In our Neuro clinic, IIH would include differential not only of Papilledema,
but crowded disc, and ONH drusen among other more obscure entitites.
We would:
Color Disc, stereo
RNFL ( more important than volume, c/d ratio etc)
FAF
Maybe a high res cube of ONHto elicit information on possible papillary
traction syndrome, otherwise would not bother
EDI because MAYBE in future information on LC might be helpful, at present, not
so much
Maybe US, if we had a strong sense that there MIGHT be ONH drusen and FAF
simply did not smoke it out. Depending on MD, age of patient, etc etc this
might be a differential we would want to put to bed ( or not )
Hope this helps
D.
Denice Barsness, CRA, COMT, CDOS, FOPS
CPMC Dept of Ophthalmology/ The Eye Institute
Ophthalmic Diagnostic Services
711 Van Ness Avenue Suite 250
San Francisco CA 94109
415-600-5781
FAX 415-558-7011
From: optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx] On ;
Behalf Of Stuart Alfred
Sent: Wednesday, October 10, 2018 1:10 PM
To: OPTIMAL <optimal@xxxxxxxxxxxxx>
Subject: [optimal] Re: FA for ONH Drusen?
Denice,
I am unaware of the IIH testing, more than drusen. Prior to communication
with the physician, I want the Ateam's advice.
Understood re. either modality of FA being unnecessary for drusen, but is it
useful for IIH detection?
Thanks.
Stuart Alfred / 317-517-9455 /
stuart.alfred@xxxxxxxxx<mailto:stuart.alfred@xxxxxxxxx>
Board of Education - OPS {Equipment Chair} -
www.opsweb.org<https://na01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.opsweb.org&data=02%7C01%7Ccpmceyelab%40SUTTERHEALTH.ORG%7C9a49b7b71c774c36462408d62eec8219%7Caef453eadaa243e0be62818066e9ff63%7C0%7C0%7C636747990666937609&sdata=7GpGiImQ%2BlYYYPDnSSiR7P2y2IRBVKVe55AHGmqnygw%3D&reserved=0>
On Wed, Oct 10, 2018 at 2:10 PM CPMC Ophthalmic Diagnostic Center
<cpmceyelab@xxxxxxxxxxxxxxxx<mailto:cpmceyelab@xxxxxxxxxxxxxxxx>> wrote:
Why are we doing FA on ON Drusen
The definitive pathognomonic testing would be FAF and US in that combo
Often, there are not enough fluorophores for FAF to smoke them out
Sometimes, with US, they are not large enough for the 150 micron resolution
Combo of both works wonders
( reference my OPS talk “Imaging for ONH Drusen, and Histopathology of the
Human Eye; Hogan )
Here, unless there is something about the history I am missing, we would NOT do
an FA
Denice
Denice Barsness, CRA, COMT, CDOS, FOPS
CPMC Dept of Ophthalmology/ The Eye Institute
Ophthalmic Diagnostic Services
711 Van Ness Avenue Suite 250
San Francisco CA 94109
415-600-5781
FAX 415-558-7011
From: Barsness, Denice
Sent: Wednesday, October 10, 2018 7:04 AM
To: CPMC Ophthalmic Diagnostic Center
<cpmceyelab@xxxxxxxxxxxxxxxx<mailto:cpmceyelab@xxxxxxxxxxxxxxxx>>
Subject: FW: [**External**] [optimal] More pediatric angiography questions
________________________________
From: optimal-bounce@freelists.orgOn<mailto:optimal-bounce@freelists.orgOn>
Behalf OfStuart Alfred
Sent: Wednesday, October 10, 2018 7:02:08 AM (UTC-08:00) Pacific Time (US &
Canada)
To: OPTIMAL
Subject: [**External**] [optimal] More pediatric angiography questions
WARNING: This email originated outside of the Sutter Health email system!
DO NOT CLICK links if the sender is unknown and never provide your User ID or
Password.
My satellite office is being sought out by the Riley Hospital ophthalmology
team for help with pt. testing. This is a personal accomplishment for me.
Really proud, and humbled.
Two upcoming visits:
14 year old. Weight: 100lb Working diagnosis: IIH, ON drusen
13 year old. Weight: 100lb Working Dx: ON drusen
My prescription of testing OU [stricly Spectralis FA &/ or Cirrus 5000] would
involve:
Fasting 2 hours prior
Spectralis OCT ON - ONH button [73 sec., 60ym] art at 9
ON photos - IR 30degree, RF//BR 30 deg., FAF 30 & 20 degrees
FA oral, using 10% AK-FLUOR
convert weight for admin. using referenced calculations. i.e. 2 vials 10%
5mL, into 3.5 oz. apple juice.
start timer upon pat. consuming. At 2 minutes start FA using 30 degree lens,
laser at 95% sensitivity. Acquire images every 3 minutes until 15 min. So OU
at 2, 5, 8, 11, 14mins.
Any advice OPTIMAL? Please!
I don't see any reason to choose IV over oral.?
Thanks,
Stuart Alfred / 317-517-9455 /
stuart.alfred@xxxxxxxxx<mailto:stuart.alfred@xxxxxxxxx>
Board of Education - OPS {Equipment Chair} -
www.opsweb.org<https://na01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.opsweb.org&data=02%7C01%7Ccpmceyelab%40SUTTERHEALTH.ORG%7C9a49b7b71c774c36462408d62eec8219%7Caef453eadaa243e0be62818066e9ff63%7C0%7C0%7C636747990666947614&sdata=MVVWbLJDLwm2LPR5Ew%2BAvRZ5kdAyRNvB%2Bs%2BEmKZz4Uo%3D&reserved=0>
