Stuart,
Just saw this thread. Sure looks like disc drusen. And look at that nasally!
Agree with Paula looks like peripapillary SRNV. Since this is nasal, I would
expect no visual symptoms. I am not aware of disc drusen causing SRNV, so two
"independent' diagnoses?
Sometimes the FA shows something not expected. I remember doing an FA on a
patient with BDR. The BDR showed up well, and there was a peripapillary net.
If you went back and looked at the color photos and "filtered out" all the BDR,
the subtle grayish lesion was there near the disc.
How old was the patient? The youngest SRNV net patient I have seen was eight
years old. The net was in the macula, no evidence of trauma or anything else
going on. Maybe a Histo patient with no Histo spots.
Tom
________________________________
From: optimal-bounce@xxxxxxxxxxxxx <optimal-bounce@xxxxxxxxxxxxx> on behalf of
Stuart Alfred <stuart.alfred@xxxxxxxxx>
Sent: Friday, October 26, 2018 11:22 AM
To: OPTIMAL
Subject: [optimal] Re: More pediatric angiography questions
Thanks Paula and Sandor. This is highly informative Sandor. EDI OCT appears
to be critical to testing these categories of patients. Thank you for sharing.
Thank you also for the OCTA lecture you are giving today! I wish I was able
to attend, but am certain many fellow imagers will gain greater insight into
OCTA, thanks to your academic commitment.. and how about that new OPS Journal
on OCTA!!!
I’ve shared this link with the patient’s pediatric ophthalmologist. Hamartoma
is indeed on her list. She is ‘chewing’ on it for a while. I’m discussing the
testing as well with the retina docs I work directly for. Sharing their
interpretations with the Ped ophthalmologist.
I do not see indication of disc edema in the IVFA. That is helpful to note.
However, regarding the right eye, nasal area to ON, hyper fluoresces at 26 sec.
Is that leakage or a window defect? I am pretty certain a window defect would
have lit up immediately. Same suspicious area continues to leak at 8 minutes?!
That indicates some sort of subretinal neovascular membrane. Doesn’t it?
Understand, clinical appearance is most important. So I have you all at a
disadvantage. On that note. I forgot that we actually do have a DRS device
here on site. It doesn’t actually belong to our Institute, but does belong the
to peds docs sending me these kiddos, so in the future I will do what I can
with that automated instrument for color documentation. Stay tuned.
No need to respond unless you are compelled to. I wanted to respond before any
more time passed.
Maybe I’ll see you Sunday some time at the AP? Enjoy the Windy City! And to
Paula, you and all those giving their time and energy in Chicago, thank you for
volunteering. It is priceless!
Stuart
From: OPTIMAL <optimal-bounce@xxxxxxxxxxxxx> on behalf of Paula Morris
<paula.morris@xxxxxxxxxxxx>
Reply-To: OPTIMAL <optimal@xxxxxxxxxxxxx>
Date: Wednesday, October 24, 2018 at 6:53 PM
To: OPTIMAL <optimal@xxxxxxxxxxxxx>
Subject: [optimal] Re: More pediatric angiography questions
Agreed, Sandor!
Sent from my iPhone
On Oct 24, 2018, at 5:11 PM, sandor ferenczy
<sandorferenczy@xxxxxxxxx<mailto:sandorferenczy@xxxxxxxxx>> wrote:
Thinking along the lines of this:
https://openi.nlm.nih.gov/detailedresult.php?img=PMC4399121_IJO-63-128-g002&req=4
but clinical appearance would be a large factor.
-sandor
On Oct 24, 2018, at 15:00, Stuart Alfred
<stuart.alfred@xxxxxxxxx<mailto:stuart.alfred@xxxxxxxxx>> wrote:
Stuart Alfred / 317-517-9455 /
stuart.alfred@xxxxxxxxx<mailto:stuart.alfred@xxxxxxxxx>
Board of Education - OPS {Equipment Chair} -
www.opsweb.org<http://www.opsweb.org>
Hi OPTIMAL,
Apologies on the delay in sharing some of these. I have simply not had the
chance.
I've attached a sample of the right eye testing I performed. Interested in
any responses.
The second potential IIH (drusen and or IIH) patient comes in on the 30th. The
MD requested IV vs. oral.
Stu
On Wed, Oct 10, 2018 at 5:08 PM Bennett, Timothy
<tbennett1@xxxxxxxxxxxxxxxxxxxxxxx<mailto:tbennett1@xxxxxxxxxxxxxxxxxxxxxxx>>
wrote:
You aren’t alone Stu….. ;-)
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 3:58 PM
To: OPTIMAL <optimal@xxxxxxxxxxxxx<mailto:optimal@xxxxxxxxxxxxx>>
Subject: [optimal] Re: More pediatric angiography questions
Tim,
Yes, I'm over thinking it.
Stuart Alfred / 317-517-9455 /
stuart.alfred@xxxxxxxxx<mailto:stuart.alfred@xxxxxxxxx>
Board of Education - OPS {Equipment Chair} -
www.opsweb.org<http://www.opsweb.org>
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} -
www.opsweb.org<http://www.opsweb.org>
<Cxxxxxx33_Hxxxxxx.jpg>
<CxxxxxxxxHxxxxxxx_001.jpg>
<edi slice horz over drusen od.jpg>
<CxxxxxxxxHxxxxxxx_007.jpg>
<CxxxxxxxxHxxxxxxx_016.jpg>
<CxxxxxxxxHxxxxxxx_003.jpg>
<TM onh od.jpg>
