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OPTIC NERVE WORKSHOP

NEW HAMSPHIRE VAMC

Peter Lalle, OD

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WHICH EYE IS BLIND ?

Further RNFL thinning was not observed in glaucomatous

eyes in which at least one-third (-10dB MD) of the visual field

had been lost.

The OCT progression analyses generated

a relatively high proportion of false positives.

Using OCT for glaucoma follow-up may not be

entirely straightforward.

ACTA May 2021 99(3)

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PLEASE PAY ATTENTION.

THESE ARE YOUR PEERS’

ANSWERS

.

Bare rim superior

No rim inferior

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d7147

dc7503

Which optic nerve is suspicious for glaucoma:

A or B

or BOTH ?

A

B

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Dc 7503

d7147

TRUE

MAG

of FIRST

EXAMPLE

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EGS 2013

RIM AREA SAME ALL THREE

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  1. OPEN BEAM UP TO COVER DISC HORIZONTALLY
  2. MAKE BEAM LONGER THAN DISC, THEN DECREASE
  3. MAKE SURE YOU ARE INSIDE SCLERAL RING
    • USE RED FREE TO ENHANCE EDGE

4. MEASURE CUP AS WELL AND THEN COMPUTE RATIO

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GOOGLE THIS

DEPENDING ON LENS USED, MEASUREMENTS VARY. THEREFORE, BE CONSISTENT

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VH = 2.5

VH = 1.6

AS MEASURED

WITH VOLK

60 DIOP LENS

USING PLANIMETRY, RANGE OF DISC AREA (NOT DIAMETER) RANGES 0.8mm2 TO 6.0 mm2 (~8 FOLD)

“IT’S THE RIM, STUPID !”

(NOT THE CUP)

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Baring of Circumlinear Vessels

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Nasalization without

Nasal Cupping

NFL visible

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SUGGESTED APPROACH FOR ON EVALUATION

  1. INSPECT SURROUNDING RETINA

  • CHECK FOR PPA W BETA ZONE

  • IDENTIFY INNER SCLERAL RING, ESTIMATE BY EXTRAPOLATION IF NEEDED

  • MEASURE DISC SIZE

  • IDENTIFY INNER RIM USING VESSEL BEND

  • CHECK FOR LOSS OF RIM BY LOOKING FOR HANGING VESSEL,

BARING OF CIRCUMLINEAR, NASAL CUPPING, BAYONETTING, NASALIZATION *

7. IDENTIFY NFL DEFECTS/DIFFUSE LOSS

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Ct 1082 os

2

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Ct 108296247 os VB vs collapse rim inf temp

3

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CT 1082

4

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CT 1082

5

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DC 7503 OD

6

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DC 7503 OD

7

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DC 7503 OS

8

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DC 7503 OS

9

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DD 2206 OD

10

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DD 2206 OD

11

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DD 2206 OD INFILTRATIVE PAPILLEDEMA

12

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DR0619 OD

13

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DR0619 OD BLURRED MARGIN ANOM VESSELS, NFL SHIFT

14

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DR3375 OD NO BC VB

15

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DR3375 OD NO BC VB

16

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DR 3375 OS VB NO BCL HV

17

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DR 3375 OS VB NO BCL HV

18

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DR 6549 OD COMPARE TO DT 5362

19

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DR 6549 OD SD, BC, VB, BLONDE, COMPARE TO DT 5362

20

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DT5362 OD; COMPARE TO DR6549 DISC SIZE

21

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DT5362 OD BD c BC VESSEL LOOP; CILIORETINAL; COMPARE TO DR6549 DISC SIZE

22

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Disc size difference between DR6549 and DT5362

Same mag

23

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F1215J OS

24

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F1215J OS PPA BY NC HV BCL

25

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F1768 OD

26

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F1768 OD NO c VB NFL WEDGE

27

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F1768M OS CL HEAP c NFL SHIFT

28

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F1768M OS

29

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F4540 A OS

30

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F4540 A OS BLONDE PPA SMALL TILTED

31

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F4540 OS

33

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F4540 OS THIN RIM IT VB xISNT

34

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F4540 A, OD

35

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F4540 A, OD THIN RIM VB SCLERAL RING

36

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FC2245 OS COLOR NOT EQUAL CUP VB

37

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FC2245 OS

38

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FR1708 OD VB NO BC SCLERAL RING

39

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FR1708 OD

40

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FR 1708 OS

41

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FR 1708 OS AMD w SRF, LARGE DRUSEN

42

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FR 1708

43

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FR 1708 BLONDE VB NO SCLERAL RING

44

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Jj 8167 OD

45

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Jj 8167 OD VB BC COLLATS BCL

46

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Jc 2237 OS

47

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Jc 2237 OS VB xISNT BC

48

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Je 1401 OD

49

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Je 1401 OD anom disc & vessels not = ISNT

50

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Jf 2125 OD SPLNTER HEME, PALLOR VB

51

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Jf 2125 OD

52

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Ji 2246 OD

54

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Ji 2246 OD

55

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Ji 2246 OD

54

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Ji 2246 OS

56

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Ji 2246 OS BC BD NVD VIT HEME

57

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Jj 4127 OD

58

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Jj 4127 OD ENDSTAGE VB BD RIM vs RING ST NC

59

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Jj 4127 OS

60

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Jj 4127 OS PRE DH NOTE VEIN ON DISC PRE DH

61

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Jj 4127 OS NOW C TWO DH INF BD BC

62

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Kc2358 OD

63

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Kc2358 OD NOT BY NOT CL

64

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Kh7 517 os

65

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Kh7 517 os DH SD BC SCLERAL RING

66

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McD 5671 OD VB BCL SD BC

67

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McD 5671 OD

68

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McD 5671 OS

69

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McD 5671 OS VB BCL BC NC

70

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Me 2874

71

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Me 2874 VB BD BC ~NC xISNT

72

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Me 6109 OD

73

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Me 6109 OD VB BD BC HV NC SCLERAL RING

74

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Mj 2352 OS

75

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Mj 2352 OS VB BD BC HV

76

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Mj2352 OD

77

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Mj2352 OD VB BD BC PPA BCL

78

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CLINICAL EVALUATION OF THE OPTIC NERVE

MODULE FOUR

PETER LALLE, OD, FAAO

79

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Mj 3703 OS

80

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Mj 3703 OS VB RING vs RIM NO

81

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Mm 5561 OD

82

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Mm 5561 OD BCL NC

83

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Mq 5151 OD

84

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Mq 5151 OD TEMP SLOPE CL

85

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S 4861 OD VB

86

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S 4861 OD VB BD HV ~ NC

87

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Sb 8460 OD

88

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Sb 8460 OD VB SL PPA xISNT

89

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Sj1251 OD

90

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Sj1251 OD PPA NASAL HEAP C TILT

91

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Sj 1251 OS

92

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Sj 1251 OS PPA NASAL HEAP WITH TILT SD BC

93

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UNKNOWN

94

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UNKNOWN ANOM DISC ROTATED; CD LONG AXIS vs 12-6

95

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UNKNOWN

96

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UNKNOWN VB RIM vs RING ENDSTAGE

97

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UNKNOWN

98

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UNKNOWN VB BC BD XISNT

99

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Sh 7430 OD DISCIFORM C SRF

100

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Sh 7430 OD DISCIFORM C SRF

101

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Sh 7430 OS SRF

102

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Sh 7430 OS SRF

103