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Poster Presentations of the 117th Annual AOA Congress & 44th Annual AOSA Conference: Optometry’s Meeting® therapy three to four times a week. Binocular vision disorders can go undetected without the proper diagnostic testing and can heavily impact a patient’s quality of life. In addition to near binocular testing, a cycloplegic refraction is essential in symptomatic patients, and healthy patients who are not correctable to 20/20. Further, it is important to discourage minus lenses during refraction when patients have near complaints. Performing distance retinoscopy not only shows the appropriate refraction but the integrity of the reflex. Vision therapy is the right treatment option for these patients. Posters are peer-reviewed and only those that meet the acceptance criteria are selected for presentation. Poster 1 The Benefits of a Cycloplegic Examination in a Complicated Refractive Case with Associated Binocular Vision Disorders BV - Binocular Vision Jennifer Cusson Illinois College of Optometry 2909 St. Marks Ave. Melbourne, Florida 32935 Poster 2 Spontaneous Non-Aneurysmal Perimesencephalic Subarachnoid Hemorrhage Presenting as Binocular Vertical Diplopia Binocular vision disorders are more prevalent than ocular diseases in the majority of the population. Yet, these disorders are often undiagnosed due to insufficient evaluation. Issues may stem from deficiencies in the patient’s vergence, accommodative and oculomotor systems. Common symptoms include double/blurry vision, headaches, eye strain, fatigue, asthenopia, and avoidance of near tasks. A 23-year-old Caucasian female presented with eye strain and fatigue at the end of the day along with blurry vision when alternating from near to far. Her ocular history includes longstanding decreased vision in her right eye, contact lens wear for 15 years, and a positive family history of keratoconus. Entering visual acuities with her current glasses were 20/50 OD through -1.50-2.50x002 and 20/25 OS through -2.00-2.00x170. On manifest refraction, she accepted minus lenses without significant visual improvement. Cycloplegic retinoscopy was performed and revealed, +2.00-4.00x010 OD and +1.00-2.25x180 OS. Further binocular vision testing showed esophoria at near, reduced stereoacuity, poor accommodation amplitudes, decreased facility testing, and limited divergence ranges. Topography was done and demonstrated with-the-rule astigmatism with no signs of keratoconus. Due to the patient’s inconsistent work hours, home vision therapy was initiated for accommodative infacility and convergence excess. Over the next six months the patient returned every three to four weeks. Over the course, she accepted +1.00-3.75x010 OD and pl-2.25x180 OS eye in both contact lenses and glasses with vision at 20/20 OU distance and near. Currently, she is free of eye fatigue and strain. Her esophoria, stereoacuity, accommodation, and vergence ranges have all improved. She continues maintenance home vision BV - Binocular Vision Ruben Roman, OD, CCHP Inter American University of Puerto Rico School of Optometry PMB 114-220 Western Auto Ste. 101 Trujillo Alto, PR, Florida 00976 Subarachnoid hemorrhage is classified as a medical emergency, life-threatening condition and its early detection and treatment is critical. In the United States, 21,000-31,000 new cases are reported annually. Common complications of subarachnoid hemorrhages are aneurysms (85% of all cases). Ten percent (10%) of all episodes of spontaneous subarachnoid hemorrhages correspond to perimesencephalic type. The diagnostic techniques include computerized tomography (CT), lumbar puncture, magnetic resonance imaging (MRI), cerebral angiography, complete blood count including platelets, partial thromboplastin time and prothrombin time to evaluate the clotting function. This case presents a 54-year old Hispanic male complaining of binocular diplopia, partial hearing loss, headaches and vomiting. No recent ocular or head trauma was reported. Retinal hemorrhages, a common complication of subarachnoid hemorrhages were not found. The cover test performed in nine cardinals position of gaze revealed 4-prism diopters constant right hypertropia at distance and at near causing a binocular diplopia. A CT scan revealed a perimesencephalic subarachnoid 2 hemorrhage. The patient was hospitalized during twelve days for proper treatment. However, the patient’s complain about diplopia persisted. A 2 prism-diopter Fresnel press-on prism was adapted to the non-dominant right eye without reducing his visual acuity. The minimum amount of prisms that permitted fusion should be prescribed. The binocular vertical diplopia disappeared and eventually, the prism was discontinued. Fusion was unstable and a visual therapy program was performed in order to stabilize fusion. A CT Scan is an invaluable test in patients with diplopia symptoms in order to establish a differential diagnosis. A Fresnel prism is a useful tool to treat diplopia in patients with comitant strabismus. This type of case reaffirms that Optometrists are uniquely qualified to manage patient’s ocular health, and these professionals can play a decisive role in the diagnosis and subsequent treatment of neurological, cardiac or systemic diseases that could be life-threatening. than 14 days later to repeat ten consecutive trials of the same programs in the same order. Subjects were positioned at eye-level 50cm from the SVI. Testing was performed under normal room illumination using a black background and white stimulus. The results of the Proactive test revealed an intraclass correlation coefficient (ICC) of 0.383 for the mean of trials 1-3 for visit 1 and 2. The ICC for Trial 4 only was 0.766. The Reactive data for Visit 1 and Visit 2 using Trial 1 data only was 0.491. The ICC for the average of Trial 1 and Trial 2 was 0.52 and the ICC for the average of Trial 1, Trial 2, and Trial 3 was 0.51. The Hand Speed program data yielded an ICC of 0.59 for Trial 1 of Visit 1 and Visit 2. The ICC for Trial 3 only was 0.77 Poster 3 CL - Contact Lens Test-Retest Reliability of the Eye-Hand Programs of the Sanet Vision Integrator JulieAnne M. Roper, OD, MS WJB Dorn VA Medical Center 500 Gills Creek Parkway Hampton Greene Apt 108 Columbia, South Carolina 29209 Poster 4 A wrinkle in time: Transient corneal epitheliopathy induced by scleral lens wear BV - Binocular Vision Additional Author(s): William J. Denton, OD Eric A. Baas, OD Illinois College of Optometry 3241 S. Michigan Ave. Chicago, Illinois 60616 As scleral lenses are a fairly new mode of correction for irregular corneas and ocular surface disease, those who fit them are still finding new fitting difficulties. While some of the more troublesome complications include lens adherence and solution hypersensitivity, we introduce a unique case of corneal epitheliopathy induced by improper insertion and removal techniques. A 76-year-old Caucasian male was fit with a scleral lens in his left eye due to traumatic corneal scarring complicated by severe dry eye syndrome (DES) from ocular rosacea. The resultant BCVA was 20/20 and proper insertion and removal was observed. At his 1-month post-scleral lens fitting follow-up appointment he presented with a chief complaint of fluctuating blurred vision OS and expressed difficulty removing his scleral lens. His BCVA OS with the lens had reduced to 20/80 and slit lamp examination showed elevated superiotemporal corneal folds with associated corneal edema crossing into the visual axis. Upon removal of the lens, BCVA OS with the lens improved to 20/40-2 within 1.5 hours and had returned to 20/20-2 at the 3-day Additional Author(s): Naiya Panchal, Brian Coffey, Susan Ann Kelly, PhD. There has been considerable research to determine the relationship between visual skills and athletic performance. One of the most important factors in visual skills testing is that tests be reliable. The Sanet Vision Integrator (SVI) is used to assess visual guidance of motor performance including eyehand coordination, visual reaction time, and hand speed and accuracy. The purpose of this investigation is to determine test-retest reliability of the Proactive, Reactive, and Hand Speed programs of the SVI. These programs evaluate the speed of a motor response to visual stimuli, which can be applied to athletic performance. Twelve male and female subjects, ages 23-29, performed ten consecutive trials of the Proactive, Reactive, and Hand Speed programs during the initial visit. There were asked to return no sooner 3 follow-up. Both the initial presentation and the resolution of the corneal folds was documented with anterior segment OCT, anterior segment photos, and corneal topography. The patient demonstrated insertion using excessive force and subsequent forceful removal with incorrect plunger placement in the center of the lens. Upon refitting the patient in a scleral lens with a thicker flange and reinstructing insertion/removal techniques, the patient was able to successfully wear his scleral lens without inducing corneal epitheliopathy. In addition to creating patient discomfort, improper insertion and removal of scleral lenses can also lead to transient corneal changes. In patients with complaints of blurred vision after wearing scleral lenses, induced corneal epitheliopathy should be considered. In these patients, it is importance to review or directly observe the patient’s scleral lens insertion and removal technique during the follow-up visit. When removal seems difficult a thicker flange can assist. amblyopia presented for contact lens fitting right eye only. Corneal topography confirmed 13.4 diopters of irregular astigmatism secondary to corneal scarring. Slit lamp examination revealed patchy anterior stromal haze without vascularization and an intact epithelium OD. Corneal gas permeable contact lens fitting was attempted first but failed due to the location and amount of irregularity. The patient was fit in a small diameter Blanchard One Fit Cone scleral lens. • Case 2: fifty-nine year old female with a history of sphenoid wing meningioma with involvement of cranial nerves V, VI, VII and VIII on the right side. She had received radiation therapy six- years prior. Since 2009, she has presented with repeated episodes of a non-healing corneal epithelial defect exacerbated by incomplete lid closure. Although treated appropriately with topical antibiotics and soft bandage contact lenses, these lenses fell out repeatedly due to surface dryness and corneal anesthesia. The patient was fit in an Advanced Vision Technology scleral lens. The end goal for each patient above was very different. For patient 1, the objective was to provide optimal vision correction eventually promoting visual improvement in the amblyopic eye as well as binocularity and eye alignment. For patient 2, the aim was to assist epithelial healing by providing a lubricated anterior surface to decrease the risk of stromal melt and potential perforation. Both patients benefited immensely from treatment. Poster 5 Scleral contact lens fitting for pediatric immune stromal keratitis and sphenoid wing meniogoma-induced neurotrophic keratopathy CL - Contact Lens Sharon Park, OD SUNY College of Optometry 330 W. 39th Street, Apt. 11F New York, New York 10018 Poster 6 Utilization of an Orion Biocolors Contact Lens on a Photophobic Patient Additional Author(s): Jennifer Gould, OD, M.S., David Libassi, OD, FAAO CL - Contact Lens Mark MacMillan, OD UAB 1716 University Blvd Birmingham, Alabama 35205 When traditional contact lens options fail, a scleral lens is an excellent alternative to provide the vision, comfort, protection and lubrication that patients require. The fluid reservoir of saline behind the scleral contact lenses not only masks corneal toricity but also promotes healing of the ocular surface. These indications prompted scleral lens fitting in two cases: (1) inactive, immune stromal keratitis which led to corneal scarring and irregular astigmatism; and, (2) neurotrophic keratitis secondary to an extraparenchymal tumor. • Case 1: four-year old female with a history of unilateral: (1) herpetic epithelial keratitis; (2) immune stromal keratitis; and, (3) form deprivation The following case will discuss the management of a patient with photophobia secondary to a fixed pupil. Using a prosthetic contact lens(CL) to control the amount of light entering the patient’s eye has been shown to limit the amount of photophobia resulting from many iris disorders. The options for prosthetic colored lenses include using fitting sets in office or sending a photo of the normal eye for color matching. A 65 year old white male presented with 4 photophobia OS. He reports an injury resulting in a fixed dilated pupil many years previous. No CL has been attempted in the past to alleviate this problem. Refractive error will attempt to be corrected with CLs as well. The Orion Biocolors lens was fit using the fitting set and guide with provided good intial results. Color match was achieved by layering different lens elements on the provided fitting device. Correct lens power was achieved by over refracting the toric trial lens. Initial lens selection was an Orion Biocolors 8.3/14.2/Pl-1.75x179 with underprint U-2, color 41, Limbal ring E, and Starburst V. A good initial color match was achieved with decent vision. Initial lens fitting was successful with good results limiting the photophobia the patient experiences. Reducing photophobia for this patient was the primary goal and this was achieved. In addition, reliance on glasses for refractive correction has been decreased. There are many options for limiting photophobia, but the Orion Biocolors lens worked well for this particular patient. The variety of color combinations made it ideal for a lens fitted in office instead of sending a picture out to have the eyes color matched. Practitioners will also find custom soft lenses ideal as the fitting technique for these lenses is not as complex as GP lenses. This case report demonstrates a successful use of custom soft lenses for patients with postoperative corneal irregularity. A 49-year-old Caucasian female was referred for custom soft contact lens fitting after penetrating keratoplasty (PKP) procedure in the left eye. The patient had previously tried GP lenses but could not tolerate them. The patient’s best corrected visual acuities were -1.50+0.75×001 20/20- OD and -8.50+4.75× 045 20/400 OS. Pinhole acuities at distance were 20/20 OD and 20/60-2 OS. Pentacam topography revealed irregular corneal astigmatism worse in the left eye. Slit lamp evaluation showed inferior corneal scars OD and a clear graft with two corneal sutures OS. The patient was fitted with KeraSoft IC (Baush & Lomb) soft lenses according to the manufacturer’s recommendations. A successful fit was found with a second diagnostic pair. The patient was happy with vision and lens comfort. The final corrected visual acuity was 20/20- in each eye. The advancement of soft lens design has expanded the available lens option for patients with postoperative corneal irregularity. Practitioners can enjoy relatively easy fitting process of soft lenses without worrying about the patient’s corneal health and satisfactory vision. Patients can enjoy comfortable and longer contact lens wear. Custom soft lenses are a safe and effective option of vision correction for patients with postoperative corneas. Poster 7 Successful Use of Custom Soft Lenses for Patients with Postoperative Corneal Irregularity CL - Contact Lens Keren H. Yang, OD The Doctors Clinic 2200 NW Myhre Road Silverdale, Washington 98383 Poster 8 Astigmatic Correction with Scleral Lenses: A Case Series Gas permeable (GP) contact lenses have been considered as a lens of choice for fitting irregular corneas. Although patients most often achieve good vision with GP contact lenses, they often experience lens discomfort and develop intolerance to GP lenses, which often result in giving up the lens wear entirely. The complexity of GP lens fitting and the patient’s lack of tolerance to GP lenses have made it challenging for practitioners to incorporate postoperative contact lens fitting into their everyday practice. With the expanded lens design options, custom soft lenses are now a viable option for fitting postoperative corneas. Custom soft lenses are great for patients with a lack of tolerance with GP lenses. CL - Contact Lens Muriel Schornack, OD Mayo Clinic 1403 City View Court NE Rochester, Minnesota 55906 One of the visual benefits of rigid gas permeable lenses (RGP’s) is neutralization astigmatic refractive error. However, when refractive cylinder does not exactly correspond to corneal cylinder, residual astigmatism can reduce the quality of the visual image through the lenses. If a front surface toricity is required, rotational stabilization of a corneal RGP can be difficult. Scleral lenses (ScL) can provide the 5 Poster 9 degree of rotational stability necessary to allow for correction of residual astigmatic refractive error on the front surface of the lens. Two cases demonstrate the use of front surface toric ScL’s for correction of residual astigmatism. A 19-year-old Caucasian male, diagnosed with keratoconus at age 17, presented with bestcorrected spectacle acuity was 20/50 in each eye. He was unable to achieve adequate visual acuity with hydrogel lenses, and was not able to tolerate either hybrid lenses or corneal RGP’s. He was fit with custom ScL’s, and achieved 20/30 acuity in each eye with spherical correction. Over-refraction revealed residual astigmatism of 1.25 D OD and 3.00 D OS, and spherical keratometry readings over the lenses eliminated lens flexure as the origin of this astigmatism. With front surface toric ScL’s, the patient achieved 20/20-2 OD, 20/20-1 OS, and 20/20+2 OU. Case #2: A 12-year-old male had been diagnosed with keratoconus in the right eye at the age of 10. When the left eye began to show signs of progression to clinically significant keratoconus, corneal crosslinking was performed on both eyes. Following crosslinking, both eyes were fit with ScL’s. Spherical lenses provided VA of 20/50 OD and 20/30 OS. With toric ScL’s, he was able to achieve 20/30 OD and 20/20-2 OS. Residual astigmatism may limit visual acuity that can be obtained with spherical ScL’s in patients with keratoconus. Although higher order aberrations may preclude attainment of 20/20 acuity in these patients, front surface toric ScL’s may provide improved visual acuity compared to spherical lenses, and offer stability that would be difficult to achieve in corneal RGP’s. Incorporation of correction for higher order aberrations onto the anterior surface of ScL’s may eventually provide even more pronounced visual improvement. Fitting Success of a New Color Silicone Hydrogel Contact Lens in Lotrafilcon B Clear Sphere Wearers CL - Contact Lens Jason R. Miller, OD, MBA Private Practice 9711-C Sawmill Pkwy Powell, Ohio 43065 Purpose: To determine whether clear, sphere lotrafilcon B contact wearers require a refit into color, sphere lotrafilcon B lenses. Methods: A novel color SiHy lens (lotrafilcon B color, Alcon) was compared to a clear, sphere SiHy lens (lotrafilcon B; Alcon) in a randomized, parallel group, multisite study of existing lotrafilcon B contact lens wearers. Overall fit and centration were each graded on a 5-point scale. The proportion of subjects attaining same fit in both eyes was determined for both lotrafilcon B color and lotrafilcon B at Day 14 and Day 28. Same fit was defined as an eye that achieved an acceptable or optimal overall lens fit with the study lens that was also within one grade of the value observed on the same eye with the habitual lotrafilcon B lens. Results: Lotrafilcon B and lotrafilcon B color are comparable in terms of lens material, plasma surface treatment, blister pack solution, base curve (8.6mm), diameter (14.2mm), center thickness (0.08mm at -3.00D), Dk/t (136 at -3.00D), water content (33%) and available powers (lotrafilcon B color includes plano power). The lotrafilcon B color lens incorporates 3 layers of ink encapsulated within the silicone material near the back surface of the lens. 251 subjects were evaluated in this study. Overall, 99.2% of subjects had the “same fit” at both visits with lotrafilcon b color lenses compared to habitual lenses; while 100% of subjects at Day 14 and 99.2% of subjects at Day 28 had the same fit with lotrafilcon B test lenses compared to habitual lenses. 99% of lotrafilcon B color lenses and 100% of lotrafilcon B lenses had acceptable centration at both visits. 