“Highlights in Optometry: how optometrist change people’s lives”
2022 Poster Abstracts
Chair: Dawn J. Goedde, O.D., F.A.A.O
OSU College of Optometry
Optometry students, residents, clinicians, educators, and researchers were invited to participate in the 2022 EastWest Eye Conference Poster Session. The theme for this year is “Highlights in Optometry: how optometrist change people’s lives.” This year’s theme was chosen to showcase how optometrist improve their patient’s lives on a daily basis. From prescribing spectacles to clear the world of a child to diagnosing systemic disease and potentially saving a patient’s life, optometrist play an important role in health care.
Inflammatory Ocular Hypertension secondary to Ocular Toxoplasmosis
Navi Hehar OD, FAAO
The Eye Institute at Salus University
Toxoplasmosis is the most common cause of infectious chorioretinitis. The purpose of this case report is to discuss current practice in the management of ocular toxoplasmosis, including atypical anterior segment inflammation resulting in ocular hypertension.
Acute Non-Accommodative Esotropia in a Highly Myopic Pediatric Patient
Kelsey E. Mach, OD, FAAO
Acute non-accommodative esotropia, also known as acute acquired comitant esotropia (AACE), is a subset of childhood esotropia defined by a sudden onset, comitant deviation seen in older pediatric patients versus the more commonly seen conditions of infantile and accommodative esotropia. AACE is traditionally organized into three subtypes: (1) esotropia following disruption of fusion, (2) idiopathic, acute, progressive esotropia (“Franschetti” subtype), (3) acute, progressive esotropia associated with mild myopia (“Bielschowsky subtype). There have been further subtypes of AACE suggested in recent years, including decompensated monofixation syndrome or esophoria, but the concern for most clinicians is the possibility of underlying neurogenic causes. The purpose of this poster is to highlight the clinical findings in patients with new onset esotropia that could be risk factors for intracranial disease and warrant neuroimaging investigations.
Diabetic Macular Edema Precipitated by a Severe COVID-19 Infection
Jordan Marentette OD
Ocular Disease at Cincinnati Eye Institute
Background: The relationship between severe COVID-19 and diabetes mellitus is bidirectional. It is established that diabetes mellitus is associated with an increased risk of a severe COVID-19 infection, additionally new onset or undiagnosed diabetes including episodes of diabetic ketoacidosis (DKA) have been observed in patients with COVID-19. DKA occurs as a result of insulin deficiency and increased counter regulation responses favoring the production of ketones. Interleukin 6 levels have been shown to be elevated in both DKA and COVID-19, which may be a helpful prognostic factor. Case reports in the literature have led to the potential conclusion that undiagnosed diabetes that caused hospitalization due to DKA in an ICU may have been triggered by COVID-19.
Title: Treating Stage 3 Neurotrophic Keratitis with an Amniotic Membrane
Kennedy Reed, OD
Ocular Disease Resident
Specialty Eye Institute – Toledo
Background/Purpose: Neurotrophic keratitis is a degenerative condition attributable to impaired sensory innervation of the cornea. Without proper trigeminal nerve input, both corneal sensation and healing are significantly diminished. This degree of compromised corneal function means that the condition can progress from early-stage epithelial changes to late-stage corneal ulceration and perforation while the patient remains asymptomatic. The purpose of this case report is to discuss the development and treatment of stage three neurotrophic keratitis in a patient who suffered a left-sided stroke.
Not all Mornings are Glorious
Priya Patel, O.D.
Louis Stokes Cleveland VAMC
Background: There are numerous types of congenital optic nerve head anomalies, with some causing visual compromise. One such anomaly conjectured to be due to the incomplete closure of the embryonic fissure during development, morning glory syndrome, has a unique appearance involving an enlarged excavation, abnormal retinal vascular pattern, annular pigmentation surrounding the nerve head, and a glial tuft. The nomenclature of this rare condition is derived by its resemblance to the morning glory flower. Characteristically, it is more common in women, unilateral, and generally has a poor visual prognosis. Although infrequently observed, other associated ocular findings with visual impact include serous retinal detachment and choroidal neovascular membrane. This case report aims to highlight the importance of closely monitoring patients with this condition so that these atypical findings can be treated and managed preemptively to prevent vision loss.
