CE4optometry

Chronic Central Serous Choroidopathy Written by: David C. Kung, OD; Pauline F. Ilsen, OD abstract... Background: Chronic central serous retinopathy (CCSR) is a lesser known variant of central serous retinopathy (CSR), with clinical features characterized by multifocal serous detachments associated with diffuse decompensation of the retinal pigment epithelium (RPE). The disease tends to be bilateral and typically affects individuals over the age of 50. Due to the chronic nature of the disease, permanently reduced visual acuity is often observed. Case Reports: Two patients with CCSR are discussed. The first patient was a 38-year-old Caucasian male presenting for a routine eye exam, with a history of chronic CSR in the right eye diagnosed four years prior by an outside provider. Fluorescein angiography (FA) and OCT revealed diffuse RPE decompensation with a gravitational tract in both eyes, with foveal thinning in the right eye. The second patient was a 56-year-old African-American male who presented for a routine eye exam, with a history of a grey spot in his left eye for over three decades. OCT revealed small areas of RPE atrophy as well as pigment epithelial detachments in both eyes. Conclusion: Chronic CSR has a wide variety of clinical presentations. In individuals with suspected chronic CSR, the optometrist should inquire about systemic conditions and medications associated with CSR. Macular line scans on OCT and FA should be performed to assist with diagnosis. A referral to a retina specialist for possible treatment should be considered. Due to poor visual prognosis, individuals with a history of chronic CSR should be evaluated on a yearly basis. Read the full article here: http://ce4optometry.com//chronic-central-serous-choroidop/

Now You See It, Now You Don’t: A Case Report of Charles Bonnet Syndrome Wrtitten by: Melanie K. Peeler, OD; Richard G. Gardner, OD, FAAO Abstract:... Background: Charles Bonnet Syndrome (CBS) is a phenomenon in which the visual cortex of the brain spontaneously fires due to loss of sensory stimulation, thereby producing visual hallucinations in patients who are mentally healthy. Most patients are aware that these visions are not real, but some patients may suffer anxiety and depression as a result. Case Report: E.L., an 87-year-old legally blind male with a history of severe neovascular macular degeneration presented to the Dorn VA Medical Center for a routine eye exam. Upon examination, both eyes had significant choroidal neovascular membranes (CNVM), for which E.L. was referred to ophthalmology for bevacizumab injection. The patient reported a variety of visual hallucinations after treatment, one of which was disturbing, the others benign. Conclusion: Most patients do not volunteer information about visual hallucinations unless questioned. Patients with severe vision loss should be screened for symptoms of CBS so that proper intervention may be taken. Read the full article here: http://ce4optometry.com//now-you-see-it-now-you-dont-a-ca/

Common Ocular Disorders in the Pediatric Population Written by: David P. Sendrowski, OD, FAAO; Robert W. Lingua, MD Abstract... While most young children and infants are referred to the eye care physician with isolated ophthalmic problems for assessment and possible treatment, a smaller percentage will harbor serious ocular pathology which may be associated with co-existing systemic or neurologic abnormalities. Infant and early childhood development can be profoundly influenced by disorders of the visual system. The eye care physician should be aware of these common ocular pathologies for potential treatment options and urgency of referral if required by the condition. The attention span of both infants and young children is quite limited and the eye care physician must conduct and accurate examination for these ocular disorders in a relatively brief period of time. Special exam techniques which are of particular importance and use in the diagnosis and management of these ocular disorders are discussed in this article. Read the full article here: http://ce4optometry.com//common-ocular-disorders-in-the-p/

Contact Lenses and Children: Improving More Than Visual Acuity Written by: Langis Michaud, OD, MSc, FAAO (Dipl) This Case Report discusses how modern technology, such as large diameter gas permeable contact lenses, can help eye care practitioners correct high refractive errors, and how contact lenses, in general, can be considered a viable option for visual correction. It also illustrates how contact lenses can have a positive impact on children’s behaviour. Read the full ar...ticle here: http://ce4optometry.com//contact-lenses-and-children-impr/

