Multimedia Posters
See all our 2024 posters during the
LIVE POSTER SESSIONS
presented in Optometry's Market Place.
Session #1: Friday | 9:45AM - 11:45AM
Session #2: Friday | 12:00PM - 2:00PM
Session #3: Friday | 2:15PM - 4:15PM
Session #4: Saturday | 9:45AM - 11:45AM
Session #5: Saturday | 12:00PM - 2:00PM
Session #6: Saturday | 2:00PM - 4:00PM
| title | lastname | folder | description | |||
|---|---|---|---|---|---|---|
| 1720 | The Role of Homocysteine in Optic Atrophy | Ria | Shah | Julie Rodman, OD, Adrianna Simmons, Mariana Ferraz OD, Leticia Rousso OD | shah_atrophy | A 37-year-old Black female presented for comprehensive eye examination with history of longstanding decreased vision bilaterally. Her medical and ocular history were unremarkable. BCVA measured 20/40 OD and 20/40 OS. Fundoscopy revealed optic disc pallor temporally OU. MRI of brain and orbits with contrast as well as CBC including metabolic panel were ordered. Laboratory testing revealed elevated homocysteine levels. Studies have identified hyperhomocysteinemia as one of the possible risk factors for a multitude of diseases including vascular, neurodegenerative, and ocular disease. Elevated homocysteine levels may lead to vascular injury causing changes in the ONH microvasculature. Resultant blood flow impairment occurs via vasoconstriction, endothelial cell remodeling, thrombogenesis and apoptic cell death of the retinal ganglion cells. Levels of homocysteine, folate, B6 and B12 should be measured early in patients with visual impairment which would aid in screening for potential life-threatening disorders related with this vitamin abnormality. |
| 1770 | Low Vision Management in a Retinitis Pigmentosa Patient with Monocular Luxturna Gene Therapy | Ellen | Ren | ren_lowvision | A 28 year old African-American female with Retinitis Pigmentosa OU presents for a low vision evaluation after receiving Luxturna gene therapy injection OS last year. She has severely reduced VA (20/500 OD/OS/OU), central islands of vision and contrast loss. These findings have given the patient difficulty with functional vision and mobility. After refraction and ocular health exam, she was referred to low vision therapy for video magnification/ORCam evaluation and orientation and mobility training. This patient is a unique comparison of an RP eye treated with gene therapy to one without. Despite treatment, the patient needs continued low vision services and interdisciplinary care to manage her ocular health and functional vision. | |
| 1777 | Peli Possibilities: Utilizing Peli Prisms for Hemianopsia | Darian | Travis | travis_peli | A 53 year old African American female presents for low vision exam. She has a history of stroke in 2020 with two subsequent strokes in 2021 in her occipital lobe. She has a diagnosis of left hemianopsia, and her central vision is intact. Previously, she was prescribed yoked prism, but she does not feel it helps. She is very anxious about leaving her house due to her visual field defect. We fit her in 40PD fresnel prisms using the Peli method to explore field expansion. She appreciates the prism affect and is training with orientation and mobility while wearing the peripheral 40PD fresnel prisms. She is demonstrating increased left visual field while utilizing the peripheral prisms both seated and walking, including on stairs. | |
| 1813 | It’s all relative… Rare Unilateral Posterior Polymorphous Corneal Dystrophy with Relative Decreased Endothelial Cell Count | Alexandra | Espejo | Zoeanne Schinas, OD. Thuy-Lan Nguyen, OD, FAAO | espejo_rare | Posterior Polymorphous Corneal Dystrophy (PPMD) is an autosomal dominant disorder, usually bilateral and asymptomatic. The cornea in PPMD is affected at the level of Descemet’s Membrane and the endothelium. The lesions vary in size and appearance as opacities, bands, or vesicles. In rare cases corneal thickening and edema can develop causing decreased vision. Specular microscopy can quantify endothelial cell count and identify patients at higher risk for complications. We present a case of unilateral PPMD with relative decreased endothelial cell count without signs of corneal edema or decrease in vision. |
| 1827 | Suspected Delayed Onset of Posterior Ischemic Optic Neuropathy Following Cataract Extraction | Kevin | La | la_ischemic | An 82-year-old male with controlled cardiovascular risk factors presented for sudden vision loss in his left eye 2 months after a noncomplicated cataract surgery. He exhibits reduced vision (20/200), an APD, dyschromatopsia, paracentral scotoma on visual field, and mild changes to his RNFL/GCC in the left eye. He is a low-risk glaucoma suspect in the setting of megalopapilla with consistently low-teen IOPs. His previous visual fields and RNFL in both eyes were normal and stable. Thus, there is low suspicion for glaucoma or NAION (no disk at risk) to explain his sudden vision loss. His GCA labs were unremarkable. Post-surgical NAION is a rare but recognized complication following cataract surgery, likely due to reduced perfusion pressure from elevated IOP. Conversely, documented cases of posterior ischemic optic neuropathy (PION) following cataract surgery are limited. Instances of surgical PION typically proceeds after prolonged procedures such as spinal surgery due to arterial hypotension, hemodilution, anemia, orbital and periorbital edema, and/or direct orbital compression in a prone position. PION is a diagnosis of exclusion. Here, we present a rare, suspected case of post-surgical PION after cataract surgery. | |
| 1737 | Successful Management of Bilateral Peripheral Neovascularization in High Myopic Patient by Self-retained Cryopreserved Amniotic Membrane: A Case Report | Seema | Nanda | nanda_bilateral | A 44-year-old male with progressive myopia (-27D OD, -24D OS) presented with bilateral recalcitrant redness, irritation, dryness, and blurry vision (BVA 20/60 OU). Examination revealed manifestations of severe superficial punctate keratitis, corneal erosion, and peripheral neovascularization in both eyes. History, examination, and fluorescein staining confirmed limbal stem cell deficiency diagnosis induced by contact lens over wear. Patient was treated with self-retained cryopreserved amniotic membranes and steroid/antibiotic drops twice a day. Visual acuity improved from 20/60 to 20/25 in the right eye and 20/30 in the left eye. In approximately one-month, complete resolution of corneal signs with total regression of blood vessel neovascularization was noted. Patient remained asymptomatic with clear corneas at the end of 24 months of follow-up. | |
| 1744 | Peekaboo, I See You: Unveiling Retinoblastoma in a 2-Year-Old Presenting for a Pink Eye Evaluation - A Journey Through Differential Diagnoses of Pediatric Retinal Detachments. | Heidi | Volos | Nathan Cheung, OD, FAAO | volos_peekaboo | Purpose: To highlight diagnostic challenges in pediatric ocular presentations, emphasizing the importance of considering a wide range of differential diagnoses for retinal detachments. Methods: An urgent appointment and examination of a two-year-old presenting symptoms initially suggestive of conjunctivitis but leading to the discovery of a more complex pathology. Results: The examination revealed a painful, red eye and total retinal detachment accompanied by neovascular glaucoma in the left eye. Enucleation was performed, and the pathology report confirmed a case of retinoblastoma. Conclusion: The case underscores the need for a thorough evaluation of pediatric ocular anomalies, considering various conditions such as Retinoblastoma, Coats' Disease, Persistent Fetal Vasculature (PFV), Familial Exudative Vitreoretinopathy (FEVR), Retinopathy of Prematurity (ROP), Stickler’s Syndrome, and ocular trauma. Each condition has its unique pathophysiology, highlighting the critical need for comprehensive assessment. |
| 1746 | Impact of Spinal Muscular Atrophy on Visual Function: A Pediatric Case Report | Katie | Kwan | Kristin Adams OD, Cynthia Heard OD, Scott Ensor OD | kwan_spinal | Spinal Muscular Atrophy (SMA), a rare autosomal recessive genetic disorder, can profoundly affect ocular structure and visual function in children. A wheelchair bound 8-year-old with SMA type 2 presented for examination, complaining of recent blurred vision hindering school adjustment after recent relocation to the USA. Optic nerve pallor was evident, confirmed by OCT and VF assessments. Subsequent low vision evaluations pinpointed needs. Tailored devices were recommended, and comprehensive documentation was relayed to the school to establish an Individualized Education Plan (IEP). This case highlights the role of optometrists in SMA awareness, advocating for optimal low vision and ocular health management, ensuring the child's best possible outcomes. |
| 1780 | Angioid Streaks: Ocular Manifestations Leading to the Diagnosis of a Systemic Condition | Shaily | Sheth | sheth_streaks | 31 year old male with an unremarkable medical and ocular history was hit in the left eye with a softball. Patient complained of blurry vision and sparkles in the vision inferiorly OS. Posterior segment findings revealed angioid streaks OU with associated subretinal hemes OS. Fluorescein angiography revealed no frank CNVM. Patient was prophylactically treated with anti-VEGF in case a potential CNVM was not observed due to the overlying bleed. Upon examination of the back of the patient’s neck, yellow papules described as “chicken skin” were observed. A working systemic diagnosis of pseudoxanthoma elasticum was determined. The patient was referred to primary care to coordinate confirmation and management of the diagnosis through blood work, echocardiography, and genetic counseling. | |
| 1837 | Making Room for your Rheumatologist | Victoria | Duque-Ferreira | duque_rheumatologist | A 62-year-old Black male presents to the emergency clinic with a recurrent unilateral uveitis. The patient reported self-discontinuing Humira for his ankylosing spondylitis a few weeks prior to the onset of his symptoms. Previous treatment included cyclopentolate BID & prednisolone Q2H, revealing little improvement in signs or symptoms after 5 days. Treatment was switched to Durezol QID, with mild improvement after 4 days. After one week of starting weekly Enbrel injections, the patient’s symptoms of pain and photophobia had completely resolved with only trace cells present. It is imperative by the clinician to explore and involve systemic treatment of autoimmune conditions when topical therapy alone becomes refractory. | |
| 1844 | Vital Systemic Associations With Hypertrophic Corneal Nerves | Sangita | Patel Vadapalli | Asad Loya, MD : Department of Ophthalmology, Baylor College of Medicine | vadapalli_hypertrophic | Hypertrophic corneal nerves exist in specific corneal diseases. Ocular conditions that may be associated with enlarged nerves include keratoconus, Fuchs’ endothelial dystrophy, Acanthamoeba keratopathy, posterior polymorphous dystrophy, and herpetic keratitis. Abnormally thickened corneal nerves may be a sign of potentially fatal systemic conditions such as multiple endocrine neoplasia type IIb (MEN 2B), neurofibromatosis type I (NF1), Refsum’s disease, and Riley Day syndrome. A twenty-six year old male presented to a VA eye clinic for a contact lens and refractive surgery evaluation. Best corrected visual acuity in each eye was 20/20-. Biomicroscopy revealed translucent thread-like lesions diffusely dispersed within the sub-epithelial and anterior stromal layer, without limbal involvement in both eyes. Initial differential diagnosis included Lattice Corneal Dystrophy, Enlarged Corneal Nerves, and Other Congenital Dystrophies. Prompt systemic work-up was ordered which included an extensive panel of blood tests and imaging. It is important to note that in cases of hypertrophic corneal nerves, ocular findings may precede systemic signs, thus accuracy of diagnosis can impact detection of a potentially deadly disease. |
| 1846 | Optometric Applications of Radiofrequency for Trichiasis Ablation | Meghan | Sue | sue_trichiasis | Trichiasis is an acquired condition characterized by the inward turning of the eyelashes leading to contact between the eyelashes and the ocular surface. Common etiologies include eyelid trauma, inflammation and trachoma infection. First line therapy for trichiasis involves manual lash epilation, but this may need to be repeated every 1-2 months as the lash regrows. Recurrent trichiasis can be treated with more permanent solutions such as radiofrequency ablation, cryotherapy, laser ablation or surgery (intermarginal split lamella with graft (ISLG) or lid lamella resection (LLR)). Radiofrequency ablation is a highly effective and low risk procedure for treating trichiasis that only requires local anesthesia. Optometrists in many states have the ability to improve patient quality of life with radiofrequency and it should be considered in all cases of recurrent trichiasis to minimize the need for frequent epilation. This case presents a 60-year-old Native American male with a history of eyelid trauma causing trichiasis of the left upper eyelid, treated with radiofrequency ablation. | |
