opment of choroidal neovascular membranes. The anatom-ical alteration of this complex, with resulting associatedrelative retinal hypoxia, is believed to stimulate choriocap-illaris new vessel growth and subsequent neovascular mem-brane. This specific case illustrates the development of ajuxtapapillary choroidal neovascular membrane with noapparent retinal etiology.Case Report: A 48-year-old woman came in for a glaucomawork-up evaluation secondary to large, symmetric C/Dratios and a positive family history of glaucoma. The patientreported no ocular or visual symptoms. Medical history waspositive for systemic hypertension, well-controlled withoral medication, and seasonal allergies, also well-controlledwith medication. Best visual acuities measured 20/20 O.D.and 20/20 O.S. Biomicroscopy was unremarkable O.D. andO.S. IOP by applanation tonometry measured 14 mmHgO.D. and O.S. Indirect ophthalmoscopy revealed C/D ratioof 0.75 round with healthy rim tissue, and no retinal pathol-ogy noted O.D.; C/D ratio of 0.65 round with healthy rimtissue, and a focal area of retinal edema with circinateexudation adjacent to the nasal optic disk margin O.S. Noadditional retinal pathology was noted O.S.Conclusion: A diagnosis of idiopathic juxtapapillary cho-roidal neovascular membrane O.S. was confirmed withfluorescein angiography and OCT. The patient was given avitreoretinal referral for possible surgical interventionsO.S., and scheduled to return to clinic in 6 months for afollowup examination.

Poster 82

Visudyne Photodynamic Therapy in OcularHistoplasmosisJohn Sharpe, O.D., Southern College of Optometry, 1245Madsion Avenue, Memphis, Tennessee 38104

Background: Presumed ocular histoplasmosis syndrome(POHS) is a well-documented eye disease, believed to becaused by the fungus Histoplasma capsulatum. It manifestsclinically with a disseminated choroidopathy (histo spots),peripapillary choroiditis (peripapillary atrophy), and sub-retinal neovascular maculopathy (CNV). Until recently,treatment options were limited to laser photocoagulation,surgical CNV excision, and perhaps high-dose corticoste-roid therapy. With the FDA approval of Visudyne, photo-dynamic therapy (PDT) has now become a popular alterna-tive to treating subfoveal choroidal neovascular membranesassociated with POHS. This case chronicles POHS withactive maculopathy and the retinal healing process follow-ing multiple PDT applications over a 2-year period.Case Report: A 34-year-old woman came in for an evalu-ation of blurry, distorted vision in the right eye. The patientreported a “hard to describe” distortion of vision O.D.,slowly worsening over the previous 3 to 4 months. Medicalhistory was unremarkable. Best visual acuity measured20/20– O.D. and 20/20 O.S. Biomicroscopy was unremark-able O.D. and O.S. Intraocular pressure by applanation

tonometry measured 18 mmHg O.D. and O.S. Indirectophthalmoscopy revealed: C/D ratio of 0.50 round withperipapillary atrophy; multiple mid-peripheral, white,punched-out, retinal lesions; and a focal, pigmented retinalelevation with edema and hemorrhage 2 mm inferior tem-poral to the fovea O.D.; C/D ratio of 0.55 round withperipapillary atrophy and multiple mid-peripheral, white,punched-out, retinal lesions O.S.Conclusions: A diagnosis of presumed ocular histoplasmo-sis syndrome OU and juxtafoveal choroidal neovascularmembrane O.D. was made. The patient was immediatelyreferred to a vitreoretinal specialist for possible surgicalintervention O.D. The patient underwent same-day Visu-dyne photodynamic therapy, with 3 additional PDT appli-cations over the following 2-year period.

Poster 83

Optic Nerve Head Elevation Associated with RenalTransplantJulie Tyler, O.D., and Zoeanne Schinas, O.D., NovaSoutheastern University, College of Optometry, 3200South University Drive, Ft. Lauderdale, Florida 33328

Background: Intracranial hypertension has been docu-mented in patients with history of renal insufficiency ortransplantation. The exact etiology is unknown for papill-edema in these patients, and may be a result of the under-lying conditions or the medications associated with treat-ment. Thus, patients undergoing renal transplant should bemonitored regularly with dilated examinations for ocularcomplications including papilledema.Case Report: A 13-year-old girl was brought to us for acomprehensive examination following renal transplantation 12months earlier. She was a patient of the clinic for the past 5years, including annual dilations to monitor for hypertensiveretinopathy secondary to renal insufficiency. Ocular historywas remarkable for mild hypertensive retinopathy and aniso-metropic latent hyperopia managed with contact lenses. Med-ical history was significant for renal transplant, for which shereported taking immunosuppressive medications. Entering vi-sual acuities were 20/20 O.D., O.S. Preliminary testing waswithout defect. Blood pressure measurement and HumphreyVF were unremarkable. However, funduscopy revealed signif-icant bilateral optic nerve head elevation. On questioning, thepatient admitted to headaches and tinnitus, but denied visualobscurations, double vision, nausea, or vomiting.Results: The patient was referred for imaging, lumbarpuncture, and serology. She was diagnosed with papill-edema secondary to renal transplant complications. Thedoctors discovered she was not taking her immunosuppres-sive medications as directed and was experiencing symp-toms consistent with organ rejection.Conclusion: This case illustrates a significant ocular findingassociated with complications following renal transplant. Oc-ular complications associated with renal transplant and themedical therapy to treat rejection will be presented. Stereo

298 Optometry, Vol 77, No 6, June 2006

optic nerve head photographs and Humphrey visual fields willbe presented, along with discussion of management options,including the importance of preventing visual deterioration.

