Poster Presentations 287

30% of the population. Common treatments for both includetreating the underlying systemic etiology, oxygen therapy forCRAO, and focal laser photocoagulation for persistent macu-lar edema after a CRVO. New treatments include Avastin, aninjectable antivascular endothelial growth factor (VEGF)drug, which reduces retinal edema thereby improving vision.Research trials on standardizing anti-VEGF’s role in treat-ment and outcomes are ongoing.Case Report: An 82-year-old white man presented to theeye clinic with sudden onset of decreased vision in hisonly seeing eye, the right eye (OD). Later in the day, he no-ticed loss of his superior visual field in the right eye. A pre-vious traumatic event resulted in blindness of the patient’sleft eye. Patient’s entering visual acuity at distance was 20/150 OD with no improvement after refraction. Right pupilwas reactive to light, confrontation fields were full to fingercount OD, and motility was full range of motion both eyes.Slit lamp examination of the right eye was within normallimits. Dilated fundus examination of the right eye foundhemorrhages along both arcades of the posterior polewith edema and an area of whitening below the macula.The patient had CRVO and a CRAO diagnosed in the righteye. After confirmation from a retinal specialist, the patientreceived Avastin treatment returning his vision to 20/40 ODwithin 6 months of initial presentation.Conclusion: In the past, vision prognosis after a vein and/orartery occlusion was guarded to poor. With the introductionof anti-VEGF injectables, such as Avastin, visual outcomesare improving. Awareness of new treatments, immediate di-agnosis, and proper referral by optometric physicians willensure the best visual outcome for the patient.

Poster 40

Cross-Over Evaluation of Blink Tears Versus SystaneUltra in Mild Dry Eye Patients

Tom Kislan, O.D., Stroudsburg Eye Specialists

Background: The purpose of this study was to evaluate theefficacy of Blink Tears versus Systane Ultra for thetreatment of mild dry eye signs and symptoms.Methods: This was a randomized, investigator-maskedcrossover evaluation of 40 patients (80 eyes). Included pa-tients were those with mild dry eye symptoms per patient re-porting/physician assessment and were not currently usingany artificial tears regularly or using low viscosity tears forsymptom relief (Refresh Tears, Visine Tears, TearsNaturelle, etc.). Patients were randomly assigned to instill ei-ther Blink Tears or Systane Ultra in each eye 4 times daily for1 month. Patients were crossed over after 1 month to the otherdrop. Study visits were at baseline, month 1, and month 2.Outcome measures included TBUT, VA, and lissamine greenstaining, and patients completed a dry eye questionnaire.Results: Blink Tears significantly improved TBUT after1 month of treatment (increase of 2.4 seconds, P50.003),while there was no significant improvement with SystaneUltra (increase of 0.3 seconds, P50.320). No significant

changes were noted for staining or visual acuity. Patientsreported that Blink was more soothing, improved vision,was less blurring, and was more comfortable than SystaneUltra (P,0.043).Conclusion: Blink Tears improved TBUT and thesymptoms of dry eye significantly better than Systane Ultra.Patients preferred Blink Tears.

(Received funding for the research.)

Poster 41

Utilization of Pattern Recognition Along With DepthCues Facilitates SD OCT Diagnosis

Jerome Sherman, O.D., Alyssa Taussig, Richard Madonna,O.D., Sanjeev Nath, M.D., Juliana Boneta, O.D., andSheikh M. Hossain, M.D., State University of New YorkState College of Optometry, New York, New York

Purpose: To determine whether pattern recognition of SDOCT images as well as depth cues can improve diagnosticyield (in a similar manner as to how many retinal specialistsuse pattern recognition and depth cues in ophthalmoscopy,photography, and fluorescein angiographic, differentialdiagnosis).Methods: A retrospective review of 1,100 SD OCT caseswas performed with either the Heidelberg Spectralis, theZeiss Cirrus, the Topcon 3D OCT 1000, or the OptovueRTVue100. Three trained observers noted and recordedOCT patterns associated with specific diseases. Depth of le-sions in specific disorders was also noted and recorded.Each OCT finding (pattern or depth) as it related to a spe-cific disease entity was assigned to 1 of 3 categories: (1)Pathognomonic for the disease, (2) Commonly found inthe disease but not pathognomonic, or (3) Randomly asso-ciated with the disease (it was shared in numerous otherdiseases as well).Results: Twelve SD OCT patterns emerged that appear tobe pathognomonic of 12 disorders. For example, only inachromatopsia was there total absence of the IS/OS junc-tion that was limited to the central 800u by 600u with allother retinal layers intact. Other patterns emerged in rod-cone degeneration, cone-rod degeneration, central serouschoroidopathy, retinal macro-aneurysm, intraretinal per-fluorooctane, macular telangiectasia type 2, retinoschisis,plaquenil toxicity, and solar retinopathy. In addition, poste-rior vitreal traction (VM, VP, VR), and full-thickness mac-ular hole were predictably pathognomonic. Commonlyfound but not pathognomonic: outer retinal tubulationsfound in 2 cases of Bietti but also found in several other ret-inal degenerations. Exudates in and around the outer plex-iform layer are common in diabetic retinopathy but alsofound in hypertensive retinopathy, vein occlusion, and mac-roaneurysms. Seven other findings fell into this category.Conclusions: Pattern recognition, during ophthalmosocpyreviewing fundus photographs and in fluorescein angiogra-phy, is very useful in SD OCT interpretation. Pattern recog-nition of ‘‘pathognomonic’’ findings often facilitates

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