300 Optometry, Vol 80, No 6, June 2009

normal. Intraocular pressures were 12 in each eye. Anteriorsegment examination revealed a raised gelatinous lesion onthe nasal conjunctiva and cornea of the right eye thatstained with rose bengal. All other examination findingswere normal. Biopsy of the lesion confirmed mild CIN.Treatment with topical INF alpha 2b was initiated 4 timesdaily. To minimize discomfort, the patient was instructedto instill an artificial tear 5 minutes before instillation ofINF alpha 2b. The patient was followed up with monthlyto monitor treatment effect. The lesion decreased in sizeby approximately 60% over the first 5 weeks, and no addi-tional improvement was seen after 3 months. The remain-der of the lesion was surgically excised with cryotherapyof the edges.Conclusion: Treatment of CIN with INF alpha 2b hasproven to be effective, with low risk for recurrence andless ocular surface toxicity when compared to other topicalchemotherapy agents. While INF alpha 2b was used in con-junction with excision in this case, we were able to signif-icantly reduce the size of the lesion prior to surgicalexcision. Based on our experience, INF alpha 2b is a viableoption for first line therapy or combination therapy in thetreatment of CIN.

Poster 32

Coats’ Disease in an Asymptomatic 29-Year-Old MaleIraq War Veteran

Kathryn Baruch, O.D., and Jaime Cohen, O.D.,John D. Dingell VA Medical Center, 4646 John R, Detroit,Michigan 48201

Background: Coats’ disease is a rare idiopathic retinal con-dition typically found in the first decade of life. Contrary toour patient, most present with blurred vision or unilateralleukocoria. Coats’ disease is characterized by a develop-ment of telangiectatic vessels and progressive accumulationof exudates, which can lead to a retinal detachment. Clas-sically, Coats’ disease is isolated, unilateral, and affectsyoung males. Early detection and appropriate referralswith treatment, if necessary, are crucial to prevent progres-sion and deterioration of visual function. This case reportdocuments a rare adult presentation while highlightingthe importance of treatment and complications associatedwith Coats’ disease.Case Report: A 29-year-old visually asymptomatic whiteman initially presented to our clinic for a routine eye exam-ination. Findings showed normal visual acuities, hyperopia,unremarkable entrance tests, and no anterior segment ab-normalities. The dilated funduscopic examination found in-traretinal hemorrhages, exudates, vascular tortuousity, andsheathing localized to the inferior temporal quadrant ofthe right eye. The left eye’s fundus was unremarkable. Ar-borization of peripheral vessels and retinal nonperfusionwere confirmed by fluorescein angiography. A diagnosisof Coats’ disease was made and later confirmed by the ret-inologist. The treatment based on the evaluation with the

retinologist included panretinal photocoagulation to thenonperfused retina, despite his asymptomatic nature. Thepatient will be followed up every 6 months with dilated ex-aminations and fluorescein angiographies.Conclusion: The clinical course and presentation of Coats’disease can manifest in the eye clinic at a variety of levels.In asymptomatic patients, because of the serious nature ofthis condition, early diagnosis and management are criticalto prevent significant ocular complications and vision loss.A recent study showed 50% of adult patients experienced adecrease in vision after diagnosis. Patients with retinal tel-angiectasia and exudates have good visual outcomes withlaser photocoagulation. Coats’ disease may present on rou-tine examination; therefore, it is critical that all eye careproviders be familiar with the clinical presentations toinsure a timely diagnosis with proper referral and manage-ment.

Poster 33

Comparison of Traditional and TargetedOphthalmoscopy With the P200C Scanning LaserOphthalmoscope

Kristen Brown, O.D., and Marjorie Rah, O.D., Ph.D.,New England College of Optometry, 930 CommonwealthAvenue, Suite 2A, Boston, Massachusetts 02215

Background: The P200C is a scanning laser ophthalmo-scope that takes ultrawide-field retinal images quickly andwithout the discomfort of mydriasis. The P200C may be avaluable screening tool for the detection of retinal lesions inan efficient and comfortable manner for patients. In addi-tion, the digital images can be used to provide patientswith information and education about their own eyes. A pi-lot study was conducted to determine the sensitivity andspecificity of the P200C SLO in detecting retinal lesionsas compared with traditional ophthalmoscopy and targetedophthalmoscopy as well as to assess patient perception ofthe technology.Methods: Forty subjects (65% female, 35% male) age 58.46 14.6 years underwent non mydriatic imaging with an Op-tos P200C SLO. Subjects were dilated and underwent tradi-tional ophthalmoscopy plus targeted ophthalmoscopy by 2independent optometric examiners in a random fashion.The traditional examination consisted of BIO and slitlamp biomicroscopy with a fundus lens. In targeted oph-thalmoscopy, Optomap images from the P200C were usedto guide the fundus examination. P200C software allowsfor zooming-in to scrutinize retinal detail and red/greenchannels enhance visualization of retinal layers. A satisfac-tion survey was conducted to evaluate patient perception ofthe technology and to assess their opinions about the infor-mation and education provided by the images. A third op-tometrist served as the reader who graded the digitalimages. The reader was masked to the findings of the exam-iners conducting the traditional and targeted ophthalmos-copy. Retinal lesions were denoted by the International