6 Poster 10 preference of 4 to 1 over habitual SiHy lenses when using computers for long hours. Clinical Performance of Bausch + Lomb Ultra™ with MoistureSeal™ technology silicone hydrogel contact lenses Poster 11 GP Wearers’ Comfort and Cleaning Experiences with Two Hydrogen Peroxide Solutions CL - Contact Lens Mohinder Merchea, OD, PhD Bausch + Lomb 1400 N Goodman St. Rochester, New York 14609 CL - Contact Lens Jeffery Schafer, OD, MS Bausch + Lomb 1400 N. Goodman St Rochester, New York 14609 Additional Author(s): Robert Steffen, OD, MS, Dan Hook Physical and surface chemistry properties can have significant impact on end of day comfort. Although there have been some improvements in silicone hydrogel (SiHy) materials, contact lenses are rarely as comfortable at the end of the day versus the beginning. A proprietary combination of formulation and manufacturing process, was used to create a novel silicone hydrogel contact lens (samfilcon A) with very high concentrations of PVP (a humectant) and with low modulus, high wettability, low COF and high Dk/t. This unique combination of chemical and physical properties was hypothesized to improve comfort over currently marketed SiHy lenses. The purpose of this study was to evaluate patient satisfaction with samfilcon A contact lenses. Subjects currently wearing Acuvue Oasys (AO), Air Optix Aqua (OA), and Biofinity (B) contact lenses were enrolled in a 2-week daily wear study. Subjects were fitted with Bausch + Lomb Ultra (samfilcon A) contact lenses and used Biotrue multi-purpose solution. Subjects were instructed to complete an Internet-based questionnaire after 7 days of use of the novel SiHy lenses to assess satisfaction and preference using a standard agree/disagree 6-point scale. Twenty-two clinical sites enrolled 327 subjects who completed the Internet based satisfaction questionnaire. Overall comfort of the Bausch + Lomb Ultra was preferred 3 to 1 and comfort throughout the day preference was reported as 3 to 1, over all habitual SiHy lenses. Subjects reported that Bausch + Lomb Ultra was as comfortable at the end of the day versus the beginning of the day with a preference of 3 to 1 over habitual SiHy lenses. Eyes feeling moist throughout the day was also preferred 3 to 1 over habitual SiHy lenses. Subjects reported a comfort Additional Author(s): Robert Steffen, OD, MS A resurgence of gas permeable (GP) contact lens fitting has resulted in hydrogen peroxide-based lens care regimens being recommended more often for cleaning and disinfection of these lens types. Some peroxide-based product formulations contain surfactants that act as cleaning agents and also help retain moisture on some lenses, and thereby may enhance comfort. The purpose of this analysis was to compare two hydrogen peroxide solution regimens with respect to GP wearers’ subjective comfort and cleaning experiences. Thirty-three habitual GP lens wearers participated in a three month study to evaluate the safety and efficacy of PeroxiClear, a novel one-step hydrogen peroxide solution. Subjects were randomly assigned to receive either PeroxiClear or Clear Care solution regimen. All subjects were dispensed a new pair of their habitual GP lenses, and were to wear their study lenses and use their assigned care regimen on a daily basis for three months. Comfort and cleaning related symptoms/complaints were recorded for four scheduled follow-up visits: 2-weeks, 1-month, 2-month and 3-month. Symptoms/complaints scores were captured on a scale from 0 to 100, with 100 being the most favorable score. Statistical analysis was based on comparisons of means and employed two-sided t-tests. For all comfort and cleaning related symptoms/ complaints scores at each follow-up visit and overall, PeroxiClear was either superior or non-inferior to Clear Care in every category. Statistically significant differences (p<0.05) over all follow-up visits were found in favor of PeroxiClear for Overall Comfort, Comfort at End of Day, [Less] Burning/Stinging on Insertion, and [Less] Dryness. For the final 3-Month 7 follow-up visit, statistically significant differences were found in favor of PeroxiClear for Comfort at End of Day, [Less] Burning/Stinging on Insertion, [Less] Dryness, [Less] Itchiness, and Lens Cleanness upon Removal. lenses cleaned using Clear Care was 241.6 and 239.3, respectively (p=0.011). Average percent surface coverage of the lenses was calculated to be 8.0% when cleaned using PeroxiClear and 33.0% when using Clear Care. Poster 12 Poster 13 In vitro Cleaning Studies of One-Step Hydrogen Peroxide Systems Ocular comfort and dryness during 4 weeks of toric silicone hydrogel contact lens wear CL - Contact Lens CL - Contact Lens Kimberly Millard, MS Institution 1400 North Goodman Street Rochester, New York 14609 Gary Orsborn, OD, MS, FAAO, FBCLA CooperVision 370 Woodcliff Drive Fairport, New York 14450 Additional Author(s): Jeffrey Schafer, OD, MS, Robert Steffen, OD, MS Additional Author(s): Robert Montés-Micó, OD, MPhil, PhD, Santiago García-Lázaro, OD, MSc, PhD, Teresa Ferrer-Blasco, OD, MSc, PhD, César Albarrán-Diego, OD, BScStats, MSc A recent clinical evaluation of Bausch + Lomb PeroxiClear, a novel hydrogen peroxide system and a currently marketed hydrogen peroxide system indicated high levels of patient satisfaction with PeroxiClear. This study compared cleaning efficacy of these two systems using an in vitro deposition model to support these clinical findings. Senofilcon A lenses were deposited in vitro with a combination of lipids and proteins commonly found in the tear film. The lenses were soaked in the deposition solution at 37ºC overnight, followed by a cleaning with both test systems. A total of 14 cycles was completed simulating 2 weeks of daily wear and daily cleaning. The cleaning regimen for Peroxiclear one-step hydrogen peroxide disinfecting system included a 5 second rise per lens with solution followed by neutralization of the hydrogen peroxide via a novel lens case containing a platinum coated disk. The manufacturer’s suggested regimen was followed for Clear Care with its companion case. Total deposits and percent coverage of lens surface were evaluated after 14 cycles using computer enhanced image analysis. An image of each lens was converted to mean grey scale with a higher value representing less total deposits. Percent coverage of the deposited lens surface was calculated. The mean grey scale value (MGSV) determined by image analysis revealed a statistically significant difference between senofilcon A lenses subjected to cleaning using PeroxiClear one-step hydrogen peroxide disinfecting system compared to Clear Care. The MGSV of lenses cleaned using PeroxiClear and The aim of this study was to investigate differences in comfort and dryness sensation between comfilcon A toric (CA) and lotrafilcon B toric (LB) silicone hydrogel contact lenses over 4 weeks of daily wear, using a subjective questionnaire. Sixty patients with low to moderate astigmatism (from 0.75D to 2.25D) were enrolled in a patient masked, open label, randomized, bilateral, crossover study comparing CA toric and the LB toric lenses. Each subject was randomized to wear one lens or the other for 4 weeks of daily wear before repeating the schedule for the second pair without a washout period. Patients were asked about comfort and dryness during 4 days over a 4 week period (days 3, 7, 13 and 27) and at different wearing times within each of those days (on insertion and at 4, 8 and 12 hours of wearing) using a 0-10 scale (0 very poor and 10 excellent). All patients wore the lenses a minimum of 12-hours a day and 7-days a week. For each of the lenses separately, there were no differences in comfort during days 3, 7 and 13, but there was a statistically significant decrease in comfort and increase in dryness sensations the last tested day (27) compared to the other days (ANOVA, p<0.001). After 4 hours on each of the tested days, comfort decreased in the same way for both lenses (ANOVA, p<0.001). Comfort ratings were higher (better) and dryness sensation was lower (better) for 8 the CA toric for each of the tested days and each of the tested hours during the day (ANOVA, p<0.001). Dk/t of 163 barrers and CoF of 0.03 (static) and 0.07 (slow kinetic). Poster 14 Poster 15 MoistureSeal: The design of a new silicone hydrogel material that works in unison with a new manufacturing process PVP Content of a Silicone Hydrogel Material with Dual Phase Polymerization Processing CL - Contact Lens CL - Contact Lens Andrew Hoteling, Ph.D. Bausch and Lomb, Inc. 1400 N. Goodman St. Rochester, New York 14609 Daniel Hook, Ph.D. Bausch + Lomb 1400 North Goodman Street Rochester, New York 14609 Additional Author(s): William Nichols, Patricia Harmon, Daniel Hook, Ivan Nunez Additional Author(s): Andrew Hoteling, Ph.D., Ivan Nuñez, Ph.D., Joseph McGee, M.S., Joseph Hoff, M.S. Polyvinylpyrrolidone (PVP) is a desirable component of contact lenses due to its water attracting properties. In-situ formation of PVP was used in a new silicone hydrogel lens material, samfilcon A, which was designed to polymerize in two time-resolved phases initially creating a silicone network followed by the creation of high molecular weight PVP. This reaction sequence allowed for the formation of a silicone matrix (with high Dk/t and low bulk modulus) and a separate PVP phase that drives high water content, exceptional surface wettability and low coefficient of friction. The extractable PVP measurements were based on an extraction with isopropanol followed by quantitation with high temperature Atmospheric Pressure Chemical Ionization (APCI) high resolution/ accurate mass (HR/AM) mass spectrometry. Unworn and worn (30 days) lenses were analyzed to evaluate the retention of PVP in the lens during wear. Bulk PVP content was measured using an off-line tube furnace connected to a cold trap to directly pyrolyze cryo-ground lens material. Unworn samfilcon A and senofilcon A lenses were analyzed to determine the total PVP content. For lens extracts, the APCI technique provides a limit of quantitation < 0.1 ppm and R2= 0.999+. The total variance including patient-to-patient variance was 11.3% CV and 5.1% CV for controls. No statistical difference in PVP concentration was observed between worn and unworn samfilcon A lenses. The bulk measurement technique was calibrated using PVP standards to determine the weight percent PVP in lens materials. The technique demonstrated the capability to differentiate lenses of know differences in PVP content. Detection limits A new silicone hydrogel lens material, samfilcon A, was designed to polymerize in two time resolved phases. This reaction sequence in combination with a newly created manufacturing platform allows for the formation of a silicone matrix (with high Dk/t and low bulk modulus) and a separate PVP phase that drives high water content, exceptional surface wettability and low coefficient of friction. The two phase reaction of samfilcon A was monitored using Photo Differential Scanning Calorimetry (Photo-DSC), Gas Chromatography with a Flame Ionization Detector (GC-FID), and high resolution/ accurate mass (HR/AM) Liquid ChromatographyMass Spectrometry (LC-MS). Water content was determined using a gravimetric procedure while modulus was measured using ASTM method 1708. Modulus and % water were collected on 30 lenses. Dk/t (oxygen transmissibility) was calculated using the polarographic technique outlined in ANSI Z80.20:2010 and the mean central thickness on 4 lots of lenses, each of different thickness. Coefficient of friction was measured on 10 lenses per lens type using a highly controlled shear rheometer operated at 0.052N of force to simulate eyelid pressure. Photo-DSC exotherms demonstrate two distinct phases of polymerization for samfilcon A. Phase 1 initiates at 1 min with an exotherm of 0.5W/g while phase 2 initiates at 8.5 minutes with an exotherm of 0.68W/g. GC-FID and LC-MS demonstrate consumption of silicone monomers corresponding to phase 1, and NVP to PVP conversion corresponding to the phase 2. Physical properties of samfilcon A are a mean modulus of 70 g/mm2, water content of 46%, 9 are less than 1 ppm of PVP and exhibit variances ranging from 2.5 to 5.5 % CV. Substantially more PVP was observed in the samfilcon A lens material than observed in senofilcon A lens material, as expected based on in-situ formation of PVP. mOsms/L. Subjective measurements of comfort gained 26% and 38.4% in the afternoon and evening with no change in the am. The subjective visual acuity improved after 1 month at 13.9%, 22%, and 22.3% from morning, afternoon to evening perceptions. The administration of the OSDI at baseline was an average of 27.6 and at the 1-month mark it was reduced 41.8% to 16.04. A tear break up time in the occluded eyes was increased 2 seconds (7.2 to 9.2) and the control eyes had a reduction in TBUT of .2 seconds (8.35 to 8.15 seconds). A sodium fluorescein (NaFL) stain was applied to cornea and an average grading score of 2.4 to the occluded eyes and at the 1-month grade of 0.75, 68.8% reduction. The control NaFL staining had an average increase of 13% (2.35 to 2.7) A conjunctival stain, lissamine green, had similar average changes with the occluded eyes reducing staining by 37.5% and the average stain of the control increased by 25%. Conclusion: The use of a punctal plug in contact lens patients resulted in a reduction in all aspects of ocular surface disease. The occluded eyes had subjective improvement in comfort (OSDI, patient survey) as well as objective improvement in the dry eye testing. Most notable was the 43% of eyes that gained lines of visual acuity. This study demonstrates that punctal plugs can help keep patients in their contacts longer and improve visual acuity. Poster 16 Lacrimal punctum occlusion in soft contact lens patients for increased comfort and improved visual acuity CL - Contact Lens Marc Bloomenstein, OD Schwartz Laser Eye Center 5101 E Calavar Rd Scottsdale, Arizona 85254 Purpose: The ocular surface is critical for the visual acuity and comfort of soft contact lenses. A controlled uniocular study evaluated the shortterm efficacy of lacrimal puntcal occlusion for the improvement in vision, OSDI, osmolarity and comfort in a soft contact lens cohort. Methods: Uniocular punctum occlusion (Parasol, Odyssey Medical) by punctum in the lower lid in 1 eye was performed on (N=50) patients who wear contact lenses. To overcome possible interindividual variability between patients, the other eye, in the same patient, was not occluded and served as a control eye. The eye to be occluded was randomly selected and patients returned in 30 days. Objective measurement of visual acuity, osmolarity, corneal staining and conjunctival staining were obtained. Subjective analysis of the patients was evaluated by a questionnaire regarding the comfort of the lens throughout the day, as well as the perceived visual acuity. The administration of the OSDI was utilized for further subjective analysis. Patients were instructed to continue cleaning their contacts and using there dry eye regiments. Results: 1 month after baseline testing and continuation of normal contact lens related treatment 33% of the eyes, with a punctal occlusion gained 1 line of acuity, 5% gained 2 lines and 5% gained 3 lines; while no eyes lost any lines of acuity. The control group had 9.3% of eyes gain a line of acuity, with 19% losing 1 line of acuity and 5 % losing 2 lines of acuity. The osmolarity on average in the occluded eyes was reduced by 17.2 mOsms/L and the control group had an average reduction of 0.25 Poster 17 Non-physiologic visual field loss with mild TBI: a case of malingering LV - Low Vision/Vision Impairment & Rehabilitation Muriel M. Ferreira, OD UHCO 4901 Calhoun Rd Houston, Texas 77204 Additional Author(s): Suzanne Wickum, OD, FAAO Malingering is a purposeful deception performed in order to obtain a reward. In adults such rewards include, but are not limited to: drugs, disability benefits, and evading incarceration. Malingering can lead to abuse of the medical system, with unnecessary tests being performed and time being wasted by clinicians. A study by Halligan et.al. found that 37% of physicians reported their patients 10 Poster 18 ‘sometimes, often or very often’ asked them to deceive health care payers. A 46 year old Hispanic male had previously been diagnosed with “optic nerve and visual pathway disorder” two years after he suffered a “mild complicated traumatic brain injury” secondary to a small explosion. The patient had been on disability for 4 years and claimed to have bilateral 360 degree field constriction with only 5-10 degrees of central vision. Aided distance visual acuities were 20/20 in each eye and 20/30 at near. Binocular vision was intact, EOMs were normal, pupils were equal, round and reactive to light with no APD, IOPs were normal, and all other external and internal ocular health findings (including ONH OCT) were normal. Prior VEP and ERG findings were normal. Humphrey 30-2 threshold visual field testing was inconsistent with complete loss of the visual field in each eye indicative of total blindness. Tangent screen visual field testing was administered under two settings: 1. Best corrected monocular fields tested at 1 meter, and 2. Best corrected monocular fields tested at 1 meter with a 2.2x reverse telescope. When used in the reverse setting the telescope minifies objects in our field of vision thus expanding the field by 2.2x. The results acquired under the first setting were consistent with those found at previous examinations: constriction of the visual field to <5 degrees. The results acquired under the second setting showed a 5-6 times increase in the claimed visual field, much greater improvement than expected. These results were implausible and support a diagnosis of malingering. It is important for health care practitioners to be proficient in the evaluation of suspected malingerers in order to prevent financial or other gain for those who are undeserving. Creative way to use filters for relief of extreme photosensitivity post central retinal artery occlusion LV - Low Vision/Vision Impairment & Rehabilitation Negin Nikahd, Ph.D Southern California College of Optometry The Center for the Partially Sighted 4735 Sepulveda Blvd. #227 Sherman Oaks, California 91403 Additional Author(s): Tina MacDonald, OD 81 year old Caucasian male presented to the Center for the Partially Sighted for a low vision evaluation. His chief complaint was extreme photophobia in both eyes. Past ocular history was positive for central retinal artery occlusion in the right eye. He complained of extreme “migraine-like” pain when attempting to use his vision in any way. Previous eye doctors have advised him to patch his right eye; however the patient stated that he could still not perform tasks such as watching television or reading for longer than 10 minutes. Patient’s best corrected visual acuity (BCVA) in the right eye was hand motion and 20/30 in the left eye. Initially, the patient was prescribed a black out lens for the right eye and a yellow polarized tint for the left eye using a Cocoons frame. The patient returned stating that he did achieve relief with the new lenses; however he did not like the cosmetic appearance, especially in social settings. The use of a wraparound Nike frame with a gray tint in the right eye and 527 CPF match tint in the left eye produced relief of photosensitivity as well as the desired comfort and cosmesis. Use of different color filters for relief of extreme photosensitivity should be attempted as the cause of photosensitivity in each eye might be different. 11 Poster 19 Poster 20 Assessment of Choroidal Morphologic Features and Vasculature in Healthy Saudi Adults Eyelash Resection Surgery for the Treatment of Chronic Trichiasis Secondary to StevensJohnson Syndrome OD - Ocular Disease OD - Ocular Disease Haya AlFarhan, Ph.D King Saud University Department of Optometry KSU P.O. Box 10219 Riyadh 11433, KSA. Riyadh, Pennsylvania 11433 Erika Anderson, OD Chinle Hospital, Navajo Area Indian Health Services PO Box 2661 Chinle, Arizona 86503 Additional Author(s): Lulwah Ahmed ALShibel, BA Additional Author(s): Christian Thompson, OD Stevens-Johnson Syndrome (SJS) is a rare, self-limiting, immune-mediated disorder of the skin and mucous membranes that is triggered by a reaction to a medication, and rarely secondary to a Mycoplasma pneumoniae infection. In many cases it can manifest in ocular tissues. In its early stages it may cause ulceration of the lids, conjunctivitis, pseudomembrane formation, and rarely iritis. In its late stages it can cause cicatricial entropion which can lead to ocular disease such as exposure keratitis and trichiasis. Treatment for the ocular manifestations of this disease can range from ocular lubrication to surgical intervention. This is a case report of a 67-year old, Navajo female who presented with cicatrical entropion and trichiasis. The patient had suffered from the sequelae of SJS for over 50 years following treatment for an eye infection as a teenager, in which, a sulfonamide was used. She had undergone prior eyelid surgeries and eyelash electrolysis for treatment of the condition, but continued to have ongoing trichiasis and corneal scarring of the right eye. She presented to our clinic for eyelash epilation weekly for several months. For a more definitive treatment the patient was sent to an oculoplastic surgeon with the suggestion of eyelash resection surgery of the right eye. In cases of patients suffering from chronic cicatricial entropion and trichiasis complete eyelash surgical resection proves to be a better surgical option than entropion repair alone. This procedure eliminates the potential for recurring trichiasis by eliminating the causative agent. Practitioners should consider this procedure for treatment of chronic trichiasis to eliminate the need for multiple clinical The aim of this study to assist choroid morphological parameters and vascularization in normal healthy young adult Saudi eyes using Spectral OptosOCT SLO. Methods In this prospective study, one eye was selected from each of 110 subjects for the assessments and measurements of choroid morphological parameters and vascularization. One examiner performed these functions and images were assessed subjectively by one experienced rater. Results were statistically analyzed using Paired t-test, correlation coefficient, and regression. Results All the images show normal foveal contour with no retinal pathology or abnormalities of the choroid. The choroid is thickest subfoveally than 750μm nasally and 750μm temporally. The results of paired t test between the age groups show statistically significant difference (p < 0.001). The regression analysis indicated that there is strong negative correlation between age and SFCT (r = -0.815, P < 0.01), and SFCT decreased by 5.53μm each year. The regression analysis indicated very weak correlation between refractive error and SFCT (r = 0.076, P < 0.214). The comparison result of paired t test between the male and female groups show statistically significant difference (p = 0.02), and the SFCT of the females was thicker than males. The choroid is thickest subfoveally than 750μm nasally and 750μm temporally. A strong negative correlation between age and SFCT, and the SFCT of the females is thicker than males. 