| 1374 | Moyamoya Disease: Clinical Ocular Implications and Subsequent Management | Maysa | Abbas | Nancy Shenouda-Awad, OD, FAAO, Theresa Zerilli-Zavgorodni, OD, FAAO | abbas_moyamoya | Moyamoya disease (MMD) is a rare, idiopathic life-threatening cerebrovascular disease that leads to chronic and progressive intracranial damage. Although much less common, various ophthalmic manifestations have been reported with MMD including morning glory disc anomaly, retinal vascular occlusion, optic disc pallor and cortical blindness, etc. Given the life-threatening and vision-threatening consequences of MMD, it is critical that the neurologist and eye care provider remain in communication to prevent further intracranial damage or vision loss. Furthermore, it is imperative that the optometrist recognizes and manages the visual disorders associated with MMD to preserve quality of life. This case will discuss a patient with MMD having multiple cerebrovascular accidents, most recently that of the posterior cerebral artery (PCA) which led to acute vision loss and cortical blindness in both eyes. Emphasis is placed on the diagnoses and comprehensive management including low vision intervention to address vision loss associated with this rare condition. |
| 1709 | Intralenticular neovascularization: A rare complication of PDR | Ria | Shah | Julie Rodman OD, MSc, FAAO Sherrol Reynolds OD, FAAO Mariana Ferraz OD, FAAO | shah_pdr | Neovascularization can manifest in various ocular structures including the retina, iris, anterior chamber angle and cornea; however, it rarely occurs in the crystalline lens. Neovascularization results secondary to hypoxic conditions within the eye. A natural balance of angiogenic and antiangiogenic factors are critical for the eye to prevent the formation of neovascularization. When this balance is upset, angiogenesis can occur. Due to the lack of an intrinsic blood supply, intralenticular neovascularization is rare. A 67-year-old black male presented with a previous diagnosis of proliferative diabetic retinopathy (PDR). His ocular history included panretinal photocoagulation and multiple intravitreal injections OU. His entering visual acuities were 20/250 OD and NLP OS. Upon biomicroscopic evaluation OS, there was evidence of a hypermature cataract with iris neovascularization and neovascularization coursing over and within the anterior capsule of the lens. Intralenticular neovascularization is a rarely reported ocular complication. We present a patient with uncontrolled diabetes resulting in proliferative diabetic retinopathy, extreme ocular ischemia, and consequent intralenticular neovascularization. |
| 1759 | Anterior Segment Glaucoma Management: Identifying and Treating Stent-Related Complications | D'Ajanee | Smallwood | smallwood_glaucoma | A 52-year-old African-American male with a history of primary open angle glaucoma presented for a comprehensive eye exam with pigmentary changes throughout the bulbar conjunctiva. Easily misdiagnosed as conjunctival melanosis, the pigmentary changes were derived from iris pigment deposited by a recently implanted Xen Stent. The patient was referred to a glaucoma specialist for stent repositioning. It is important for optometric physicians to recognize complications with this relatively new implant (FDA approved in 2016). This poster presents a personal case report along with findings within the literature of complications and suggestions for management of the Xen Gel Stent. | |
| 1774 | Poppers Maculopathy: Ocular Consequences of Recreational Alkyl Nitrate Inhalants | Vasudha | Rao | Tran Nguyen OD, FAAO; Shanida Ingalla, OD | rao_poppers | ‘Poppers’ are alkyl nitrate inhalants used recreationally for euphoric vasodilation and enhanced intercourse. Poppers maculopathy is a rare form of retinal toxicity characterized by interrupted foveal ellipsoid zone on optical coherence tomography (OCT). Most reported cases occur in men in their forties who have used poppers for several years. Symptoms of poppers maculopathy include blurred vision and central scotoma. We present a case of a 42-year-old male who presented to Palo Alto Veterans Affairs Hospital with a complaint of partially faded letters when reading text that started three months prior. His examination revealed bilateral decreased visual acuity, Amsler grid irregularities, and disrupted foveal ellipsoid zone on OCT of the maculae. The patient endorsed using poppers for many years and denied sungazing or laser use. With maintained discontinuation of poppers the patient’s visual acuity, visual disturbances, and OCT findings improved at follow-up. |
| 1823 | Grave Mistakes to Avoid when Diagnosing Thyroid Eye Disease | Marsha | Zaman | zaman_mistakes | In this case we will explore an atypical presentation of Thyroid Eye Disease (TED). Case: A 46-year-old male presents to clinic with complaints of horizontal binocular diplopia for the past 4 months. This diplopia occurs every morning and has been increasing in duration to one and a half hours. He reports symptoms occurring intermittently at night as well. The patient also states his right eye has been proptotic for the past month. The BCVA was 20/20 OD, OS. EOMs were abnormal in the right eye and the patient was unable to follow a straight H pattern, however there was no restriction present. The patient is a current smoker. Lab work shows low TSH levels, and high T3 and T4 levels. MRI shows enlargement of the right lateral, medial, and inferior recti muscles. This case report will discuss diagnosis, management, and prognosis of TED. | |
| 1859 | Funny looking nerve? | Fareed | Dosani | dosani_nerve | ||
| 1705 | Talking about Talc: A Case Series | Mariana | Ferraz | Leticia Rousso OD, FAAO & Ariel Chao OD | ferraz_talc | Talc retinopathy is a crystalline retinopathy associated with chronic drug abuse. Talc crystals deposit in the retinal capillaries.Ocular symptoms range from asymptomatic to ischemic sequelae due to non-perfusion leading to neovascularization. Two patients presented for CEE with complaints of blurry vision. BCVA for both were 20/20 OD, OS, OU. Upon dilation, presence of scattered punctate refractile crystals were seen in the posterior pole and peripheral retina, following the contour of retinal blood vessels. Ancillary testing performed included OCT and fundus imaging. Both patients had deposits in the inner retina corresponding to talc particles in both eyes. Case 2 also had a serous retinal detachment nasal to the retina. |
| 1741 | “An Artificial Tear vs. a Nutritional Supplement: Is there a Clear Winner for Dry Eye?” | Coralis | Millien | Christopher Wroten | millien_tear | Dry Eye Syndrome (DES) is a multifactorial disease of the ocular surface characterized by a loss of tear film homeostasis leading to ocular surface damage and inflammation. The two main categories of DES causing tear film instability are aqueous deficient and evaporative dry eye. DES symptoms include foreign body sensation, red eyes, intermittent blur and tearing, and its causes can be multifactorial (e.g. medications, systemic diseases, environmental factors, eye surgeries, etc.). Treatment options vary from over-the-counter eye drops to prescription pharmaceuticals and nutritional supplements to therapeutic procedures. This poster compares the efficacy of a relatively new multivitamin gummy for DES (FitEyez) versus a traditional first line therapy artificial tear eye drop (Refresh Relieva). A small case-series of willing, symptomatic dry eye patients completed a baseline Ocular Surface Disease Index (OSDI) questionnaire and the Phenol Red Thread Test. Patients were evenly and randomly divided into an experimental group taking FitEyez and a control group taking Refresh Relieva. Patients were then seen 30 days later, at which time the OSDI and Phenol Red Thread Test were repeated. Results were analyzed and reported here. |
| 1742 | Analysis of Pupil Size Impact on Near Vision Improvement | David | Evans | S. Barry Eiden, OD; Sherif El-Harazi, MD; Gail L. Torkildsen, MD; Marc G. Odrich, MD | evans_pupil | INSIGHT was an independently randomized, double-masked, crossover, multicenter, and vehicle-controlled study that evaluated the effectiveness of miotic eyedrops in development for the treatment of presbyopia [LNZ100 (1.75% Aceclidine) and LNZ101 (1.75% Aceclidine + Brimonidine)] in subjects aged 46-73 with a refractive range of -3.25D SE to +1.5D SE. Primary efficacy endpoint was the percentage of subjects who achieved ≥ 3-line improvement in mesopic, high-contrast, monocular BCDVA at 40 cm with no loss in BCDVA ≥ 5 letters at 4m measured at 1 hour post-treatment. (LNZ100 n=49, LNZ101 n=50). Pupil size was measured pre- and post-instillation under consistent lighting conditions. Results: All measurements (1,377) at all timepoints (0.5,1,3,5,6,7,8,9,10 hours post-instillation) for all subjects were analyzed. A strong correlation was observed between pupil size and NVI. In the analysis, a <2 mm pupil is >3 times more likely to result in a ≥ 3-line NVI than the measurements ≥ 2 to 2.5 mm, 69% vs. 20% respectively. Above 2.5mm, ≥ 3-line NVI was below 5% for all segments. The percent of NVI ≥ 3 lines for pupil diameters: <2, 2 to <2.5, 2.5 to <3, 3 to <3.5, 3.5 to <4 mm, were 69%,20%,2%,3%,2% respectively. |
| 1755 | Homonymous Hemianopsia following Hit and Run | Alice | Lim | lim_hemianopsia | 24 yo female patient presents after recovering from a 8 month long comatose state following a hit and run accident. Patient presents with complaints of blur and eye strain since waking up from her coma. BVA is 20/25 in each eye but was noted to have a congruous left sided homonymous hemianopsia with retrograde degeneration of the ganglion cell complex OU. Hospital exam records from accident noted a right sided parietal-occipital lobe subdural hematoma at time of accident which resulted in her coma and subsequent left sided visual field defect. Patient also had a CI consistent with TBI. Management included vision therapy and low vision to assist with visual function. | |
| 1756 | Shedding Light on Diplopia: A Case of Dragged-Fovea Diplopia Syndrome | Ruhi | Mathew | Theresa Zerilli-Zavgorodni | mathew_diplopia | Dragged-Fovea Diplopia Syndrome (DFDS) refers to central binocular diplopia as a result of foveal displacement, most often caused by macular diseases such as epiretinal membranes. This poster reviews two patients having persistent diplopia for many years despite management by multiple providers prescribing various magnitudes of prisms. In each of the cases, diagnosis of DFDS was confirmed with the room lights on-off test and occlusion was the recommended treatment. Clinical characteristics, including the role of OCT imaging and the simple lights on-off test which is pathognomonic for this syndrome will be reviewed. Furthermore, treatment options will be discussed as this syndrome is often not amendable to prism therapy. |
| 1791 | The Case of the Pallorous Pescatarian | Breanna | Zeller | Patricia Kranz OD | zeller_pallorous | We will present a unique case of toxic optic neuropathy. A 46yo new patient presented with a chief complaint of blurry vision at distance in both eyes. Entrance testing was normal. Dilation revealed mild temporal optic nerve head pallor in both eyes. OCT testing revealed superior/temporal RNFL thinning in both eyes and a visual field test showed an inferior nasal defect in the left eye. Our patient denied substance or alcohol abuse. An MRI of the brain and orbits revealed no intracranial abnormalities. Extensive blood tests returned normal with the exception of elevated mercury levels. After co-management with neuro-ophthalmology, the patient noted that he was a pescatarian and was diagnosed with a heavy metal (mercury) induced toxic optic neuropathy. This poster will include a detailed discussion of the less common causes of toxic optic neuropathy, OCT images, fundus photos, unique lab results, visual field testing and highlights the importance of a thorough dilated eye examination. |
| 1792 | Don't Get Too Attached | Jackeline | Pivaral | pivaral_attached | Proliferative vitreoretinopathy (PVR) is one of the leading complications of retinal detachment surgery. It is the growth and contraction of epiretinal and subretinal membranes that exert traction and can lead to a tractional retinal detachment. PVR may reopen successfully treated retinal breaks or create new breaks. It occurs in response to rhegmatogenous retinal detachment, surgical intervention, or trauma. A 76 year old white male presented with decreased vision at near OU when reading print. He also noted trouble with depth perception while playing golf 3 weeks ago and noticed his bathroom sink had a purple hue. The patient had a history of a macula off retinal detachment OD and a macula on retinal detachment OS, both of which were repaired. The patient was diagnosed with a macula off retinal detachment OS secondary to proliferative vitreoretinopathy. | |