Vitreous Hemorrhage from Proliferative Type I Diabetes Mellitus
Ashley Bonneau, OD
Cincinnati Eye Institute
Diabetes comes in many forms and can cause varying degrees of retinopathy. This case focuses on type 1 diabetes, which is usually diagnosed at a younger age than type 2, and the effects on the eye. Diabetes is a systemic condition of high blood sugar and presents bilaterally. The less controlled and longer duration of hyperglycemia a patient has, the increasing risk for and severity of retinopathy. The more microaneurysms (MAs)/dot blot hemorrhages (DBHs) and exudates, the worse the severity. Proliferative is most severe and results from neovascularization seen in the iris, anterior chamber angle, optic disc, or peripheral retina. Neovascular vessels leak and can result in vitreous hemorrhages (VH), causing decreased vision and new floaters and if left untreated retinal detachments. Dilated eye exams diagnose retinopathy, fluorescein angiography (FA) identifies non-perfused tissues most likely to cause neovascularization, and OCT imagining identifies swelling in the macula.
Herpes Zoster Ophthalmicus
Brittany Finch, O.D.
Louis Stokes Cleveland VAMC
Purpose: The purpose of this case report is to review presentations and management of Herpes Zoster Ophthalmicus (HZO) with an emphasis on the dermatological and corneal presentations seen in this case. Herpes zoster classically presents with a painful vesicular rash that follows a dermatome and respects the body’s midline. HZO can present with epithelial, stromal, or disciform keratitis, uveitis, and less commonly, posterior segment complications including retinal necrosis and optic neuritis. Epithelial keratitis associated with HZO classically presents with a pseudodentrite. Occurrence of herpes zoster is more common in immune-compromised patients and is less likely following vaccination.
Diagnosing Multiple Evanescent White Dot Syndrome (MEWDS): The Common Cold of the Retina
Ravneet K Meeta, O.D., Erica D. Baranwal, O.D.
VA Central Ohio Health Care
Background: Multiple evanescent white dot syndrome (MEWDS) is one of many white dot syndromes that are characterized as an inflammatory chorioretinopathy of unknown etiology. MEWDS is typically a unilateral condition that most often affects females aged 20-50 years old, however bilateral cases have also been reported. Presenting signs frequently include blurred vision, photopsias, and paracentral and temporal scotomas. Visual acuity ranges from 20/20 to 20/400 and a relative afferent pupillary defect may be apparent. While anterior segment examination is seldom remarkable, a mild vitritis and hyperemic optic nerve head appearance may be of note. As hinted at by its name, MEWDS is characterized by multiple, flat, grey-white lesions at the level of the retinal pigment epithelium or outer retina, while a granular appearance of the fovea is pathognomonic. Although this condition is known to be self-limiting without treatment, ancillary testing plays a successful role in facilitating an accurate diagnosis.
Understanding Secondary Choroidal Neovascularization in Central Serous Chorioretinopathy
Amber Watkins, OD; Matthew Horton, OD
Cincinnati VA Eye Center
Background: First described in 2013, the pachychoroid spectrum is a collection of conditions characterized by choroidal thickening and retinal pigment epithelial (RPE) changes caused by dilated or congested choroidal vessels. The resulting stress on the RPE can lead to different presentations in the spectrum including pachychoroid pigment epitheliopathy (PPE), central serous chorioretinopathy (CSCR), pachychoroid neovasculopathy (PNV), and polypoidal choroidal vasculopathy (PCV). Advances in imaging resolution have enabled increased diagnostic specificity through enhanced visualization of retinal and choroidal vessels. Evolving terminology can create some confusion in cases of CSCR with secondary CNV. Many cases of CSCR have underrecognized type 1 CNV that represent a PNV. This is distinct from CNV encountered as a complication of chronic CSCR, often presenting as a type 2 CNV. This poster describes a case of CSCR with secondary CNV.