12 visits, several surgical procedures, and to improve patient satisfaction status post surgery. Muriel Schornack, OD Mayo Clinic 1403 City View Court NE Rochester, Minnesota 55906 that is not yet well-described in the literature. It is currently thought to occur when a central defect develops within an ERM, which weakens that area. Compression of photoreceptors, along with mild macular edema, results in an anteriorly directed force posterior to the membrane. Tractional forces generated by the ERM itself compound this force, and may eventually rupture the defect, allowing foveal tissue to herniate. Clinical appearance of this condition is similar to an early macular hole or pseudohole. OCT allows for definitive diagnosis and prompt intervention. Additional Author(s): Alaina Softing Hataye, OD Poster 22 Ocular coherence tomography (OCT) allows us to visualize disturbances of retinal architecture in much greater detail than was possible without this technology, and allows us to differentiate between conditions that would have similar clinical appearance. We describe a case of foveal herniation through an epiretinal membrane (ERM). Its diagnosis is facilitated by examination of macular OCT. A 61 year old Caucasian male reported blurred vision without metamorphopsia OD, along with relative magnification OD. Symptoms had worsened over several months. Ocular history was unremarkable. Medical history included hyperlipidemia and basal cell carcinoma, but was otherwise unremarkable. Best corrected visual acuity was 20/40-2 OD, 20/20 OS. Cover test, motilities, pupillary reaction and confrontation fields were normal. Amsler grid was positive for mild distortion OD only. Goldmann tonometry measured intraocular pressure at 11 OD, 13 OS. Dilated fundus examination revealed an epiretinal membrane (ERM) with vitreoretinal traction and straightening of macular vasculature OD, with no abnormalities OS. OCT confirmed a significant ERM OD, along with tractional retinoschisis, mild cystoid edema and foveal herniation through the center of the ERM. OCT OS showed normal retinal architecture. Fluorescein angiography OD showed mild late phase cystoid macular edema and straightening of macular vessels and no abnormalities OS. Pars plana vitrectomy with an uncomplicated ERM peel was performed OD. On post op day #39, the patient reported slow resolution of symptoms, visual acuity was 20/20 OD and the OCT revealed normalization of the foveal contour with no recurrence of the ERM. Foveal herniation through an ERM is a condition The Utilization of the Visante OCT in the Management of Acute Corneal Hydrops Poster 21 Epiretinal Membrane with Foveal Herniation OD - Ocular Disease OD - Ocular Disease Hillary B. Schweihs, OD Illinois College of Optometry 3241 S. Michigan Ave Chicago, Illinois 60616 Additional Author(s): Jennifer S. Harthan, OD, FAAO Corneal hydrops is a rare but potentially visually significant complication of keratoconus. An acute rupture of Decement’s membrane occurs, leading to stromal edema and loss of corneal transparency. Patients present clinically with a varying degree in severity of symptoms making the diagnosis challenging to make in some cases. The utilization of the Visante OCT can assist the practioner in the diagnosis and management of these complex cases. A 48-year-old African American female presented with complaints of acute vision loss, redness, tearing, and photophobia in her right eye. Her medical history is significant for hypertension and hyperlipidemia. The patient had no history of eye rubbing or atopic disease. Ocular history was positive for keratoconus. Entering vision without correction was CF@ 1 foot in the right eye, pinhole no improvement. Corrected vision in the left eye through a Rose K contact lens was 20/30.. Biomicroscopy evaluation of the right eye revealed 1+conjunctival injection and a 5mm central edematous cornea with few scattered bullae. Secondary to the edema, a break in Descemet’s was difficult to appreciate. Anterior segment OCT confirmed a central Decement’s membrane rupture. Left eye findings showed central corneal thinning 13 with stromal scarring and Decement’s folds. The patient was started on atropine 1% QD, moxeza QID, muro 128 solution QID, and preservative-free artificial tears every hour while awake. The patient was monitored closely over the course of three months and resolution was noted with Visante OCT. Acute corneal hydrops occurs in less than three percent of keratoconic patients. Although the condition is rare, the acute vision loss is significant for the patient. Repair of Decement’s break and resolution of edema typically occurs within two to four months, however residual stromal scarring will occur in its place. Treatment of acute hydrops focuses on reducing patient discomfort, preventing further complications and decreasing stromal edema. Management of these patients is often difficult as the secondary corneal edema often obscures the Descemet’s break. The Visante OCT is a noninvasive procedures that provides high-resolution anterior segment images of these complications and assists the practitioner in the diagnosis and management of these conditions. The second case presentation in the series is a 27 year old African American female who presented to the clinic post-blunt trauma OD 2 days prior. She refused to provide details behind the injury and reported 9/10 pain, with visual acuity of counting fingers at 2’ OD. Hyphema was noted along with corneal edema, chemosis, anterior chamber fibrin, and subconjunctival hemorrhage. She was monitored closely through several follow-ups including retinal consult for vitreous hemorrhage and open globe that had self-sealed. She was also referred for cataract extraction due to subsequent development of traumatic cataract. Included in this multimedia poster are various anterior segment photographs, ophthalmic ultrasounds, radiology scans, surgical notes, ultimate patient outcomes, and a review of evaluation and management options for ocular trauma. Poster 24 A Presentation of Ocular Ischemic Syndrome. Poster 23 OD - Ocular Disease Moderate-to-Severe Orbital Trauma: 2 Case Reports and a Review of Evaluation & Management Considerations Reena Lepine, OD Southern College of Optometry 535 N Jefferson Pl. Apt 6 Memphis, Tennessee 38105 OD - Ocular Disease Additional Author(s): Joanne Smith, OD Addie Smith, OD Family Practice Residency through Southern College of Optometry 60007 West Way Dr. Amite, Louisiana 70422 Ocular ischemic syndrome (OIS) results from chronic hypoperfusion that leads to ischemia of the entire eye. It is usually secondary to at least a 90% stenosis of the ipsilateral carotid artery. OIS is a rare condition that maybe misdiagnosed due to its subtle presentation in some patients. The ultimate treatment is to manage the underlying cause to prevent further complications. The mortality rate for patients with OIS is 40% at five years, and the two leading causes of death are cardiovascular disease and cerebral infarction. Furthermore, the visual prognosis can be devastating. With such drastic potential outcomes, early diagnosis is necessary for the best possible systemic and ocular results. A 55 year old female patient came into the clinic with a complaint of a throbbing left eye with indistinct vision for a week. She has a history of hypertension and smokes daily. Her best corrected visual acuity was 20/20 OD and OS. Pupils were equal, round, and reactive with Additional Author(s): Chris Wroten, OD This poster presents two different cases of orbital trauma, both of which led to surgical intervention. The first case involves a 39 year old African American male who presented to clinic after being elbowed in the left eye during a basketball game four days prior. He reported with 6/10 pain that increased in extreme left gaze, visual acuity of 20/20 OS, and no afferent pupillary defect. He displayed extreme ecchymosis and a subconjunctival hemorrhage OS, but retina remained flat and intact. Subsequent CT revealed a left medial wall fracture with no muscle entrapment, and the patient was referred to oculoplastics for a surgical consult. 14 no afferent pupillary defect. Extraocular motilities and confrontation visual fields showed normal results. Intraocular pressures measured at 16 mmHg OD and 14 mmHg OS. Anterior segment findings of the left eye revealed dilated episcleral vessels and engorged iris vessels. The posterior segment showed mid-peripheral hemorrhages with dilated veins and narrowed arteries in the left eye. An OIS diagnosis was confirmed by intravenous fluorescein angiography (IVFA) which showed delayed choroidal and arteriole venous filling, diffuse vascular leakage, and peripheral capillary non-perfusion. Doppler carotid ultrasound and CT angiography revealed a 95% stenosis of the left internal carotid artery. The patient is currently on medical therapy and being monitored. A carotid endarterectomy is recommended after resolution of her concurrent thrombocytopenia. This case stresses the importance of a proper diagnosis in a presentation of OIS in order to prevent severe ocular and systemic consequences. It addresses the signs, diagnostic testing, and treatments of OIS. Images include IVFA, anterior segment photography, and fundus photography. 73 y/o Caucasian male presented for a comprehensive eye exam. Ocular health history included cataracts and pseudoexfoliative glaucoma controlled with latanoprost. The patient’s last IOP check was three months prior. Recent medical history indicated the patient was hospitalized for pneumonia and suffered a fall with subsequent internal bleeding. Entrance testing revealed new onset anisocoria and external examination revealed ptosis of right upper lid but he denied anhidrosis. All other cranial nerve testing was normal. Although apraclonidine use did not produce reversal of anisocoria, the affected pupil dilated 1mm while the unaffected pupil did not dilate, which supports the diagnosis of HS. Subsequent imaging revealed pulmonary nodules of the right upper lobe that were metabolically inactive and not impinging on the sympathetic chain. MRI of the neck and thoracic spine revealed bilateral severe neuroforaminal stenosis at C2-C6 which is the probable cause of the new onset of HS. New onset of Horner Syndrome can present with the clinical triad of ptosis, miosis and facial anhidrosis; however, these signs do not always present equivocally. The use of 0.5% apraclonidine has at least the same sensitivity and specificity as the cocaine test for diagnosis of HS. Given its wide availability, it is important for primary eye care providers to employ apraclonidine in the diagnosis of new onset Horner Syndrome. Poster 25 Apraclonidine in the diagnosis of a new onset Horner OD - Ocular Disease Poster 26 Anna L.O. Moore, OD Southern Arizona VA Healthcare System, Marshall B. Ketchum, Southern California College of Optometry 5470 Waco Dr. Sierra Vista, Arizona 85635 Delayed Onset Reversible Bilateral Corneal Edema From Amantadine OD - Ocular Disease Neal K Shastri, OD Seidenberg Protzko Eye Associates Additional Author(s): Danielle. L. Weiler, OD Additional Author(s): Scott Smearman, OD The use of apraclonidine in the diagnosis of Horner Syndrome (HS) as an alternative to cocaine and hydroxyamphetamine is well documented. Loss of sympathetic innervation in HS leads to the upregulation of alpha-1 receptors in uveal tissue. In this sensitive state, apraclonidine can cause mydriasis. Although the use of apraclonidine in the diagnosis of HS is supported, the time frame between onset and reliable use of apraclonidine for diagnosis has not been determined. This case provides support for the use of apraclonidine in the diagnosis of Horner Syndrome within three months of onset Amantadine is an antiviral drug approved to treat influenza A, Parkinson’s disease, and certain movement disorders, and used off-label to treat chronic fatigue in patients with multiple sclerosis (MS). Listed in the product label are rare corneal side effects of punctate subepithelial opacities with superficial punctate keratitis, corneal epithelial edema, and reduced visual acuity. Although an occasional patient developing bilateral corneal edema 15 from amantadine has been reported, we describe an unusual case of bilateral corneal edema after three years of continuous use of amantidine at 100mg PO BID, that dramatically responded to stoppage of amantadine. A 53 year old female patient with MS, on Amantadine and Gilenya, presented with three weeks of gradual blurred vision in her left eye. Upon examination, her BCVA was 20/40 and 20/70. Externals were unremarkable. Angles were open. IOPs were 15 and 16 respectively. Slit lamp examination was unremarkable OD , and revealed diffuse stromal corneal edema with descemet’s folds OS. There was no evidence of epithelial abnormality, guttata, or uveitis OU. Dilated fundus exam and OCT of the optic nerves/maculae were also unremarkable. She was treated with muro-128 drops QID OS and Lotemax QID OS. On two week follow up, her BCVA was 20/70 and 20/80. Slit lamp exam showed corneal edema OS>OD with descemets folds OU. Pachymetry was 774 and 741. After a discussion with her neurologist, amantadine was discontinued. One month later, her vision improved. BCVA was 20/30+2 OU. Corneas showed minimal edema, and pachymetry was 551 and 600. Corneal edema is associated with herpes keratitis, corneal dystrophy, or post-surgical endothelial dysfunction. Without these conditions, toxic insult should be considered in the differential diagnosis. We presented this case to alert clinicians about amantadine induced corneal edema, since high index of suspicion and a careful medication history is required for correct diagnosis; it can occur after a long duration of treatment, and might be reversible. Early recognition and stoppage of amantadine may prevent severe endothelial cell loss, and potentially irreversible corneal edema. diagnosed with Iridocorneal Endothelial syndrome with secondary angle closure glaucoma. Early diagnosis and treatment may have prevented severely restricted peripheral fields. Case Presentation: 57 year-old white female presented with progressively blurring vision in her left eye over the past 6 months. Medical Hx: heart disease, HTN, hypercholesteremia, anxiety Medications: exforge, nexium, aspirin, vytorin, celebrex, metoprolol, and xanax Fm Hx: Glaucoma-sister Ocular Hx: None BCVAs: 20/20 OD, OS Pupils: OD: WNL OS: irregular, poor reactivity, APD by reverse CF: OD: WNL OS: peripheral constriction Anterior segment: OD: WNL OS: beaten metal appearance on corneal endothelium iris: ectropion uveae, atrophy with TI defects and high PAS at 5 o’clock IOP: OD: 22 OS: 57 C/D OD: .6/.6 OS: .85/.8 thinning inferiorly/ nasally, deep/excavated cup Peripheral retina and Macula: WNL OD, OS Gonioscopy OS: multiple areas of high PAS extending past Schwalbe’s line Specular microscopy: OD: normal endothelial size/ count OS: pleomorphism and polymorphism, light/ dark reversal OCT: OD: healthy NFL OS: significant thinning inferiorly and superiorly VF: OD: WNL OS: dense superior arcuate and inferior nasal step defect Ddx: ICE syndrome, Axenfeld-Reiger Syndrome, aniridia, PPMD Diagnoses and treatment: Based on clinical exam and specular microscopy she was diagnosed with ICE syndrome causing severe secondary glaucoma. She was started on Combigan BID, Azopt TID, Travatan qhs OS and referred to a glaucoma specialist. Trabeculectomy was performed and pressures equalized to 7. Discussion: ICE syndromes are rare, usually unilateral, and occur in young-middle aged patients. Corneal endothelial cells are replaced with epithelial-like cells with migratory characteristics. These ICE cells can lead to corneal edema, iris changes/atrophy, and secondary angle closure glaucoma. Specular microscopy is an important diagnostic tool showing asymmetric cells loss and atypical cell morphology: light/dark reversal. Fifty percent of ICE patients will develop glaucoma. ICE syndromes are an important differential diagnose in young/middle-aged patients who present with unilateral glaucoma, endothelial abnormalities, corneal decompensation and iris changes/atrophy. Regular eye exams are important to catch ICE syndromes before significant visual field loss occurs from secondary angle closure glaucoma. Poster 27 A Case of Unilateral Glaucoma -Iriodocorneal Endothelial Syndrome OD - Ocular Disease Julianne Jantzi, OD Seidenberg Protzko Eye Associates 1200 Brice Square Belcamp, Maryland 21017 Abstract: A 57 year-old white female with a chief complaint of blurry vision in her left eye was 16 Poster 28 Poster 29 Electrocution Cataracts Acute Retinal Pigment Epithelitis OD - Ocular Disease OD - Ocular Disease Roslyn Howell, OD Northeastern State University 3469 Southridge Place Tahlequah, Oklahoma 74464 Allissun Hoppert, OD Arizona College of Optometry 19555 N. 59th Ave Glendale, Arizona 85308 Cataracts can be caused by many things, including trauma, but we don’t typically think of them being caused by electrocution trauma. Even though we may not see cataracts caused by electrocution very often, they are a well documented effect of electrocution: usual onset being several months after the event. This case illustrates a classic example of electrocution cataracts. A 39 year old male presents with gradual onset blurred vision and glare, over the past 3 months. While working as a lineman, six months previous, he was electrocuted and lost his right arm, as well as having significant neck and facial scarring. Best corrected visual acuities were 20/40 OD and OS. On examination 3-4+ cortical cataracts were found in both eyes with no other ocular health abnormalities. It is assumed that these cataracts are related to the electrocution event, due to the patient’s young age and the appearance of the cataracts. The cataracts were completely cortical with no nuclear sclerosis or posterior subcapsular component. The patient was referred for cataract surgery. Cataracts are a fairly common outcome after a high voltage electric shock. Patients should be screened several months after the event. Cataract surgery is no more risky in these patients then it is for patients with age related cataracts. Additional Author(s): Wendy Harrison, OD, PhD, FAAO Acute Retinal Pigment Epithelitis is an uncommon, self-limiting condition that tends to affect young healthy adults. It is characterized by blurred vision and often a central scotoma. Although cases have been well documented in the literature, the etiology is still unknown. AF, a 23 year old female medical student presented to clinic as an urgent walk-in appointment after a dark gray hole had formed in the central vision of her left eye. The hole had remained constant in size over the last two days and was large enough to obstruct entire words on her computer monitor. The patient denied ocular pain and any history of ocular disease, surgeries, or trauma OU. Neither she, nor any family member had ever had similar symptoms in the past. Her systemic history was unremarkable except for a single bout of supraventricular tachycardia which she had experienced one month earlier a few hours after receiving the flu shot. The patient’s corrected entering visual acuities were 20/15 OD and 20/60-1 OS. Pupil testing, IOP’s and a slit lamp examination revealed no abnormalities OD, OS. The fundus exam unveiled a circular, well circumscribed hypopigmentation of the left macula. An OCT revealed a small focal foveal disruption at the level of the RPE and the photoreceptor layers with a small amount of overlying fluid. The patient was referred first to a retinal specialist for an evaluation and Fluorescein angiogram, and then for an ERG. The Fluorescein angiogram revealed inconclusive results. The full field ERG was normal OD, OS, but the multifocal ERG demonstrated a missing central hexagon with decreased amplitudes and normal timing OS. All tests failed to identify an exact diagnosis. Repeat OCT’s over the next few weeks showed no residual fluid and an improvement in the initial foveal disruption OS. One month later, the patient spontaneously regained 20/20 acuity 17 in her left eye and the central scotoma dissipated leaving only residual foveal scarring. Upon reviewing the clinical course of the disease, the patient was determined to have an Acute Retinal Pigment Epithelitis. neuritis. Early recognition is crucial in treating this condition. The discovery of aquaporin-4 autoantibodies has helped identify and differentiate NMO from other similar diseases. This case illustrates the importance of testing for NMO in cases of recurrent optic neuritis especially in the presence of normal MRI findings and concurrent autoimmune disease. Poster 30 Recurrent Optic Neuritis Leading to the Diagnosis of Neuromyelitis Optica Poster 31 OD - Ocular Disease Treatment of Gout Reactivates Herpes Simplex Keratitis George Hanna, OD Illinois College of Optometry 655 W Irving Park Rd #3705 Chicago, Illinois 60613 OD - Ocular Disease Mariem Abdou, OD The Pennsylvania College of Optometry 4040 Presidential Blvd #2409 Philadelphia, Pennsylvania 19131 Neuromyelitis optica (NMO) is an autoimmune demyelinating disease that targets astrocytes in the spinal cord and optic nerves. Patients often present with optic neuritis months, or years, before NMO is diagnosed. The most common ophthalmic presentation is a recurrent optic neuritis resulting in severe vision loss. A 31 year old African American Female presented to the emergency clinic at the Illinois Eye Institute in 2013. She reported sudden painful vision loss in the right eye. She had previously been diagnosed with optic neuritis in the left eye in 2010. Her medical history is remarkable for Systemic Lupus Erythematosus. Vision at this visit was 20/50 OD and 20/15 OS with an afferent pupillary defect, abnormal color vision and pain on eye movement in the right eye. The dilated fundus exam revealed moderate disc edema in the right eye and disc pallor in the left eye. An MRI of the brain and orbit showed only enhancement of the right optic nerve. The patient was seen four days later and vision had recovered to 20/30 OD. The patient presented about 4 weeks later with a complaint of painful vision loss in the left eye. Vision was 20/20 OD and NLP OS with an afferent pupillary defect OS. Dilated fundus exam revealed resolving disc edema OD and moderate disc edema OS. An MRI was repeated and showed only enhancement of the left optic nerve. Blood work was ordered including FTA-ABS, RPR, serum lysozyme, ACE and NMO IgG titer. The NMO IgG titer was positive. The patient was diagnosed with Neuromyelitis optica and was started on oral methotrexate. NMO is a rare condition that may be mistaken for other demyelinating diseases such as Multiple Sclerosis (MS) when the initial presentation is optic Additional Author(s): Andrew Gurwood, OD, FAAO, Diplomate, Optometry Herpes simplex is a double stranded DNA virus that is present in 60-95% of the world’s population. It is one of the leading causes of infectious corneal blindness. When an initial infection occurs, the virus travels retrograde through sensory nerves to the neural ganglia and remains latent until an immunocompromised state permits reactivation and the variable provocation of signs and symptoms. The literature recognizes increased stress, immunosuppression, trauma, nerve damage and systemic corticosteroid therapy as potential triggers. The use of topical or oral steroids provoke resurfacing of the virus via an immunosuppressive mechanism. A 57 year old Asian male presented with complaints of unilateral ocular pain and redness OS of 3 weeks duration. The ocular history was remarkable for an episode of herpes simplex keratitis with associated uveitis six months prior, successfully treated with topical and oral antivirals and a topical steroid. The systemic history was remarkable for gout, recently medicated with increased prednisone. The best corrected visual acuities were 20/20 at distance and near, both eyes. External examination was normal with no afferent defect. Biomicroscopy revealed a dendritic lesion in the left eye surrounded by stromal haze and diffuse punctate epithelial erosions in both eyes. A large stromal scar in the left eye was noted secondary to a previous HSV event. 18 The patient was prescribed Viroptic 1% nine times per day for one week and tapered to four times a day at the subsequent visit in conjunction with a topical steroid consistent with the recommendations of the Herpetic Eye Disease Study. Oral medications were also initiated to limit the risk of recurrences. Correspondence was sent to the medical team advising them of what had happened along with recommendations describing how additional events might be avoided. Topical or systemic steroids have the potential to induce reactivation of the herpes simplex virus. Ophthalmic and systemic practitioners should prescribe steroids with caution in patients who have a history of herpes simplex keratitis. Prophylactic oral antivirals should be considered for patients who require oral of topical steroid administration to reduce the likelihood of recurrence. hemorrhage superiorly, and a mass beneath the palpebral conjunctiva superiorly. Intraocular pressure by tonometry were 10 mmhg OD, 13 mmhg OS. Posterior segment evaluation was unremarkable for both eyes. Orbital CT scan with contrast revealed an enhancing superior left orbital mass causing mild infero-posterior displacement of the globe without obvious globe deformity. Orbital mass biopsy had no formal read, but flow cytometry revealed B-cell lymphoma. The patient subsequently underwent three weeks of radiotherapy without ocular or systemic complications. At the follow up examination, bestcorrected visual acuities were 20/20 OD, 20/20 OS. Extra-ocular muscles evaluation was smooth and unrestricted for both eyes. The left orbital subconjunctival lesion resolved and posterior segment evaluation was unremarkable for both eyes. The patient continued follow up visits with his radiation oncologist and will undergo further treatment if indicated. Through collaboration with colleagues and careful attention to clinical findings led to the proper diagnosis and management of the patient. Poster 32 “I think the ficus fig trees caused my eyelid to become droopy” OD - Ocular Disease Charlie Ngo, OD UC Berkeley School of Optometry 1919 Dwight Way #311 Berkeley, California 94704 Poster 33 A 68 year old Caucasian male initially presented the clinic with chief complaint of a new upper lid ptosis and vision changes to his left eye. He described that five weeks ago while in the Key West, his eyes were red the next day after trimming ficus fig trees. He started over-the-counter anti-histamine eye drops and Visine with little relief. One week later he noted that his left upper lid became droopy and has been stable since the initial presentation. The patient denies diplopia, eye pain, headaches, facial numbness, recent infection, injuries, and history of any cancer. The patient’s incoming visual acuity was 20/20 OD, 20/50 OS, pinhole improved to 20/20-2 OS. Distance cover test revealed a left hypotropia. Extraocular muscles evaluation of the left eye revealed grade 2- superior restriction. Confrontational visual fields and pupils were unremarkable with no afferent pupillary defect of both eyes. Hertel revealed mild asymmetry, 18 mm OD, 19 mm OS. Anterior segment evaluation of the left eye revealed 2-3 mm upper lid ptosis, diffuse subconjunctival OD - Ocular Disease Cystoid Macula Edema In a Diabetic Patient After Cataract Surgery: A Case Report Betty Harville, OD Southern College of Optometry 1245 Madison Ave. Memphis, Tennessee 38104 Additional Author(s): Leroy Norton, OD Cystoid Macula Edema is the most common complication and subsequent cause of decreased visual acuity after cataract surgery, especially in diabetic patients. Research suggests cataract surgery worsens macula edema in diabetic patients and may show progression of diabetic retinopathy. This is especially true for patients who undergo longer surgical procedures secondary to dense cataracts and those who have long standing diabetes. Management of diabetics includes pretreatment with non-steroidal anti-inflammatory drugs and steroids to decrease CME. Visual acuity and OCT can be utilized to monitor changes post-operatively to minimize poor outcomes. 