| 1806 | Low Vision Considerations for a Patient with Multiple Complications from Glaucoma | Carmen | Perez | perez_lowvision | A 66 year old Asian male presents for a low vision exam. Patient has Glaucoma OU, has had cataract surgery OU (1980s) and corneal transplants OU (2022). He has a history of Ankylosing Spondylosis. He also presents with corneal edema. The patient claims that his vision is blurrier when he wakes up and recovers throughout the day. He is being followed by several specialists. He struggles when walking and seeing the ground so he often falls and misses steps. Patient is retired but works part time doing taxes as an accountant. He currently uses a magnification app on his phone for paper documents and magnification on his computer. Patient stated goals are navigation, efficiency at work, and driving in the state of Florida. During his exam we collected data about his vision, contrast, visual field and ocular health. We provided him with a new glasses prescription, as well as trialed and dispensed several devices. Including electronic and optical aids to meet all of his needs. The patient is very happy with his new devices and thriving in his work place. In this poster I will summarize ocular and systemic health background, how it may have affected his vision and lifestyle, and how we helped him claim his life back. | |
| 1841 | Amar-OH-NO-sis Fugax | Behrad | Garmsiri | Ryan Walchuk, Simran Kaur | garmsiri_fugax | A 76-year-old female presents with complaints of transient vision loss OD. Medical history included hypertension and hyperlipidemia. Examination with dilation and imaging revealed unremarkable ocular health. The patient was diagnosed with amaurosis fugax and urgently referred for stroke work-up. CT scan was performed and ruled unremarkable for acute abnormalities. Four days later the patient reported to the clinic with complaints of profound vision loss. VA decreased from 20/20 to 5/100 with eccentric fixation. DFE revealed a macular cherry red spot. A diagnosis of CRAO OD was made and the patient was referred for further evaluation with ophthalmology and stroke workup. Amaurosis fugax is considered a potential sign of impending vaso-occlusive events. In addition to embolic stroke workup, close observation may be indicated to provide emergent treatment for CRAO in the hopes of mitigating permanent vision loss. |
| 1842 | Caffeinated Choroidal Congestion: A Case Report of Central Serous Chorioretinopathy | Behrad | Garmsiri | garmsiri_congestion | A 34-year-old white male presented with complaints of blurry vision OD. OCT imaging revealed subfoveal serous detachment presumed to be central serous chorioretinopathy (CSCR) OD. The patient was in good health and reported no stress. He reported using several doses of “pre-workout” supplement and consuming approximately 700mg - 1100mg of caffeine daily. The literature suggests that caffeine and sympathomimetics (similar to those found in pre-workout supplements) contribute to choroidal congestion, leading to serous detachment. Our diagnosis was CSCR likely induced by excessive caffeine and sympathomimetic intake. Counseling about the use of caffeine and sympathomimetics may be further warranted for patients who consume excess amounts of these substances. | |
| 1856 | Ortho-K Made My Tropia Go Away: Utilization of Orthokeratology in the Management of Intermittent Exotropia in Children with Anisometropia | Anushka | Mistry | M.H. Esther Han, OD, FCOVD, FAAO, Dipl ABO | mistry_orthok | Treatment of intermittent exotropia in children with anisometropia is challenging as one eye sees well at distance and the other at near, leading to poor compliance with spectacle wear. A strabismic patient, having successfully completed optometric vision therapy, presents with a decompensated intermittent exotropia at distance and near. While vergence ranges and fusion abilities remain at expected levels with correction, what could be causing the tropia to resurface? The patient manifests with a progressing myopic spectacle prescription with about 3 diopters of anisometropia and poor compliance to glasses wear. Unequal, blurry vision throughout the day inhibits fusion and increases stress on the vergence system, leading to an intermittent sensory exotropia. In this case, the more myopic eye drifts at distance and the less myopic eye drifts at near. OK serves as a treatment option for eliminating the patient’s exotropia as it ensures equal visual acuity in both eyes when not wearing correction during the day. In anisometropic patients non-compliant with glasses or soft contact lens wear, OK should be recommended as a treatment modality not only for controlling myopia as the patient ages but also for preventing a sensory exotropia. |
| 1722 | Symptomatic Pigmented Posterior Vitreous Detachment and Vitreous Seeding in the Presence of Optic Nerve Head Melanocytoma | Jacob | Wilson | wilson_vitreous | Ocular melanocytomas are locally invasive tumors that can occur within multiple structures of the eye, including the optic nerve. Though these growths are benign and rarely metastasize, it is imperative optometrists be aware of the potentially visually significant complications that can arise. In this case, we'll evaluate a forty-five-year-old female who presented to the clinic with a history of a long-standing optic nerve head melanocytoma OS and a complaint of new onset flashes and floaters. She was previously diagnosed by a retinal oncologist but was lost to follow-up for over four years. With the help of a dilated exam, fundus photos, and a macular OCT, my exam revealed an acute posterior vitreous detachment and vitreous seeding secondary to invasive growth of the tumor. Though still benign in nature, its growth had caused a destabilization of the vitreous which resulted in the patient's symptoms. After being fully evaluated to rule out retinal tears or breaks, she was referred to the retinal oncologist for further evaluation of the melanocytoma and our clinic will continue to monitor her frequently with dilated exams. If the vitreous seeding becomes visually significant in the future, a pars plana vitrectomy may be in order. | |
| 1772 | Ready? Aim...Fire! A case of torpedo maculopathy in a pediatric patient | Tiffany | Jones | Ariela Baran | jones_torpedo | Seven-year-old Hispanic male presents with his mother due to a failed a school screening. The patient’s medical history was remarkable for autism spectrum disorder. Upon exam BCVA was 20/20 OD, 20/25 OS with a refraction of -2.00 OD, -2.50 OS. Dilated Fundus Exam revealed a 1.5DDx1DD oval shaped, hypopigmented lesion with pigmented edges inferior to the macula OS. Differentials included torpedo maculopathy, CHRPE, Vitelliform Dystrophy, and RPE Hamartoma. Patient was diagnosed with Torpedo Maculopathy, a rare, congenital finding, typically occurring unilaterally. Torpedo maculopathy is a benign condition, often diagnosed incidentally. Management for patients with torpedo maculopathy usually involves periodic monitoring for rare complications. |
| 1807 | Purtscher's Retinopathy Following Car Crash After Sudden Vision Loss | Brooke | Hubbard | Dr. Sophia Ries, Dr. Kieran McMillan | hubbard_crash | We discuss a rare case of Purtscher’s Retinopathy following a motor vehicle accident. The patient is a 50-year-old Native American male who presented to the ER following a single vehicle accident after sudden vision loss. He was evaluated by medical staff and CT scans showed a splenic laceration, pulmonary embolism, and lesion of right parietal lobe. An ER optometry consult revealed entering visual acuities of 20/40 OD, 20/70 OS, left-sided hemianopsia on CVF, normal pupillary response, and unremarkable anterior segment. Posterior segment revealed areas of cotton wool spots in both eyes with no hemorrhaging appreciated. The patient was diagnosed with likely Purtscher’s Retinopathy secondary to trauma. Further testing revealed the patient suffered a brain abscess due to strep milleri and underwent an occipital mini craniotomy. The patient returned 8 weeks later following hospital discharge for optometry follow up where cotton wool spots were resolved. The patient is to return in the following month for visual field testing. Purtscher’s Retinopathy requires thorough case history and eye examination, CT scans as indicated, and systemic work up in cases with no history of trauma. |
| 1840 | A BRVO? A MDS Marvel with a Retinal Twist | Hania | Mahmood | Courtney Liang OD, MS, Jamie Wang OD, Danielle Kalberer OD, MBA, FAAO, Lynn Finnegan OD | mahmood_brvo | A 75-year-old Caucasian male presents with reduced vision in OS for 1 week. Patient reports increased stress in his daily life and a recent diagnoses of MDS. Upon examination, OS vision is significantly reduced (BCVA: OD 20/25+, OS 20/80- PH:NI). Dilated examination reveals macular edema. Fluorescein angiography reveals late-stage leakage OS of temporal macular venule with telangiectasias, suggesting BRVO. Myelodysplastic syndrome (MDS) signifies bone marrow failure, categorized by ineffective hematopoiesis with potential progression to acute myeloid leukemia (AML). Branch retinal vein occlusion (BRVO) results in visual impairment due to hemorrhages or macular edema. Studies note rare RVO diagnoses in MDS and AML patients due to hyperviscosity secondary to leukemic infiltrates. While BRVO has been extensively studied individually, MDS has not and the relationship between the two remain a subject of growing interest. |
| 1857 | Dramatic Intraocular Pressure Spike Following Laser Peripheral Iridotomy in an Eye with a Scleral Buckle | Margaret | Moore | moore_pressure | A 67-year-old white male with a history of a retinal detachment in the right eye repaired with a scleral buckle at Massachusetts Eye & Ear Infirmary in 1976 presented to our clinic complaining of moderate pain in this eye. This pain had begun two days prior, following a laser peripheral iridotomy performed by a general ophthalmologist in our practice. The visual acuity was stable (count-fingers at 2 feet). The intraocular pressure in the right eye measured 48 mmHg, which did not change within 25 minutes following in-office instillation of one drop of timolol 0.25% and one drop of brinzolamide/brimonidine tartrate 1%/0.2%. Oral acetazolamide and cyclopentolate 1% decreased the pressure to 36 mmHg. The addition of atropine 1% TID and loteprednol 0.38% QID achieved IOP 26-32 mmHg. Ultimately, the patient underwent cataract surgery, GSL (goniosynechialysis) and GATT (gonioscopy-assisted transluminal trabeculotomy). Vision improved to 20/400 and intraocular pressure improved to the mid-teens. This case will discuss potential mechanisms of intraocular pressure spike following laser peripheral iridotomy and management strategies. | |
| 1858 | Choroidal Melanoma Misdiagnosed as Exudative Macular Degeneration | Miriam | Anglo | anglo_melanoma | Choroidal melanoma is an intraocular malignancy with a notoriously high rate of metastasis. Prompt diagnosis is essential due to the potential risk of fatality. Differentiating choroidal melanoma from other elevated subretinal lesions can be difficult, but recognizing the ophthalmoscopic features and utilizing diagnostic imaging are crucial. This presentation discusses a case of choroidal melanoma that was misdiagnosed as exudative macular degeneration and reviews the incidence, clinical presentation, ancillary studies, differential diagnoses, prognosis, and treatment of choroidal melanoma. | |
| 1721 | Malingering Motives: More than Meets the Eye | Courtney | Allen | Leticia Rousso, OD., FAAO | allen_motives | Functional vision loss in a pediatric patient can be a difficult diagnosis for optometric providers. Determining pertinent testing and a proper case history is essential in proper management. A 13-year-old female presented to clinic with a complaint of blurry vision uncorrected. The patient came into the examination with her head down and responded minimally to questions. Patient’s reduced visual acuity in both eyes at distance and near did not correlate with an autorefraction and retinoscopy of low hyperopia and astigmatism. Interestingly, a manifest refraction of Plano in each eye yielded 20/20 vision. For comprehensive care, it is important to determine if psychological stressors were leading to the patient’s behaviors. |
| 1726 | A Rare Case of Flecked Retina of Kandori | Serena | Shanko | shanko_retina | Fleck retina of Kandori is a rare, genetic retinal dystrophy. It is characterized by multiple irregular, yellowish-white lesion of various size and pattern that are concentrated mainly in the nasal equatorial region of the retina. These are isolated findings, without any vascular or optic nerve head abnormalities. They frequently manifest as mild and stationary night blindness. This case report discusses the prognosis and management of this condition. | |