Typical Case and Workup of a Patient with Branch Retinal Artery Occlusion
Louis Stokes VA
BACKGROUND: The purpose of this case report is to describe the typical presentation and management of branched retinal artery occlusion (BRAO) in a vasculopath. BRAO describes a disruption of the normal perfusion of downstream arteries supplied by the central retinal artery – often caused by embolic material from the carotid arteries or heart. This usually occurs in patient over 60 with vascular comorbidities including hypertension carotid artery occlusive disease, diabetes, and cardiac valvular disease. Prognosis is generally good if the fovea is spared with partial recovery of the visual field.
Dupixent Induced Conjunctivitis in a Pediatric Patient
Anjali Patel, OD,
Akron Children’s Hospital
Background: Dupixent (Dupilumab) injections have been associated with conjunctivitis in up to 28% of adult patients. FDA approval for use in pediatric patients with atopic dermatitis has been phased in over the past five years. With approval for use down to 6 months of age pediatric Dupixent conjunctivitis is becoming more common. Dupixent’s mechanism of action blocks IL-4 and IL-13 signaling pathways, depleting goblet cells on the ocular surface, potentially leading to conjunctivitis, keratitis, blepharitis, and other infections. Initiating treatment is imperative to prevent damage and scaring to the cornea.
Perifoveal Reticular Pseudo-drusen with Acquired Vitelliform Dystrophy
Farrah Sitto, OD
Reticular pseudo-drusen (RPD), or subretinal drusenoid deposits, signify a change to the retina divergent from other subtypes of drusen by being located above the level of the retinal pigment epithelium (RPE). Although their highest occurrence is in association with age-related macular degeneration (AMD), they are also found with acquired vitelliform lesions. Acquired Vitelliform Lesions (AVLS) occur between the retinal pigment epithelium and photoreceptor layer. These lesions signify the accumulation of lipofuscin, melanolipofuscin, melanosomes, and outer segment debris in the subretinal space. Current research depicts RPD is not a finding restricted to eyes with AMD but rather a finding common among diseases where the pathophysiological mechanisms primarily involve damage to the basement membrane and retinal pigment epithelium. This case report aims to further support the prevalence of RPD with presenting acquired vitelliform dystrophy.
Tricky Teens: Atypical Case of Pseudotumor Cerebri Syndrome
Authors: Micah Isabel Sarmiento, OD, Veeral S. Shah, MD, PhD, Melissa Rice OD, FAAO
Cincinnati Children’s Hospital Medical Center
Pseudotumor cerebri syndrome (PTCS) features elevated intracranial pressure of unclear etiology. Most common symptoms are headaches and visual disturbances with other possible symptoms including diplopia, pulsatile tinnitus, and photopsia. Exam findings may include papilledema, cranial nerve VI palsy, and visual field loss. Definitive diagnosis normal neuroimaging and lumbar puncture (LP) with elevated opening pressure with a normal cerebrospinal fluid composition. Treatment is guided by the patient’s clinical presentation. The purpose of this case report is to consider overlooked causes of PTCS as it presents in a pediatric population.
Scleral Lens Correction for Concurrent Aphakia and Keratoconus
Fareedah Haroun, OD and Chantelle Mundy, OD, FAAO, FSLS
The Ohio State University Havener Eye Institute Department of Ophthalmology and Visual Sciences
Background: Aphakia, lack of a crystalline lens, typically occurs due to cataract surgery, trauma or a congenital condition. Patients can experience blurred vision, photophobia, trouble focusing and issues with color perception. Traditional treatment includes surgically inserting an IOL, spectacles or specialty contact lenses. This poster aims to explore non-surgical management of an aphakic and keratoconic patient that has been treated with a penetrating keratoplasty (PKP).