19 An 86 year old female reported for an eye exam in May of 2013, with complaints of blurred vision OD, OS. The patient’s visual acuity was OD 20/40, OS 20/50 at distance and 20/30 OD, OS at near. No improvement with pinhole. Internal ocular examination showed 4+ nuclear sclerosis and anterior cortical cataracts OD, OS. Patient was positive for longstanding DM, HTN and arthritis. Medication included Lidoderm patch, Insulin 70/30, cilostazal and diltiazem. Patient was referred for cataract surgery July 2013 with follow-up performed at surgery center. Patient returned October 2013 with decreased VA OS. OCT showed CME OS with large cystic pockets. Visual acuity was reduced. Patient restarted on Pred Forte (steroid) and Prolensa (NSAID). OCT was repeated one month later with improvement noted. Two months later improvement continued, but not completely resolved. Patient was counseled on other treatment options especially intravitreal Avastin, but patient refused. Continue monitoring patient utilizing NSAID and steroid to reduce CME and improve the patients outcome. This patient presented with decreased visual acuity and history of DM. Patient had dense cataracts OS> OD and was referred for cataract surgery. The outcome with NSAIDs and steroid prior to surgery did not prevent CME. Patients with DM are more prone to decreased visual acuity after cataract surgery when the cataracts are more mature. The ideal management is intravitreal injections, but the patient did not desire further surgical intervention. Photodocumentation and OCT results along with follow-up care will be included in this poster. hyphemas of varied etiology are referred to as spontaneous hyphemas. Causes of spontaneous hyphemas include ocular surgery, neovascularization of the iris, intraocular malignancies, vascular abnormalities, blood dyscrasias and medications. Approximately one third of all hyphema patients experience an increase in intraocular pressure. Hyphema is usually a self-limiting condition causing little to no permanent vision loss. Hyphemas greater than 50% or persistent elevation of intraocular pressure usually necessitate medical or surgical intervention. Patients need to be closely monitored until the IOP is normalized and the hyphema has resolved. A 58 year old Caucasian male was referred by another eye group due to high intraocular pressure in the left eye as a consequence of anterior uveitis. The visual acuity was 20/20 OD and 20/25 OS. The intraocular pressures were 18 and 35 mmHg in the right and left eyes, respectively. Anterior segment examination revealed a small amount of fibrin coated with blood in the anterior chamber with no associated cell and flare. A microhyphema in the inferior quadrant of the anterior chamber was discovered on gonioscopy. The intraocular pressure was lowered in office and a complete fundus examination was performed. A Blood work up was ordered and the results were negative. The patient was followed more frequently until the intraocular pressure was stable at or below the target and the hyphema was cleared. Thorough evaluation and prompt management can usually prevent permanent vision loss in patients with spontaneous hyphema. When a local cause for the spontaneous hyphema cannot be found, a search for an underlying medical condition should be initiated. Our case illustrates the evaluation and management of a patient with spontaneous hyphema associated with elevated intraocular pressure. Poster 34 Spontaneous Hyphema OD - Ocular Disease Salma Kiani, OD Omni Eye Specialists-Affiliated with Salus University 5 Skipworth Court Catonsville, Maryland 21228 Additional Author(s): Edward Wasloski, OD Any disruption of the vascular uveal structures that results in bleeding into the anterior chamber is called a hyphema. Hyphemas are most commonly caused by blunt or penetrating trauma, either to the head or directly to the orbit itself. Non-traumatic 20 Poster 35 an area of localized inflammation and the patient was symptomatic a steroid/antibiotic suspension was prescribed to decrease inflammation and quiet any underlying infectious process. The Case of the Hidden Cyst OD - Ocular Disease Poster 36 Rebecca L. Pietrasik, OD West Haven VA/NECO 224 Elm St Apt 206 West Haven, Connecticut 6516 Uncovering CIN: How Atypical Benign Lesions Can Appear Malignant OD - Ocular Disease Additional Author(s): Kassandra Wedeking, OD, Nancy Shenouda-Awad, OD, Charles Haskes, OD Astrid Campagna, OD West Haven VA/NECO 224 Elm St Apt 206 West Haven, Connecticut 6516 Dacryops are rare lacrimal duct lesions that occur due to obstruction and consequent enlargement of the lacrimal gland duct. They account for 2-6% of pathologies of the lacrimal gland and typically present in young adults or middle-aged patients with female predominance. Dacryops can form after an infection or inflammatory episode. Treatment options include observation, topical or oral antibiotics/ steroids, puncture/aspiration, and surgical excision. This poster discusses the case of a patient with an inflammatory unilateral dacryops. An 85 year old white male presented to the Optometry clinic at the West Haven VA Medical Center with foreign body sensation for three days prior. The patient had the symptoms of mild irritation/foreign body sensation located temporally in the right eye only. Patient presented with no other associated symptoms. For relief, the patient tried using Lacrilube ointment qhs without any relief. Upon clinical examination, a conjunctival cyst with a focus of white cells in the center was found when the lid was pulled temporally OD on the palpebral conjunctiva. The cyst was treated with Tobradex suspension QID, Preservative Free Artificial Tears BID-QID, and Erythromycin ung qhs. Five days later at the patient’s follow up appointment, the dacryops was much improved and almost completely resolved. The patient was no longer symptomatic. He was educated to continue the current regimen for three more days and then discontinue the Tobradex suspension and Erythromycin ung. Dacryops are a rare, but important differential to be considered when evaluating conjunctival lesions. This case was atypical because the dacryops occurred in an elderly male with no history of infection/inflammation. When choosing treatment for a patient with dacryops, symptoms, reoccurrence, and evidence of active infection are three important factors to consider. Since there was Additional Author(s): Rebecca L. Pietrasik, OD, Charles Haskes, OD, Nancy Shenouda-Awad, OD Conjunctival lesions can be challenging to diagnose just based on clinical appearance and range from benign to malignant. Conjunctival intraepithelial neoplasia (CIN) is considered to be the most common tumor of the ocular surface. As CIN can be a precursor to conjunctival squamous cell carcinoma, it must be promptly treated as it can threaten not only the patient’s visual function but also his or her life. A 68 year old Caucasian male presented to the Optometry Clinic at the West Haven VA Medical Center for his yearly eye exam. His only complaint was redness OS which he had noticed for two months. His clinical exam was significant for a temporal 8x7mm gelatinous and highly vascularized conjunctival growth extending two millimeters within the limbus onto the cornea OS. The main differentials at that exam were an atypical presentation of a pterygium, a viral papilloma or CIN. The patient was subsequently presented to the corneal specialist who agreed that the lesion was highly suspicious for CIN. She recommended excisional biopsy of the lesion with cryotherapy. The patient consented to the procedure and had the lesion removed. Though the final pathology report noted the lesion as consistent with a pterygium, this case discusses differentials, work up, and proper management of a patient when CIN is suspected. It also illustrates that a pterygium has a tendency to masquerade as other lesions. As this case highlights, a benign pterygium can at times present atypically and in ways very similar to other more ominous conditions. The vessels of a 21 pterygium are usually normal caliber and straight because they are dragged by the pterygium lesion. However, one of the most important conditions to rule out in a patient presenting with a conjunctival lesion is CIN. This patient’s lesion was gelatinous, located within and around the limbus and contained engorged and tortuous vessels. All of these factors can be associated with malignancy so an excisional biopsy was the appropriate course of action. It is very important to consider all differentials and order a biopsy when malignancy is suspected. PIL above drusen and visual threshold as measured by microperimetry. Microperimetry enables clinicians to identify visual sensitivity at individual drusen or drusen-like lesions, and to monitor visual thresholds over time. Poster 38 Glaucoma is the Pits! OD - Ocular Disease MaryCarol Graby, OD VHA Connecticut West Haven 219 Fountain St Apt 10 New Haven, Connecticut 6515 Poster 37 SD-OCT and Microperimetry Correlates in Drusen and Drusen-like Lesions Additional Author(s): Astrid Campagna, OD, Charles Haskes, OD, MS, Theresa ZerilliZavgorodni, OD, Nancy Shenouda-Awad, OD OD - Ocular Disease Daniel Epshtein, OD SUNY College of Optometry 33 West 42 st New York City, New York 10036 Acquired optic cup pits (AOCP) represent a focal excavation of the neural rim and loss of the lamina cribosa. Their presence is thought to be pathognomonic for glaucoma. It is well known that congenital pits often cause fluid accumulation and subsequent serous macular detachments, but is the same true for acquired optic cup pits in glaucoma? While visual fields and optic nerve OCTs are important for monitoring for progression in patients with glaucoma, it may also be prudent to follow patients with concurrent acquired optic pits with macular OCT’s. This poster will discuss the proper management strategy for patients with glaucoma and AOCPs and discuss why macular OCTs may be prudent. A 61 year old white female presented to the West Haven VA Optometry clinic for a Glaucoma consult, with an incoming diagnosis of Normal Tension Glaucoma and AOCPs. She was being treated with Latanoprost qhs OU, and had consistently been meeting target pressures. Previous visual fields had shown inferior nasal defects OD, matching the superior temporal location of her optic pit, and inferior central defects OS, with a superiorly located pit. Her most recent field showed possible progression OS due to an increased number of depressed central points. Upon examination of the patient’s optic nerves and visual fields, the Glaucoma specialist agreed that her field defects were attributable to the AOCPs. He recommended monitoring the patient not only with visual fields and OCT of the RNFL/ONH, but also with OCT of the Additional Author(s): Jerome Sherman, OD The maia™ (Macular Integrity Assessment) microperimeter unites perimetry with scanning laser ophthalmoscopy (SLO) and eye tracking technology. The Expert Test enables monitoring of visual threshold at precisely selected fundus loci. This technology enables investigation of the impact of individual drusen on visual sensitivity. The correlation of this functional information with SD-OCT (spectral domain optical coherence tomography) structural analysis provides insight into the relationship between visual sensitivity and localized retinal integrity. A case series demonstrates variable sensitivity of drusen on maia™. One case demonstrates a patient in whom drusen show differing impacts on visual sensitivity. SDOCT identifies concordant impact of these drusen on the photoreceptor integrity line (PIL): Reduced integrity corresponds with reduced visual sensitivity. Another case shows a patient with dry age-related macular degeneration (AMD) and multiple drusen in whom maia™ identifies a severely reduced threshold over one particular “white spot.” SD-OCT reveals this locus to be a finite area of geographic atrophy of the RPE amidst a sea of drusen. Additional cases confirm these relationships between visual sensitivity and retinal integrity. There is a correlation between the integrity of the 22 macula, as patients with optic cup pits can develop associated maculopathy and decreased vision from damage to the papillomacular bundle fibers. It is common practice for glaucoma patients to be monitored with 24-2 visual fields and optic nerve/RNFL OCT’s, but additional testing should be performed when an acquired cup pit is present. Optic cup pits in many cases may present with central visual field defects that are not typically associated with early glaucoma. This makes it essential to monitor these patients with serial macula OCT and 10-2 visual fields. patient was lost to follow-up and the hyphema never completely resolved. Ten weeks later, the patient returned with severe ocular pain. Exam findings revealed a 10% re-bleed, inducing an IOP of 70 mmHg and provoking a grade 3 uveitic response. She was prescribed Homatropine every 12 hours, Pred Forte every 3 hours, Azopt twice a day, and Alphagan three times a day, OD. Ultimately, she underwent an anterior chamber washout and an Ahmed valve implantation to normalize the IOP level and restore her comfort. Hyphema has the potential to produce complications that may be sight threatening. Frequent follow-up is required so timely intervention can be administered. When medical therapy fails, surgical modalities may be warranted. Poster 39 Medical and Surgical Management of Intractable Hyphema Poster 40 OD - Ocular Disease Degenerated Cornea: An Atypical Case of Salzmann’s Nodular Corneal Degeneration Giezel M. Rivera, OD Salus University 1050 N. Hancock Street #715 Philadelphia, Pennsylvania 19123 OD - Ocular Disease Kassandra M. Wedeking, OD West Haven VA - Connecticut Healthcare System 219 Fountain Street, Apt 10 New Haven, Connecticut 6515 Additional Author(s): Andrew Gurwood, OD Hyphema is defined as layered blood in the anterior chamber. While it is often a result of trauma, it may develop following intraocular surgery, secondary to conditions that cause iris neovascularization, as a complication of systemic diseases, or use of substances that have anticoagulation properties. The goal of therapeutic management is to stabilize the clot to prevent complications such as re-bleeding, corneal blood-staining and glaucoma, and to manage any concomitant iritis. A 70-year-old African American female presented for a surgical consultation regarding an anticoagulative hyphema with a protracted and painful course, OD. Systemic history included hypertension and cerebral vascular accident, medicated with Diovan and Coumadin. Ocular history was significant for a choroidal detachment and longstanding traumatic glaucoma, OD. Initial episode of the hyphema (occurring 10 weeks earlier) was presumed secondary to use of medical anticoagulation. It manifested as 75% filling and produced an IOP of 40 mmHg, OD. Treatment consisted of topical cycloplegic, topical antiinflammatory, and topical anti-glaucoma medications. According to the referring practitioner’s records, the Additional Author(s): MaryCarol Graby, OD, Shannon Santapaola, OD, Nancy ShenoudaAwad, OD, FAAO A condition characterized by superficial greyish corneal nodules, Salzmann’s Nodular Corneal Degeneration (SNCD) is a relatively rare, slowly progressive condition most commonly seen among middle-aged women. Though SNCD can be idiopathic, chronic ocular surface inflammatory conditions are known to be associated, most commonly: meibomian gland dysfunction, contact lens wear, peripheral corneal vascularization, pterygium, keratoconjunctivitis sicca, and exposure keratitis. Symptoms of SNCD are variable and range from asymptomatic to moderate irritation with wide ranges of reduced vision. This poster will demonstrate an atypical case of SNCD with discussion of differential diagnoses and management options. A 74 y/o white male presented for new glasses without complaints or changes in vision. Ocular history was remarkable for dry eye syndrome, 23 Poster 41 proptosis and lid retraction OD, pseudophakia OU, low-risk glaucoma suspect, and history of mild NPDR OS. Systemic history was remarkable for stage 3A lung cancer, type 2 diabetes, and chronic kidney disease. Exam revealed a reduction in BCVA of 20/40+ OD and 20/25 OS with large variability between follow-up visits over the course of two weeks. Corneal examination showed multiple peripheral superficial whitish-grey elevations with overlying epithelial compromise and positive staining with sodium fluorescein, OD>OS. Posterior segment findings were unremarkable and macular OCT was normal. SNCD was diagnosed based on clinical appearance and the attributed cause of reduced vision. Corneal topography showed irregular astigmatism OU consistent with SNCD. The patient was started on Restasis OU in addition to artificial tears six times daily and lubricating ointment at bedtime. Warm compresses and lid hygiene were recommended OU BID. Vision at follow-up was improved to 20/30+ OD and 20/20- OS. This case demonstrates an atypical presentation of SNCD with unexpected vision loss due to induced irregular astigmatism. Management of this patient was conservative as the patient was asymptomatic with significant comorbid health concerns; surgical options are available for more severe cases. Though symptoms may vary, SNCD can significantly affect vision and should be differentiated from bullous keratopathy, spheroidal degeneration, hereditary hypertrophic scarring, granular dystrophy, and amyloidosis. Appropriate management of SNCD involves treating the associated factors, and patient compliance is vital for optimal outcome. Spectral-domain OCT findings of retinal ischemia in Neurofibromatosis Type 1 OD - Ocular Disease Ashley Cowart, OD University of Florida-Jacksonville Department of Ophthalmology 580 West 8th Street, Tower II, 3rd Floor Jacksonville, Florida 32209 Additional Author(s): Wassia Khaja, MD, Sandeep Grover, MD Optic nerve glioma is a well-known ocular finding in patients with Neurofibromatosis Type I (NF-1). The diagnosis of optic nerve involvement can be made based on clinical examination, visual field testing and radiological imaging. The following case describes gradually progressive unilateral vision loss in a child with NF-1 caused by retinal ischemia, without evidence of optic nerve glioma. A 12-year old Caucasian boy presented with unilateral progressive decrease of central vision from 20/25+2 to 20/400 over a period of approximately 4 years. There was clinically evident optic nerve pallor, an afferent pupillary defect on the same side and reduced color vision in that eye. Serial radiological studies showed a normal appearing optic nerve without any evidence of glioma. Although the retinal examination was normal, spectral-domain optical coherence tomography (SD-OCT) showed diffuse inner retinal thinning, also involving the macular area. The thinning was more in the inferior half of the retina as compared to superior half. Digital video angiography showed delayed and patchy choroidal flush with delayed filling of central retinal artery, relatively sparing the superior temporal artery. A full-field electroretinogram (ERG) performed on that eye showed a negative ERG with selective reduction of b-wave confirming diffuse retinal ischemia. The fellow eye was normal on examination and SDOCT testing. Undoubtedly, a patient with NF-1 presenting with decreased vision and signs of optic nerve involvement should be appropriately investigated with radiological studies for any evidence of optic nerve glioma. However, in the absence of glioma, it is important to consider a relatively rare finding of ‘retinal ischemia’ as a probable cause. This case 24 report highlights the utilization of recent technology such as SD-OCT and digital fluorescein video angiography to diagnose this condition and confirm it with ERG testing. with Idiopathic Bilateral Granulomatous Uveitis. Her signs and symptoms have since resolved with oral prednisone. She will be followed by Rheumatology and Optometry on a regular basis. While the negative test results did not indicate a particular systemic cause for her chronic uveitis thus far, the patient continues to have symptoms of fatigue and back pain. Research has shown that many cases of bilateral anterior uveitis that have been classified as idiopathic have eventually revealed a positive diagnostic test and thus indicated an underlying systemic disorder. Regular monitoring for change is crucial in order to detect whether this idiopathic case will remain idiopathic or if it is more than just an ocular issue. Poster 42 Idiopathic may not always stay idiopathic: A case of chronic bilateral anterior granulomatous uveitis OD - Ocular Disease Amy Moy, OD New England Eye, New England College of Optometry 75 Bickford St. Jamaica Plain, Massachusetts 2130 Poster 43 A Bumpy Road to Diagnosis: Follicular Conjuncitvitis to Ocular Lymphoma Additional Author(s): Syeda Kutub Chronic bilateral anterior granulomatous uveitis usually indicates a systemic cause. In some cases, however, all lab tests may initially show negative results while the patient continues to have episodes of uveitis and other nonspecific systemic complaints. Over time, these cases can progress and finally produce a positive test, inherently revealing the underlying systemic disease. This case illustrates the need for optometry to diligently co-manage chronic uveitic patients with their primary care physician (PCP) by periodically re-assessing and re-testing for a possible systemic cause. A 15 year old Hispanic female presented with red, painful eyes with photophobia. She was diagnosed with acute bilateral anterior granulomatous uveitis, which resolved. Four months later, she had a recurrent episode. The optometrist referred to the PCP for a full workup, but only an ESR and CBC panel were ordered. ESR values were only minimally elevated, which led the PCP to preclude further testing. Meanwhile, the patient still reported nonspecific complaints of fatigue and body aches over a 4-month period. Despite switching from Pred Forte to Durezol, her signs and symptoms continued to progress over several weeks. She developed a 2 diopter myopic shift, posterior synechia OD, and pars planitis OU. The optometrist pursued a full workup with the PCP, and requested specific tests. When all results returned normal, the PCP referred the patient to Rheumatology. After repeating all lab tests and chest x-ray, all of which returned negative, Rheumatology officially diagnosed her OD - Ocular Disease Stephanie R Fromstein, OD Illinois College of Optometry 3241 South Michigan Ave. Chicago, Illinois 