| 1785 | Cosmetic Prosthetic Lenses for Traumatic Cataract Management | Dena | Naaman | Dr.Thuy Lan Nguyen | naaman_lenses | Traumatic cataract occurs after blunt or penetrating ocular injuries. Traumatic cataract can cause decreased vision and cosmetic concerns. A 50 year old patient presented to Nova Southeastern University with vision loss due to traumatic cataract and severe Band Keratopathy and glaucoma in the fellow eye. He uses low vision devices for activities of daily living, but was interested in a tinted contact lenses to cover his dense white cataract. He was fit with a prosthetic black pupil contact lens purely for cosmesis. This case demonstrates the importance of co-management between low vision and contact lens specialists to enhance patient’s overall quality of life. |
| 1794 | Clearing through the Fog: Combatting Midday Fog Associated with Salzmann’s Nodular Degeneration | Samantha | Round | Thuy-Lan Nguyen OD, FAAO, FSLS | round_fog | Midday fogging is a visual phenomenon where scleral lens wearers experience clouding or visual haze after a few hours of wear. The following case report explores preventing midday fogging in a patient with Salzmann’s nodular degeneration. A 74-year-old Caucasian female presents to Nova Southeastern University reporting visual haze in both eyes after three to four hours of scleral lens wear. After increasing the tear reservoir’s viscosity, she reports improvement of her visual quality. Salzmann’s nodular degeneration can cause bluish-white elevations of corneal epithelium at Bowman’s layer. This highlights the importance of utilizing scleral lenses to vault over the subepithelial nodules while considering the impact of tear composition in visual clarity. |
| 1828 | Pigmentary glaucoma with a side of optic nerve staphyloma | Briana | Vargas | vargas_pigmentary | Pigment dispersion syndrome (PDS) occurs when the lens zonules rub against the posterior iris creating a mechanical liberation of pigment granules. This may result in iris transillumination defects, and pigment deposition on the corneal endothelium and in the trabecular meshwork. The deposition of pigment in the trabecular meshwork may result in elevated IOP with or without glaucoma. The risk of pigment dispersion syndrome converting to pigmentary glaucoma is 35-50%. The case presented is a typical case of pigmentary glaucoma in a young myopic male with left optic nerve staphyloma . The patient complaints of progressive decrease in vision within the past year and presents with signs and symptoms seen in this disease. The patient's intraocular pressure was 36/36, gonioscopy revealed heavy pigmentation of the trabecular meshwork, and optical coherence tomography (OCT) revealed a large disc to cup ratio. OCT imaging had to be analyzed carefully considering the optic nerve staphyloma in the left eye. Patient was follow-up for a period of one year. Pigmentary glaucoma, if caught early and treated appropriately, blindness will be rare. Regular follow ups and management of the disease is important to preserve sight. | |
| 1853 | Hide and Seek: Disc Drusen's Cloaking Effect on Glaucomatous Optic Nerves | Ashka | Patel | patel_drusen | Disc drusen present challenges in diagnosing and monitoring glaucoma due to obscuration of the optic nerve head. This presentation evaluates clinical strategies for assessing glaucoma disease progression despite the concealing effects of drusen. While the drusen can obscure the neural rim tissue, careful serial evaluation is key especially with visual fields that remain crucial to assess functional fiber loss over time. OCT RNFL and macular GCC scans can reveal fiber thinning compared to the patient's earlier baseline. Photos help compare progressive structural change. As there is no good treatment yet that exists to minimize or resolve drusen themselves once formed, aggressively managing co-existing glaucoma is beneficial. Visual field testing should include strategies to reduce effects of drusen, such as retesting suspicious areas to confirm loss. Images need scrutiny since drusen cause nerve head elevation. Providers should heavily weigh serial changes rather than focusing on threshold values. In summary, disc drusen require adapting the approach to glaucoma testing and follow-up, but thoughtful evaluation and test interpretation can reveal true disease progression despite the drusen camouflage. | |
| 1736 | Successful Treatment of Acute Thyroid Related Orbitopathy with Monoclonal Antibody Therapy | Jennifer | Maples | none | maples_thyroid | Thyroid eye disease is an autoimmune disorder characterized by congestion of the orbit due to edema of the extraocular eye muscles and expansion of the orbital fat. Manifestations are diverse and vary among patients. The condition can produce exophthalmos, altered eyelid position, abnormal eyelid mobility, dry eyes, and double vision. In severe cases, sight threatening compressive optic neuropathy and/or corneal ulceration can occur. This case presents a patient with thyroid orbitopathy due to undiagnosed hyperthyroid disease that was successfully treated with Tepeeza monoclonal antibody and highlights the premier and integral role of the optometric physician in the management of this systemic condition. MRI images included. Key Words: exophthalmos, proptosis, monoclonal antibody, lid lag, von Graefe’s sign, lagophthalmos, scleral show, exophthalmometry, magnetic resonance imaging (MRI) |
| 1761 | Dupixent | Ana | Astruc | astruc_dupixent | Dupixent is an FDA approved biologic treatment for moderate-severe atopic dermatitis that is not well managed with topical therapies. Although rare, roughly four to six months after starting subcutaneous treatment, patients can present with ocular side effects producing intermittent, chronic symptoms with periods of exacerbation and remission. Ocular symptoms present in the form of blepharitis, eye pruritus, erythema, papillary reactions, conjunctivitis, dry eye, and in severe cases, ulcerative keratitis. Long term low dose topical steroids, allergy and dry eye medications are indicated if patients wish to continue Dupixent treatment. It is important for eye care providers to understand and know the ocular side effects of Dupixent due to its growing usage in the United States. | |
| 1779 | Unraveling the Complexities of Recurrent Herpetic Keratitis | Amanda | Whitbeck | Rajni Acharya, O.D. | whitbeck_herpetic | An 81-year-old male presents with redness, photophobia, epiphora, blurred vision, and sharp 10/10 pain OS that had progressively worsened for the past 3 days. Entering vision was 20/20 OD and 20/50 OS. Examination revealed matted lashes, 4+ conjunctival injection, mucopurulent discharge, diffuse corneal edema, and a 3mm corneal ulcer. On follow-up the next day, a new hypopyon and hyphema were observed so the ulcer was cultured, and fortified vancomycin and tobramycin were started immediately. In time, the patient's vision declined to counting fingers, ultimately requiring an AC tap, intravitreal injections of numerous medications, a BCL, and eventual Prokera to achieve 20/40 vision. The patient had a history of recurrent herpetic keratitis OS after which he had been on a maintenance dose of oral acyclovir. As highlighted in this case, treatment of corneal complications presenting in an already compromised cornea is imperative for preserving vision. |
| 1804 | Pituitary Apoplexy: a rare clinical syndrome | Sharon | Bisighini-Fiske | Tam Ying, OD, MS, FAAO | bisighini_apoplexy | A 52-year-old male presented for examination reporting sudden decreased vision OS, nausea, vomiting, and headache for two days. He had a history of pituitary adenoma resection 4 years prior. Visual acuity OS was 20/40 and color vision was also diminished. Dilated fundus exam was remarkable for disc pallor OS only. Visual field testing revealed new bitemporal defects. MRI confirmed recurrent macroadenoma with a hemorrhage. The patient was diagnosed with pituitary apoplexy (PA) and admitted to the hospital for treatment. PA is a rare and potentially life-threatening clinical syndrome caused by spontaneous hemorrhaging of the pituitary gland, usually within an adenoma. Urgent imaging is essential to confirm diagnosis. IV corticosteroids need to be administered immediately and once hormones are stabilized, surgical resection of the tumor can be considered. This poster will provide a comprehensive review on PA, underscoring the importance of prompt diagnosis and treatment so that complications such as panhypopituitarism, permanent loss of vision, or visual field are avoided. |
| 1829 | Pseudoexfoliation glaucoma exacerbated by partial lens subluxation and iris bombe | Khanh | Hoang | hoang_glaucoma | Pseudoexfoliative syndrome (PXF) is characterized by protein-like deposits within various parts of the body, primarily in the anterior segment of the eye. Signs of PXF also include zonular instability, phacodonesis, and disruption to the blood-aqueous barrier. PXF can further develop into pseudoexfoliation glaucoma (PXG) with elevated intraocular pressures (IOP), glaucomatous optic nerve damage and visual field damage. This case reviews a 74 year-old female, being followed for mild PXG, who presents for a one week follow up post Externo Xen-gel stent. The patient complains of blurry vision, excess tearing and headaches. Best corrected acuity in the eye was 20/60 and intraocular pressure was 30 mmHg. Slit lamp examinations showed a diffusely shallow anterior chamber and the Xen-gel stent embedded into the iris. The patient’s treatment course was complicated by a partial lens subluxation resulting in an iris bombe. This case will review the patient’s treatment course following the complication and how mixed mechanism glaucoma should be considered when diagnosing glaucoma. | |
| 1843 | A Viral Case: Bilateral NAION following Viral Encephalitis | Elaine | Ho | ho_naion | A 59-year-old Caucasian male, recently discharged from the hospital for viral encephalitis, presents for an eye exam complaining of sudden decreased vision while hospitalized. While correctable to 20/20, the patient exhibits notable findings such as tortuous retinal vessels, disc edema, and disc hemorrhages in both eyes. OCT reveals diffuse thickening of the retinal nerve fiber layer. HVF 24-2 indicates a superior and inferior arcuate defect in the right eye and an inferior altitudinal defect sparing fixation in the left. Considering the recent history of encephalitis, an urgent referral was made to neuro-ophthalmology. An MRI of the orbit with and without contrast showed no signal changes, optic nerve enhancements, or compressive lesions. Given the patient’s visual field defects and risk factors for NAION including male gender, hypertension, hypercholesterolemia and small cupping, the patient was monitored without treatment. NAION is a condition characterized by poor blood flow to the eye leading to painless, sudden vision loss. There are few case reports of optic neuritis occurring following encephalitis, but this is an unprecedented case of bilateral NAION following viral encephalitis. | |
| 1788 | Eye-Spy A Pattern: A Case of Butterfly-Shaped Pigment Dystrophy | Ashley | Carvin | carvin_pigment | Pattern dystrophies are a group of inherited autosomal dominant diseases of the macula characterized by pigmentary changes due to retinal pigment epithelium (RPE) dysfunction. The RPE is an important retinal layer responsible for the removal and recycling of retinal byproducts. The etiology of these inherited retinal diseases are thought to be a result of mutations within the PRPH2 gene. This gene is responsible for coding a protein called peripherin-2. Due to the RPE dysfunction seen in these conditions, there are clinical identifiable patterns of the pigment distribution in the retina. These patterns can be classified into 5 different conditions: adult-onset vitelliform dystrophy, butterfly-shaped pigment dystrophy, multifocal pattern dystrophy, reticular dystrophy, and fundus pulverulentus. There are multiple modalities to aid in diagnosing these conditions; however, identifying the clinical appearance of each pattern dystrophy is key in managing these patients. The visual prognosis is generally very good until later in life and slowly progresses. This case report will go through one of the pattern dystrophies, butterfly-shaped pigment dystrophy, to highlight the clinical manifestations and management of this disease. | |