Poster 84

Vitreomacular Traction Syndrome: The Usefulness ofOCT in Management and TreatmentSusannah Marcus-Freeman, O.D., andJoseph Convertino, O.D., Malcom Randall VA MedicalCenter, 2038 SW 102nd Terrace, Gainesville, Florida32607

Background: Patients with vitreomacular traction (VMT)syndrome may report metamorphopsia, reduced visual acu-ity (VA), or photopsias. VA may range from mildly reducedto the 20/400 level. On examination, partial PVD is presentwith persistent macular attachment. Macular signs may besubtle, and include CME and/or thickened epiretinal tissue.OCT reveals a tented foveal appearance, making the diag-nosis of VMT obvious.Case Report: A 61-year-old man came in with a chiefsymptom of floating spots and “sparkly things” in his righteye central vision for the previous month. His ocular historywas remarkable for blunt trauma to the left eye 1 yearearlier. His medical history included hypertension and aor-tic bifemoral bypass. His best-corrected VA was 20/150O.D. and 20/20 O.S. Slit lamp examination, pupils, andintraocular pressures were all unremarkable. Dilated fundusexamination revealed an incomplete posterior vitreous sep-aration and a subtle area of thickened hyaloid overlying themacula O.D. Optical Coherence Tomography (OCT) re-vealed a tuft of vitreoretinal tissue causing traction anddramatically disrupting the foveal architecture in a tent-likefashion. The diagnosis of VMT syndrome was made. Sur-gical intervention was recommended by the retinal special-ist, and pars plana vitrectomy with membrane peel wassubsequently performed. Postoperative OCT revealed a sig-nificant decrease in the macular thickness and release of thetraction on the fovea.Conclusion: Historically, it has been sometimes difficult todifferentiate between early macular hole, epiretinal mem-brane, and VMT syndrome. Because the prognosis, man-agement, and treatment differ among them, it is very im-portant the correct diagnosis be made. With the use of newimaging technologies—particularly OCT—such diagnosishas been considerably simplified, as each entity can beeasily distinguished from the others.

Poster 85

Azoor: Proper Testing and DiagnosisSimi Bhardwaj, O.D., PCO/Seidenberg Protzko EyeAssociates, 103 Remington Circle, Havre De Grace,Maryland 21078

Background: White dot syndromes are often acute condi-tions that occur with or without visual loss. Acute zonal

occult outer retinopathy (AZOOR) is a white dot syndrome,presumed to be an inflammatory disorder, damaging broadzones of the outer retina in one or both eyes. AZOOR isusually seen in young women with an acute onset ofphotopsia. Diagnosis of AZOOR is often missed withoutaccurate diagnostic tests. An accurate diagnosis is made bycombining results from the fundus evaluation, visual-fieldtesting, fluorescein angiograms, and an electoretinogram(ERG).Case Report: A 16-year-old girl was brought to the officereporting flashing lights for 3 days. The patient’s medicalhistory is unremarkable presently, but she stated she had acold the week before. Anterior and posterior segment eval-uation of left eye was found unremarkable; however, pos-terior segment of the right eye showed white dot-like lesionsin the nasal periphery. Trace vitreous cells were seen pos-teriorly in the right eye. No retinal detachment was noted ineither eye. Fundus photographs were taken and a diagnosisof white dot syndrome was made. The patient was referredto a retinal specialist for further evaluation, where a floures-cein angiogram, visual fields, and an ERG were called for.Based on the characteristic findings, the patient was diag-nosed as having AZOOR.Conclusion: AZOOR is a condition in which inflammationcauses the eye to malfunction. Seeing flashing lights andhaving an enlarged blind spot are symptoms of AZOOR.The area of visual loss may increase for a period of time andthen stabilize. In the majority of patients, the retina recoversits function and sight returns over 1 to 3 years. Flouresceinangiography shows retinal and optic nerve head capillaryleakage. Visual-field testing may show a scotoma, whereasan ERG would be markedly reduced. Although an ERG isnot commonly performed, an understanding of the diseaseand proper testing become imperative toward diagnosis ofAZOOR.

Poster 86

Optic Nerve Head DrusenRobert Carter, O.D., and Sherah Eavey, O.D., MichiganCollege of Optometry at Ferris State University, 1310Cramer Circle, Big Rapids, Michigan 49307

Background: Optic nerve head drusen, thought to be theresult of abnormal axonal metabolism, are typically bilat-eral, present in 0.4% to 3.7% of the population, and slowlyprogressive. The most notable complication is progressiveperipheral vision loss.Case Report: A 15-year-old girl had lost her glasses andpresented with a symptom of blurred vision. Cycloplegicrefraction results were �2.50 DS O.D. and �4.75 DS O.S.,with visual acuities of 20/20 O.D. and 20/30� O.S. Oph-thalmoscopy revealed disc elevation and surface drusenOU. All other findings were normal.

299Poster Presentations