[optimal] Imaging for ONH Drusen From Denice

From: CPMC Ophthalmic Diagnostic Center <cpmceyelab@xxxxxxxxxxxxxxxx>
To: "optimal@xxxxxxxxxxxxx" <optimal@xxxxxxxxxxxxx>
Date: Wed, 10 Oct 2018 20:06:32 +0000

[Note that the US on the left demonstrates the ONH Drusen, whereas the FAF on
the right does not  Drusen exists, but not calcified enough ( enough for US )
and more importantly, not enough fluropore IN the calcium   To manifest on
FAF][cid:image013.jpg@01D4609A.0E5468F0][cid:image014.jpg@01D4609A.0E5468F0][cid:image015.jpg@01D4609A.0E5468F0]

        [Third image on the right clearly denotes presence of Drusen.  These
large WOULD manifest on US, but not necessary as FAF answered the question
He]

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 12:55 PM
To: OPTIMAL <optimal@xxxxxxxxxxxxx>
Subject: [**External**] [optimal] Re: More pediatric angiography questions

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Hi Katie,
Could you post an EDI slice/image/scan that seems to demonstrate drusen?
Stuart Alfred / 317-517-9455 /
stuart.alfred@xxxxxxxxx<mailto:stuart.alfred@xxxxxxxxx>
Board of Education - OPS {Equipment Chair} -
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On Wed, Oct 10, 2018 at 1:07 PM Katie Lachut
<katie.lachut@xxxxxxxxx<mailto:katie.lachut@xxxxxxxxx>> wrote:
I usually do a dense cube scan with EDI over the optic nerve followed by an AF
image.

Katie Lachut | (315)806-9733 |
https://www.flickr.com/photos/katielachut<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.flickr.com%2Fphotos%2Fkatielachut&data=02%7C01%7Ccpmceyelab%40SUTTERHEALTH.ORG%7C7709f9d5ef5b43c7cb3608d62eea709c%7Caef453eadaa243e0be62818066e9ff63%7C0%7C0%7C636747981793868206&sdata=2%2FMwWRKD0BfxwxoVplGlorSbh9qkw4XjjMR8VEWRDiY%3D&reserved=0>
Ophthalmic Photographer with VCU Health System |  RIT 2013

On Wed, Oct 10, 2018 at 1:05 PM Stuart Alfred
<stuart.alfred@xxxxxxxxx<mailto:stuart.alfred@xxxxxxxxx>> wrote:
I was texted by my BOE team to consider EDI scans for Drusen too!   All worthy
considerations.  Keep up coming.  !st patient is tomorrow at 1pm.
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%7C7709f9d5ef5b43c7cb3608d62eea709c%7Caef453eadaa243e0be62818066e9ff63%7C0%7C0%7C636747981793878211&sdata=froVNIFIXB0A%2BO%2FnOQLYv%2F6j53WzVHt60IadD%2BQNh1c%3D&reserved=0>

On Wed, Oct 10, 2018 at 1:01 PM Bennett, Timothy
<tbennett1@xxxxxxxxxxxxxxxxxxxxxxx<mailto:tbennett1@xxxxxxxxxxxxxxxxxxxxxxx>>
wrote:
Why not start with autofluorescence? That’s what our docs do here. That usually
answers the question. On rare occasions they may also order a B-scan.

I haven’t done an FA for disc drusen for ages.

tim

From: optimal-bounce@xxxxxxxxxxxxx<mailto:optimal-bounce@xxxxxxxxxxxxx>
[mailto:optimal-bounce@xxxxxxxxxxxxx<mailto:optimal-bounce@xxxxxxxxxxxxx>] On
Behalf Of Stuart Alfred
Sent: Wednesday, October 10, 2018 10:02 AM
To: OPTIMAL <optimal@xxxxxxxxxxxxx<mailto:optimal@xxxxxxxxxxxxx>>
Subject: [optimal] More pediatric angiography questions

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} -
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[optimal] Imaging for ONH Drusen From Denice

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