| 1802 | From Irritation to Impairment: Neurotrophic Keratitis in the Spectrum of Dry Eye Disease | Katelyn | Fleischman | Carly Rose, OD, FAAO | fleischman_keratitis | Neurotrophic Keratitis (NK) is an orphan disease and has a prevalence of 1-5/10,000. Identifiable causes include herpes simplex virus, herpes zoster virus, ocular surgery, thermal or chemical burns, diabetes, neurodegenerative disorders, iatrogenic injury, and chronic dry eye to name a few. We present a case of NK in a 51-year-old female with chronic dry eye, complex retinal history, and glaucoma. Treatment included Tyrvaya BID, cryopreserved amniotic membranes OU, and a series of four: Intense Pulsed Light, Radio Frequency, and Low-Level Light Therapy sessions. Future treatments will include cenegerim-bkbj , biologic eye drops, additional cryopreserved amniotic membranes, and dry eye therapies. |
| 1838 | A Sequel: Episcleritis Returns | Courtney | Liang | Dr. Hania Mahmood, OD, Dr. Jamie Wang, OD, Dr. Danielle Kalberer, OD, MS, FAAO, Dr. Shephali Patel, OD, MS, FAAO | liang_episcleritis | A 79 year old Caucasian male presents with a red, irritated right eye for the last week. He describes a foreign body sensation in the corner of OD that does not improve with Ketotifen BID OU and artificial tears TID OU. Pertinent ocular history includes a recurrent red eye once a year in the fall for the last 14 years, always preceded by a cold store and sinusitis. Auto-immune workup was ordered for CBC, ESR, FTA-ABS/RPR, quantiferon, ACE, RF, ANA. Quantiferon test result is positive for tuberculosis and patient had a subsequent chest x-ray. Episcleritis is typically a benign, self-limiting disease that is idiopathic in nature, however it can be an initial sign of a systemic disease requiring further treatment. Previous studies have noted a significant number of patients, 26% - 36%, with an associated systemic disorder. This case highlights the importance of a careful review of systems when an initial diagnosis of episcleritis is made. |
| 1845 | Ocular Toxicity of Immunotherapy for Metastatic Melanoma | Lydie | Tubene | tubene_melanoma | The emergence of targeted antineoplastic agents, such as immune checkpoint inhibitors, have altered cancer treatment. These agents modulate the immune system, causing T cell activation to destroy malignant cells. However, there is an increased risk of immune-mediated adverse events. Inflammatory ocular disease has been demonstrated with nivolumab including papilledema, neuroretinitis, episcleritis and uveitis. This case highlights the importance of ocular considerations in patients treated with immune-mediated antineoplastic drugs. A 92-year-old male with metastatic melanoma of the head and neck treated with nivolumab-relatlimab presented with hazy vision. Exam revealed bilateral acute granulomatous anterior uveitis, anisocoria, and blepharitis which was managed chronically. This case emphasizes the important role of optometry in diagnosing and managing ocular complications with oncology. | |
| 1716 | Paracentral Acute Middle Maculopathy in a Pregnant Female | Samantha | Manzo | Janae Thomas, OD | manzo_acute | A 21-year-old Hispanic female presented to the Optometry clinic on a routine basis with a complaint of a spot in her vision in her right eye that had been present for 1 week. This spot was present constantly and followed her vision when she moved her eyes. She was 26 weeks pregnant without any complications. Her ocular history was significant for PRK OU in 2021. Her uncorrected distance visual acuity measured 20/20 in each eye. All other entrance testing and exam findings were unremarkable except for a small area of retinal darkening superior nasal to the fovea in her right eye. OCT through this area showed an opaque appearing plaque starting in the inner nuclear layer and spanning to the outer nuclear layer with haze within the outer retina. This patient was diagnosed with Paracentral Acute Middle Maculopathy and a systemic work up was ordered to rule out microvascular disease, hypercoagulable states, and cardiovascular risk factors. All testing was normal. The patient was seen back monthly where eventually thinning/atrophy of the affected inner nuclear layer was noted. The patient still complained of a spot in her vision but had adapted to where it wasn’t as bothersome. |
| 1782 | Effect of OTX-101 0.09% on corneal staining and SANDE scores in patients with dry eye disease uncontrolled on cyclosporine ophthalmic emulsion 0.05% | Josh | Johnston | Richard Adler, Michelle Hessen, Kelly K Nichols, Stephen C Pflugfelder, Kim Truett, Maitee Urbieta, and Brittany Mitchell | johnston_otx | We assessed the effect of cyclosporine ophthalmic solution 0.09% (CsA 0.09%) in patients with dry eye disease (DED) inadequately controlled on current cyclosporine ophthalmic emulsion 0.05% (CsA 0.05%). In this Phase 4 study, patients received 1 drop CsA 0.09% per eye twice daily for 12 weeks. Corneal fluorescein staining (CFS; 0–4 modified National Eye Institute scale) and modified Symptom Assessment in Dry Eye questionnaire (mSANDE; 0–100 visual analog scale) were assessed at baseline and Weeks 4, 8, and 12/early discontinuation. The intent-to-treat population included 124 patients. Mean (standard deviation) baseline total CFS and mSANDE scores were 5.7 (3.37) and 67.1 (21.05), respectively. Mean improvements from baseline were statistically significant for both endpoints at Weeks 4, 8, and 12 (P<0.0001). Overall, 58 (43.3%) patients reported ≥1 adverse event (AE); most AEs were mild (73.8%). CsA 0.09% elicited significant improvement in CFS and mSANDE scores from Weeks 4–12 in patients with DED inadequately controlled on CsA 0.05%. Disclosures JJ, RA, KKN, KT report consultant and/or speaker fees from Sun Pharma. MH, SCP have no relevant disclosures. MU, BM are employees of Sun Pharmaceutical Industries, Inc. |
| 1816 | Mite Eradication with Lotilaner 0.25% Ophthalmic Solution | Patrick | Vollmer | James Mun, PhD | vollmer_mite | Demodex blepharitis affects around 25 million patients in the United States. This highly prevalent yet woefully under diagnosed lid disease has remained an elusive anterior pathology for decades, until recently. This case highlights a patient suffering from chronic Demodex blepharitis for many years with failed therapy on both topical and oral medications. However, with the use of lotilaner ophthalmic solution 0.25%, our patient demonstrated rapid improvement from grade 4 collarette score (greater than or equal to 2/3 of upper lashes with collarettes) to a score of grade 0 (0-2 lashes with collarettes). Additionally, symptoms improved substantially, and she was able to rewear contact lenses and aesthetic makeup products. With the recent FDA approval of lotilaner ophthalmic solution 0.25%, many more patients may receive similar clinical benefits. |
| 1831 | Shining a Light on Night Blindness | Anna | Pamula | pamula_light | Choroideremia is an X-linked recessive chorioretinal dystrophy characterized by the diffuse, progressive degeneration of the retinal pigment epithelium, photoreceptors, and choriocapillaris. Men are predominantly affected due to its X-linked etiology. This presentation will go over the clinical course of X-Linked Choroideremia in a 40 year old caucasian male that initially presented to a retinal specialist in 2018. The presentation will go over initial Fluorescein Angiography, genetic SPARK TEST results, 10-2 Visual Field, and Optic Coherence Tomography changes over a span of 5 years. Best corrected visual acuities in 2023 were 20/20 OD and 20/30 OS, and the patient is legally blind due to visual field limitation. This disease has a poor prognosis with legal blindness by 50-60 years of age. Patients can benefit from a low vision examination and resources. | |
| 1712 | A Rare Case of Bilateral & Simultaneous CNV and GA | Mariana | Ferraz | Julie Rodman, OD, MSc, FAAO | ferraz_cnv | Advanced AMD is defined as wet or exudative with CNV and dry or non-exudative with GA.Albeit distinct entities, these can occur simultaneously and are not independent of one another.We present a case of a patient that presented with bilateral, simultaneous CNV and GA.A 74yo male presented for examination.He presented with a history of wet AMD OU for which he was receiving intravitreal injections.At his first visit with us, his BCVA measured 20/80OD, OS.This acuity was consistent with the clinical presentation of paramacular atrophy and pigment clumping.3-years later the patient presented with a reduction in vision: 20/100 BCVA OD,OS and worsening symptomatology.Clinically, there was evidence of geographic atrophy without presence of active neovascularization.His condition has continued to progress with BCVA measuring 20/200OD & 20/400OS and worsening of his functional vision.Despite distinct clinical appearances, advanced forms of AMD share common modifiable and non-modifiable risk factors which puts pre-disposed patients at increased risk of developing one or both manifestations of the disease.Pathophysiology behind simultaneous presentation of these diseases requires further investigation. |
| 1771 | Can't Keep It Together!: How Corneal Ectasia affects Binocular Vision | Azalia | Roach | Thuy-Lan Nguyen, OD, FAAO, FSLS. | roach_ectasia | Corneal ectasia is characterized by progressive corneal steepening and thinning associated with decreased uncorrected visual acuity, increased ocular aberrations, and loss of best-corrected visual acuity. Progressive decrease in visual acuity can lead to deterioration of the binocular vision system although there are few published articles that demonstrate the correlation between corneal ectasia and binocular vision. The lack of a clear retinal image, in one or both eyes, for an extended period causes a deterioration of the binocular vision system. This case report discusses the diagnostic findings and visual outcome of a patient with uncorrected decreased vision due to keratoconus over the course of thirteen years. |
| 1776 | A Little Angle, a Lot of Trouble | My | Huynh | Davina Kuhnline | huynh_angle | Angle closure glaucoma occurs when there is obstruction of aqueous humor outflow, causing a variety of symptoms such as nausea, unilateral eye pain and blurred vision with an associated headache. This poster illustrates a 77- year old white female presenting for an emergency visit with eye pain and high intraocular pressure in the right eye, who was ultimately diagnosed with chronic angle closure glaucoma secondary to intraocular inflammation. This case demonstrates the different levels of management for complex angle closure cases with a combination of topical therapy, oral therapy and surgical interventions. |
| 1805 | Luminopia from Clinical Trials to Real World Outcomes: A Registry for the Binocular, FDA- Approved Digital Therapeutic for Amblyopia | Elizabeth | Bennett | Endri Angjeli Shelley Hancock | bennett_luminopia | Luminopia is an FDA-approved digital treatment for amblyopia in 4-7 year olds. Treatment consists of wearing a lightweight (<500g) virtual-reality headset for 1 hour a day/6 days a week prescribed by an eye care professional. In the Phase III clinical trial, there was a statistically significant increase in amblyopic eye BCVA of 1.8 lines vs. 1.0 line control, glasses alone, over 12 weeks. No SAEs were reported. An IRB-approved registry has been created to track outcomes following prescription of Luminopia in a real world setting. To date, 70 patients have entered the registry with an average follow-up duration of 21.7 ± 12 weeks. The average baseline BCVA at the time of prescription was approximately 20/50 (0.421 ±0.258 logMAR). Patients had significantly improved by 1 line of vision by the first follow-up visit (p<.001). By the second follow up, vision improved to an average of 20/32 (0.247 ±0.179 logMAR, n=17). |
| 1812 | Vision Enhancement Introduction and Case Report | Dean | Schultz | schultz_enhancement | Vision Enhancement, often referred to as Sports Vision, is still an emerging field in optometric practice. This poster presentation will review some key studies and history, concepts, and practices of vision enhancement training, as well as an individual case report of an 18-year-old high school basketball player. The participant completed a short 3-week vision enhancement training program that resulted in several objective and subjective improvements in critical visual performance skills. The presentation will compare his pre- and post-training assessments, share short videos and photos of some of the various training exercises completed, and touch on the subjective self-assessment improvements the player noted. | |
| 1698 | Normal tension pre-perimetric RNFL loss following disc hemorrhage. current evidence-based mechanism and management. | Eulogio | Besada | Barry J Frauens | besada_rnfl | Purpose. Pre-perimetric retinal nerve fiber RNFL loss in a normo-tension patient is discussed. In the absence of OCT, detection of early glaucoma progression risk would have gone undetected. Case. 57-year-old female presents with a disc hemorrhage OD. OCT RNFL was normal. Three years later a corresponding RNFL defect developed. Visual field (VF) was normal. The highest IOP over an 11-year period was 13 mm Hg. Conclusion. Lamina cribosa defects concurrently occur with disc hemorrhages but are not directly related to the development of hemorrhages. A similar mechanism may cause vascular and laminar damage. In normal tension patients, lowering intraocular pressure may be beneficial at reducing the rate of RNFL loss. |
