2. Desinee Drakulich O.D.

3.  I have no affiliation, nor do I received financial compensation from any of the companies or brands used in this presentation.

4.  Historical Overview  Review of Retinal Anatomy  Review Normal Retinal OCT  Review of Optic Nerve Anatomy  Review of Normal ONH OCT  Review of Corneal Anatomy  Review of Normal Corneal OCT  Review of Angle Anatomy  Review of Normal Angle OCT  Case Studies of Abnormal OCTs

5.  OCT – Optical Coherence Tomography  In Ophthalmology for the past 15 years  Gives us the ability to image high resolution ocular structures  Based on the technology of low-coherence interferometry (used to measure Axial length)  Early models allowed scans with 10 um resolution  Current models allow scans with 2 um resolution

11.  The human retina is 10 layers  Each layer performs a specific function in the eye  Nine of the ten layers are not visible to the human eye  The OCT can image all ten layer with almost histological precision

23.  44 y.o. white male  Presents with sudden onset reduced vision OD.  Entering visual acuity 20/40 OD, 20/20 OS.  Patient is concerned cause he is a airline pilot and has always had perfect vision.  No other significant information revealed in the history.  External slitlamp exam is normal. IOP 16 mmHg OU.

26.  Central Serous Retinopathy  Fluid trapped under the retina, that causes an RPE detachment  Common in males, over 40 y.o. Type A personality with a stressful job.  Treatment – monitor most likely will resolve on its own.

27.  65 y.o. white female  Chief complaint, just time for a yearly exam  Dva 20/20 OU sc  Visual Fields normal OU  Dilated Fundus Exam appears normal OU  IOPs 12 mmHg OU  External slitlamp exam appears normal OU

30.  Epiretinal membrane secondary to a tractional PVD causing macular sceissis.  Due to the fact that the RPE is unaffected no vision disturbance was noticed.  Treatment - monitor

31.  77 y.o. white male  Presents for annual exam, chief complaint is reduced vision OD>OS  IOPs 12 mmHg OU  Visual Field show central loss OD>OS  External slit lamp exam shows pseudoaphakic OU  Dilated fundus exam show retinal exudates OD>OS

34.  14 y.o. white female  Presents with chief complaint of blurry vision and headaches  Saw PCP, no diagnosis except overweight BMI 32  IOPs were 14 OD and 15 OS  DVa was 20/40 OU cc  External slitlamp exam appears normal

37.  Pseudotumor cerbrei  Swollen ONH secondary to increased intraocular pressure  Common in young overweight females  Treatment - Diamox

38.  13 y.o. white male  Presents for contact lens exam  No visual or systemic complaints  Highly myopic OU  Entering DVa cc 20/20 OU  IOPs 16 mmHg OD and 19 mmHg OS  External Slitlamp exam was normal

42.  Crowded Optic Nerves  Can easily be mistaken for Pseudotumor  History and images reveal this benign diagnosis  Treatment - none

43.  20 y.o white female  Presents for annual eye exam  No visual complaints  Entering DVa 20/20 OU sc  IOPs 14 mmHg OD and 15 mmHg OS  Visual Field showed scattered defects OU  External slitlamp exam was normal  Benign Astrocytoma OS

47.  Optic Nerve Head Drusen  Calcium deposits that are embedded in the optic nerve  Can cause decrease in nerve sensitivity; including reduced color vision and contrast sensitivity  Can also affect visual field  Treatment – monitor, possible nerve protecting agents like Alphagan P

48.  32 y.o. white male  Presents as new patient, told at his last eye exam that he had a “lazy eye”  Visual Acuity cCL 20/20 OD and 20/200 OS  IOP 16 mmHg OD and 12 mmHg OS  Initial slitlamp exam appear normal, questionable thinning OS?  Dilated Fundus Exam normal OU

51.  Keratoconus OS >OD  Keratoconus is the thinning of the cornea secondary to loss of stability of corneal collagen fibers  NOT a “lazy eye”  Treatment – Rigid Gas Perm CL, UV corneal crosslinking, Intacs and PKP

52.  44 y.o. white male  Presents for CL exam  Chief complaint is decreasing near vision  History high hyperopia OU  DVa cc 20/20 OU  Slitlamp exam reveal narrow angles OU  No DFE today  Gross retinal structures appear normal

56.  Anatomically narrow angles  Patient at risk for angle closure glaucoma  More prevalent in high hyperopes  Treatment – peripheral irodotomy