Oculomotor therapy in a patient with developmental delays
Jehann Dagher, OD
The Ohio State University College of Optometry
Oculomotor dysfunction can occur secondary to traumatic brain injuries, central nervous system disorders, cerebral palsy, and premature births. They also can coexist in children with learning disabilities. Presence of such problems can cause a multitude of visual performance deficits, such as slowed reading and impaired visual search. Vision therapy plays an important role in improving binocular vision performance, specifically in children. This case report will look at vision therapy techniques for the treatment of oculomotor dysfunction in this population.
Current Approaches in Refractory Irvine-Gass Syndrome Elizabeth Bedell, OD
Irvine-Gass syndrome (IGS), or pseudophakic cystoid macular edema, is one of the most frequent complications of cataract surgery. Clinically significant CME occurs after uncomplicated cataract surgery in 1-2% of cases but has been confirmed on fluorescein angiography and OCT in up to 40% of patients. Most cases of IGS see spontaneous resolution but there may be persistence of edema causing long-term visual compromise. This case will discuss a presentation of refractory IGS. Important differential diagnosis and current approaches to management of IGS will be discussed.
Evaluation of Pre-retinal Hemorrhages
Rachel Chandra, O.D
Louis Stokes Cleveland VAMC
Background: Pre-retinal hemorrhages are often boat-shaped hemes, which collect blood between the posterior vitreous and internal limiting membrane. Although retinal hemorrhages are a common clinical manifestation in many patients, pre-retinal hemorrhages specifically can be associated with a proliferative process and warrant further evaluation to determine underlying etiology. Possible causes are Valsalva retinopathy, posterior vitreous detachment/retinal detachment, proliferative diabetic retinopathy, retinal vein occlusions, sickle cell disease, and anemic retinopathy. The purpose of this case report is to give an overview on how to evaluate and manage treat pre-retinal hemorrhages.
Orbital Mass Evaluation in the Primary Eyecare Setting
Kristen Zulliger, OD, MS; Erica Baranwal, OD
Background: An orbital mass is a growth of abnormal tissue affecting the structures and space around the eye. This lesion can be benign or malignant; it can originate from the orbit or be a metastasis from a different area of the body. A patient may present with no symptoms or can experience gradual or rapid vision loss, diplopia, or blurry vision. An orbital mass can cause proptosis of the affected eye and may be seen or felt during an examination. Imaging methods, like CT or MRI, can aid in the detection and diagnosis of an orbital mass. If a patient presents with a recently diagnosed orbital mass, it is important to perform a comprehensive examination of the health and function of the patient’s visual system.
The Use of Implantable Contact Lenses to Treat High Degrees of Myopia
Poonam Panda, OD
Richard Erdy, MD
Eardy Searcy Eye Group
Background: As of 2010, 27% of the world’s population is made up of people who struggle with distance refractive error, also referred to as myopia. The prevalence of myopia is estimated to grow in the next fifty years in certain age groups, as well as various racial demographics. Visual impairment, such as myopia has been known to be traditionally treated through spectacle correction or the use of contact lenses. More recently refractive surgeries have enticed those with high degrees of refractive error,that no longer can tolerate the use of glasses or contact lenses. Through minimally invasive surgery, one can correct myopia (-3 to -20D) as well as astigmatism (-1 to -4D) with the placement of an implantable contact lens (ICL). This procedure shows minimal risk factors, with promising visual outcome. Newly FDA approval has allowed for fenestrated models to be placed, which has removed the need for a peripheral iridotomy prior to surgery and allow optimal aqueous flow to prevent pupillary block.
Asymmetric Glaucoma: A Diagnosis of Exclusion
Natalie Meaghen Wong, OD MS, Chillicothe/Columbus VAMC, Jennifer Rene Steineman, OD, Chillicothe VAMC
Normal-tension glaucoma is a subset of open-angle glaucoma wherein progressive optic nerve damage and visual field loss occur in the presence of statistically normal IOP measurements. As a result, a diagnosis of normal-tension glaucoma heavily relies on the appearance of the optic nerve head. However, there are many non-glaucomatous causes of optic nerve damage including compressive, ischemic, and traumatic optic neuropathy. In cases of highly asymmetric optic nerve damage in the presence of normotensive IOP, there is a higher concern for these non-glaucomatous causes of optic nerve damage, which increases the importance of ruling out these differentials; this reinforces the understanding that normal-tension glaucoma is a diagnosis of exclusion.