| 1732 | Nutritional Optic Neuropathy | Aalaa | Shahin | shahin_optic | We present a case of nutritional optic neuropathy secondary to B vitamin deficiency associated with chronic alcoholism. A 60 year old white female presents to the Emergency Department with ataxia and confusion. A subsequent diagnosis of Wernicke-Korsakoff Syndrome was established based on laboratory studies with ensuing supplement treatment. Sequelae included a complaint of blurred vision concomitant with aforementioned symptoms. Discussed are relevant findings, imaging, and laboratory studies in suspected nutritional optic neuropathies. The role of B Vitamins in visual function is discussed as well as associated neurologic symptoms presenting in severe deficiencies. Practitioners need to be aware of the possibility of nutritional optic neuropathies and associated neurologic symptoms as timely intervention may lead to visual and neurologic recovery. | |
| 1783 | MIRA-2 and MIRA-3 Clinical Trial Results for Reversal Mydriasis | Justin | Schweitzer | Drey Coleman, Carrie Murray, Mitchell Brigell, Mitchel Ibach, Jay Pepose | schweitzer_mira | Phentolamine ophthalmic solution (POS) is an alpha-adrenergic blocker recently FDA-approved (trade name RYZUMVI) for the reversal of mydriasis produced by adrenergic agonists or parasympatholytic agents. Two, randomized, double-masked, vehicle-controlled trials were conducted to evaluate the efficacy and safety of POS: MIRA-2 (NCT#04620213) and MIRA-3 (NCT#05134974) in a total of 553 subjects, aged 12 to 80 years. Across both trials, the percentage of subjects with study eyes returning to ≤0.2 mm from baseline pupil diameter was statistically significantly greater (p<0.01) at all time points measured from 60 minutes through 24 hours in the POS group compared with the vehicle group. The most common ocular adverse reactions reported in >5% of subjects were instillation site discomfort (16%) and conjunctival hyperemia (12%). The availability of a mydriasis reversal agent has the potential to reshape how eye care professionals advise patients on dilated eye exams. |
| 1800 | An Unlucky Tear on Turkey Day: A Textbook Horseshoe Tear Resulting in Mac-Off RRD | Janzen | Pigg | pigg_tear | Horseshoe retinal tears (HRT) are characterized by a U-shaped configuration and can develop into a rhegmatogenous retinal detachment (RRD). This case report highlights a textbook presentation of a horseshoe tear that progressed into a macula-off retinal detachment. A 66 yo male presented as an emergency walk-in with recent onset of floaters in the left eye 4 days prior (Thanksgiving). He reported a yellowing of floaters with opacification, and flash of light at time of onset. VA OD 20/20-1, and OS CF @ 1ft. DFE revealed HRT at 1’ in the periphery OS. This case highlights the importance of recognizing distinctive features of retinal breaks to facilitate timely and appropriate intervention. | |
| 1817 | Peripapillary Pachychoroid Syndrome | Ryan | Carey | Emily Carr OD | carey_syndrome | A new patient presented with bilateral peripapillary fluid and exudate with elevation greatest temporally, encroaching the macula, with associated choroidal folds. Fundus autofluorescence photos show an atrophic area with hyper and hypoautofluorescence surrounding the optic nerve head. Further testing included OCT of the macula and a macular cube over the optic nerve head, OCT-A and HD raster scans with enhanced depth imaging to measure choroidal thickness. The patient was diagnosed with peripapillary pachychoroid syndrome, a condition belonging to the pachychoroid spectrum disorder (PSD). PSD includes many other conditions such as central serous chorioretinopathy, pachychoroid pigment epitheliopathy, polypoidal choroidal vasculopathy and others. Conditions on this spectrum share clinical features including choroidal thickening, Haller vessel dilation and choroidal hyperpermeability. |
| 1847 | Idiopathic Intracranial Hypertension leading to a Diagnosis of Arnold-Chiari Malformation | Krima | Shah | Shagufta Bi Bi, OD, Sherrol A. Reynolds, OD, FAAO, Alexandra Espejo OD, FAAO | shah_hypertension | Arnold-Chiari Malformations (Type I-III) encompass a spectrum of pathologies characterized by ectopy of the cerebellum through the craniocervical junction at the foramen magnum. This condition presents with variations in age of onset, presenting symptoms and underlying causes. In most instances, the Arnold-Chiari phenomenon results in an obstruction of cerebrospinal fluid from the fourth ventricle, leading to hydrocephalus. Hydrocephalus has been theorized to be a contributing factor to the development of Idiopathic Intracranial Hypertension (IIH) or Pseudotumor Cerebri. We present a case of IIH in a patient that led to a diagnosis of Arnold-Chiari Malformation of type I Arnold-Chiari Malformations. |
| 1697 | Reis-Bücklers Corneal Dystrophy with Granular Stromal Deposits - a Rare Presentation of Possible Two Genetic Mutations | Beata | Lewandowska | Marlon J. Monelyon-Demeritt, OD, MBA, FAAO | lewandowska_dystrophy | Abstract Reis-Bücklers (RBCD) is a rare epithelial-stromal corneal dystrophy. We present a case report discussing the two proposed gene mutations associated with RBCD with granular deposits in deep stroma. Case Report A 25-yo female with a history of RBCD and RCEs presented with uncorrected VA was OD 20/30 and OS 20/50. AS-OCT showed dense hyperreflective material at the level of the Bowman layer and hyperreflective deposits within the deeper stromal layer OU. Conclusion The 2015 IC3D classification lists RBCD as an epithelial-stromal TGFBI dystrophy. It is an autosomal dominant dystrophy that primarily affects the Bowman layer. The human transforming growth factor β-induced (TGFβ1) gene located on chromosome 5q31 encodes the transforming growth factor beta-induced protein (TGFBIp) also referred to as keratoepithelin (KE). This protein is secreted by the corneal epithelium and acts as an adhesion protein. KE is a 68-kDa extracellular matrix (ECM) protein composed of 683 amino acid residues. Type A and D mutations in RBCD result in a p.Arg124Leu amino acid substitution and may facilitate abnormal deposition in the stromal layer as well as impair its degradation. |
| 1699 | The great masquerader | Aysha | Siddique | siddique_masquerader | Syphilis is an infectious disease caused by the spirochete Treponema pallidum. Transmission of the disease can occur through small breaks in the skin during sexual contact, or via congenital transmission in utero, either across the placenta or less commonly by contact with an active genital lesion during delivery. This case reviews a 64-year-old male with severe stage primary open-angle glaucoma with chronic uveitis. This review will include differential diagnosis, when consider ordering blood work and how to approach management chronic uveitis in someone with refractive severe stage glaucoma. | |
| 1714 | Circumscribed Choroidal Hemangioma | Kristen | Fuller | fuller_choroidal | Circumscribed choroidal hemangiomas are benign, vascular tumors that present in middle-aged adults. Correct diagnosis of hemangiomas still seem to give eye care professionals difficulty as only one third are referred with the correct diagnosis. A 63-year-old new patient presents with symptoms of “a small black cloud” and flashes in the dark OD for 1 week. A 1.5DD elevated, amelanotic lesion was found in the superior temporal macula involving the fovea. Our differential diagnosis list included amelanotic choroidal melanoma, choroidal metastasis, or choroidal hemangioma. Choroidal hemangioma was confirmed by an ocular oncologist upon referral. Typically, choroidal hemangiomas are present at birth but symptoms manifest later in life, including blurred vision, metamorphopsia, field defects, or photopsia. Treatment is usually observation. If treatment is indicated, it is aimed at resolution of the symptoms by using laser, thermotherapy or anti-vegf injections. | |
| 1748 | Telltale Symptoms and Questionable Signs: Various Clinical Presentations of Acute Central Retinal Artery Occlusion | Caitlynn | Estevez-Averhart | estevez_telltale | An established 67-year-old white, male reports to clinic with sudden, painless vision loss in the right eye for 2 hours. He reports an island of superior temporal vision remaining. Denies eye pain, jaw claudication, and signs/symptoms of stroke. The patient reports taking Aspirin 81mg and his blood pressure medication every night. Based on patient history and previous exam findings, NAION was initially the top differential. Fundus examination revealed, retinal whitening and severe segments of interrupted blood flow. These clinical signs lead us to CRAO as a diagnosis. The pathogenesis of a CRAO and NAION are separate events with similar comorbidities and risk factors. The biggest challenge to diagnosing a CRAO is delayed presentation because clinical signs are often no longer present. Even with acute cases, each patient can be unique in their presentation and present with other conditions that make diagnosis difficult. | |
| 1784 | Investigator Initiated Trial Outcomes on the Efficacy of Varenicline Solution Nasal Spray in Post-Refractive Subjects | Justin | Schweitzer | Mitchel Ibach | schweitzer_trial | Three prospective, randomized 1:1, double-masked, vehicle-controlled investigator-initiated trials (IITs) were conducted to evaluate the efficacy and safety of varenicline solution nasal spray (VNS) in subjects following Laser-Assisted in Situ Keratomileusis (LASIK), Photorefractive Keratectomy (PRK), or Collagen Crosslinking (CXL). Spanning 84 days for LASIK and PRK and 28 days for CXL, 100 subjects aged over 18 years were enrolled in the trials. A primary endpoint using the NEI-VFQ25 questionnaire indicated directional improvement in VNS over control group across all trials. Notably, in the PRK and CXL trials a 24-hour accelerated epithelial healing rate was observed in the VNS group, and corneal fluorescein staining improvement was observed at day 84 in the LASIK trial. Although statistical significance was not achieved, the results suggest VNS as a promising option for mitigating post-refractive dry eye symptoms and enhancing epithelial defect healing. |
| 1797 | Navigating the Orbital Frontier: A Case Study of Spaceflight-Associated Neuro-Ocular Syndrome (SANS) | Ramie | Sahota | sahota_orbital | A 58-year-old African male presents to clinic with a chief complaint of blurred vision and a past medical history of headaches. Initially, the patient was deemed a normotensive glaucoma suspect due to nerve fiber layer defects, moderate-sized cup-to-disc ratios, and low intraocular pressures OU. Further case history revealed that the patient, an aerospace engineer, spends ten days a month in zero gravity orbiting the Earth. Following an inconclusive glaucoma workup, anomalous examination results, and considering the patient's distinctive profession, a diagnosis of presumed spaceflight-associated neuro-ocular syndrome (SANS) was made. SANS is a condition characterized by ocular signs and symptoms exhibited by astronauts who undergo long-duration space flight missions in microgravity environments. This case underscores the importance of considering occupational and environmental factors in the diagnostic process, particularly in patients with atypical presentations. | |
| 1814 | Sequential NAION | Sabryna | Owens | Dr. Jeffery Sterling, Dr. Andrew DiMattina, Dr. Armstrong Keodara, Dr. Leticia Santa | owens_naion | Sequential NAION/Pseudo-Foster Kennedy Syndrome A 67-year-old white male presents for blurry vision OD x 8 days upon wakening with shadows and black spots. Ocular history was significant for a NAION OS several months prior. The top differential diagnosis was AAION, ruled out with same day lab testing. In office BP was elevated with two readings. Upon further testing, the diagnosis of Pseudo-Foster Kennedy Syndrome was reached secondary to acute NAION OD and ONH pallor OS. The patient had several risk factors for the development of NAION including; disks at risk with a C/D ratio of 0.10, over the age of 55, sleep apnea without the use of a CPAP, elevated blood pressure, and PDE-5 inhibitor use. Retinal and low vision referrals were made due to macular edema and poor visual prognosis. |
| 1833 | Unilaterally Unique: Evaluating Asymmetry in Pellucid Marginal Dystrophy | Samantha | Round | Vassiliki Prattas OD | round_pellucid | Pellucid marginal degeneration is a bilateral, non-inflammatory corneal disorder causing peripheral cornea thinning. Although the disease can appear asymmetrical, there are rare instances of unilateral presentation. The following case report explores the pathophysiology of unilateral progression secondary to trauma. A 51-year-old African American female presents to Nova Southeastern University reporting visual blur in her left eye. She states a history of traumatic injury to the left eye with an associated physical depression of the eye and ocular misalignment. Further topographic evaluation shows substantial against-the-rule steepening with inferior corneal thinning of the left eye. This case highlights how changes to the cornea’s structural integrity may exacerbate the progression of corneal ectasia. |
