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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