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

304 Optometry, Vol 80, No 6, June 2009

be visualized in all normal subjects. This study is designedto assess what percentage of patients with outer retinal dis-ease have abnormal photoreceptor integrity lines.Methods: One hundred randomly selected eyes of 100 pa-tients with retinal disorders affecting the outer retina wereclinically evaluated. SD OCTs were obtained in all caseswith either the Topcon 3-D OCT, Zeiss Cirrus HD OCT orthe Heidelberg Spectralis. Disorders include rare congenitalones, such as Lebers congenital amaurosis, complete and in-complete achromatopsia, rubella retinopathy; inherited disor-ders, such as retinitis pigmentosa and cone dystrophy; rareacquired disorders, such as acute zonal occult outer retinop-athy (AZOOR), acute multifocal placoid pigment epitheliop-athy (AMPPE), plaquenil toxicity; and common disorders,such as drusen, geographic atrophy of the RPE, CNVM, cen-tral serous choroidopathy, macular holes, and myopic degen-eration. The IS/OS junction was classified as either normal,thin, discontinuous with gaps, disorganized, or absent.Results: In every eye with reduced visual acuity (VA), theIS/OS junction was abnormal under the foveal pit. In pa-tients with RP but 20/20 VA, the IS/OS junction was pre-sent in the central 5� from where it continuously taperedand then disappeared toward the periphery. In cone dystro-phy, the IS/OS junction is missing in the central 5� but pre-sent in all other scan locations. Mf ERGs correlated wellwith the status of the IS/OS junction with 2 exceptions:In one case of early symptomatic AZOOR, the IS/OS junc-tion was abnormal before mf ERG loss, and in one case ofearly plaquenil toxicity, the mf ERG was abnormal beforeloss of the IS/OS junction.Conclusions: In a previous study, the IS/OS junction orphotoreceptor integrity line (PIL) has been reported to benormal in 500 consecutive eyes. In all cases studied here,the junction abnormality correlated well with tests of reti-nal function. Hence, the junction can be considered as abiomarker for photoreceptor integrity.

(Investigators received support Topcon and Zeiss.)

Poster 41

Artificial Tear Preferences in Post-LASIK Patients

Jim Owen, O.D., Encinitas Optometry, 1279 EncinitasBlvd., Encinitas, California 92024

Purpose: The aim of this study was to evaluate patient per-ception and preference of artificial tears after LASIKsurgery.Methods: This was a randomized, open-label, multicenter,contralateral eye study of 201 patients undergoing LASIK.One week after LASIK, patients used Blink Tears(Advanced Medical Optics, Santa Ana, California) in1 eye, and one drop of the practice-preferred tear (Systaneor Optive) in the other eye for 1 month. Patients docu-mented typical daily usage and were asked to complete aquestionnaire about preference, blur, comfort, and reliefof symptoms.

Results: Most patients (86%) said postoperative use of ar-tificial tears helped improve symptoms of dry eye. Moreeyes achieved 20/20 or better with Blink Tears than withSystane (82% vs. 57%), and 57% of patients found thatBlink most improved their vision, making objects crisper(compared with 27% with Systane and 10% with Optive).Blink Tears provided longer lasting relief of dry eye symp-toms (53% versus 34% with Systane and 9% with Optive),and was more comfortable than Systane (48% for Blinkversus 34% for Systane and 10% with Optive). Blinkcaused less blur upon instillation than Systane (55% vs.25%). The majority of patients (60%) preferred Blink Tearsto the other artificial tears. After LASIK 97% of all patientssaid their quality of life improved, and 97% would recom-mend laser vision correction to their friends or family.Conclusion: Blink Tears helped improve visual acuity aswell as the signs and symptoms of post-LASIK dry eyemore than other artificial tears. Most patients preferredBlink Tears.

(Study funded by an unrestricted grant from AMO.)

Poster 42

‘‘I’m Not a Type A, I Just Have Asthma!’’ CorticosteroidUse and Its Relationship to ICSC

Abby Vanderah, B.S., 2LT, USA, Melinda Gruszka, B.S.,and Joni Scott-Weideman, O.D., CPT, USAFR, IllinoisCollege of Optometry/Illinois Eye Institute, 3241 SouthMichigan Avenue, Chicago, Illinois 60616

Background: Idiopathic central serous chorioretinopathy(ICSC) is a condition affecting the macula in which the ex-act etiology is not clearly understood. ICSC is a predomi-nantly male disease (10:1), which most often affects the20- to 50-year-old age group. This condition is often unilat-eral and found to be associated with stress, uncontrolled hy-pertension, gastroesophageal reflux disease, pregnancy, andcorticosteriod use. Corticosteroid use, via any route ofadministration, has been found to be associated with thedevelopment of ICSC. Symptoms include decreased or dis-torted vision, central scotomas, and photopsia. A compre-hensive examination along with supplemental testing suchas fluorescein angiography (FA) and optical coherence to-pography (OCT) is often used in the diagnosis of ICSC.A ‘‘smoke-stack’’ appearance on FA is observed in 10%to 15% of cases. Although ICSC is usually a single, selflimiting episode, recurrence is possible. In severe and re-current cases, laser and photodynamic therapy (PDT) maybe considered.Case Report: A 37-year-old white man presented to theclinic after recent hospitalization and treatment with high-dose corticosteroids for severe asthma. The patient noteda severe decrease in vision and photopsia in his left eye.Upon examination, the patient’s entering visual acuitieswere 20/20 O.D. and 20/150 O.S., with best correction to20/20 and 20/40, respectively. An amsler grid defect wasfound in the left eye. A fundus examination found a round