Poster Presentations 301

Classification of Disease (ICD-9-CM) and categorized into1 of 3 regions:

1) Optic nerve2) Macula/posterior pole3) Mid-to-peripheral retina

Results: Sensitivity and specificity were computed to quan-tify the reader’s ability to identify lesions and to rule out thepresence of lesions. Reader performance was evaluatedwith respect to traditional and targeted ophthalmoscopy.Targeted ophthalmoscopy outperformed traditional oph-thalmoscopy somewhat. Composite measures by regionfound greatest overall reader sensitivity in the mid-to-peripheral region at 80% O.D. and 81.5% O.S. comparedwith targeted ophthalmoscopy. Specificity of the readerwas highest in the composite macular region at 88.5%O.D. and 94% O.S. compared with targeted ophthalmos-copy. The survey found 92.3% of subjects believe that us-ing cutting edge technology to examine their eyes andexplain findings is very important. More than 86% werevery satisfied with the quality of the technology used andthe information and education provided by P200C images.Conclusions: The P200C SLO may serve as a valuablescreening tool in the detection of retinal lesions. Targetedophthalmoscopy, or detection and assessment of retinal le-sions before BIO, may improve efficiency of a traditionalfundus examination; hence, patient comfort may be im-proved. Patients appreciate the use of advanced technologyto examine their eyes and the information provided by see-ing images of their own eyes. Given the lack of a true goldstandard and small number of subjects in this pilot study,sensitivity and specificity are subject to error and shouldbe interpreted with caution. Further study is necessary tomeasure sensitivity and specificity against a true goldstandard.

(Investigators’ study was funded by Optos.)

Poster 34

The Effect of Corneal Drying on Optical CoherenceTomography

James LaMotte, O.D., Ph.D., Jenny Kuan, B.S., andJenny Le, B.S., Southern California College of Optometry,3550 La Jolla Village Drive, San Diego, California 92161

Background: A noninvasive technique to image retinalstructures, optical coherence tomography (OCT), is becom-ing popular in the assessment and diagnosis of neurosen-sory pathology. The OCT provides high-resolution,cross-sectional imaging and has applications in care ofdiseases of the retina, macula and optic nerve head.Commercially available units produce highly reproducible2-dimensional images with 10 mm resolution. Quantitativemeasurements generated by the OCT, such as central fovealthickness and retinal volume, have been shown to have highdiagnostic value. Because the instrument evaluates back-scattered light, results can be affected by corneal surfacefactors such as tear breakup, which distorts the optical

wave front and degrades retinal images. Our study investi-gated the effect of corneal drying on measurements at thefovea and macula.Methods: Twenty-five young, healthy subjects with no ret-inal pathology were evaluated to ensure they had normalcorneal health and the absence of dry eye. A randomly as-signed test eye was dilated with tropicamide. Two baselinereadings were taken with a Stratus OCT version 4.0 usingthe Fast Macular Thickness scanning protocol. After base-line readings, proparacaine was administered and the eyelidtaped open. Three subsequent measurements were taken at30-second intervals.Results: Paired t-test analysis was used to compare signalstrength, minimum foveal thickness, foveal volume, and to-tal macular volume. Of these 4 parameters, only signalstrength showed a significant decrease (P , 0.0005), whichoccurred at 60 seconds. The other parameters showed non-significant fluctuations.Discussion: For the first 30 seconds of corneal drying, ourresults showed decreasing foveal thickness readings as thesignal strength decreased. After 30 seconds of induced dry-ing, our subjects tended to make small eye movements andreported difficulty fixating on the target, causing our read-ings to fluctuate. Despite continued corneal drying, signalstrength did not decrease significantly until 60 seconds,and OCT readings did not change significantly from base-line over the 90-second period. Our results show that cor-neal drying will degrade signal strength, but readings offoveal thickness, foveal volume, and total macular volumewill not be significantly affected on subjects with normalcorneas. We intend to apply this procedure to dry eyesubjects.

Poster 35

CRVO in an Atypical Patient: The Importance ofNephrotic Syndrome and Antithrombin III Deficiency

Brooke Vegas, O.D., and Sylvia E. Sparrow, O.D., VisionSource-Deerbrook, 20119 Hwy 59 N, Humble, Texas 77338

Background: Central retinal vein occlusion (CRVO) is usu-ally seen in those over age 50 and often is associated withhypertension and diabetes. In younger patients, however, itmay be associated with collagen-vascular disease, oral con-traceptives, and antithrombin III (ATIII) deficiency. ATIII isa powerful inhibitor of the coagulation cascade and is mostcommonly associated with venous thrombus. ATIII defi-ciency can be congenital or acquired; the latter can becaused by protein loss caused by nephrotic syndrome(NS). NS is a collection of clinical findings that is the resultof huge renal losses of protein. Primary nephrotic syndrome(PNS) is associated with glomerular diseases inherent to thekidney. Several glomerular lesions can be seen in PNS, in-cluding membranous nephropathy. Nephrotic syndromecarries with it an increased risk for thrombosis, partly be-cause of decreased ATIII.