari types II through IV have severe displace-ment of the base of the brain through the foramen magnum,whereas Arnold-Chiari type I is limited to cerebellar tonsilherniation. Arnold-Chiari I malformation and intracranial hy-pertension have potential vision-threatening consequences,and thus early diagnosis and appropriate treatment is para-mount. We present a case of Arnold-Chiari I malformationto display typical ocular manifestations of this process andconduct a review of the literature to exhibit associated oph-thalmic signs, symptoms, and sequelae along with appropriatetreatment regimens.

Primary Care

Poster 65

Clinical Comparison of Temporal vs. Central Optic Pits

Ashley Fortney, O.D., and Sylvia E. Sparrow, O.D.,Southern College of Optometry, 1245 Madison Avenue,Memphis, Tennessee 38104

Background: An optic pit is a form of optic disc dysplasiathat results in a depression in the optic disc. More than 50%are located temporally (usually inferior), but about 20% to33% are found centrally. Regardless of location, a pit isusually gray-white, unilateral, and ranges in size from0.25 to 0.40 disc diameters. With a unilateral presentation,the disc with the pit usually appears larger than normal, anda cilioretinal artery is present approximately 60% of thetime. Visual acuity is normally unaffected unless there isa localized serous retinal detachment in the macular region,which may develop in 30% to 50% of patients with a tem-poral pit; central pits are typically not associated with de-tachment. Visual field defects are similar to those inglaucoma and vary from arcuate scotomas to nasal or tem-poral steps and are seen in approximately 55% to 60% ofeyes.Case Report: A 40-year-old black male with hypertensionand diabetes presented with uncorrected distance acuitiesof 20/20 O.D. and O.S. Ocular examination was unremark-able with the exception of a large, vertically elongated tem-poral optic pit in the O.D. A 24-2 Humphrey visual field ofthe right eye detected an absolute scotoma located nasally