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Sometimes, you get a pterygium and you shake your head.
what kind of vision did this patient have ? (just curious)
Sometimes, you get a pterygium and you shake your head.
The vision was CF 5 feet with a normal pupil and 20/200 with a dilated pupil.what kind of vision did this patient have ? (just curious)
spots of hemorrhages around the ONH, macula, and superiorly -- the patient suffer from retinal leak?; macular degeneration?(not sure if those are drusen or leaks, pic too small to tell); optic chiasm
optic nerve atrophy
not much branching. i'm honestly not sure, you asked what else so i took a guess.
+ retinal scar by any chance?
swelling?
microaneurysms all around the macula. not impressive in the disc besides some vessel abnormality.
Actually, it would signify early (or low risk) proliferative diabetic retinopathy. Background and pre-proliferative diabetic retinopathy were eliminated as classifications with the release of the ETDRS. I am sure there are retina docs that still use those classifications, but they are considered obsolete.I think the most notworthyhing you should see is the NVD (neovascularization at the disk). NVD is often missed but is prominent as this signifies pre-proliferative diabetic retinopathy.
Actually, it would signify early (or low risk) proliferative diabetic retinopathy. Background and pre-proliferative diabetic retinopathy were eliminated as classifications with the release of the ETDRS. I am sure there are retina docs that still use those classifications, but they are considered obsolete.
You are absolutely correct. NVD less than 1/3 disc area with VH would be classified as High Risk PDR. I was only referring to the comment "NVD is often missed but is prominent as this signifies pre-proliferative diabetic retinopathy". Any neovascularization, whether it be NVD or NVE signifies proliferative diabetic retinopathy, not pre-proliferative. Low, moderate, or high risk is determined by the amount of neo in relation to location as well as other findings such as vitreous hemorrhages. Pre-proliferative diabetic retinopathy is a classification that no longer applies based on the ETDRS. Furthermore, there are some retinal specialists that seriously consider treatment at the severe NPDR stage. Regardless, this patient needs to be referred for a retinal consult fairly quickly.If I recall the ETDRS study correctly, high risk characteristics include NVD of any amount if associated with VH. If that hemorrhage below the disc is in the vitreous then this patient needs to be referred for PRP.
If I recall the ETDRS study correctly, high risk characteristics include NVD of any amount if associated with VH. If that hemorrhage below the disc is in the vitreous then this patient needs to be referred for PRP.
I've been inundated recently with a lot of new projects but I saw this interesting chap a couple of weeks ago. For all of the hot shots, what do you see, what history would you take, what is your working diagnosis, how woud you manage it?
Richard Hom OD FAAO
http://www.geocities.com/rchom/http://www.geocities.com/rchom/
Hey Dr. Hom, great pics! Any chance you could post what YOU would do (and how you are currently handling these cases)? It would be very helpful.
Looks like a pterygium - ask the patient if he's been exposed to too much sunglight recently. the growth can be surgically excised.
The ring around the iris looks like a case of senilis - ask the man about his eating habits, and cholesterol level. Can be treated with medication (lipitor).
Already one post operative procedure done already. Successful?
Richard Hom OD FAAO
www.geocities.com/rchom/
Quite often, contact lens wearers experience misfortune when they panic about their lenses. This is a 24 year old woman who thought her lens was still in her eye and proceeded to attempt removal repeatedly.
How would you manage this?
Richard Hom OD FAAO
Grand Rounds Web Site for the OD
This makes me cringe just looking at it. Poor thing -- she must have been in lots of pain ! The one I saw this week was only half that size.
First, what is your background? pre-optometry or in a program?
Richard Hom OD FAAO
http://www.geocities.com/rchom/
late reply.... I am a third year optometry student at SCCO about to go on rotations, I can't wait! Anyways, I was hoping that you would put your assessment and management of these patients on your website, maybe "after the jump" so that we could learn from your experiences.
Your questions are thought provoking, and your images are excellent! We would all just like to see how you approached and handled these cases.