Treatment Options for Seasonal Allergic Conjunctivitis Written by: Michael L. Nordlund, MD, PhD abstract... Allergies affect more than 50 million Americans and may involve multiple organs, including the ears, nose, skin, and lungs. However, allergy sufferers report that ocular symptoms of allergic diseases such as seasonal allergic conjunctivitis (SAC) cause the greatest discomfort and contribute significantly to decreased quality of life and work productivity. Prevalence of allergic diseases is increasing and allergic eye disease is a leading cause of visits to internists, optometrists, and ophthalmologists. The number of prescriptions for ocular allergy medications has been on the rise and is projected to continue to increase at a rate of greater than 20% annually. To illustrate these treatment options, two Case Reports by Drs. Thomas and Melton have been included herein. The first involving a young man presenting with severe allergy distress of unknown origin. The second Case Report describes a middle-aged woman experiencing increasingly severe allergy symptoms. Read the full article here: http://ce4optometry.com//treatment-options-for-seasonal-a/

Modern Management of Keratoconus Patients Written by: Langis Michaud, OD, MSc, FAAO (Dipl) This Case Report illustrates the modern management of patients presenting with keratoconus. It aims to provide some clues about the signs and symptoms which should alert eye care practitioners about the presence of this corneal ectasia. It also presents surgical and non-surgical approaches to stabilize the corneal condition, and presents options to improve visual functioning.... Read the full article here: http://ce4optometry.com//modern-management-of-keratoconus/

The Importance of Looking Beyond the Cornea Written by: Langis Michaud, OD, MSc, FAAO (Dipl) This Case Report illustrates why the utmost effort on the part of the practitioner should be applied any time a patient comes to our office with reduced visual acuity. This case refers to a lady who was referred to rule out a corneal condition because of reduced visual acuity. Topographic examination and rigid gas permeable fitting did not improve the condition. Ocular health assessme...nt through a dilated fundus exam revealed a macular hole. Despite the fact that the lesion had been present for many years, surgery was performed and in the end, visual acuity was restored. Two lessons can be gleaned from this: first of all, do whatever it takes to find the cause of reduced visual acuity; and second, never give up seeking out potential treatments to restore ocular health. Read the full article here: http://ce4optometry.com//the-importance-of-looking-beyond/

A Review of Cavernous Hemangioma of the Retina and Other Vascular Tumors of the Retina and Choroid Written by: Derek MacDonald, OD, FAAO Vascular tumors of the retina and choroid may be found in isolation or in association with syndromes involving cutaneous and central nervous system lesions. Ophthalmic lesions may be sight-threatening, and may be the presenting sign of systemic disease with life-threatening consequences. The role of the eye care practitioner in establishing... a prompt and accurate diagnosis cannot be understated. Read the full article here: http://ce4optometry.com/Cope-Credits/product/68/

Spontaneous Malignant Glaucoma in a Phakic Patient Written by: Wess Jordan, OD; Lane Fujimoto, OD; Paul Vejabul, OD; Theresa Chong, OD; Michelle Matson, OD Background: Malignant glaucoma is a rare form of secondary glaucoma characterized by an axially shallow anterior chamber angle and elevated intraocular pressure despite a patent iridectomy. Case Report: A 71-year-old Caucasian female presented for a cataract evaluation with the complaint of blurred vision in the right eye.... Ocular examination revealed a fixed, mid-dilated right pupil, a shallow right anterior chamber, a closed right anterior chamber angle, and intraocular pressure of 44 mmHg OD and 18 mmHg OS. Despite placement of two patent laser iridotomies OD, the patient's anterior chamber remained shallow and her IOP remained elevated. The patient was consequently diagnosed with malignant glaucoma and referred for trans-pars plana vitrectomy. Due to surgical complications, the patient ended up with a blind, painful right eye necessitating enucleation. Conclusion: Eye care providers need to make the proper referrals and initiate the proper treatment protocols to prevent significant ocular morbidity. Read the full article here: http://ce4optometry.com//spontaneous-malignant-glaucoma-i/