60616 Ocular lymphoma is a malignant lesion of the orbital soft tissue, conjunctiva or eyelid. It can present as intraocular, orbital or adnexal growth. Ocular adnexal lymphoma is characterized by painless, pink, fleshy lesions of the conjunctiva known as salmon patches. Notably, the condition can also masquerade as a pronounced follicular conjunctivitis. Most ocular adnexal lymphomas are categorized as non-Hodgkins, low-grade B-cell tumors. An infectious and autoimmune etiology has been suggested for the disease, but has not been definitively proven. The lifetime risk of ocular lymphoma is 2.8%, making it the most common primary malignant tumor. A 79 year old African American female presented for a consultation regarding “bumps” on the inside of her lids, which were persistent over two months. She was referred by another practitioner with no treatment initiated. The patient noted some mild foreign body sensation and irritation, but denied pain, photophobia or discharge. Her ocular history was significant for a complicated cataract extraction OS five years prior. Acuities were 20/30 OD and CF@5ft OS. All preliminary testing was normal, noting a surgical pupil OS. Anterior segment 25 evaluation revealed a bilateral 4+ inferior follicular conjunctivitis. The patient was treated with steroid drops QID in both eyes, and a conjunctival biopsy was performed due to a suspicion of malignant or non-malignant growth. At the one-month follow-up, all pertinent examination findings were identical. Biopsy results were reviewed and revealed a stage 1 B-cell follicular lymphoma, positive for biomarkers CD20 and BCL2. The patient was referred to oncology to rule out systemic lymphoma. Following testing, the disease was determined to be localized, and the patient was started on Rituximab therapy. Fortunately, many ocular lymphomas are low grade, localized tumors which follow an indolent course and tend to respond well to systemic therapy. Therapy includes observation, radiation, cryotherapy, interferon, monoclonal antibodies and chemotherapy. The overall five-year survival rate for non-Hodgkins lymphoma is approximately 60%, with the rate for ocular adnexal disease being significantly higher at 86-100% with treatment. As this disease can present as a chronic follicular conjunctivitis, recalcitrant follicular disease warrants reconsideration and prompt referral if the condition fails to improve. categorizes macular holes into stages based on macular appearance and presence of vitreomacular traction (VMT). A 61 year old, Caucasian male presented for his annual eye exam. He is monocular due to trauma while in military service and he had a history of macula pseudohole in his remaining eye with a best corrected visual acuity (BCVA) of 20/30. His BCVA had decreased to 20/80-, and on spectral domain OCT, the patient was found to have a stage three macular hole with a 216 µm aperture size. He was referred to retina for surgical consideration. At his three month follow-up visit his vision had improved to 20/40-, however he had never received surgical intervention. The OCT showed a bridge formation of inner retinal tissue. At the five month follow-up visit the retinal layers showed complete closure and a mostly intact IS/OS junction with BCVA of 20/30! The spectral domain OCT has proven to be a very helpful tool in determining structure differences between pseudohole, lamellar hole, and macular hole stages along with establishing anatomical success post surgical intervention. RN Johnson and JDM Gass found spontaneous closure of stage 2 or 3 macular hole at being less than 10%, and suggests surgical intervention at stage two macular hole especially if there is deteriorating BCVA. Anatomical closure does not always correlate with successful vision recovery, studies have proven that having an intact IS/OS photoreceptor layer is the only correlating factor related to visual recovery. Poster 44 “On the Verge of Closure” a Case of Spontaneous Macular Hole Resolution OD - Ocular Disease Jessica Cameron, OD South Georgia North Florida Veterans Optometry Clinic 4700 SW Archer Rd. Apt C24 Gainesville, Florida 32608 Poster 45 One and a Half Syndrome with a Partial Seventh Nerve Palsy in Multiple Sclerosis OD - Ocular Disease Additional Author(s): Carrie Heller, OD Rosaline Cha, OD Illinois College of Optometry 3241 S. Michigan Ave. Chicago, Illinois 60616 A macular hole is a partial to full thickness retinal defect involving the fovea, symptoms including metamorphopsia, central scotoma, and decreased visual acuity. Treatment consists of pars plana vitrectomy (PPV) with inner limiting membrane peel and gas tamponade. The historical classification of macular holes, first reported by JDM Gass in 1988, has been used to plan macular hole treatment. Recently a new classification system based on optical coherence tomography (OCT) was developed by the International Vitreomacular Traction Study (IVTS) Group. It focuses specifically on the vitreomacular interface (VMI). This new system One and a half syndrome is a manifestation of central brain stem disease not commonly observed in every day optometric practice. One and a half syndrome occurs due to a unilateral lesion in the dorsal pontine tegmentum involving the ipsilateral paramedian pontine reticular formation, abducens nucleus, and medial longitudinal fasciculus. This interaction causes a distinctive clinical appearance 26 Poster 46 which is characterized by a complete lateral gaze palsy in one direction with an internuclear ophthalmoplegia in the other. Due to the location of the 6th and 7th nerve nuclei, multiple cranial nerve palsies may also be observed. Patients often present with blur, oscillopsia, or double vision. Common causes of the syndrome include vascular insults, brainstem tumors, and multiple sclerosis. Treatment and prognosis depend on the etiology of the condition. A 28 year old African American female presents with sudden onset blur in right gaze only, for three days. Entering acuities were 20/20 OD, OS and EOM pattern was normal. Pupils were equal, round, and reactive with no APD and dilated fundus examination was unremarkable. Three days later she returned with a complaint of ongoing blur in right gaze and reported “crossing eyes.” EOMs revealed complete paralysis of right gaze OD, OS, and paralysis of nasal eye movement OD with horizontal nystagmus OS in left gaze. Convergence was spared. In addition, she had a widened palpebral fissure and decreased definition of her nasolabial folds on the right side of her face. MRI revealed an enhancing lesion of the right facial colliculus with greater than fifteen non-enhancing lesions of the paraventricular white matter. The patient was referred to a neurologist and was diagnosed with and managed for multiple sclerosis. One and a half syndrome with partial seventh nerve palsy in patients is specific for the anatomical site of the disorder, but not for the cause. Resolution of the syndrome within days to weeks is common, however, demyelinating conditions, ischemia, and masses must be ruled out. When multiple sclerosis is the underlying cause, referral to a neurologist for early treatment is imperative to preserve not only visual but systemic function. Contents Under Pressure: An Atypical Presentation of Pseudotumor Cerebri OD - Ocular Disease Benjamin Thayil, OD Bill Hefner VAMC 7808 Kotz Ct. Apt 226 Charlotte, North Carolina 28269 Additional Author(s): Jarett Mazzarella, OD Pseudotumor cerebri (PTC) or Idiopathic Intracranial Hypertension is associated with increased intracranial pressure without a mass lesion and normal cerebral spinal fluid (CSF) composition. PTC is considered a diagnosis of exclusion and classically presents in obese females in their third decade of life. This case study presents an atypical case of PTC, investigates modes of recognition, and evaluates current treatment modalities. A 66-year-old African-American male presented to our VA eye clinic after examination by telehealth imaging. Immediate referral for in-office evaluation of bilateral blurred disc margins was recommended. The patient complained of painless visual loss, onset four months ago. Significant systemic history included diabetes, hypertension and bilateral above the knee amputation. The patient’s quality of vision was subjectively described as a generalized blur at distance and near. The patient also complained of transient visual loss when turning his head left and right. There was subsequent denial of headaches, nausea, tinnitus and diplopia. Preliminary testing including motilities, confrontation fields, and pupils were evaluated and unremarkable. Entering acuities were 20/40 OU. Red cap desaturation testing revealed no dyschromatopsia. Dilated funduscopic evaluation revealed edematous optic discs OU with associated disc hemorrhaging. Baseline nerve fiber layer analysis was performed to evaluate the extent of edema. The patient was sent immediately to the emergency department for an MRI of the head and complete blood count including sedimentation rates and C-reactive protein. The patient was admitted for further neurological workup. Carotid ultrasound and lab work was unremarkable; MRI revealed no associated pathology. Opening pressure of the lumbar puncture was 340mmHg, which lead to the diagnosis of pseudotumor cerebri. Treatment was with oral acetazolamide. Ophthalmology and 27 neurology were consulted for comprehensive co-management. Several differential diagnoses must be ruled out before diagnosing PTC: diabetic papilitis, hypertensive optic neuropathy, pharmaceutical induction, ischemic optic neuropathies, infiltration of the discs, and mass lesions must be considered. Traditional treatment for PTC include oral acetazolamide, weight loss, discontinuation of causative pharmaceuticals, optic sheath decompression or oral steroids. To ensure a good prognosis, atypical presentations of conditions not presenting with textbook signs and symptoms require meticulous evaluation and appropriate management in a timely manner. anterior and middle cranial fossa as well as the left orbit. Mass compression and displacement of the optic nerve sheath complex, superior and lateral rectus muscles appeared significant. Therapeutic intervention consisted of a transfacial and transorbital resection of the orbitotemporal, inferotemporal fossa, and middle fossa meningioma with extradural resection of the tumor. One month later, patient presented with a perforated left cornea likely due to a history of exposure keratopathy or a possible neurotrophic keratopathy. A tectonic corneal graft procedure was performed. This case highlights the importance of prompt diagnosis, neuroimaging, treatment, and close monitoring for recurrence because atypical meningiomas exhibit a more aggressive biological behavior, with the potential to cause significant morbidity. Atypical meningiomas, correspond with the World Health Organization (WHO) grade II classification and tend to grow much more quickly than benign meningiomas and recur at a much higher rate. Pain alone is rarely a presenting feature of orbital meningiomas, but orbital tumors or orbital apex tumors commonly present with insidiously progressive visual loss or proptosis. Mild and inconsistent headache is described in some patients but significant pain is rare. Poster 47 Painful Recurring Orbital Frontal Meningioma with Compressive Optic Neuropathy and subsequent Corneal Perforation OD - Ocular Disease Dong C Suk, OD James H Quillen VAMC, Southern College of Optometry 115 Beechnut ST, Ste. #B5 Johnson City, California 37601 Poster 48 The use of interferon alfa- 2b in the treatment and management of ocular surface squamous neoplasia (OSSN) Additional Author(s): Loren Bennett, OD, FAAO, Nanette Coelho, OD Meningiomas represent approximately 4% of all infraorbital tumors and 20% of all intracranial tumors. Although meningiomas are typically benign and slow growing in about 90% of cases, the intermediate and high-grade subtypes of meningiomas (WHO grades I and II) constitute 10% of cases. For most nervous system tumors the World Health Organization (WHO) grade is really an estimate of malignancy, reflecting the likelihood of recurrence and aggressive behavior. Meningiomas in the orbit are challenging lesions to manage because of their typical posterior location and progressive, painless, and variable visual loss. A 65-year-old male presented with a painful proptotic, inferiorly displaced left orbit with extraocular muscle restrictions and secondary exposure keratopathy in an eye with longstanding reduced vision. Radiologic and neuropathologic evaluation revealed a large atypical meningioma in the OD - Ocular Disease Jessica E. Rodriguez, OD Aran Eye Associates, Nova Southeastern University 9985 SW 2nd terrace Miami, Florida 33174 OSSN consists of a spectrum of neoplastic squamous epithelial abnormalities including squamous dysplasia, squamous cell carcinoma in situ (also known as CIN), and invasive squamous cell carcinoma. These can affect the conjunctiva, cornea, and even invade the globe and orbit. Patients at high risk include those exposed to UVB radiation, cigarette smoke, HPV, HIV, petroleum products, and immunosuppressive agents used for organ transplants. These abnormalities tend to be 28 unilateral, leukoplakic lesions that have a gelatinous appearance. If left untreated, they can evolve to invasive squamous cell carcinoma. The preferred treatment is a complete excisional biopsy followed by cryotherapy to the surrounding tissue. There are topical treatments available including mitomycin C, 5- fluorouracil, and interferons. Interferon alfa-2b is ideal due to its low toxicity and non-threatening adverse effects. An 89 year old Hispanic male presents with complaints of blurry vision in the left eye. It has been progressive for the past 6 months. The BCVA in the right eye was 20/30 and the left eye was CF at 1 ft. Slit lamp examination of the right eye was unremarkable. The cornea of the left eye had epithelial keratinization with a raised vascularized lesion. The patient was diagnosed with a CIN in the left eye and started on alfa-2b interferon, 1 million units/ml, 5 times a day, and was to return in 1 month. After 10 weeks of treatment BCVA was CF at 3 ft. The cornea had sub-epithelial scarring with complete resolution. The patient was instructed to continue the medication and return in 2 months for a follow up. Several studies have successfully reported that topical treatment of interferon alfa- 2b has shown an 80-100% tumor control in the CIN subtype. Currently, interferon alfa-2b is not FDA approved for OSSN. Surgical excision remains the primary treatment strategy. Topical treatment is beneficial for those patients that are ineligible for surgery, due to age or medical history. Shah et al reported complete control with interferon alfa 2-b in 67% of CINs and 83% of OSSN overall. neuritis is an inflammatory attack of the optic nerve and a common manifestation of multiple sclerosis. Visual impairments are a common finding of multiple sclerosis in patients with and without a history of optic neuritis. The utilization of spectral domain OCT technology allows the ability to monitor and correlate subjective visual symptoms with pathophysiology at the level of the retina and optic nerve in patients with no clinical presentation or known history of optic neuritis. We present a case of a 64 YOWM with multiple sclerosis being followed for symptoms of diplopia, relieved with prism and complaints of progressive decreased vision OU. The patient was followed for over a 1 year period with significant fluctuations in refraction and vision ranging from 20/40 to 20/25 OD and 20/100 to 20/40 OS at sequential visits. Anterior segment was only remarkable for mild nuclear sclerosis that was not contributing to visual reduction OU. Fundus examination revealed pink and perfused optic nerves without pallor and no clinical findings of optic neuritis were revealed on MRI of the head with gadolinium contrast. Cirrus OCT of retinal nerve fiber layer revealed mild superior nasal thinning OD and superior temporal thinning OS while ganglion cell analysis demonstrated progressive thinning of the ganglion cell complex as well as the inner nuclear layer OU from his initial visit 9 months earlier. These findings suggest a subclinical state of progressive axonal loss and retinal degeneration/thinning leading to reduced best corrected visual acuity OU, without clinical or MRI findings of acute optic neuritis or past optic neuritis events OU. In multiple sclerosis spectral domain OCT technology can be used to detect subclinical neurodegeneration at the level of the retina in patients without any prior presentation of optic neuritis. OCT with retinal ganglion cell complex analysis and retinal layer segmentation technology is a useful tool to help detect neurodegeneration of the inner retina layers without the presence of acute optic nerve inflammation or retrograde degeneration that could be contributing to visual and ocular complications. Poster 49 Ganglion Cell Analysis utilization in detecting progressive neurodegeneration of the retina in Multiple Sclerosis OD - Ocular Disease Kristine Loo, MS, OD W.G. (Bill) Hefner VA Medical Center 3507 French Woods Rd. Charlotte, North Carolina 28269 Additional Author(s): Jarrett Mazzarella, OD, FAAO Multiple sclerosis is a systemic neurodegenerative disease that can lead to many ocular complications including vision loss. Optic 29 Poster 50 Poster 51 Retinal capillary hemangioma: A review of key retinal features Regressed Proptosis: A sphenoid metastatic lesion targeted with groundbreaking new treatment, Radium-223 OD - Ocular Disease OD - Ocular Disease Sandip K Randhawa, OD, M.Sc. University of Waterloo 474 Duncan Lane Milton, Ontario, Alabama Emily Lubbers, OD WG Hefner VAMC residency 6207 Grandeur Drive Salisbury, North Carolina 28146 There is a large variety of retinal tumors associated with abnormal retinal vasculature. The use of key diagnostic tools, such as fluorescein angiography and optical coherence tomography (OCT), are used in aiding in the final diagnosis and management. Forty-eight year old female presented with complaints of left eye blur. No associated symptoms of flashes or floaters. Past ocular history remarkable for non-central corneal scar secondary to a contact lens related ulcer. Systemic health overall unremarkable; current medications include tri-cyclen lo and omega-3 supplements. Reduced visual acuity in the left eye was noted. Facial amsler revealed an inferior temporal paracentral scotoma in the left eye, pupil testing revealed no relative afferent pupillary defect. Dilated fundus examination revealed a vascular lesion within the retina and optic nerve superiorly surrounded by intraretinal hemorrhages and paramacular exudates with macular edema. OCT confirmed cystic spaced in the outer plexiform layer. Differential diagnoses include vasoproliferative tumors of the retina, Coat’s disease, Racemose hemangioma (Wyburn-Mason syndrome), retinal capillary hemangioma (sporadic versus von Hippel-Lindau associated) and retinal cavernous hemangioma. Fluorescein angiography confirmed the presence of a vascular tumor with a feeder vessel from the superior retinal arteries with late leakage. Magnetic resonance imaging of the brain and orbits revealed no additional lesions. Sporadic juxtapapillary retinal capillary hemangioma was confirmed. The treatment for juxtapapillary lesions have been difficult due to the close proximity to the optic nerve. The patient underwent photodynamic therapy reducing the macular edema with slight improvement in visual acuity. Additional Author(s): Charles Davis, OD, MPH, MHA, Benjamin Thayil, OD Orbital metastases are an infrequent etiology of adult proptosis. Approximately 3-7% of orbital biopsies have demonstrated a metastatic tumor. Clinically evident bone metastases occur in almost all patients with advanced prostate cancer, typically involving the lumbar spine, rib and pelvis . Involvement of skull convexity is frequent, but the skull base and orbits are less commonly affected. 64 year old Caucasian male first presents to the eye clinic with painful proptosis, diplopia, and ptosis of the left eye. Pertinent history includes Stage 4 prostate cancer with multiple metastases to bone. Clinical testing revealed limited extra ocular motilities in supraduction, a red cap desaturation, and a trace afferent pupillary defect of the left eye. Palpebral apertures were measured at 14 mm in the right eye and 8 mm in the left eye. Bilateral optic disc edema was evident upon fundus examination and measured by OCT. Same day CT scan of the orbits revealed a 2.9 cm by 2.8 cm lesion at the left sphenoid wing with extension anteriorly into the retro bulbar space. Ocular status was communicated to the managing oncologist and additional treatment was implemented with radium - 223 dichloride. Radium-223 is an alpha-emitting alkaline earth metal ion which is preferentially absorbed into bone by virtue of its chemical similarity to calcium. This treatment was recently FDA approved in May 2013 and specifically designed to target bone metastasis from prostate cancer. Radium-223 emits 95% alpha radiation with a short range in tissues of 2-10 cells. Tissue damage is therefore reduced in surrounding healthy tissues and a localized effect is produced. At 1 week follow-up after administration of treatment, patient displayed dramatic improvement in presentation. Pain and diplopia were improved, as 30 well as the appearance of proptosis and ptosis. Due to this patient’s dramatic response to Radium-223, we will continue to monitor him over time and other treatment options of radiation or excision of the orbital lesion have been halted. We hope that our patient will be a success story to represent a new novel, less invasive treatment that can treat orbital metastases, preserve vision, and improve quality of life. diagnostic findings, discusses differential diagnoses, provides rare photodocumentation of the vortex vein varix with a portable posterior segment camera in different gazes, a spectralis optical coherence tomography (OCT) and B-scan ultrasonography which eliminates the need for more invasive diagnostic procedures such as Flourescein angiogram. Poster 52 Septo-Optic Dysplasia Now you see it. Now you don’t. A rare case of vortex vein varix. OD - Ocular Disease Poster 53 Kara Lynn Tison, OD Southern College of Optometry 672 Harbor Edge Circle #201 Memphis, Tennessee 38103 OD - Ocular Disease Babita Gounden, OD Orlando Veterans Affairs Medical Center 759 Birgham Place Lake Mary, Florida 32746 Additional Author(s): Marie Bodack, OD, FAAO, FCOVD Septo-optic dysplasia is a congenital condition involving optic nerve hypoplasia, an absent septum pellucidum and thinning of the corpus callosum. Endocrine dysfunctions may also be present. A 6-year-old African American male presented for an eye exam due to failing a school vision screening the prior year. Mom also reported that she noticed that the patient’s right eye turns out occasionally. The patient had no significant medical or family history. He also had no history of trauma and was born full term. Entering distance visual acuity without correction was OD: 20/500, OS: 20/20. The patient was not responsive to near visual acuity testing for OD. Near acuity OS was 20/25. Extra ocular motilities were full without pain or diplopia reported. Cover test revealed orthophoria at distance and near. No nystagmus was noted. Pupils were equal, round and reactive to light with grade 1+ relative afferent pupillary defect OD. No significant refractive error OU. Anterior segment was unremarkable with pressures being 14mm Hg OD and 13mmHg OS with the iCare tonometer. Upon