| 1848 | The Great Masquerader Strikes Again: Syphilitic Uveitis in a New Patient | Jacquelyn | Melton | melton_uveitis | The incidence of syphilis in the United States has been on the rise since 2017. Regrettably, a scarcity of injectable Penicillin G has contributed to the spread of this sexual transmitted infection. A 38-year-old female presented with a red, painful and photophobic left eye that did not improve with topical steroids and oral ibuprofen provided by her referring optometrist. She was referred to our office due to decreased vision and worsening ocular pain despite treatment. After a prompt diagnosis and appropriate treatment, her condition fully resolved. This case review discusses a classic presentation and diagnosis of syphilitic uveitis along with the recommended treatment and management of this condition. | |
| 1718 | Vogt-Koyanagi-Harada (VKH) Disease | Sarah | Rappach | rappach_vogt | Vogt-Koyanagi-Harada (VKH) disease is a central nervous system condition that can have widespread effects on the visual system, auditory system, and integumentary system. Although the etiology is poorly understood, it is thought to be an autoimmune condition that predominantly affects melanocytes and therefore has a predilection for darker pigmented individuals. Regardless of the initial clinical signs and symptoms, this condition typically requires an interprofessional healthcare team to help monitor and manage the various system-wide effects throughout the various stages of the disease. | |
| 1729 | Are you taking you vitAmins? | Aditi | Bellur | bellur_vitamins | How to proceed when a once in a lifetime case is sitting in the chair? Often, in practice, it can be easy to forget about the cases which are far removed from the usual demographics of the day to day. This is where the importance of case history and a thorough examination of the patient can open the practitioner up to diagnosis that may have never been considered. This case is about a 46 y/o AA male, who came in reporting extreme dry eye and vision loss. After an examination of the patient, it was discovered that he had changes in the conjunctiva resembling Bitot’s spots. This patient did not report having lived anywhere else and only reported one recent surgery. This review will include the cause of his symptoms, the treatment, and a protocol for discovering a puzzling case. | |
| 1793 | A New Vessel for Hemolacria: Exploring Management of Hemolacria Associated With Scleral Lens Wear | Emily | Brill | JulieAnne M. Roper, OD, MS, FAAO | brill_vessel | As an uncommonly encountered condition with an alarming presentation, hemolacria has rarely been documented in contact lens wearers. A 63-year old patient with irregular astigmatism from a unilateral penetrating tree branch injury reported consistently waking up with blood on his pillow following difficulty with scleral lens removal. Examination revealed significant scleral lens suction, complicated by eyelid telangiectasias. We will present a comprehensive overview of hemolacria management by exploring etiologies, differential diagnoses, and associated treatments. We will include strategies specifically for approaching hemolacria with scleral lens wear, highlighted by the successful resolution of hemolacria in our unique case following scleral lens adjustments and anterior segment treatment, illustrated by photography and OCT’s. |
| 1811 | When SMALL hemorrhages lead to a BIG diagnosis: A Case of Vertebral Artery Occlusion | Ria | Shah | Mariana Ferraz OD, FAAO, Leticia Rousso OD, FAAO | shah_small | Ocular ischemic syndrome is caused by ocular hypoperfusion from occluded or stenosed carotid arteries and can present as visual loss, orbital pain and various anterior and posterior segment signs. Carotid artery disease is the main cause of strokes and ophthalmic findings can often preclude severe disease. A 69 year old black female presents for an unspecified visual disturbance with a headache that radiates to her forehead. Her medical history is positive for hypertension and she is currently taking Lisinopril and Nifedipine . Her best corrected visual acuity was 20/40 OD, OS. Her blood pressure in-office was 164/84mmHg. Upon biomicroscopic evaluation, she had multiple dot blot hemorrhages in the midperiphery and cotton wool spots in the superior arcade in both eyes. Patient was referred to the ER for bilateral carotid doppler and bloodwork to rule out ocular ischemic syndrome. The diagnosis of Ocular ischemic syndrome was confirmed at the ER and the patient was further diagnosed with 2 vertebral artery occlusions at the V2 and V3 branch. Patients with a suspicious clinical presentation and a history of cardiovascular disease benefit from a detailed vascular and neurologic workup to rule out impending adverse diseases. |
| 1854 | Migraines or MEWDS? | Sherene | Vazhappilly | vazhippilly_migraines | Multiple Evanescent White Dot Syndrome (MEWDS) is a rare, idiopathic posterior uveitis characterized by whitish dots in the posterior pole and midperiphery. Generally unilateral and acute, it can present with migraine-like symptoms such as decreased vision, scotomas and/or photopsias. This case reviews a 33-year-old female diagnosed with MEWDS, and discusses relevant clinical findings, differential diagnoses, and management updates. In primary care, it is essential for optometrists to be able to effectively detect and diagnose white dot syndromes, co-manage as needed and be able to educate the patient effectively. Special testing such as OCT and fundus autofluorescence may aid in diagnosis, and structured follow-up is ideal to ensure that the patient resolves completely. | |
| 1707 | Using Visual Fields to Fill in the Missing Pieces | Crystal | Sol | sol_fields | Altitudinal visual field defect involves loss in half of the visual field, respecting the horizontal. Typically, it is a hallmark for anterior ischemic optic neuropathy (AION), however the list of differential diagnosis is long for what can cause altitudinal visual field defect. This case reviews 38-year-old female who presented with sudden unilateral altitudinal visual field defect. When this visual field defect presents an efficient yet diagnosis is critical as it may require rapid medical attention such as compressive masses and optic neuritis. This presentation will include differential diagnoses, utilizing various diagnostic testing and further treatment and management plans. | |
| 1740 | 1-Year Results of a Randomized Controlled Trial for Myopia Progression Control Using Catenary Power Profile Contact Lenses | Kuang-mon Ashley | Tuan | Sally M. Dillehay OD EdD, Douglas P. Benoit OD | tuan_randomized | PURPOSE: A commercially available daily disposable soft contact lens delivering up to +8D Add (with catenary Neurofocus Optics Technology) has previously demonstrated effectiveness for myopia progression control in multiple real-world studies. PROTECT is a double-masked, randomized controlled trial (RCT) evaluating the effectiveness and safety of these lenses for myopia progression in children. METHODS&RESULTS: 145 children age 7 to <13 (Avg 9.9±1.5) with cycloplegic autorefraction (CSER) between -0.75D and -5D (Avg -2.4±1.3) were recruited from 8 clinics. Subgroup analysis based on FDA-approved initial age and myopia treatment range (8 to <13, -0.75D to -4D) for myopia control using SCL MF, there were an average reduction of CSER progression of 0.41D (69%) and AXL elongation reduction of 0.17mm (59%). No device-related Serious Adverse Event. CONCLUSIONS: 1-year RCT results corroborate with multiple real-world retrospective data. Catenary Power Profile contact lenses are safe and effective for myopia management under different settings. |
| 1757 | Asymptomatic Idiopathic Multiple Serous Retinal Pigment Epithelial Detachments (IMSRPED): A Rare Diagnosis | Anna | Dobrokhodova | Nancy Shenouda-Awad, Theresa Zerilli-Zavgorodni | dobrokhodova_serous | Bilateral idiopathic multifocal retinal pigment epithelial detachments (IMRPEDs) is an extremely rare condition and often asymptomatic. It is typically diagnosed as an incidental finding upon dilating a patient during a routine exam. In most cases, the patients are young or middle aged. Pathophysiology of this condition is generally not well understood but it is thought to be caused by a widespread primary defect in adhesion between RPE and Bruch's membrane causing multiple PEDs similar to pachychoroid. OCT and FA are instrumental in identifying any potential complications in early stages. This poster presents such a case with IMRPED in a young asymptomatic patient. Clinical features, diagnosis and management will be discussed. |
| 1758 | A Hole in One: Scleral Lens Fitting for a Patient Post Corneal Descemetocele, a Rare Complication of Ocular Rosacea | Hsuan Ariel | Chao | Stacy Zubkousky, OD, FAAO, FSLS | chao_scleral | A 31-year-old Hispanic woman presented for a contact lens fitting at Nova Southeastern University. She had severe ocular rosacea that led to a rare complication of corneal descemetocele in her right eye. Her right eye was treated with a sutured amniotic membrane, with the best-corrected vision in spectacles of 20/80. Tomography and AS-OCT revealed irregular astigmatism and a pachymetry of 93um at the scar. The patient was successfully fitted with a scleral lens with improved vision to 20/30+ and great subjective visual and ocular comfort. This case highlights a debilitating and rare complication of severe ocular rosacea, and how scleral lenses can aid in comfort and vision for those patients. |
| 1808 | Contact Lens Management of RK scars with Endothelial Corneal Dystrophy | DIPTI | SINGH | Thanh T Le | singh_scars | A 81 yo Caucasian female who has RK scars with endothelial corneal dystrophy, sought help for cloudy vision both eyes. She is currently using Muro 128 ointment at night and Muro 128 drops qid OU. The best corrected visual acuity were 20/80 OD and 20/50 OS. Examination showed grade 2+ guttata centrally with corneal edema OD greater than OS. This case discusses the management of contact lens options with corneal scars and corneal dystrophy. |
| 1822 | Vision with Sectoral Retinitis Pigmentosa after 20 years | Shagufta | Bi Bi | Barry J. Frauens, O.D., FAAO, Dipl-ABO | bibi_sectoral | Retinitis pigmentosa (RP) is a retinal disorder that initially impairs rod followed by cone function leading to nyctalopia, peripheral visual field constriction, and eventually impaired central and color vision. RP has many modes of inheritance including autosomal dominant, autosomal recessive, X-linked, and mitochondrial genes. Sectoral retinitis pigmentosa is an atypical presentation of RP with usually good long-term visual prognosis. This case study examines the progression of sectoral RP in a patient diagnosed 20 years ago that was lost to follow-up until 2023. Although sectoral RP is a milder form of RP, multimodal imaging and visual field testing is necessary for appropriate patient counselling and management. |
| 1825 | Molluscum Contagiosum Lid Bumps Found on Kidney Transplant Patient | Jennifer | Kahn | kahn_bumps | A forty seven year old African American female presented to clinic with multiple lid bumps bilaterally beginning three weeks prior to examination that were gradually increasing in number. Patient symptoms included mild itch, irritation, and noticeable cosmetic changes to appearance of her ocular adnexa. Patient signs included multiple clusters of molluscum lid bumps OD>OS and bilateral grade one follicular conjunctivitis. Relevant patient history includes a kidney transplant in 2021 and subsequent use of immunosuppressants, including mycophenolate and oral prednisone. The patient was treated with 500 mg of valacyclovir three times per day after coordinating with her nephrologist. At recent follow-up, the patient had decreased itchiness and showed improvement in lid appearance. | |
| 1839 | "Attack of the (Infectious) Ulcers: What's Eating You?" | Bayinah | Elyaman | elyaman_ulcers | Infectious corneal ulcers are a serious cause of vision loss resulting from microbial penetration of the corneal surface. We report a case of a 59-year-old white male who presented to referring optometrist with a corneal abrasion and a history of Herpes Zoster. Upon first encounter patient presented with two focal corneal infiltrates which, despite initial antibiotic treatment, expanded rapidly and coalesced within a matter of days to form a large ulceration encompassing 8mm of central cornea. This poster will focus on this particular case and relating factors that led to the severity of ulceration and how close monitoring and care referral is crucial at the first sign of ulcer development. | |
