Optometry Commons^™

Iris Melanoma: A Case Report And Review, Emily Scully Od, Breyne Middleton Od

Optometric Clinical Practice

Background: Uveal melanoma is the most common primary cancer of the eye. It can be diagnosed with fundus exam and ancillary tests. Metastasis occurs in about half of primary uveal melanoma patients and is very often fatal. The liver is the most common site of metastasis. Iris melanomas are the least common type of uveal melanoma. Choroidal and ciliary body melanoma are the most common. Iris nevi are quite common and the rate of transformation into melanoma is low but early detection is critical given the high mortality rate associated with metastasis.

Case Report: This case highlights the importance of …

We Are Each One Second Away From Being Someone Else's Patient, Paul B. Freeman Od

Optometric Clinical Practice

Editorial

Birdshot Chorioretinopathy: A Review Of Diagnosis And Treatment, Jill Gottehrer Od, Steven Follansbee Od

Optometric Clinical Practice

Background: Birdshot chorioretinopathy is a rare, bilateral chronic uveitis resulting in choroidal and retinal inflammation in the form of vasculitis, papillitis, and/or macular edema. For an accurate diagnosis, a thorough patient history, fundoscopic exam, and appropriate ancillary testing are necessary.

Case Report: A 49-year-old male presented to the eye clinic due to vitreous floaters in both eyes that had worsened over the last year. The patient was new to the clinic with no prior history of eye examinations. At presentation, a mild vitritis was noted along with small, multiple white dots in the posterior pole of both eyes. Ancillary testing, …

Focal Choroidal Excavation Associated With Resolved Central Serous Chorioretinopathy, Loren W. Bennett Od, Katherine M. Mehalik Od

Optometric Clinical Practice

Background: Focal choroidal excavation is a localized concavity of the choroid within the macula defined by its appearance on optical coherence tomography. The condition is typically nonprogressive and often an incidental finding. It may not impact vision, although it can be associated with other visually significant macular pathologies.

Case Report: A 48-year-old male patient presented with a recent history of blurred vision in the left eye. A dilated fundus examination revealed a discrete area of pigment mottling in the macula; both the history and clinical appearance were consistent with resolved central serous chorioretinopathy. Optical coherence tomography did not show residual …

Use Of Anterior Segment Optical Coherence Tomography To Manage Acute Corneal Hydrops In Keratoconus, Michelle K. Man Od

Optometric Clinical Practice

Background: Acute corneal hydrops, a rare complication of keratoconus and other corneal ectatic disorders, is characterized by a break in Descemet’s membrane (DM). The subsequent corneal edema caused by leakage of aqueous into the stroma and epithelium may result in corneal scarring that often reduces visual acuity and may mandate corneal transplantation as resolution. The initial diagnosis is sometimes challenging but can be confirmed with anterior segment optical coherence tomography (AS-OCT). AS-OCT is also useful in deciding treatment regimen.

Case Report: This case report discusses the use of AS-OCT to aid in the diagnosis of acute corneal hydrops in a …

A Case Of Adolescent Papilledema Secondary To Oral Hormonal Contraceptives, John D. Tassinari Od, Phil Kwok Od

Optometric Clinical Practice

Background: Papilledema, optic disc swelling secondary to elevated intracranial pressure (ICP), is a medical emergency given the gravity of possible disease etiologies, including but not limited to intracranial mass.

Case Report: A 12-year-old female with normal body mass index developed marked headaches and subsequently manifested bilateral swelling of the optic discs and retinal folds. Scanning laser ophthalmoscopy, particularly in the fundus autofluorescence mode, provided a striking image of the retinal folds. The posterior segment abnormalities were accompanied by reduced visual acuity and corresponding visual field defects. The edema of the optic nerve and retinal fluid were worse in her left …

Point Of Care Ultrasound For Rapid Identification Of Central Retinal Artery Occlusion And Subsequent Vision Rescue Utilizing Intravenous Alteplase, Joseph Pepe, Karl Kasischke, Calen Hart

Florida Journal of Emergency Medicine (FJEM)

Central retinal artery occlusion (CRAO) is a rare but critical diagnosis to make in patients with acute vision loss. Cases of central retinal artery occlusion historically have a poor prognosis due to delayed presentation, lack of early identification, and limited effective treatment options. Due to these challenges, patients are often left with permanent loss of vision.