Ocular Manifestations of Valsalva Maneuver Written by: Cindy Tampoya, OD; Mark H. Sawamura, OD, FAAO; Judy Tong, OD, FAAO; Pauline F. Ilsen, OD Background: The Valsalva maneuver is classically described as an increase in intrathoracic pressure against the closed glottis, which causes a subsequent increase in venous pressure above the neck. Veins anterior to the heart use gravity to maintain proper circulation and thus lack valves that are normally required to prevent backflow.... This unique mechanism potentially allows blood to surge backwards into the ocular circulation and damage the capillary vessels. Clinical ocular manifestations include hemorrhages within the periorbital skin, conjunctiva, retina, or in the vitreous. Patients experiencing Valsalva retinopathy may complain of sudden and painless vision loss. We present three cases that demonstrate the myriad ways in which Valsalva maneuver can present clinically within or around the eye. Case Reports: The first case is a 57-year-old male patient with a history of self-induced emesis who presented with petechial hemorrhages located on his periorbital skin and conjunctiva. The second case is a 38-year-old female patient with a history of recent laproscopic surgery that resulted in deep intraretinal hemorrhages in the posterior pole of both eyes. The third case is a 34-year-old male who engaged in power exercising including strenuous weightlifting noticed within hours a leaf shaped floater in front of his central vision which paralleled a similarly shaped intraretinal hemorrhage juxtaposition to the macula. Conclusion: The optometrist should be aware of Valsalva maneuver as a possible cause for periorbital, conjunctival or retinal hemorrhages. One must keep in mind that Valsalva retinopathy is a diagnosis of exclusion and should be considered only after confirming a history of induced Valsalva and ruling out any underlying retinal or systemic diseases. Spontaneous resolution is the treatment of choice, but other options, such as Nd:YAG laser hyaloidotomy and vitrectomy are also utilized if warranted. Read the full article here: http://ce4optometry.com//ocular-manifestations-of-valsalv/ See more

Post-LASIK Management of Glare and Halos Written by: Langis Michaud, OD, MSc, FAAO (Dipl) This case report discusses a patient who underwent refractive surgery and is complaining about visual disturbance, especially at night. Examination revealed that high order aberrations were impacting the visual acuity. These aberrations originated from a decentered treatment, leading to a high level of vertical coma. Treatment options and patient management are explored. Importance of re...lying on modern technology, such as aberrometry, to comanage patients is also discussed. Read the full article here: http://ce4optometry.com//post-lasik-management-of-glare-a/

A Case of Monocular Diplopia Written by: Langis Michaud, OD, MSc, FAAO (Dipl) This Case Report describes a young male patient referred to Clinique Universitaire de la Vision at the Université de Montréal for a topographic examination to rule out cornea distortion as the main cause of what had been identified as a monocular diplopia. Listening to the patient and establishing the appropriate testing in a timely manner helped solve the problem.... Read the full article here: http://ce4optometry.com//pro/a-case-of-monocular-diplopia/

The diagnosis of pars planitis is actually a process of exclusion Pars planitis is a specific type of intermediate uveitis that is idiopathic in nature and characterized by a vitritis with inflammatory condensates (snowballs) and pars plana fibrovascular exudation (snow banking). It is a chronic condition with exacerbations and remissions that usually occurs in children and young adults. Once diagnosed it is important to consider the severity of the condition including its effect on vision, in order to decide if treatment is necessary. The case report of a 16-year-old Caucasian female who presented with pars planitis, and the details of her diagnosis is available online at: http://ce4optometry.com//pars-planitis-a-review-and-case-/

The Importance of Looking Beyond the Cornea Recently, a 63-year-old glaucoma patient was referred to us in order to rule out any underlying corneal conditions that could be reducing her visual acuity. Topographic examinations on both eyes revealed nothing significant and RGP fittings did not improve her condition. However, an ocular health assessment through a dilated fundus on her left eye did reveal a macular hole, and optical coherence tomography (OCT) confirmed a grade 4 ...full thickness macular hole which was subsequently successfully repaired. This case illustrates why it is so important to never give up until determining the etiology of reduced visual acuity and to consider all available diagnostic and treatment options. This case is available as a CE credit course online at: http://ce4optometry.com//the-importance-of-looking-beyond/