Retinal Vasculitis in Presumed Behçets Disease
Josef Koberlein, OD,
Cincinnati Eye Institute
Named for Dr. Hulusi Behçet who first formally characterized the classic triad of aphthous ulcers, genital ulcers, and uveitis in 1924, Behçet Disease (BD) represents an auto- inflammatory multisystem disease process that can result in devastating effects on patients’ systemic and ocular health. Ocular signs and symptoms can include scleritis, episcleritis, uveitis, vascular sheathing, retinal hemorrhage, macular edema, ophthalmalgia, hypopyon, decreased visual acuity, scotoma, papilledema, optic atrophy, and more. The condition is commonly associated with the Silk Road as patients often have Middle Eastern or Asian ancestry. Current management approaches are not curative and typically rely on immunosuppressive and/or anti- inflammatory therapy. It is theorized that genetics may play a role in BD etiology, however definitive pathogenesis has yet to be determined. The purpose of this case report is to explore a unique presentation of BD and shed light on the varied ocular manifestations and management approaches of the condition.
Herpes Keratitis: A Different Presentation Calls for an Alternate Approach
Alvin Alegado, OD
Dayton VA Medical Center
Background: Herpes keratitis can take on a variety of clinical manifestations depending on the structures affected. Herpes epithelial keratitis typically presents with classic dendritic ulcers. Stromal Keratitis presents with mid to deep stromal infiltrates that can result in deep stromal vascularization. Endothelial Keratitis results in diffuse stromal edema with a distinct disc pattern making it also known as disciform or round keratitis. Herpes endotheliitis presents similarly whether the etiology is from the herpes simplex virus or the herpes zoster virus. Herpes endotheliitis is not an active infection, but rather a cell-mediated immune response to viral antigens. This autoimmune response affects the corneal endothelium and hinders its ability to pump fluid out of the cornea resulting in loss of corneal transparency. Corneal endotheliitis is characterized by corneal edema, keratic precipitates and a mild anterior chamber reaction. Because this is an autoimmune response, treatment includes antivirals and corticosteroids to clear up the edema and haze in the cornea and prevent any permanent ocular damage.
Diagnosis and treatment of interstitial keratitis due to the Epstein-Barr Virus
Mackenzie Gershom, O.D.
Columbus Ophthalmology Associates
Interstitial keratitis is a rare inflammatory reaction of the corneal stroma often with deep neovascularization and without epithelial or endothelial involvement. It is an immune-mediated response to an infectious or autoimmune trigger. In the United States, Herpes Simplex Virus and Syphilis are the most common causes of interstitial keratitis. Other causes include Herpes Zoster Virus, Epstein-Barr Virus, Tuberculosis, Sarcoidosis, and Cogan’s Syndrome. Patients typically present with a red, painful eye with blurred vision and light sensitivity. The degree of blurred vision varies depending on the location and extent of corneal involvement. If not treated properly, stromal inflammation can result in visually significant corneal scarring. This case report describes the importance of the diagnosis and treatment of interstitial keratitis due to the Epstein Barr Virus with an initial uncharacteristic presentation of epithelial involvement.
Herpes Simplex Epithelial Keratitis
Author: Jeskaren Deol, OD
Daniel Grangaard, OD
Columbus/Chillicothe VA Residency
Category: Ocular Disease
Background: Herpes simplex epithelial keratitis is caused by the herpes simplex-1 virus. After primary infection, HSV-1 remains dormant in the body until reactivation occurs due to triggers such as stress, hormonal changes, trauma, fever, or immunosuppression. 56.3% of reoccurrences take the form of dendritic epithelial keratitis. Examination should include a thorough case history, as well as an external and slit lamp exam with fluorescein dye and IOP measurement. Checking corneal desensitization and laboratory testing can also be used to confirm or deny the presence of HSV. Due to the risk of posterior involvement, dilation may also be indicated. Prognosis of the disease is often very favorable with the correct topical and/or oral antiviral treatments.