| 1719 | Atypical Presentation of Central Serous Chorioretinopathy with Persistent Subretinal Fluid and Cyst of the Ciliary Body in the Same Eye | Graham | Chung | Sweta Das, OD, FAAO, Dipl ABO | chung_serous | A 39-year-old hispanic male presented with constant, distorted blurry vision in the right eye for one month. He was diagnosed with central serous chorioretinopathy (CSCR) in the right eye two weeks ago in Brazil but reported worsening of symptoms. He denied steroid use or higher stress levels. His best-corrected visual acuity was 20/25+2 in the right eye and 20/20 in the left. On slit lamp examination, the right temporal iris was focally apposed to the cornea, suggestive of ciliary body mass or cyst. Gonioscopy was unremarkable. Dilated fundus examination showed subretinal fluid centrally, consistent with CSCR. During the 1-month follow-up appointment, the patient reported worsening of vision, the iris lesion appeared larger in size and macular OCT showed increased retinal thickening B-scan and ultrasound biomicroscopy was performed to rule out uveal mass. Although the B-scan came back negative, ultrasound biomicroscopy was suspicious for ciliary body melanoma given that hollowness of the lesion. The patient was referred to an ophthalmology oncologist for further work-up. |
| 1762 | What’s hiding in hydrops? Beware of latent onset of subepithelial microcysts with acute corneal hydrops | Hsuan Ariel | Chao | Pinar Haytac, OD, FAAO, Thuy-Lan Nguyen, OD, FAAO, FSLS | chao_hydrops | A 34-year-old male with keratoconus presented to Nova Southeastern University for sudden severe burning and blurry vision in the left eye. Severe corneal edema was visible upon slit lamp examination. AS-OCT confirmed a break in the Descemet’s membrane with intrastromal cystic spaces, diagnostic of acute corneal hydrops. Initial evaluation of the corneal epithelium was intact, with diffuse epithelial staining to fluorescein suggesting dryness. He was treated with Muro 128 drops and ointment for edema, prednisolone acetate for inflammation, and latanoprost to lower IOP’s distending effect on Descemet’s membrane. Two visits later, subepithelial microcysts appeared on slit lamp and AS-OCT examination and prompted the addition of Moxifloxacin to prevent bacterial keratitis. |
| 1787 | Ocular Complications of Myotonic Dystrophy | Alexandra | Guildford | guildford_ocular | Myotonic dystrophy is an inherited muscular dystrophy that causes progressive muscle weakness. This disease affects many systems in the body including the heart, lungs, voluntary muscles, and the eyes. Ocular complications associated with myotonic dystrophy include ptosis and early onset cataract formation. The ocular manifestations of this systemic disease will be presented in a patient case study. This case will introduce a discussion of ocular surface disease associated with poor eyelid muscle movements due to myotonic dystrophy. The patient presents with exposure keratopathy following a surgical bilateral ptosis repair. Management and treatment will be discussed, tailored to the patient’s physical capabilities due to the progressive muscle weakness. Myotonic dystrophy is a systemic disease that has ocular manifestations and potential iatrogenic complications. | |
| 1796 | Exudative maculopathy: diagnostic and treatment considerations for polypoidal choroidal vasculopathy | Ka Wei Miranda | Cheng | cheng_exudative | Polyploidal choroidal vasculopathy (PCV), or aneurysmal type 1 neovascularization, has long been considered a subtype of neovascular age-related macular degeneration (NAMD). More recently, PCV has also been defined within the pachychoroid spectrum of disease, with several defined clinical features that distinguish PCV from AMD. A 79-year-old Black male presented with longstanding macular subretinal fibrosis of unknown etiology in his right eye. Newly noted subretinal fluid in the fellow eye associated with a branching neovascular network, and other findings on multimodal imaging led to a unifying diagnosis of PCV. In patients with exudative diseases, distinguishing PCV from typical AMD is critical as verteporfin photodynamic therapy combined with anti-VEGF injections may lead to a better visual prognosis when compared to anti-VEGF monotherapy. | |
| 1821 | Visual and Structural Changes in Branch Retinal Vein Occlusion: A Case Report | Shagufta | Bi Bi | Alexandra Espejo OD, FAAO, Sherrol A. Reynolds OD, FAAO, Krima Shah, BS | bibi_branch | Branch retinal vein occlusion (BRVO) is a subgroup of retinal vein occlusion (RVO), one of the most common retinal vascular condition that can lead to visual impairment. BRVO is classified as perfused (non-ischemic) or non-perfused (ischemic). Visual and structural changes are indications of major complications of BRVO such as macular edema, macular ischemia, and retinal nonperfusion. Studies have found that greater areas of retinal non-perfusion on optical coherence tomography angiography (OCTA) have been linked to recalcitrant macula edema in BRVO. We present a case of ischemic BRVO with recalcitrant ME, macular ischemia, neovascularization, vitreous hemorrhage, and retinal detachment leading to vision loss despite treatment with anti-VEFG and intravitreal steroid implant. |
| 1826 | Deja VO: Assessing Risk Factors for a Recurrent CRVO | Eman | Al-Yousefy | al-yousefy_crvo | Central retinal vein occlusions can be a visually devastating consequence of vascular and metabolic disease. Recurrence of CRVOs, whether in the same or contralateral eye, has the same incidence as the initial occurrence. Visual prognosis of a recurrent CRVO in the same eye is significantly poorer than that in the initial occurrence. Therefore, it is important to address the variable risk factors of vasculopathy and hypercoagulability that may predispose a patient to a recurrence. This case report will facilitate a discussion on the importance of a multidisciplinary approach to managing a patient's systemic health and its pertinence to ophthalmic treatment and management. | |
| 1830 | Diagnostic Obstacles and Treatment Limitations in the Management of Congenital Peter’s Anomaly | Kristin | Joseph | joseph_limitations | This is a case of an adult with bilateral Peter’s Anomaly, deprivational amblyopia, and nystagmus. Peter’s Anomaly occurs in approximately 1 in 70,000 live births likely from inherited or sporadic gene mutations. It is characterized by unilateral or bilateral central corneal opacities with relatively clear periphery. Over 50% of Peter’s Anomaly cases involve glaucoma due to angle closure from adhesions and trabeculodysgenesis. Patients can develop deprivation amblyopia and sensory strabismus when corneal opacities obstruct the visual axis. This patient was prescribed Latanoprost nightly and Combigan twice daily in both eyes to manage ocular hypertension, referred to a corneal specialist, and recommended to seek a low vision consultation. Corneal findings impeded optical coherence tomography of optic nerves to diagnose glaucoma. Penetrating keratoplasty (PKP) is typically recommended after 6 months but prior to 2 years of age to prevent amblyopia and decrease risk of graft opacification. PKP may allow better resolution of the posterior segment, prevent amblyopia in young patients, and improve cosmesis; however, it poses the risk of inducing secondary glaucoma and resultant procedures. | |
| 1860 | Assessing Clinical Performance and Fit Success of Lehfilcon A Daily Wear Monthly Replacement Multifocal Soft Contact Lens | Katherine | Bickle | bickle_success | ||
| 1700 | Pilot Case Study: Functional Visual Field Loss in Post-Partum Patient | Tiana | Berezu | Xiaojing Yu, OD. Ph.D., Nicholas Green, OD, FAAO | berezu_postpartum | Functional visual field loss a.k.a. non-organic visual field loss in post-partum patients has not been reported in prior studies. Three major types of non-organic disorder include somatoform, factitious, and malingering. The purpose of this pilot case study is to discuss characteristics and review a case of functional vision loss (FVFL) as established by kinetic Goldmann visual field testing. An established 31-year-old female patient presents with complain of sudden recent vision loss OU. The examination was remarkable for BCVA 20/25 OD, OS, severely constricted visual field in 4 quadrants OD, OS. Humphrey 24-2 showed generalized field constriction OD, OS. Further testing with kinetic Goldmann perimetry using III4e and V4e targets revealed findings consistent factitious FVFL, including circular constriction with non-physiologic overlap of isopters, continuous spiral, jagged star-like, and clover-leaf patterns. Patient was educated on condition, managed with counseling and monitoring. Functional visual loss resolved at 6 month follow up. Optometrists should be aware of FVFL in post-partum patients. Diagnosis of functional visual field loss requires positive findings and is not a not diagnosis of exclusion. |
| 1747 | Acquired Nystagmus from non-penetrating traumatic brain injury treated with oral trihexyphenidyl | Annie | Ku | Chung To, OD, FAAO | ku_nystagmus | A 50-year-old Caucasian male presented with complaints of oscillopsia and binocular diplopia due to a prior history of moderate non-penetrating traumatic brain injury (TBI) from a motor vehicle accident in 1993. Examination revealed an incomplete right hemianopsia, micro-nystagmus, constant alternating exotropia, and left hypertropia. The patient did not respond to any prism amounts. Optometric management included the use of a frosted lens placed in front of the right eye for diplopia control. Oral trihexyphenidyl, an antispasmodic agent, was used for oscillopsia and nystagmus management. At follow up, patient reported subjective improvements in oscillopsia with stable nystagmus findings. This is an interesting case that highlights the management of nystagmus with oral trihexyphenidyl in a moderate TBI patient. |
| 1781 | Management of Uveitis with Trabeculitis after New Diagnosis of Severe Glaucoma | Mariah | Lucas | lucas_uveitis | A 73-year-old Caucasian male with bilateral, severe open-angle glaucoma presents with unilateral pain, erythema, and irritation approximately one month after his initial glaucoma diagnosis and just 11 days after beginning brimonidine therapy. Examination reveals severe anterior uveitis with fibrin, posterior synechiae, and intraocular pressure elevated at 36 mmHg in the right eye. Discussion will highlight the management of uveitis with trabeculitis and address anterior uveitis secondary to topical brimonidine- an uncommon drug-induced uveitis and important differential in this patient case. Ultimately, with topical steroid and cycloplegic treatment, the inflammation and secondary elevated intraocular pressure resolved. Eventually, the patient underwent combined cataract surgery with EX-PRESS filtration implants for continued glaucoma treatment. | |
| 1798 | Right Orbital Apex Syndrome secondary to Invasive Fungal Sinusitis Causing Permanent, Unilateral Vision Loss | Der | Vang | vang_apex | A patient with end-stage kidney disease and diabetes presents with sudden, unilateral vision loss of the right eye. Additional symptoms include intermittent diplopia prior to vision loss and right-side facial pain. Exam showed positive relative afferent pupillary defect and optic nerve pallor of the right eye. Patient was referred to the emergency department for suspicion of giant cell arteritis (GCA). Results were negative for GCA, but MRI of the brain revealed findings suggestive of Invasive Fungal Sinusitis (IFS) with right orbital apex involvement. Fungal culture was positive for Scedosporium. Patient was treated with surgical debridement and irrigation then placed on systemic antifungal therapy. Permanent vision loss of the right eye is an ocular sequela of right orbital apex syndrome secondary to IFS. | |
| 1815 | Early Detection of Plaquenil Toxicity | karan | johal | johal_plaquenil | A 33-year-old female presented for an annual Plaquenil screening with a chief complaint of blurry vision at distance in both eyes. Her medical history was remarkable for lupus for which she had been taking 200mg hydroxychloroquine BID for 5 years. Her best corrected visual acuity was 20/20 OD and OS. Due to this patient’s risk profile which included long duration of use, daily dose greater than 5.0 mg/kg, and renal disease, she underwent diagnostic imaging to screen for retinal toxicity. Although she was asymptomatic, SD-OCT imaging revealed early signs of toxicity with the presence of focal thinning of the ellipsoid zone. 10-2 visual field testing revealed a correlating paracentral defect. Retinal specialist was consulted to confirm the subtle findings. Patient was referred for ERG testing and a letter was sent to Rheumatologist. |