We present a case of a male patient in his late 70s with sudden onset of loss of vision to the right eye. Identification of CRAO was made utilizing point of care ultrasound (POCUS). After discussion with neurology, the patient was treated with alteplase …

Thank You To Our 2024/2025 Reviewers, Paul B. Freeman Od, Brian K. Foutch Od, Phd

Optometric Clinical Practice

Reviewers

Branch Retinal Artery Occlusion After Covid-19, Danielle Kalberer Od, Mba, Grace Tan Od

Optometric Clinical Practice

Background: A healthy, 39-year-old male patient presented with sudden onset, painless vision loss of the right eye’s superior visual field two months after a mild case of COVID-19.

Case Report: The patient was diagnosed with an acute branch retinal artery occlusion and referred to the emergency department for prompt evaluation. When the emergency workup was unremarkable the patient was referred to cardiology and hematology and follow up with a retinal specialist. The exhaustive systemic work-up was unremarkable other than recent COVID-19. Retinal perfusion to the affected area resumed in the weeks after the incident but irreversible vision loss occurred.

Conclusion: …

Ocular Myasthenia Gravis: A Case Report, Erica Vanderpool Od, Carla Gilbertson Kuiken Od

Optometric Clinical Practice

Background: Myasthenia gravis (MG) is an autoimmune disease caused by faulty transmission at the neuromuscular junction leading to fatigable muscular weakness. Ocular MG is distressing in that it can cause visual difficulties, but generalized MG can be life-threatening. MG is an acquired disorder that can easily be overlooked in clinic and is commonly misdiagnosed. Providers should be aware of the clinical features of this condition, as well as the critical testing needed to confirm the diagnosis so the appropriate management course can be implemented.

Case Report: This case features a 67-year-old Caucasian male diagnosed with ocular myasthenia gravis …

Treatment Considerations For Early Primary Open Angle Glaucoma In Active-Duty Military, Ridwan Carim-Sanni Od, Danielle Kalberer Od, Mba

Optometric Clinical Practice

Background: Glaucoma is one of the leading causes of blindness in the United States. The tools available to treat glaucoma via intraocular pressure (IOP) reduction include pharmacological therapy or surgical intervention.

Case Report: This case study explores these tools in the context of glaucoma in active-duty military personnel. It involves an active-duty army patient diagnosed with early Primary Open Angle Glaucoma (POAG) who was initially prescribed IOP-lowering medication. Barriers in treatment compliance occurred while the patient was deployed that led to significant glaucomatous changes detected when the patient returned stateside.

Conclusion: This report suggests a shift from the traditional pharmacological …

Cryopreserved Amniotic Membrane For Corneal Epithelial Abrasions: Case Series, Laura Goldberg Od

Optometric Clinical Practice

Background: Corneal abrasions are one of the most frequent ocular conditions encountered in the emergency department and can lead to significant morbidity and visual impairment. Amniotic membrane has inherent anti-inflammatory and anti-scarring properties that help accelerate epithelialization and help prevent the complications known to be associated with corneal injuries. Herein we assessed the time till complete epithelialization after in-office application of cryopreserved amniotic membrane in cases of traumatic corneal abrasions in the acute setting.

Case Reports: A total of ten eyes (5 right eye; 5 left eye) of ten consecutive patients (8 Male; 2 Female; average age 40.9 ± 17.8 …

The Art Of Prescribing Low Amounts Of Prism: Optimizing Outcomes, Leonard J. Press Od

Optometric Clinical Practice

Expanding the Box

Learning From Our Future Colleagues, One Case At A Time, Paul B. Freeman Od

Optometric Clinical Practice

Editorial

Enhancing Cataract Surgery Outcomes: Optimal Use Of Pre- And Post-Operative Eye Drops, Keith Skolnick M.D., Anu Valiaveedu