Minimal Magnification for Maximum Impact
Authors: Jennifer Chlam, OD, MS
Gregory Hopkins, OD, MS, FAAO Department of Veterans Affairs Chalmers P. Wylie Veterans Outpatient Clinic
One important aspect of low vision rehabilitation is discovering solutions that allow patients to continue enjoying meaningful activities and hobbies in their lives. This poster outlines a case where a low vision device, which may appear insufficient for this particular patient at first glance, was uniquely tailored to fit a specific task.
Branch Retinal Artery Occlusions and Their Implications
Sarah Mastrorocco, OD
Dayton VA Medical Center
Background: Branch retinal artery occlusions are caused by an acute blockage of blood flow within a branch retinal artery. This condition usually presents unilaterally in patients 65 years and older as acute unilateral, painless vision loss. The etiology can be associated with an embolus (cholesterol, calcific, or fibrin-platelet), inflammation or less commonly with vasculitides. Artery occlusions appear clinically as superficial opacification or whitening along a branch retinal artery, with the affected retina becoming edematous. Commonly, an embolus may be visualized at an arterial bifurcation. An afferent pupillary defect may also be noted. Due to potential life-threatening consequence, it is crucial to have appropriate systemic work up to rule out conditions such as temporal arteritis (~1-2%) and stroke. Most patients improve to 20/40 or better visual acuity, though most will have a lasting field defect.
Management of Fuchs’ Endothelial Corneal Dystrophy with Descemet Membrane Endothelial Keratoplasty
Dalton Kincaid, O.D.
Columbus Ophthalmology Associates
Fuchs’ endothelial corneal dystrophy (FED) is described by the progressive dysfunction of corneal endothelial cells and thickening of Descemet membrane with excrescences known as guttata. A partial corneal transplant, such as Descemet membrane endothelial keratoplasty (DMEK), may be indicated to resolve severe endothelial decompensation and edema if conservative management is not sufficient. This case report details the pre- and post-operative periods of a patient who underwent DMEK and provides information on indications for referral, cataract-DMEK combination surgical intervention options, and education for patient expectations.
Diabetic Papillopathy- A Rare Ocular Manifestation of Diabetes Mellitus
Ohio Eye Alliance
Background: Diabetic papillopathy (DP) is a rare disease that is seen in patients with diabetes mellitus. It is characterized by unilateral or bilateral optic disc edema and can be associated with diabetic retinopathy and macular edema. DP is a diagnosis of exclusion and therefore it is important to rule out any inflammatory conditions, infections, space-occupying lesions or increased intracranial pressures that could be causing optic disc edema. Treatment and management for patients with DP involves monitoring signs and symptoms due to its self-resolving nature. However, intravitreal bevacizumab injections have shown promising results in helping with faster recovery of vision and regression of disc edema.
Optic Pit, Macular Detachments or Not?
Brian Vo, OD
Background: Optic disc pits (ODP) are congenital malformations of the optic nerve derived from an imperfect closure of the embryonic fissure. This results in a round/oval depression found within the optic nerve head. ODP present as a grey-yellow spot, most commonly at the temporal or inferotemporal rim, and can be bilateral in up to 15% of cases. Patients with ODP are often asymptomatic and are discovered incidentally, however maculopathies including serous retinal detachments, retinoschisis, and cystoid macular edema have been reported to occur in 30-75% of patients. Management of asymptomatic ODP should include serial dilated fundus examination, optical coherence tomography (OCT) imaging, and home Amsler grid. This poster aims to outline a case of a patient with an asymptomatic ODP and her management.