Do You See What I See!!! Shane R. Kannarr, OD

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1 Do You See What I See!!! Shane R. Kannarr, OD skannarr@kannarreyecare.com

2 Define Specialty Testing Additional Test to: Prove/Disprove Diagnosis To monitor progression of a condition To document a condition to monitor for progression

3 Examples of specialty testing Anterior Segment photography Pachymetry Topography Visual Therapy Testing MRI/CT scan Lab work Pathology Gonioscopy

4 But today s focus Optical Coherence Topography (OCT) Retinal Imaging Nerve Head Analysis Fundus Photos Visual Fields

5 Optical Coherence Photography Looks at the structure of the retina or nerve Technology works by: Common Manufacturers Optivue/Ivue Heidelberg Zeiss GDx Nerve Fiber only

6 OCT Commonly used to monitor such conditions as: Retina Diabetic Retinopathy ARMD Macular Edema Macular Hole PVD with Traction Nerve Fiber Glaucoma

7 OCT (Retinal) Drusen Treatment Image of Drusen

8 OCT (retinal) Diabetic Retinopathy Treatment Image: Background Retinopathy Proliferative Retinopathy

9 OCT (retinal) PVD with Traction and Without Treatment options Image PVD with traction PVD without traction Macular hole

10 OCT (retinal) Central Serous Retinopathy Treatment Image Central Serous Retinopathy

11 OCT (nerve fiber) Glaucoma TSNIT Graph Monitoring progression of nerve fiber loss Comparative data

12 OCT (nerve fiber) Treatment options for glaucoma Image Normal Nerve fiber Early Glaucoma Progression of Glaucoma Advanced Glaucoma Pachymetry v. Gonioscopy

13 Fundus Photography Why do we take Fundus photos? To document a condition or disease More importantly: To have an accurate baseline to measure change Tips to take good photos Background illumination Adjust flash Dilate even an non mydriatic camera Keep it simple Screening photos v. Medically necessary

14 ARMD Why would we document ARMD Image 1---Drusen Image 2---Exudates Image 3 Sub Retinal Hemorrhage Image 4---Neovascularization of Macula

15 Diabetic Retinopathy Monitoring the progression When do we refer to retina? Image 1---Background Diabetic Retinopathy Image 2---Proliferative Diabetic Retinopathy Image 3---Post Laser Therapy

16 Macular Hole What is a macular hole? Image 1---Full thickness macular hole

17 Glaucoma What is glaucoma? How would photographs help? Image 1---Healthy Nerve Image 2---Early Glaucoma changes Image 3---Advanced Glaucoma

18 Central Serous Retinopathy Compare this image to OCT Which would be more difficult to monitor progression Image 1---Central Serous Retinopathy What are stereo photos

19 Visual Fields Screening Fields v. Threshold fields Frequency Doubling v. Spot Perimetry Central v. Peripheral fields Scotoma Nasal Step 30-2/24-2 ect

20 Visual Fields Common vocabulary to describe fields Arcuate Scotoma Homonymous v. Heteronymous Altitudinal field defect Congruous v. incongruous hemianopsia

21 Glaucoma What information would we gain from visual fields in glaucoma Does nerve fiber analysis match field Image 1---Normal field Image 2---Early glaucoma change Image 3---Advanced glaucoma

22 Altitudinal Defect What causes this type of defect What other test might you complete if you see this defect Image 1---Altitudinal defect

23 ARMD Why would a field defect occur with ARMD? What type of field is best for this patient? Image 1---field loss secondary to ARMD

24 Central Scotoma What diseases cause this type of field loss Macular edema Central Serous Retinopathy Advanced Glaucoma Image 1---central scotoma on 24-2

25 Now how do we put the information together Treating eye disease is like putting a puzzle together Each test is another piece but not the entire puzzle The art is to make sure all the testing agrees (at least most of the time)

26 The Glaucoma Patient Image 1---Fundus Photo Image 2---Nerve Fiber Analysis Image 3---Visual field Matrix and Humphrey Do the answers correlate

27 Diabetic Retinopathy Image 1---Fundus Photo Image 2---OCT of Retina Image 3---Visual field

28 Central Serous Retinopathy Image 1---Fundus photo Image 2---OCT of retina Image 3---Visual field Monitoring for progression

Fundus Autofluorescence. Jonathan A. Micieli, MD Valérie Biousse, MD

Fundus Autofluorescence. Jonathan A. Micieli, MD Valérie Biousse, MD Fundus Autofluorescence Jonathan A. Micieli, MD Valérie Biousse, MD The retinal pigment epithelium (RPE) has many important functions including phagocytosis of the photoreceptor outer segments Cone Rod