1. WHAT’S NEW? TECHNOLOGIES IN OPTOMETRIC MANAGEMENT OF EYE DISEASE ASHLEY S. REDDELL, OD, FCOVD HOACLS 2015

2. ABOUT ME From Haysville, KS Graduated from KU…..Rock Chalk! Graduated from Southern College of Optometry Completed pediatric residency at SCO Joined a private practice in Leavenworth in 2010 Now have 3 locations, 5 ODs, and ~28 staff

3. HOUSEKEEPING I have no financial interests in any of the products I may mention during this presentation. If you have questions please email me…. areddell@FamilyEyeCareCenterLV.com

4. OPTICAL COHERENCE TOMOGRAPHY (OCT)

5. OCT – NORMAL OPTIC NERVE

6. OCT - GLAUCOMA

7. OCT – GLAUCOMA – GANGLION CELL LAYER

8. OCT – MACULAR DEGENERATION

9. OCT – DIABETIC RETINOPATHY

10. OCT – TIPS FOR ADMINISTERING Go over instructions before putting in machine Patient positioning is key Need to make sure lines are going through the desired area (i.e. macula) Know your software Some can be manipulated after scan, others must be done before

11. VISUAL EVOKED POTENTIAL (VEP) Measures signal from the eye to the visual cortex How quickly does signal arrive at visual cortex? (latency) What is strength of signal? (amplitude)

12. VEP

13. VEP - GLAUCOMA Advanced OD Moderate OS

14. VEP – MULTIPLE SCLEROSIS MS is a delay in the conduction of signals along the nerves in the body Prolonged latency, often asymmetric

15. VEP - AMBLYOPIA As the check size gets smaller, the amblyopic eye will have a weaker and weaker signal Want to see changes in the signal with patching or therapy Sometimes if debating on whether patching or therapy is needed and the VEP can be used to gauge the neurological difference between the 2 eyes.

16. VEP – VISUAL PATHWAY DISORDERS Visual field loss Swollen optic nerve heads Anything affecting the brain or the tract from the eye to the visual cortex will show a change in the VEP

17. VEP - AUTISM Can help if non-communicative to prove that vision is normal. Larger check-size measures more peripheral vision Smaller check-size measures more central vision ASD found to have reduced fine tuning between mid- to high-spatial frequency. Could explain the lack of desire to make eye contact, etc. More research is being done in this area

18. VEP – TIPS FOR ADMINISTERING Good connection with all 3 probes is the most important thing Need a quiet, distraction free room without interruptions Try to have patient information entered ahead of time to speed up the process Warn people you will be messing with their hair

19. VISUAL FIELD Not necessarily new technology, however is still the standard of care for many conditions so we need to make sure we are getting accurate results. Continuing to develop more patient friendly protocol

20. VISUAL FIELD - GLAUCOMA

21. VISUAL FIELD – PLAQUENIL TOXICITY

22. VISUAL FIELD – VISUAL PATHWAY DISORDER

23. VISUAL FIELD - TIPS FOR ADMINISTERING Goals Fixation losses <30% (roaming eyes) False positives <30% (trigger happy) False negatives <30% (the hold out) Take a break if starts to go south Remind them to blink Let them know how much time left “You are over half way”

24. DNA TESTING Cheek swab for knowing likelihood of progression of ARMD Identified as Low Risk High Risk If high risk, make lifestyle changes/treatment recommendations earlier

25. TEAR TESTING If tears are evaporating quickly in Dry Eye Syndrome then the tears are more concentrated  stresses the corneal epithelium & conjunctiva. This test is looking for hyperosmolarity of tears (increased concentration) Objective and more accurate at identifying mild to moderate DES than schirmer testing and corneal staining

26. ANTERIOR SEGMENT PHOTOGRAPHY Pathology Monitoring

27. ANTERIOR SEGMENT PHOTOGRAPHY Pathology Education

28. QUESTIONS areddell@FamilyEyeCareCenterLV.com