Retinal Imaging Conference Ahmet Ozkok MD University of Louisville School of Medicine Department of Ophthalmology & Visual Sciences 6/5/14

Subjective CC: Decreased vision OD HPI: 71 year-old female referred to Retina clinic for decreased vision in the right eye. She complains of difficulty driving and floaters of last few years duration and getting worse gradually. POH: CE+IOL OU 2004 PMHx: NIDDM (10 years), artritis, hypothroidism, GERD Meds: Omeprozole, hydrocodone, metformin, levothyroxine, meloxicam Allergies: Codeine

Exam OD OS BCVA 20/80 20/ , X Pupils: 3 → 2 3 → 2 no APD IOP: 11 mm Hg 12 mm Hg EOM: Full OU CVF: Full OU Ant Segment: PCIOL OU

Slit lamp photo OD OS

Exam DFE:OD: ON: C/D= 0.2 Blurry view 2/2 AH Vessels: atherosclerotic changes A/V 1/2 Macula: Blurry OS: ON: C/D=0.1 Macula: blurry view Veins: Atheroscloric changes A/V 1/2

OD

ASSESSMENT 71 year old female with epiretinal membrane and asteroid hyalosis Plan: PPV+ERMp OD

ASSESSMENT POW# 3 BCVA 20/60+

Take Home Message Fa and oct

Asteroid Hyalosis  Characterized by diffuse spherical white opacities stuck to vitreous  Unilateral (75-90% )  Etiology ?  Calcium-associated phospholipids  Presence is obvious upon ocular exam but patients are usually asymtomatic  May interfere with retina exam (FA, OCT, AF)  Rarely cause visual disturbance and needs Sx

Asteroid Hyalosis Risk Factors  Age AJO 2001;132:70-75

Asteroid Hyalosis Risk Factors (under debate)  Gender (m>f)  DM  Hypercholesterolemia  HT  Hypercalcemia  Hyperphosphatemia  Hyperopia  Gout  Alcohol consumption  RP

Cataract Surgeon Be Careful!  IOL calculation  Falsely short axial lenght measurement with automated biometry  Association between asteroid hyalosis and late postoperative dystrophic calcification of silicone lenses.

1.Ikeda Y, Hisatomi T, Murakami Y, Miyazaki M, Kohno R, Takahashi H, Hata Y, Ishibashi T: Retinitis pigmentosa associated with asteroid hyalosis. Retina 2010, 30(8): Kador PF, Wyman M: Asteroid hyalosis: pathogenesis and prospects for prevention. Eye 2008, 22(10): Fawzi AA, Vo B, Kriwanek R, Ramkumar HL, Cha C, Carts A, Heckenlively JR, Foos RY, Glasgow BJ: Asteroid hyalosis in an autopsy population: The University of California at Los Angeles (UCLA) experience. Archives of ophthalmology 2005, 123(4): Browning DJ, Fraser CM: Optical coherence tomography to detect macular edema in the presence of asteroid hyalosis. American journal of ophthalmology 2004, 137(5): Foot L, Werner L, Gills JP, Shoemaker DW, Phillips PS, Mamalis N, Olson RJ, Apple DJ: Surface calcification of silicone plate intraocular lenses in patients with asteroid hyalosis. American journal of ophthalmology 2004, 137(6): Mitchell P, Wang MY, Wang JJ: Asteroid hyalosis in an older population: the Blue Mountains Eye Study. Ophthalmic epidemiology 2003, 10(5): Komatsu H, Kamura Y, Ishi K, Kashima Y: Fine structure and morphogenesis of asteroid hyalosis. Medical electron microscopy : official journal of the Clinical Electron Microscopy Society of Japan 2003, 36(2): Moss SE, Klein R, Klein BE: Asteroid hyalosis in a population: the Beaver Dam eye study. American journal of ophthalmology 2001, 132(1): Winkler J, Lunsdorf H: Ultrastructure and composition of asteroid bodies. Investigative ophthalmology & visual science 2001, 42(5): References

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