Mako: NSU Undergraduate Student Journal

Many preoperative and postoperative cataract patients struggle with comprehending the use of prescription medication as directed. Language barriers and low health literacy levels are major factors contributing to improper use of prescriptions. To increase patients comprehension, the Fort Lauderdale Eye Institute employed an educational intervention consisting of a live presentation and an instructional video. Results found that 44% of patients were hesitant to ask questions to clinical staff, 32% felt overwhelmed, and nearly 70% lacked confidence in using their prescribed eye drops. Following the intervention, 91% of patients reported increased confidence in their medications, and most indicated that the video …

Analyzing The Role Of Ai In Resident Education: An Evaluation Of Chatgpt On Ophthalmology Trainee Examination Questions By Subtopic, Kimberly Cartagena, Simran Ohri, Carolina Ramos, Yaxel Levin-Carrion, Alexandra Sanchez, Marko Oydanich, Albert S. Khouri

Journal of Academic Ophthalmology

Background: ChatGPT is a large-scale language model trained on various datasets to learn, analyze, and generate human-like answers to user’s questions. To assess its applicability to medical education, more information is required to understand whether its analyses can provide accurate and coherent responses to questions. The aim of this study was to characterize ChatGPT responses to ophthalmology questions according to subtopic to determine where the system might be used reliably in resident education and where its performance remains weak.

Methods: Ophthalmology questions were obtained from a widely utilized study resource, OphthoQuestions. Thirteen sections, each with a differing ophthalmic …

Book Review: Neuro-Visual Processing Rehabilitation: An Interdisciplinary Approach, Paul B. Freeman Od

Optometric Clinical Practice

Book review

Disc Edema Secondary To Sleep Apnea: A Case Report, Jeannette A. Wong-Powell Od

Optometric Clinical Practice

Background: Bilateral optic disc edema is associated with multiple systemic conditions of potentially dire consequences. Idiopathic intracranial hypertension (IIH) is a common culprit and diagnosis of exclusion, which has been observed in multiple patients with obstructive sleep apnea (OSA) and raised questions of a pathophysiological link between the two.

Case Report: A 28-year-old Caucasian male with history of transient ischemic attack-like symptoms presented with bilateral disc edema prompting a multi-disciplinary work up that included imaging, lumbar puncture, laboratory analysis, neuroophthalmological, cardiological, and pulmonary evaluations that ultimately led to a diagnosis of OSA. The case is unique in that it followed …

An Uncharacteristic Case Presentation Of Functional Vision Disorder, Ramandeep Kaur Od, Theresa Zerilli-Zavgorodni Od, Nancy Shenouda-Awad Od

Optometric Clinical Practice

Background: Functional Vision Disorder (FVD), also commonly referred to as functional vision loss (FVL) or non-organic vision loss (NOVL), is defined as a visual acuity (VA) loss and/or visual field (VF) loss, without any identifiable ocular or cortical pathology. Many clinicians look at FVD as a diagnosis of exclusion and while it is imperative to rule out organic pathology, FVD diagnosis must be supported by clinical findings that prove normal visual function. Incorporating supplementary tests specific for demonstrating the integrity of the visual system and the non-organic nature of the symptoms will allow clinicians to be more confident when diagnosing …

A Case Report Of Vitreopapillary Traction Mistaken For Optic Disc Edema, Breyne Middleton Od, Drew Anderson Od

Optometric Clinical Practice

Background: Traction of the optic disc occurs during incomplete detachment of the posterior vitreous from the peripapillary glial tissue. It can sometimes cause the appearance of disc edema and bilateral cases can be confused with papilledema or cause patients to be worked up for pseudotumor cerebri.

Case Report: A patient presented with an outside diagnosis of unilateral optic disc edema and was found in fact to have vitreopapillary traction.

Conclusion: Costly, ultimately unnecessary testing such as magnetic resonance imaging can be sometimes avoided if vitreopapillary traction is considered as a differential for disc edema. It can be easily identified with …

A Space-Occupying Lesion Manifesting As Unilateral Optic Disc Edema, Len V. Koh Od, Phd, Anna Wells Od, Lindsay Jansen Od

Optometric Clinical Practice

Background: Primary and secondary orbital diseases can arise from different tissues in the periorbital regions as space-occupying lesion leading to ophthalmic symptoms. Therefore, eye care providers are often the first encounter for these patients.