dilation, the right eye was positive for a double ring sign. Cup to disc ratio was observed at 0.45H/0.50V OD. All findings were normal OS, with the cup to disc ratio being 0.30H/0.35V. An OCT confirmed the small size of the right optic nerve relative to the left. The patient was diagnosed with Optic Nerve Hypoplasia OD and the parents were educated on the condition. The patient was prescribed polycarbonate protective glasses. An MRI of the brain was ordered Additional Author(s): Derek Richardson, OD, Maria J. Mandese, OD, FAAO A varix of the vortex vein ampulla is a rare, interesting, yet benign finding that can cause diagnostic confusion with other choroidal malignancies. A 46 year old white male presents for an eye exam without complaint. Best visual acuity was 20/20 od, os. Anterior segment was clear and unremarkable. His posterior segment exam revealed a large, steeply elevated 3 disc diameter pigmented lesion with distortion and asymmetry in the inferior nasal peripheral retina od upon examination with binocular ophthalmoscopy. Resolution or flattening of the lesion occurred when the patient was in the supine position, and in manipulation of gaze or head position. Asymptomatic findings of the retina should be thoroughly investigated for malignancy or other morbidity/mortality systemic conditions. Despite being asymptomatic, it was necessary to consider the differential diagnoses in this case. When large enough, vortex vein varices can simulate a choroidal melanoma. Other benign differentials include a nevus, congenital hypertrophy of the retinal pigment epithelium and hyperplasia of the retinal pigment epithelium. When nonpigmented lesions are apparent, careful consideration is given to posterior scleritis , choroidal metastases, choroidal osteoma, and hermangioma. The case report explains the 31 to rule out midline cranial anomalies. The MRI revealed a hypoplastic optic nerve OD and partial absence of the septum pellucidum, consistent with the diagnosis of septo-optic dysplasia. The patient will be monitored for development of endocrine dysfunctions. While only 30% of patients have a triad of optic nerve hypoplasia, absence of septum pellucidum and pituitary dysfunctions, early diagnosis of this disorder is important. This case report will help optometrists with the diagnosis of septo-optic dysplasia, treatment of the signs and symptoms from this condition, and the appropriate referrals and testing that is needed for these patients. Lamotrigine, and Fluoxetine. The patient was 20/25 OD and OS with a low myopic prescription. The anterior segment was unremarkable and color vision was unaffected as evaluated with pseudoisochromatic plates. Funduscopy revealed subtle perifoveal pigmentary changes correlating to Photoreceptor Integrity Line (aka ellipsoid/inner segment-outer segment junction) disruption on OCT and slight increased fluorescence on both FA and ultra-widefield FAF. A shallow incomplete perifoveal ring scotoma was found on central VF with points tested 0.7 degrees apart. The patient was then referred to the Vitreous-Retina-Macula Consultants of New York for AO and to Columbia University for genetic screening for a mild Stargardt mutation G1961E. AO studies revealed perifoveal cone disorganization and the foveal cone mosaic was imaged surprisingly well. AO is becoming a leading diagnostic modality in retinal degenerations. Further increases in resolution are necessary to follow foveal changes with AO in most patients. Regardless of this limit, current generation AO systems may emerge as a useful technology in the assessment of early bull’s eye maculopathy. Poster 54 Adaptive Optics Reveals Foveal Cone Mosaic in Bull’s Eye Maculopathy OD - Ocular Disease Daniel Epshtein, OD SUNY College of Optometry 33 West 42 Street New York City, New York 10036 Poster 55 Additional Author(s): Ayah Ahamed, Jerome Sherman, OD Neovascularization of the Iris as the Presenting Sign of Complete Unilateral Intracranial Carotid Artery Occlusion Bull’s Eye Maculopathy is a common finding in many retinal degenerations including cone dystrophy, cone-rod dystrophy, Stargardt disease, benign annular concentric macular dystrophy, and Plaquenil toxicity. Bull’s Eye Maculopathy presents as pigmentary changes perifoveally on funduscopy and is often confirmed with ancillary testing such as OCT, visual field, ERG, fundus autofluorescence (FAF), fluoroscein angiography (FA), and most recently adaptive optics (AO). Adaptive Optics is an emerging technology that is quickly improving in its ability to aid in clinical diagnosis. One major constraint of AO is its insufficient resolution to image the increased cone density of the fovea. In our 19 year old patient with bull’s eye maculopathy, the foveal cones are much more defined, possibly as a consequence of decreased foveal cone density as a result of retinal degeneration. AO imaging of this patient with bull’s eye maculopathy revealed a subtle finding not seen with other diagnostic studies. A 19 year old female presented for evaluation of reduced BCVA OU. Her history was positive for ADD and bipolar disorder treated with Vivance, OD - Ocular Disease Tina R. Porzukowiak, OD, FAAO Midwestern University, Arizona College of Optometry 19379 N. 59th Ave. Glendale, Arizona 85308 Additional Author(s): Laura Addy, BS, Matthew Kaminsky, BS, Elizabeth Lyon, BS, Ryan Anderson, BS This case illustrates a rare presentation of ocular ischemic syndrome (OIS) where the primary ocular finding was neovascularization of the iris and angle. Complete, unilateral, intracranial carotid artery occlusion was diagnosed via brain magnetic resonance angiography (MRA). An asymptomatic 82-year-old Caucasian female presented for a routine eye examination. Medical history included Type II diabetes mellitus, congestive heart failure, essential hypertension, peripheral 32 vascular disease, and myocardial infarction. Bestcorrected visual acuity was 20/30 OD, OS. Entrance testing was unremarkable. Slit lamp examination revealed neovascularization of the iris and angle OD; negative OS. The cornea showed 2+ guttata with trace endothelial edema OD, OS consistent with Fuch’s Corneal Dystrophy. The intraocular pressures were normal OD, OS. Dilated fundoscopy revealed moderate optic nerve head cupping OD, OS. Rare scattered microaneurysms were noted throughout the posterior pole OD, OS; there was no evidence of retinal neovascularization. Humphrey visual field demonstrated glaucomatous loss OD, OS. Bilateral carotid duplex revealed 50% stenosis of the internal carotid arteries. CBC w/ diff, ESR, and CRP was normal. Brain MRA revealed 100% occlusion of the right intracranial portion of the internal carotid artery (ICA). Neovascular glaucoma secondary to OIS OD and normal tension glaucoma OS was treated with topical anti-glaucoma medication. Retina consultation did not advise panretinal photocoagulation (PRP). The primary care physician added oral anti-platelet therapy. This case was managed conservatively. PRP was not pursued in the absence of retinal ischemia as intraocular pressure has been documented to rise post-treatment leading to further compromise of optic nerve perfusion. This case further supports the theory that uveal ischemia alone in the absence of retinal ischemia may be a significant contributor for the neovascularization noted in ocular ischemic syndrome. Clinicians must maintain a high index of suspicion for intracranial ICA stenosis in the presence of anterior segment neovascularization of unknown etiology and essentially normal Carotid Duplex ultrasonography. Unlike lung cancer, more than 90% of patients with uveal metastasis from breast cancer have a history of treatment prior to ocular involvement or known multi-organ metastasis. When breast cancer metastasizes to the eye, the risk of it spreading to the brain or central nervous system increases significantly. This poster will review a case of a 53 year old Caucasian female whose recent visual complaints and medical history lend to a diagnosis of an intraocular choroidal metastasis after being diagnosed, treated and in remission for breast cancer for nearly fifteen years. Breast cancer metastasis can take place 10 years or even longer after the original treatment. According to the American Academy of Ophthalmology, metastases to the eye are being diagnosed with increasing frequency for various reasons: • Increasing incidence of certain tumor types that metastasize to the eye • Prolonged survival of patients with certain cancer types • Increasing awareness among medical oncologists and ophthalmologists [and optometrists] of the pattern of metastatic disease Not every patient will present at the earliest onset of their symptoms or be forthcoming with all of their medical history. A thorough history, in addition to further imaging helps assist in confirming a diagnosis of a choroidal metastasis. Early detection and referrals help in saving ones eye physically and functionally, as well as discovering additional sites of metastasis that can be treated early in hopes to prolonged survival. Poster 56 Poster 57 Breast Cancer “Eye”wareness Idiopathic Central Serous Chorioretinopathy in an Operation Enduring Freedom Veteran OD - Ocular Disease OD - Ocular Disease Essence N. Robinson, OD, FAAO Texas State Optical, Beaumont, TX 6105 N Major Drive #317 Beaumont, Texas 77713 Christopher L. Suhr, OD, MPH Department of Veterans Affairs 11031 US HWY 19, Ste. 102 Port Richey, Florida 34668 Breast cancer is the second deadliest cancer among American women, the first is lung cancer. Twenty to forty percent of all breast cancers will metastasize at some point, and when they do they are staged as an invasive (stage IV) cancer. Additional Author(s): Mark Phebus, OD Idiopathic central serous chorioretinopathy (ICSC) is a condition of which there is a serous 33 detachment of the neurosensory retina at the macula. It occurs over an area of edema and leakage from hyperpermeability of the choriocapillaris through dysfunctional retinal pigment epithelium (RPE). The localized serous detachment occurs in the absence of subretinal blood or lipid exudates. The detachment is typically round, or oval, with a blister-like appearance and sloping margins that gradually merge into intact retina. ICSC is not fully understood, and there are current hypotheses that include disruption of ion transport across the RPE, focal choroidal vasculopathy, or a combination of the two for the pathophysiology of this disease. A 38 year-old white male veteran presented to our clinic because of distorted vision in his left eye. The patient described his vision through his left eye by stating it is “like looking through a peephole in a door. Although traditional dilated fundus examination will provide the clinician with the ability to diagnose ICSC, the advent of OCT allows for more precise analysis of the compromised macula. OCT should be considered when the diagnosis is in question, for monitoring as resolution occurs, and patient education. their underlying cause for the ophthalmic findings were different and thus required a different treatment plan. The male patient was diagnosed with multiple sclerosis; the female patient was diagnosed with idiopathic optic neuritis. These two cases illustrate a multidisciplinary approach to clinical management of optic neuritis. Poster 59 Rapid Visual Field Improvement of Macroprolactinoma after Treatment with Cabergoline OD - Ocular Disease Mayur Bhavsar, OD VA NJ Healthcare System 325 Page Ave Lyndhurst, New Jersey 7071 Prolactinomas are non-cancerous pituitary tumors which result in an excess release of prolactin hormone. I present a case of macroprolactinoma detected with hemianopic VF defects. CT, MRI and lab testing confirmed the diagnosis of prolactinoma and treatment with cabergoline was initiated. 5 weeks after treatment was initiated absolute VF defects, APD and color vision deficits began to improve. Furthermore, prolactin levels normalized and tumor shrinkage was noted. A 54 yo BM presented with complaints of blurred vision. His systemic history included pericarditis, asthma, and HTN for which he was taking medications. There was a grade 2 left APD but full motilities. Confrontation VF showed a temporal deficit OD and constriction in all quadrants OS. Color vision testing showed OD 7/7 and OS 0/7. Red cap was desaturated by 80% OS. His BCVA was OD 20/20 and OS 20/70. Slit-lamp findings were unremarkable. His IOP’s were 21 OU. Dilation revealed a healthy 0.35 optic nerve OD and a 0.4 optic nerve with disc pallor 360 OS. Visual field testing exposed a temporal hemianopsia OD and complete defect with mild temporal sparing OS. An immediate CT revealed a 4.3 cm bilobed sellar/ suprasellar mass lesion with local mass effect. Pituitary specific lab tests and MRI were ordered. Prolactin levels were elevated to 4700 µg/L and MRI confirmed a large mass originating from the pituitary with outward extension to involve the cavernous sinuses, posterior ethmoids, sphenoid air Poster 58 Optic Neuritis: Getting to the Root of the Problem OD - Ocular Disease Adrienne B. Ari, OD, MPH US Army 37 Hunt St Fort Bragg, North Carolina 28307 Optic neuritis is an inflammation of the optic nerve caused by demylination, infection, inflammation and autoimmune diseases. Commonly, these patients present with reduced visual acuity, an afferent pupillary defect (APD), pain with eye movement and abnormal color vision. Patients may present similarly but have very different clinical outcomes. This case report will discuss two young healthy patients (Caucasian male, 28 years old and Caucasian female, 25 years old) that presented to our clinic with papillitis, reduced visual acuity, mild APD, pain on eye movement, and inferior altitudinal visual field defects. Although they presented similarly, 34 cells and clivus. The endocrinologist started him on 0.5 mg cabergoline 3 times/week. 5 weeks later, VA, VF, and optic nerve improvement were noted. Also, prolactin levels decreased to 3 µg/L. 1 month later; VF findings showed further improvement and repeat MRI imaging indicated shrinkage of tumor by 50%. Studies have shown that prolactin levels decrease by 96% within 3-6 months, VF improve, and tumors shrink. Our patient reports quick resolution of prolactin levels and VF improvement. This may be due to a high level of D2 dopamine receptor expression on the tumor. Literature reveals that quick resolution may lead to CSF rhinorrhea, chiasmal herniation, or pituitary apoplexy. MRI records of our patient reveal no such complications. recommended. Annual follow-ups with a dilated fundus exam and OCT is preferred. It is important for clinicians to educate the patient on the possible genetic component of the disease. As clinicians, we should also remember the functional implications this disease can have on a patient’s daily activities, and to refer for low vision rehabilitation when needed. Poster 60 Clinical Diagnosis and Management of Adult Type Vitelliform Dystrophy OD - Ocular Disease Salma Kiani, OD Omni Eye Specialists-Affiliated with Salus University 5 Skipworth Court Catonsville, Maryland 21228 Additional Author(s): Stephanie Schmiedecke Barbieri, OD, F.A.A.O Adult type vitelliform dystrophy is a rare, autosomal dominant disease that leads to bilateral, foveal lesions in the retinal pigment epithelium layer of the retina. This condition is grouped with other macular dystophies called pattern dystrophies. This dystrophy affects adults between the ages of 30-50 years. Patients with this condition present to clinic with mild to moderate decrease in vision (20/30-20/100). It can be associated with a choroidal neovascular net resulting in severe visual impairment. Researchers have found two genes associated with this disease that can have mutations. Consequently, genetic counseling as well as low vision rehabilitation is an essential part of the management of this patient as a whole. A 75 year old Caucasian female presented to the clinic with blurry vision that she had, for a long time. The diagnosis was made primarily on clinical results such as OCT, corrected acuities, and fundus findings. Even though the prognosis of this condition is favorable, careful monitoring of the patient is 35 Poster 61 Poster 62 Spontaneous Hyphema Urgent Care Facility Misdiagnoses HSV Disiform Keratitis OD - Ocular Disease OD - Ocular Disease Salma Kiani, OD Omni Eye Specialists-Affiliated with Salus University 5 Skipworth Court Catonsville, Maryland 21228 Utham Prathap Balachandran, OD Pennsylvania College of Optometry 2033 Christian Street Apt. 2 Philadelphia, Pennsylvania 19146 Additional Author(s): Edward Wasloski, OD Additional Author(s): Helene Kaiser, OD, FAAO, Connie Chronister, OD, FAAO Any disruption of the vascular uveal structures can cause bleeding into the anterior chamber called a hyphema. Hyphemas are most commonly caused by blunt or penetrating trauma to the head or directly to the orbit itself. Non-traumatic hyphemas of varied etiology are referred to as spontaneous hyphemas. Some causes of spontaneous hyphemas include surgery, neovascularization of the iris, malignancies, vascular abnormalities, blood dyscrasias and medications. Approximately a third of all hyphema patients can experience an increase in intraocular pressure. It is usually a self-limiting condition causing little to none permanent vision loss. If the hyphema is greater than 50% or total hyphema is seen with the IOP remaining elevated, then treatment is preferred. Patients need to be followed up until the IOP is lowered and the hyphema is cleared. A fifty eight year old Caucasian male was referred by another eye group due to high intraocular pressure with an active uveitis in the left eye. The visual acuity was 20/20 OD and 20/25 OS with pressures of 18 and 35 mmHg OD, OS. Anterior segment examination revealed a small fibrin coated with blood in the anterior chamber with no associated cell and flare. This was a key finding that prompted performing gonioscopy. A hemorrhage in the inferior quadrant of the anterior chamber was seen. In most cases, spontaneous hyphemas are a selflimiting condition causing little to no permanent vision loss if followed and treated appropriately. This can include, IOP lowering methods and constant monitoring until the hyphema is cleared. A general blood work up should be ordered as well. Our case represents how we managed and treated a patient with spontaneous hyphema associated with an increase in intraocular pressure, with no history of trauma. Herpes simplex virus (HSV) disciform keratitis is an example of endotheliitis, caused by an immune response to HSV antigens on the endothelial cells. We present a case of unilateral blurred vision preceded by pain and photophobia that was originally treated with an antibiotic at an urgent care facility. The vision worsened until presentation to our clinic where the correct diagnosis of HSV disciform keratitis was made. The patient was followed over nine weeks with photos and OCT. This is a unique presentation of disciform keratitis with no prior history of herpetic incidence. The case illustrates the importance of accurate diagnosis and appropriate management of herpetic disease at the initial onset. The inception of the Affordable Care Act could be expected to increase such cases as more patients may seek treatment at timely urgent care facilities rather than emergency rooms that often have ophthalmic instruments and personnel, but require long wait times. A subsequent rise in the incidence of misdiagnosed non-bacterial ocular pathology may occur in the near future. A 46 year-old female complains of progressively “cloudy” vision in the left eye. She reports that three weeks ago she felt pain and photophobia in the same eye as well blisters along the left side of her nose. The best-corrected acuity measured 20/50OS. Gross examination revealed faint scabs where the patient had reported blisters. Biomicroscopic examination revealed a central area of stromal and microcystic corneal edema with folds in Descemet’s membrane. Marked corneal thickening was measured at 859 microns. Clinical presentation suggested disciform herpetic keratitis. The patient was treated with Pred Forte, Trifluridine, and Valtrex. Ultimately, acuity returned to 20/20, corneal thickness measured 533 microns, and only a faint stromal scar remained. Following resolution, a maintenance dose of 36 Acyclovir was initiated. A rare condition, untreated HSV disciform keratitis can result in permanent endothelial injury and decompensation. Endotheliitis can result from other viral infections, thus making it a diagnostic dilemma. Appropriate diagnosis is important in establishing the correct therapeutic regiment. The goal of treatment is to reduce corneal inflammation while suppressing any lingering viral infection or risk of reactivation. revealing a large area of irregularity in the superior cornea which altered the topographical structure of the cornea, inducing corneal astigmatism and visual distortion. The patient was managed by Prednisolone Acetate 1% drops every 2 hours for 2 days and then 4 times daily for two weeks . At two weeks followup, the patient’s vision had returned to baseline with inflammation resolved. Corneal involvement, especially with vision loss involving inflammation of the superior limbus, is not found widely in literature. This atypical case presentation was clearly triggered by an inflammatory reaction as it was responsive to steroid treatment. Although it is possible that a concurrent viral and episcleritis event occurred, it is still unclear as to why such a vigorous inflammation involved only the superior limbus. Oculus pentacam tomography and anterior segment images will be presented along with further discussion and differentials. Poster 63 A unique case of acute unilateral vision loss from Keratoconjunctivitis isolated to the superior limbus OD - Ocular Disease Emily Lubbers, OD WG Hefner VAMC resident 6207 Grandeur Drive Salisbury, South Carolina 28146 Poster 63.2 Optic Nerve Head Elevation Secondary to Vitreopapillary Traction Additional Author(s): Joan Sears, OD, FAAO OD - Ocular Disease The superior limbus is prone to a number of conditions due to a mild hypoxia and increased mechanical sensitivity due to lid and tarsal plate apposition. Disorders involving the superior limbus include a wide range of conditions from keratoconjunctivitis to episcleritis and from GPC to SLK. However, most of these conditions are either not isolated to the superior limbus or if so, tend to be bilateral in nature. A 64 year old caucasian male presents with complaint of blurred vision, monocular diplopia and throbbing pain in the left eye for 1 week. His symptoms started after he suffered a flu-like virus 1 week prior. Acuity in the left eye upon examination was 20/50 with ghosting of images. Slit lamp examination revealed severe inflammation isolated to the superior bulbar conjunctiva with engorged vessels and limbal hypertrophy. A large area of coalesced infiltration with elevated epithelial overlying defect was observed on the superior cornea. Corneal edema extended from the superior half of the cornea towards fixation. Palpebral response showed minimal follicular response inferiorly and upper palpebral conjunctiva was clear with lid eversion. A macular scan was ordered to rule out other pathology contributing to decreased vision; but none was noted. Pentacam tomography images were obtained Andria M Pihos, OD Illinois College of Optometry 3241 South Michigan Ave. Chicago, Illinois 60616 Additional Author(s): Bruce Teitelbaum, OD Complete posterior vitreous detachments are a common and well documented finding in elderly patients. Incomplete vitreous detachments are less frequently described and occur when