How proactive should you be with your contact lens patients? When asked, how many of them will tell you that they think that it’s normal to be less comfortable at the end of the day? And how many more of your patients will tell you that they do feel some dryness but that’s OK with them. But their OK is actually a red flag indicating that something is wrong. And if it is not followed up in a timely manner this discomfort will undoubtedly increase and so will the chances that your patient will stop wearing their contact lenses. This is the subject of a CE credit article by Dr. Langis Michaud entitled, What Patients Never Tell You, that is available online at http://ce4optometry.com//pro/what-patients-never-tell-you/

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About the CE Credit Course: Coats’ disease is a condition involving retinal telangiectasias and retinal vessel aneurysms causing sub-retinal and intraretinal exudation and lipid accumulation in healthy individuals. Current treatment options for Coats’ include laser photocoagulation, steroid injection and intravitreal anti-vascular endothelial growth factor (VEGF) injections. Careful evaluation of location and severity of lesions must be assessed prior to determination of trea...tment modality. Read the full article: http://www.ce4optometry.com//m/36339-PS-CRO235ferrucci.pdf To register and/or login to take the CE Credit Test http://www.ce4optometry.com/web/index.php About the photo: Color fundus photography showing peripheral retinal exudation and hemorrhages OS

About the CE Credit Course: Properly fitted contact lenses, for children, can be considered a viable option for visual correction not to mention how contacts can have a positive impact on children’s behaviour. To read the full article:... http://www.ce4optometry.com//m/36340-CL-CRO23.5michaud.pdf To register and/or login to take the CE Credit Test: http://www.ce4optometry.com/web/index.php About the photo: Optimal conjunctival landing with no blanching or vessel compression

About the CE Credit course: This Case Report illustrates why the utmost effort on the part of the practitioner should be applied any time a patient presents with reduced visual acuity. A woman was referred me to rule out a corneal condition because following a topographic exam and a rigid gas permeable lens fitting her visual acuity did not improve. However an ocular health assessment through a dilated fundus exam revealed a macular hole and following surgery visual acuity wa...s restored. Two lessons were learned from this: first of all, do whatever it takes to find the cause of reduced visual acuity; and second, never give up seeking out potential treatments to restore ocular health. To read the full article: http://www.ce4optometry.com//m/35712-PS-CRO23.4michaud.pdf To register and/or login to take the CE Credit Test: http://www.ce4optometry.com/web/index.php About the photo: OCT scan of the left eye preoperatively. Note the full thickness macular hole with some remaining vitreous membrane (blue line superiorly)

About the CE Credit course: Some children can harbor serious ocular pathology which may be associated with co-existing systemic or neurologic abnormalities. Infant and early childhood development can be profoundly influenced by disorders of the visual system. Moreover, the attention span of both infants and young children is quite limited; therefore eye care physicians must conduct accurate exams in relatively brief periods of time. To read the full article:... http://www.ce4optometry.com//35714-SD-CRO23.4sendrowski.pdf To register and/or login to take the CE Credit Test: http://www.ce4optometry.com/web/index.php About the photo: Five month old male with nasal lacrimal obstruction (NLO) causing mucopurulent discharge from inferior puncta. Orbit and lids remain uninvolved from the blockage at this time.

About the CE Credit course: Examination of patients who have undergone refractive surgery and complain about visual disturbance post-operatively, especially at night, have revealed that high order aberrations have impacted on their visual acuity. These aberrations originated from a decentered treatment, leading to a high level of vertical coma. To read the full article:... http://www.ce4optometry.com//medi/CRO%2023.1%20Michaud.pdf To register and/or login to take the CE Credit Test: http://www.ce4optometry.com/web/index.php About the photo: Topography map (OD) showing superior decentration of the ablation zone vs pupil.

About the CE Credit course: Valsalva retinopathy is a diagnosis of exclusion and should be considered only after confirming a history of induced Valsalva and ruling out any underlying retinal or systemic diseases. Spontaneous resolution is the treatment of choice, but other options, such as Nd:YAG laser hyaloidotomy and vitrectomy are also utilized if warranted. To read the full article:... http://www.ce4optometry.com//medi/CRO%2023.1%20Tampoya.pdf To register and/or login to take the CE Credit Test: http://www.ce4optometry.com/web/index.php About the photo: Petechial hemorrhages on upper and lower lid OS resulting from self-induced vomiting.