Case report: A 54-year-old Caucasian male presented as a new patient at the eye clinic with an incidental finding of edema of the left optic disc. After a thorough optometric evaluation, a referral was made to a local ear-nose-throat (ENT) specialist who confirmed a diagnosis of cavernous hemangioma by further neuroimaging. Surgical removal eventuated in resolution of disc edema with restoration of vision.

Conclusion: An insidious …

Marijuana And Intrinsically Photosensitive Retinal Ganglion Cells, Denise A. Valenti Od

Optometric Clinical Practice

Expanding the Box

Editor's Note: Debbie Hettler, Od, Mph, Paul B. Freeman Od

Optometric Clinical Practice

Editor's note

Where Have All The Doctors Gone?, Paul B. Freeman Od

Optometric Clinical Practice

Editorial

Thank You To Our 2023/2024 Reviewers, Paul Freeman, William Miller

Optometric Clinical Practice

Reviewers

Applying Multimodal Imaging In The Evaluation Of A Rare Complication Of Retinal Cavernous Hemangioma, Mariana Ferraz Od, Julie Rodman Od, Msc, Jose Diaz Md

Optometric Clinical Practice

Abstract

Background: Retinal cavernous hemangiomas are rare, benign vascular tumors usually encountered incidentally on routine examination. Although usually asymptomatic, complications have been reported and can result in vision loss. Ancillary imaging modalities such as fundus photography, fluorescein angiography, optical coherence tomography, and optical coherence tomography angiography provide valuable information about the lesion and possible associated findings. Case Report: A 66-year-old Caucasian female presented to the clinic for a comprehensive exam with mild blurry vision in both eyes with current spectacles. Her ocular history was remarkable for a retinal cavernous hemangioma along the superior-temporal arcade of the left eye. Dilated fundus …

Herpes Zoster Ophthalmicus Associated With Ipsilateral Bell's Palsy, Patricia Salazar Od

Optometric Clinical Practice

Abstract

Background: Herpes zoster is caused by reactivation of the varicella zoster virus with spread along the dorsal root ganglion and sensory nerve to a dermatome. In herpes zoster ophthalmicus (HZO), involvement of the ophthalmic (V₁) branch of the trigeminal nerve results in ocular sequelae and often presents with a characteristic pseudodendrite. Reactivation within cranial nerve VII can lead to the neurologic complication of facial nerve palsy on the affected side. Case Report: This case report describes a patient diagnosed with HZO and subsequent same-sided facial nerve palsy (Bell’s palsy) and discusses the potential link between the two …

Acute Syphilitic Posterior Placoid Chorioretinopathy: A Case Report, Kendra R. Null Od, Danielle E. Toms Od, Elizabeth M. Phillips Od, Candice A. Law Od, Ms

Optometric Clinical Practice

Abstract

Background: Acute syphilitic posterior placoid chorioretinopathy is a rare manifestation of ocular syphilis that can significantly impact the patient’s vision. However, it has been shown to have a good prognosis with the appropriate diagnosis and treatment of the underlying systemic syphilis infection. In addition to discussing the details of the case, this report also highlights the systemic staging, diagnosis, and treatment of syphilis. Case Report: This case features a 60-year-old Caucasian male diagnosed and treated for acute syphilitic posterior placoid chorioretinopathy after a recent diagnosis of syphilis. Conclusion: With the incidence rates of syphilis infections increasing, it is imperative …

Ocular Myasthenia Gravis; A Case Report, Amy Garbo Maxey Od, Kristin Wilson Od

Optometric Clinical Practice

Abstract

Background: Myasthenia gravis (MG) is an autoimmune disease disorder that affects the skeletal muscles causing increased fatigability and weakness. When it affects the ocular muscles only, it is known as ocular myasthenia gravis (OMG). Patients with OMG will often have symptoms of diplopia and ptosis, which will be worse towards the end of the day. This case report will discuss the common symptoms of OMG as well as the appropriate treatment and management. It will also review the diagnostic tests used to aid in the diagnosis of OMG and discuss the prognosis of OMG. Case Report: A 67-year-old male …

A Most Difficult Conversation, Paul Freeman Od

Optometric Clinical Practice

Editorial