there is a partial separation of the vitreous cortex from its attachment to the optic nerve head. Vitreopapillary traction is recognized when the posterior hyaloid retains an incomplete adhesion to the optic nerve head resulting in traction and the appearance of optic nerve head elevation. Vitreopapillary traction is not widely reported in elderly patients in the absence of diabetic retinopathy or other retinal vascular disease. A 76-year-old female presented to the primary eye care clinic with a complaint of gradual onset of blurry vision over the past month. The patient’s medical history was significant for diabetes and hypertension and her ocular history was negative. Her best corrected acuity at this time was 20/20 OD and 20/30 OS. Her pupils were round and equally 37 reactive with no relative afferent pupillary defect. Extraocular motilities were normal. The patient’s anterior segment was normal with the exception of mild cataracts in both eyes. Intraocular pressures were 22 mmHg OD, OS. Dilated fundus exam revealed mild nasal disc elevation OS greater than OD. The maculae were flat and the retinal vessels and background were normal without any retinal hemorrhages or exudates in both eyes. Visual field testing revealed a very mildly enlarged blind spot OS. Optical coherence tomography of both eyes demonstrated nasal vitreopapillary traction and mild el evation to the nasal aspect of the optic nerve heads. Primary eye care providers should be aware of this condition in the differential diagnosis of optic disc elevation. This case also demonstrates the appropriate use of OCT technology to avoid expensive and unnecessary medical testing. of the right eye, with no significant findings OS. The patient indicated no history of trauma, known systemic disease, or awareness of right eye visual deficit. The retinal changes were photo documented and though present, were not in proportion to the extent and severity of the visual field defect. An MRI of the brain and orbits was ordered to rule out a pre-chiasmal lesion. The MRI was unremarkable and the patient was referred for a retinal consult. The visual fields were repeated with similar results, with the specialist noting mild retinal variations in the left eye and atypical sector retinitis pigmentosa OD much greater than OS was diagnosed with vitamin A therapy initiated. Six month follow up revealed unchanged visual fields and mild pigment clumping OD. This case highlights the variable nature of retinitis pigmentosa and the challenges in diagnosing the condition when it presents without its most classic signs and confounding visual fields. The earliest signs of RP are retinal granularities, and pigment can be lacking for variable lengths of time. Genetic counseling is one of the most important aspects of this diagnosis, however, this patient had no previous family history (simplex RP), which occurs 50% of the time in RP cases. Poster 64 Atypical Sectoral Retinitis Pigmentosa: A Case Report PC - Primary Care Lindsay Elkins, OD Southern College of Optometry 1225 Madison Ave Memphis, Tennessee 38104 Poster 65 Bilateral Abduction Deficit Secondary to Influenza Retinitis pigmentosa (RP) is a heritable retinal degeneration classically presenting with bilateral RPE rearrangement mimicking “bone spicules,” night blindness, progressive “ring scotoma” visual field defects, and abnormal electroretinography. There are many variations in presentation, including sectoral RP; typically bilateral, symmetric, with a hallmark of pigment deposition in the inferior quadrants. A 32 year old female complained of eye strain, both eyes, worse at night, especially driving, over the last three months. Distance acuities, uncorrected were 20/20 OD, 20/15 OS. Confrontation visual fields were completely constricted temporally OD, and normal OS. Other entrance testing was within normal limits. Posterior segment evaluation was normal OS, though OD revealed abnormal retinal stippling nasally and along the superior temporal arcade, with no pigment deposition. Humphrey’s 24-2 testing was reliable, demonstrating absolute visual field defects respecting the vertical midline and encompassing the entire temporal hemi-field PC - Primary Care Chelsea M. Dunn, B.S. Chemistry Pennsylvania College of Optometry at Salus University 1200 West Godfrey Ave. Philadelphia, Pennsylvania 19141 Additional Author(s): Kelly A. Malloy, OD, Erin M. Draper, OD, Maegan E. Folk, Student An abduction deficit can be caused by many etiologies, and may localize to either extra-ocular muscles, neuro-muscular junction, the entire course of CN VI, or the pons. The localization of a bilateral abduction deficit may be similar. However, a bilateral presentation is more concerning for increased intracranial pressure or a clivus lesion, especially when no other signs localizing to the orbit or brainstem are present. When work-up, including neuro-imaging and laboratory testing 38 Poster 66 are unremarkable, a vasculopathic process is often considered. However, if the diplopia is preceded or accompanied by cold/flu symptoms or a recent flu vaccination, a viral etiology always needs to be considered. A 60-year-old man complains of constant horizontal diplopia starting 2 weeks ago. Three weeks ago, the patient reports suffering from cold symptoms, including temporal headache, hypersensitivity to taste, decreased appetite, and pulsing sensation throughout his body. His PCP treated him with antibiotics and over-the-counter pain relievers. He has had elevated blood pressure over the past few months without a diagnosis of hypertension and has smoked for 40 years. Clinical examination is remarkable for a bilateral abduction deficit with an abducting capacity of 40-50% OD and 60% OS. A 30 diopter eso deviation is present in primary gaze. Blood pressure is 140/95 mmHg. MRI of brain and orbits is unremarkable. Laboratory testing shows slightly elevated erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP). At follow-up 10 days later, the patient reports resolution of cold symptoms. Cover testing shows an improvement in the eso deviation to 20 diopters. Repeat ESR and CRP are normal. A thorough history including investigation into recent cold/flu symptoms is pertinent in all cranial nerve palsies. Mildly elevated inflammatory indicators such as ESR and CRP will also help differentiate an active virus from vasculopathic processes. These indicators can also be elevated in GCA, but they will not return to normal levels as they did in this case. Although other more urgent etiologies need to be ruled out, viral etiologies can be differentiated by improvement in the nerve palsy concurrent with resolution of cold symptoms. Eliminating the need for binocular balancing with point spread function technology PC - Primary Care David I Geffen, OD Gordon Weiss Schanzlin Vision 8695 Robinhood Laneq La Jolla, California 92037 Additional Author(s): Mille Brujic, OD, FAAO, OD Binocular balancing is the step in subjective refractions that involves matching the accommodative stimulus for the two eyes. It also relaxes the accommodation as a result of both eyes being open and enables the matching of the visual acuity between two eyes. Binocular balancing is required because there is a risk of overminusing a patient during a subjective refraction when using a phoropter and Snellen letters. However, this procedure can be confusing or even disturbing to patients, and may not be possible in patients with differing visual acuities in the two eyes. Moreover, binocular balancing can be technically challenging for optometric staff and technicians, making the delegation of a subjective refraction difficult. A device that utilizes point spread function (PSF) for the subjective refraction (PSF Refractor, VMax Vision, Maitland, FL) instead of Snellen letters provides the opportunity to obtain an accurate refraction without the need for binocular balancing. Our center participated in a clinical study comparing the performance of this technology with that of a traditional phoropter. The assessments were conducted in the right eyes of 30 patients who presented for a routine visual examination. Each patient underwent a subjective refraction first with a standard phoropter with binocular refraction using +1.0 D fogging in the fellow eye, and binocular balancing at the end. In the same patient and the same eye, monocular refraction was performed with a PSF Refractor and without binocular balancing. The manifest refraction and visual acuity (VA) were recorded. Results The mean age of the patients was 37.3 years (range 10−68 years). In 70% of patients, the spherical equivalent (SE) with the PSF Refractor was within 0.13 D of that with a binocularly balanced phoropter. In 27% and 3% of patients, respectively, the SE differed by 39 more than 0.13 D and 0.255 D. PSF refraction results were equal to or better than those obtained with the phoropter binocular method in 93.5% of patients. The point spread function based refractor provides accurate manifest refraction and visual acuity readings without the need for binocular balancing, which makes subjective refraction a simpler and faster process. used to follow the patient. With observation alone, vision in the left eye improved to 20/60, and the patient reported a near full functional recovery with a new appreciation for the sight he feared he would not regain. Patient education and counseling is an important part of an optometrist’s role in patient care. It is crucial for clinicians and patients alike to understand any underlying pathology before expectations and visual prognosis are discussed. In this case, a patient was surprised to recover some vision after being prematurely told it was a lost cause. Poster 67 Traumatic Optic Atrophy PC - Primary Care Poster 68 Janet Garza, OD University of Houston 10711 Staghill Dr. Houston, Texas 77064 Additional Author(s): Pat Segu, OD The Problem of Pain: A Delayed Diagnosis of Ankylosing Spondylitis PC - Primary Care Amy Moy, OD New England Eye, New England College of Optometry 75 Bickford St. Jamaica Plain, Massachusetts 2130 Ocular trauma is an unfortunate, yet relatively common ocular condition seen in optometric practice. Approximately three million cases of ocular injuries are seen in the United States per year. Incidence of traumatic optic atrophy ranges from 0.5 to 5% of all ocular trauma related cases, and 60% of traumatic optic atrophy cases present with severe vision loss. Although there are different mechanisms which can result in optic atrophy, it is imperative to conduct a thorough eye examination as well as obtain proper diagnostic testing and imaging to properly understand viable treatment options and visual prognosis for the patient. A 41 year old Hispanic male experienced a blow to the face involving the left eye during a robbery altercation. Immediately after the offending injury, the patient reported to the emergency room because he had seemingly lost all vision to the eye in question. No imaging was performed at the emergency room, yet the patient was told that he had no hope of regaining any degree of vision. The patient reported to clinic one month post trauma and emergency room visit for his first ever comprehensive eye examination. The chief complaint was that of reduced, however improving, vision in the left eye following the injury. Initial examination findings for the left eye included a best corrected acuity of 20/200, +APD, generalized depression on visual field, defects on Amsler and red cap saturation test, and temporal ONH pallor with associated RNFL thinning. Over the course of two and a half months, objective and subjective measures were Additional Author(s): Andrea Liu Ankylosing spondylitis (AS) is diagnosed due to age, history of back pain due to inflammation of the sacroiliac joint, physical exam, x-rays, and positive response to non-steroidal inflammatory drugs (NSAIDS). A positive HLA-B27 result can indicate AS, but does not always mean that a patient has AS. Acute anterior uveitis occurs in a significant percentage of patients with AS over the course of their condition. A 44-year-old Columbian female presented to our clinic with her second occurrence of bilateral granulomatous uveitis. Upon initial questioning, she did not have significant pain in her body. However, it was later found in previous primary care notes that she had chronic right-sided body pain and knee pain, and had been trying palliative treatment and physical therapy for years. It was later revealed that after her first episode of bilateral anterior uveitis, she tested positive for HLA-B27 and Rheumatoid Factor. X-ray testing showed mild osteoarthritis of the knee. The consulting rheumatologist reported no evidence of a spondyloarthropathy or connective tissue disorder, and the plan was to monitor. Three years went by in which the patient had chronic pain in her buttocks and knees, but no further 40 rheumatological assessment was ordered by her PCP. Due to the recurrent nature of the uveitis and history of chronic pain, the optometrist contacted the PCP and ordered an inflammatory workup. The HLA-B27 and Rheumatoid factor results were again positive, with no other significant lab findings. After referral to Rheumatology and further testing, the patient was finally diagnosed with AS, mostly due to her history and symptomatology. She now has a diagnosis for her chronic pain, and takes oral Etodolac with marked improvement. An optometrist can have significant impact on finding a diagnosis for a patient in chronic pain. Even if the uveitis was not present, it may be prudent for the optometrist to probe more deeply into a patient’s pain history if there is prior history of bilateral granulomatous uveitis. In coordinating care between Primary Care, Rheumatology, and Optometry, the optometrist was able to make the interdisciplinary connections that were needed to improve the patient’s health and well-being. conducted at one, four, and eight days. By the fourth day the epithelium had healed but the iritis remained. Erythromycin ointment was discontinued and Pred Forte was added four times a day in the right eye. At the one week follow up the iritis had resolved completely and distance VA was correctable to 20/25+2 OD, OS. Corneal abrasions heal quickly, often with 24 to 72 hours depending on the initial size of the defect. Possible secondary complications include bacterial infections and traumatic iritis. Antibiotic ointments can be very beneficial both to ensure antibacterial coverage in a population that often resists drops and as a barrier between the abrasion and eyelid, helping to decrease pain. Cycloplegic agents are unnecessary for pain management unless an anterior chamber reaction is occurring. Pressure patching is no longer recommended for healing or pain reduction. Oral OTC analgesics can be used to manage pain during the healing process. There is a lack of evidence comparing pain reduction in topical NSAIDs with oral analgesics. Topical NSAID use in children has not been studied and should be avoided. Potential devastating complications in adults include corneal melting. Corneal scaring is rarely seen in children with corneal abrasions. Poster 69 Treatment of a Corneal Abrasion in a Pediatric Patient PC - Primary Care Poster 70 Casandra Solis, OD Children’s Mercy Hospital 8979 Renner Blvd #1604 Lenexa, Kansas 66219 Diagnosis of a hemi-retinal vein occlusion with only half the case history. PC - Primary Care Corneal abrasions are one of the most common forms of ocular trauma found in the pediatric population. Current treatment for corneal abrasions in children is based off of accepted treatment for adults. Limited research and publications exist regarding this specialized population and confusion on proper treatment still exists, both for the optometrist and primary care provider. A 7-year-old male presents with pain, reduced vision and photophobia. Patient reported something got in his eye at school, but was unsure of the substance. Distance VA measures 20/100 OD, 20/20 OS. Anterior segment exam revealed a large corneal abrasion, diffuse moderate injection and 2+ cells in the anterior chamber OD. He was instructed to use erythromycin ointment three to four times a day in the right eye. In addition, cyclopentalate 1% twice a day was added in the right eye to help with comfort due to secondary traumatic iritis. Follow-ups were Stacey Chong, BSc, MSc, OD School of Optometry and Vision Science 200 University Ave West Waterloo, Ontario, Alabama 99999 Additional Author(s): Tammy Labreche, OD, Patricia Hrynchak, OD, FAAO, MScCH(HPTE), Michelle Steenbakkers, BSc (Hons), OD, FAAO A 90 year-old Caucasian female presented for a full oculovisual assessment at the long term care facility where she resided. The patient reported an episode one-month prior where the vision in her left eye was quite reduced but had since returned to normal. The patient’s systemic history was positive for gastroesophageal reflux disease, transient ischemic attacks, Alzheimer’s disease, iron-deficient anemia, systemic hypertension and vertigo. The patient’s ocular history included glaucoma that 41 was being treated with Xalacom® (latanoprost 0.005% and timolol 0.5%). Best-corrected visual acuities were 20/20-3 in the right eye and 20/253 in the left eye. Intraocular pressures were 11mmHg and 10mmHg in the right and left eyes, respectively. A dilated fundus exam of the right eye was unremarkable; left eye revealed an inferior hemi-retinal vein occlusion. Macular edema was minimal in the left eye. Glaucomatous damage was not detected in either eye. A family member later provided her new ocular history, which included “leaking blood vessels in the back of her left eye” which was diagnosed during a routine glaucoma follow-up visit with her ophthalmologist. She had received one of a series of three monthly injections. This new information was not in the patient’s medical record. This case outlines the challenges in patient care when there is cognitive impairment and a caregiver or family member is not present. In this case, the patient’s son was often present but was not at this exam. As a result, the majority of the case history was determined after the eye exam. Lack of communication resulted in duplication of services and increased cost to the health care system. The lack of co-ordination has also resulted in multiple visits for the patient that can be strenuous on the patient as well as the family. Effective communication between healthcare practitioners is essential in providing care for all patients, especially those who are affected by cognitive impairment. which cleared with +2.50 OTC readers. Ocular history included laser peripheral iridotomies (LPI) 4-weeks prior. A short course of topical steroids post-LPI was complete and he was currently using an unknown drop for irritation. Visual acuity improved from 20/25-2 to 20/15 in each eye with +1.25DS in the right eye and +1.50 - 0.25 x 100 in the left eye. Intraocular pressures were 18mmHg in each eye, slit lamp biomicroscopy was negative for inflammation and blood. The LPIs were patent. Fundus examination revealed flat maculae and cup-to-disc ratios of 0.25 and 0.30 in the right and left eye, respectively. The patient was referred to his ophthalmologist and seen 4-weeks later when the unaided vision had returned to baseline. There was no evidence of macular edema, as confirmed with optical coherence tomography. At a followup 3 months later the patient’s unaided vision was stable at 20/15 in each eye. Updating the medical history revealed recent diagnosis of Type 2 diabetes managed with Janumet (sitagliptin metformin). This case presents a patient with a hyperopic shift in refraction, likely secondary to a decrease in bloodglucose levels after initiating Janumet. Post-LPI complications include post-operative increase in IOP, anterior uveitis, release of pigment, bleeding, focal cataract, corneal decompensation, blurred vision and glare. It was hypothesized that ciliary body displacement or macular swelling may have caused the hyperopic shift; however, ciliary body effusion has been documented to cause a myopic shift and in this patient, there was no evidence of macular edema. A review of medical history was vital to determining potential causes for the hyperopic shift. Post-LPI complications causing hyperopic refractive shifts are not documented in the literature and the refractive error change warranted further investigated in this case. The patient was not initially forth coming with the diagnosis of Type 2 diabetes but when asked about any changes in health or medications, the patient provided an updated medical history. Poster 71 Post Laser Peripheral Iridotomy Complications: A Case of Differential Diagnosis PC - Primary Care Stacey Chong, BSc, MSc, OD University of Waterloo School of Optometry and Vision Science 200 University Ave West Waterloo, Ontario, Alabama 99999 Additional Author(s): Patricia Hrynchak, OD, FAAO, MScCH(HPTE), Michelle Steenbakkers, BSc (Hons), OD, FAAO A 56-year-old white male presented with complaints of a 24-hour history of decreased vision 42 Poster 72 patient with forme fruste keratoconus who developed significant astigmatism following diamond burr polishing for RCE. The safety profile of these procedures for RCE in patients with keratoconus has not been established thus making it imperative that thorough screening for concomitant corneal disease be performed before referral for surgery. Traumatic Recurrent Corneal Erosion in a Keratoconic Eye PC - Primary Care Hitomi Ezumi, OD Pennsylvania College of Optometry at Salus University 1050 N Hancock St #715 Philadelphia, Pennsylvania 19123 Poster 73 Fighting the Silent Killer: One Role of Primary Care Optometry in Managing the Patient with Hypertension Recurrent corneal erosions (RCE) are characterized by sudden pain during sleep or upon awakening often accompanied by a history of trauma. This condition is commonly managed with lubrication, bandage contact lenses (BCL), and hypertonic solutions and ointments. In cases where these treatments fail, surgical intervention such as anterior stromal puncture (ASP), diamond burr debridement, or phototherapeutic keratectomy (PTK) may be necessary. A 24 year old Hispanic male presented to the emergency service with a complaint of severe pain, redness, photophobia, and tearing in the right eye upon awakening the previous day. He reported a history of an altercation three months prior for which he was evaluated in the emergency room but was not treated. Since then he had experienced five episodes of pain upon awakening but none severe enough to seek treatment. Upon examination the patient was found to have reduced vision, mild lid edema, a large corneal epithelial defect, corneal edema, conjunctival injection, and an anterior chamber reaction. Initial treatment involved cycloplegia, BCL, and a topical antibiotic. He was subsequently treated with a topical corticosteroid and hypertonic solution and ointment. Prior exam records indicated that the patient had keratoconus which became more apparent as the corneal edema resolved. The patient has had no further episodes of RCE. While most cases of RCE can be managed with topical therapy, recalcitrant cases may need more aggressive treatment. Corneal abrasions and erosions are not uncommon in keratoconic eyes corrected with rigid gas-permeable contact lenses, though in this case the erosion was related to trauma. ASP and PTK have been used to treat RCE secondary to subepithelial nodular scars in keratoconus, though there was a report of keratolysis leading to a descemetocele following PTK. One case described a PC - Primary Care Amanda Phelps, OD Southern College of Optometry 1424 River Boat Circle Memphis, Tennessee 38103 Additional Author(s): Beth Sparrow, OD Retinal arterial macroaneurysms are outpocketings of major arteries within the retina most commonly seen in hypertensive females in the 6-7th decade and usually are indicative of severe cardiovascular disease. Macroaneurysms have several sight-threatening sequelae including macular edema, exudates, multi-layer retinal and vitreal hemorrhages. A multi-layered retinal hemorrhage is considered pathognomonic for the presence of a macroaneurysm and includes the simultaneous presentation of subretinal, intraretinal, and preretinal/ subhyaloid hemorrhages. A 74 year old black female presented with sudden, painless vision loss for two weeks in the left eye. Medical history was positive for NIDDM for fifteen years and hypertension for twenty years. Ocular history included mild non-proliferative diabetic retinopathy OU for three years, primary open angle glaucoma suspect OU for three years, and pseudophakia OS. LEE was one year prior. BCVA was 20/20-1 OD and 20/400 @ 2 feet OS. All chair skills and anterior segment findings were normal and intraocular pressures were 16 mmHg OU. Posterior segment findings revealed A/V crossing changes OU, one dot heme OD, and a multi-layered retinal hemorrhage in the left eye effecting the macula. The patient was referred to a retinal specialist and an injection of Avastin© was administered with the patient to be monitored in one month. Her one month follow up with the retinal specialist showed 43 significant resolution of the hemorrhage in the left eye. This case is currently in progress and a follow up examination has been scheduled with the referring optometrist and the patient is being closely monitored by her primary care physician. Macroaneurysms are associated with hypertension, typically have sight-threatening complications and may indicate a potentially lifethreatening cardiovascular condition. The presence of a macroaneurysm warrants a referral to the patient’s primary care physician or cardiologist depending on the presence and severity of comorbidity factors. This case demonstrates the role of the primary care optometrist in identifying the potential lethality of systemic disease during an ocular examination. lens was ordered with an opaque backing, blue iris (specifications 42-V, U-3) and limbal ring to match the right eye. After dispensing the trial, the patient remained in the office for an hour then walked into the sunlight. She immediately noted relief from photophobia, increased clarity on the left side and was pleased with the appearance of the contact lens. As optometrists, our assumption may be that cosmesis is the primary concern for a patient with anisocoria, but this may not always be true. Our patient stated “I’m not really concerned with the way it looks. I’m used to it, but it just feels weird over here.” Our responsibility is to understand the complaints of our patients based on our knowledge of anisocoria and its effects on the visual system. Optometrists must be sensitive to all possible symptoms and at the same time, deliver an acceptable cosmetic solution. Before and after photos will be included in the poster. Poster 74 Traumatic Anisocoria: More than Cosmesis Poster 75 PC - Primary Care Amanda Phelps, OD Southern College of Optometry 1424 River Boat Circle Memphis, Tennessee 38103 Retention of Knowledge of Retinal Microanatomy by Optometric Students, Faculty, and Practitioners Additional Author(s): Beth Sparrow, OD Ruth Trachimowicz, OD, Ph.D. Illinois College of Optometry 3241 South Michigan Ave. Chicago, Illinois 60616 PC - Primary Care Traumatic anisocoria not only presents the patient with obvious cosmetic issues but can also result in functionally debilitating symptoms including photophobia that often prove more bothersome than the appearance of differing pupil sizes. A 43 year old female was referred to our academic institution from a local military base for a prosthetic contact lens fit for relief of symptoms due to traumatic anisocoria OS for seven years. She presented with complaints of photophobia, “headache” on the effected side, blurred vision and a sense of being “off balance.” She was an uncorrected compound myopic astigmat in each eye with BCVA of 20/20 OD, OS. Her pupil diameters were 3.5 mm OD, 7.5 mm OS in light and 5 mm OD, 8 mm OS in dark conditions with appropriate reaction to direct light OD and minimal reaction to direct light OS. Her iris color was light blue with a dark limbal ring. All other medical and ocular findings were unremarkable.After one fitting session with a diagnostic fitting set, an Orion BioColors© soft contact lens with base curve 8.8, 14.3 diameter, clear pupil 4.2 mm and plano power was chosen.This Additional Author(s): Barclay W. Bakkum, D.C., Ph.D Anatomy can be considered one of the basic pillars of optometric training. Because advanced imaging technology allows cross-sectional ocular microanatomy to be visualized, this study was developed in order to identify the ability of fourth year optometric students, faculty members at an optometric college (including residents), and a group of private practice optometrists to label a histologic image of the retina showing the 10 layers in a similar orientation as represented on optical coherence tomography. After an IRB approved consent process, the subjects were asked to provide information about how many years since they had graduated and any self-reported optometric specialties, e.g., primary care, contact lenses, pediatrics/binocular vision, low vision, or a combination of these. They were then 44 allowed 5 minutes maximum to label the layers of the retina on a histologic image provided to them. A total of 172 participants were recruited for this study: 35 4th-year optometry students, 41 optometry school faculty optometrists (including 9 residents), and 96 private practitioners. Nearly ½ of the private practitioners and about 1/3 of the faculty members had graduated over 15 years ago. The students correctly identified an average of 7.3 (±3.3) retinal layers. The faculty members identified an average of 3.5 (±3.5), and the private practitioners identified an average of 1.1 (±1.9). The retinal pigmented epithelium and the internal limiting membrane were the most commonly identified layers. Nearly 1/3 of the private practitioners either left their answer sheet blank or had non-retinal structures as answers. latency, average constriction velocity, dilation velocity, and 75% recovery time. Poster 77 Comfort and Cost Comparisons of Ketotifen Anti-Allergy Drops PH - Public Health / Policy Jennifer M. Snyder, OD Southern College of Optometry 1245 Madison Ave. Memphis, Tennessee 38104 Additional Author(s): Andrew Neighbors, B.A., William Edmondson, MAT, OD, FAAO, Earlena McKee, M.A., OD, FAAO Poster 76 This study compares the perceived ocular comfort and cost of three current formulations of OTC Ketotifen fumarate (0.025%) anti-allergy ophthalmic solution. Ketotifen drops provide mast cell stabilizing as well as antihistamine activity. A double blind study at Southern College of Optometry compared the comfort of three different Ketotifen brands based on a comfort survey scale from 1-10 with 10 representing very comfortable and 1 representing very uncomfortable. The first drop instilled in the patient’s right eye, TheraTears lubricating eye drop, was used as a reference of very comfortable with a grade of 10. Following the reference drop, the three anti-allergy drops were instilled in the subject’s right eye in random order, allowing five minutes between drops. Subjects completed the drop comfort survey following each drop. Data were analyzed with a single factor ANOVA testing and on a pair-wise basis using a two-tailed t-test for a difference of means. Two significantly distinct groups (p<0.05) of comfort rankings resulted. Of the three OTC Ketotifen brands, there were was no significant comfort difference (p=0.689) between TheraTears Allergy Eye Itch Relief (Advanced Vision Research) and Zaditor (Alcon), the original Ketotifen formulation. Alaway (Bausch & Lomb) was rated as the significantly least comfortable drop (p<0.05). TheraTears Allergy Eye Itch Relief and Alaway are available in 10mL bottles, while Zaditor is only available in 5mL bottles and costs twice as much as the two other medications. Objective Biomarker for Early Identification of Blast-Induced mTBI: Pupillary Light Reflex (PLR) PC - Primary Care Grace Lea Y. Dumayas, OD Womack Army Medical Center, Northeastern State University 771 Sun Road Aberdeen, North Carolina 28315 Additional Author(s): Jose E. Capo-Aponte, OD, Ph.D There is an increase in mild traumatic brain injury (mTBI) in US Warfighters resulting from exposure to explosive devices. However, there is a lack of objective biomarkers to accurately identify mTBI in order to make a return-to-duty (RTD) determination in the battlefield. The present study examined pupillary light reflex (PLR) as a potential objective biomarker for early identification of mTBI. The PLR-200â„¢ monocular infrared pupillometer was used to quantify PLR under mesopic conditions in 20 U.S. military personnel with blast induced-mTBI and 20 age-matched nonTBI military personnel. Eight PLR parameters were assessed: maximum diameter; minimum diameter; percent of constriction; constriction latency; average constriction velocity; maximum constriction velocity; 75% recovery time; average dilation velocity. Four of the eight PLR parameters were statistically different between the groups: constriction 45 Poster 78 Improving Follow-up Attendance by Patients Examined at a Community Service Event for the Homeless Population rate after the September event was only 18.5%. Onsite scheduling did not appear to improve follow-up compliance. There was a much higher pick-up rate for prescription glasses of 82% (February) and 85% (September). PH - Public Health / Policy Poster 79 Zakiya Nicks, OD Southern College of Optometry 1225 Madison Ave Memphis, Tennessee 38104 Short-term (2 month) subjective and objective improvement for meibomian gland dysfunction after a single treatment using the LipiFlow Thermal Pulsation System. Additional Author(s): Wilson McGriff, OD, MPH PH - Public Health / Policy Access and utilization of healthcare services is a significant area of concern in the homeless population. A recent survey revealed 92% of homeless individuals in Memphis and Shelby County, TN had no health insurance coverage. Over 60% of these individuals have been diagnosed with health conditions that required routine medical attention. Project Homeless Connect Memphis (PHC), coordinated by The Community Alliance for the Homeless, is a large-scale, oneday service delivery event through which hundreds of community volunteers work hand-in-hand with homeless neighbors to break down barriers to services needed to leave the streets of Shelby County. The objective of this study was to determine if onsite scheduling improved follow-up compliance for eye care in the homeless population served during PHC events. Through funding provided by Optometry Cares®- The AOA Foundation 2013 Healthy Eyes Healthy People® State Association Grant, The Eye Center (TEC) at Southern College of Optometry (SCO) participated in PHC Memphis at the Cook Convention Center in Memphis, TN on February 14 and September 19, 2013. Comprehensive eye exams were provided to registered individuals in a temporary clinic at both events. Patients diagnosed with or identified as at risk of having an ocular disease were referred for medical follow-up care at TEC and its clinical partners. In February, patients were provided contact information and instructed to contact TEC after the PHC event to schedule their follow-up appointment. In September, TEC staff scheduled the recommended follow-up appointments before the patients left the event. A total of 346 patients ages 18-72 were seen over the course of two PHC events. The follow-up rate after the February event was 20%. The follow-up Leslie E. O’Dell, OD, FAAO May Eye Care- Private practice 250 Fame Av Ste. 225 Hanover, Pennsylvania 17331 Additional Author(s): Raman Bedi, MD, Ophthalmology To determine short-term (2 month) subjective and objective outcomes following treatment with the LipiFlow Thermal Pulsation System for patients with Meibomian gland dysfunction and dry eye symptoms. Data from 101 charts were reviewed after having one or both eyes treated with a single 12-min treatment using the LipiFlow Thermal Pulsation System. Meibomian gland function, classified as the number of glands secreting clear oil and patient symptoms using the SPEED questionnaire were measured. Data is presented for pretreatment (baseline) and 2-months post-treatment. Statistically significant improvement in the number of Meibomian glands secreting clear oil was found in all treatment scenarios, OU, right and left eye treatments. Speed scores, a subjective measure of symptom relief were also significantly reduced with baseline scores of 15.2176 (5.61356) and 2 month scores reduced by half at 8.1683 (5.30107) p< 0.001. One 12-min. treatment with the LipiFlow Thermal Pulsation System can improve both function of Meibomian gland and reduce patient symptoms. This review demonstrates Lipiflow as a efficacious treatment choice in patients diagnosed with Meibomian gland dysfunction. 46 Poster 80 Poster 81 Assessment of Eye Health Awareness through Community Engagement: “Eye†Evidence-Based Optometry and the Need for New Clinical Practice Guidelines PH - Public Health / Policy Trennda Rittenbach, OD Minneapolis VA Medical Center 7600 Lyndale Ave S Unit 330 Minneapolis, Minnesota 55423 Zakiya Nicks, OD Southern College of Optometry 1225 Madison Ave. Memphis, Tennessee 38104 Additional Author(s): Bennett McAllister, OD, FAAO Additional Author(s): Lindsay Elkins, OD Clinical Practice Guidelines (CPG) have traditionally been based on expert opinion and consensus but must now be supplanted by higher level evidence as required by the Institute of Medicine (IOM). The American Optometric Association (AOA) developed consensus-based guidelines in the mid-1990s that have been periodically reviewed and revised as needed since their introduction. Originally, they were intended to be used as a resource for clinicians, policymakers and the general public. Recently, the IOM has been mandated by the U.S. Congress through the Medicare Improvements for Patients and Providers Act of 2008 to find the best methods for developing quality, trustworthy, evidence-based clinical practice guidelines. Any clinical guidelines not meeting the new IOM standards would not be eligible to be listed as a trustworthy guideline. Therefore, as the optometric leader in CPGs, the AOA assembled a guideline-development group (GDG) that includes a multidisciplinary panel of content experts and representatives from key stakeholder groups with transparency of process, clearly identified conflicts of interest and an open development process. The first of the new, Evidence-Based Optometry (EBO) guidelines that follow the eight IOM standards for trustworthiness are now coming online with more scheduled for future dissemination as they are developed. In conclusion, Clinical Practice Guidelines are entering a new era of evidence basis that will lead the way for better care of patients, more informed policy and legislative decisions and general public knowledge of optometry’s scope of practice. Parents completed a registration form including the child’s gender, age, race, and home zip code, which was used to assess the population serviced. Upon completion of the event, parents were asked to answer the following questions to assess the perceived effectiveness of this model of eye health awareness delivery and the need for further education about the importance of a comprehensive eye exam to this population: 1) How many children did you bring to the event? 2) Of those you brought, how many have had a comprehensive eye exam? 3) Did this event increase your understanding of the eye and vision? 4) Did this event influence your understanding of the importance of an eye exam (for your child)? Of the 536 kids that registered for the event, 48% reported not having an eye exam in the last year with 33% never having had a comprehensive eye exam. The event was far reaching with fifteen states represented, including California, Colorado, and Wisconsin. A majority of the families were from the local mid-south area (TN 42%, MS 31.4%, AR 16.6%). Of the 118 parents that answered the last two survey questions, 94% agreed that this event increased their understanding of the eye and vision, and 92% agreed that this event influenced their understanding of the importance of an eye exam for their child. There was a high level of perceived effectiveness with this model of eye health awareness delivery. With a third of children reporting never receiving an eye exam, there is need for further education regarding its importance. Visual health is important for all populations, but none more so than children, as visual impediments are more likely to affect early learning and potentially future achievements. 47 Poster 82 number of schools and colleges of optometry in the US currently participating in IPE, the profession is attempting to embrace the importance of this health-care trend. However, it is also noteworthy that an equal number of schools reported barriers for IPE. It is ASCO’s mission to provide optometry degree programs with the tools to break through these barriers in order to more effectively prepare graduates for the healthcare delivery system within which they will practice with the ultimate goal of improved patient outcomes. Interprofessional Education at Schools and Colleges of Optometry in the US; Current Practices and Challenges Melissa A Vitek, OD Pennsylvania College of Optometry, Salus University 1521 Old Welsh Road Huntingdon Valley, Pennsylvania 19006 Poster 83 Additional Author(s): John L. Baker, OD, MSEd, Jenny Smythe, OD, MS TITLE Family Practice Residents and Optometry Students Collaborate in Clinical Care at PCO: An Example of Interprofessional Education at Salus University Background: Interprofessional education (IPE) occurs when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes. The importance of interprofessional education in optometric education is a basic tenet of ASCO’s 2011 revised “Attributes of Graduates of the Schools and Colleges of Optometry” report. In 2013, ASCO developed an interprofessional education task force that was, in part, charged with identifying best practices within ASCO institutions to prepare graduates for team-based practice. Methods: A Survey of Interprofessional Education Programs in the Schools and Colleges of Optometry was mailed to each President and Chief Academic Officer of the twenty-one schools and colleges of optometry in July 2013. The sixteen question survey, originally developed in 2011 by an ASCO Government Affairs staff member was modified to ask about existing IPE activity, as well as about attitudes, challenges and future plans relating to IPE at each institution. Results: Nineteen of the twenty-one schools and colleges of optometry reported their institution participated in IPE activites and eight reported it was a requirement of their programs. Eight schools and colleges of optometry described IPE coursework involving students from different programs teaching one another. Fourteen programs indicated they were providing interprofessional patient care while eight institutions have a partnership with schools and programs outside of their own institution. Representatives from eleven institutions have taken part in an Interprofessional Education Collaborative (IPEC) sponsored workshop. Nineteen programs reported barriers for initiating or furthering IPE at their institution. Conclusion: As evident by the Melissa Vitek, OD Salus University 1521 Old Welsh Road Huntingdon Valley, Pennsylvania 19006 Additional Author(s): Linda Casser, OD, Valerie Pendley, MD AUTHORS Melissa Vitek, OD, Director of Electives and Advanced Studies, PCO Academic Liaison to International Programs, Assistant Professor, PCO at Salus University; Linda Casser, OD, Professor, Dean, PCO at Salus University BACKGROUND Beginning in October, 2012, The Eye Institute at PCO, Philadelphia, PA and Chestnut Hill Hospital Family Practice, Philadelphia, PA, have joined forces in both patient care and education by implementing a model in which second year family practice residents take part in weekly sessions of active observation of comprehensive ophthalmic patient care at The Chestnut Hill satellite clinic of The Eye Institute. The satellite clinic is conveniently located just minutes away from Chestnut Hill Hospital. METHODS Drs. Melissa Vitek, OD and Valerie Pendley, MD, clinical educators and patient care providers in their respective programs, in recognition of their patient needs and the opportunity for a unique educational opportunity, presented the idea of this clinical/educational collaboration to their supervisors, Drs. Linda Casser, OD, PCO Dean, and Marc McKenna, MD, Residency Program Director, both of whom were instrumental in bringing the concept to fruition. RESULTS A total of six 48 residents have taken part in four sessions of patient care each since its initiation. The residents have the opportunity to take part in primary, pediatric, and emergency eye care. The residents have been so pleased with the experience that they have recently indicated they would like to expand their role to two sessions per week. Plans to accommodate this request are in place. CONCLUSION On a direct level, this initiative has allowed practitioners from both professions to gain further respect for each profession’s contribution to patient care. On a larger scale, the collaboration represents a synergistic model of both inter-professional healthcare and education. Most importantly, this approach to patient care and education promises more effective healthcare delivery ultimately leading to improved patient outcomes. yellow) anomaloscope testing, as well as the Cone Contrast Test, used USAF-wide, to diagnose type and severity of hereditary color deficiency. This presentation will describe the unique capabilities of the VNS, exemplary cases, as well as opportunities for research and development which encourages collaboration between Optometry, Ophthalmology, Neurology and myriad other fields directed at interprofessional collaboration. Poster 84 UIWRSO Visual Neurophysiology Service Jeff Rabin, OD, MS, PHD UIWRSO 9725 Datapoint Druve San Antonio, Texas 78229 Additional Author(s): Andrew Buzzelli, OD, MS, James Chapman, OD, MS, Timothy Wingert, OD The University of the Incarnate Word Rosenberg School of Optometry Visual Neurophysiology Service (VNS) is a unique clinical service with the goal of detection, diagnosis, and monitoring of myriad visual, systemic, and neurologic conditions. The VNS offers state-of-the-art visual electro-diagnostic testing, as well as color and contrast sensitivity assessment to identify origin and etiology of visual dysfunction. Testing includes electro-oculograms (EOGs) to assess RPE and outer retinal function; full field flash electroretinograms (ERGs) to assess outer and middle retinal function; multifocal ERGs to assess focal areas of visual loss mapped to rthe etina and visual field; pattern ERGs to assess inner retina/optic nerve function; flash and pattern visual evoked potentials (VEPs) to asses macular function at the level of the visual cortex. Moreover, the VNS includes full-scope color vision diagnosis using multiple pseudo-isochromatic book tests (e.g., Ishihara, HRR, Dvorine), hue arrangement tests (D15, de-saturated D15, FM100 with quantitative computerscoring), Rayleigh (red-green) and Moreland (blue49