SPECTRAL DOMAIN OCT AT C.E.C.

 

Capital Eye Consultants has updated our Stratus OCT to Cirrus HD OCT.  The difference in technology is equivalent to a Porsche Targa vs. a Volkswagen Rabbit.  Both will get you there but one performs a heck of a lot better than the other.  For those of you that own an OCT or have seen them at trade meetings, you know that the resolution is exquisite with the spectral domain instruments.  In addition to retina, the OCT has an anterior segment mode that can look at angle structures as well as corneal pathology in great detail.  We are also using the OCT to screen for subtle retinal pathologies such as an epiretinal membrane or macular degenerative changes in the fovea that might affect the quality of vision after cataract surgery.  This becomes particularly important if the patient has selected a multifocal IOL in which he or she has made a significant investment and needs to have a high resolution eye to take advantage of the complex optics.  We also screen monovision eyes to rule out subtle pathologies which would degrade from the near image.

 

Prior to upgrading to the new machine, we were not in compliance with the recommendations for monitoring Plaquenil therapy. Now, we can provide a 10-2 threshold visual field and an OCT capable of resolving the loss of retinal thickness associated with early Plaquenil toxicity.

 

CEC had owned the first GDx in the State of Virginia and upgraded that instrument several years back.  OCT technology has now replaced the GDx technology.  On the glaucoma report, a portion of the data is presented as retinal nerve fiber layer thickness, similar to what we saw on the GDx.  Additionally, the OCT gives detailed information about the anatomy of the optic disc including cup volume, vertical and horizontal dimensions and rim tissue volume.  With the macular cube report, one can also monitor changes in macular thickness in diseases such as glaucoma and macular degeneration. 

 

It has been exciting and rewarding to share these detailed results with patients as we explain their diagnoses to them.  We look forward to having a more up-to-date and accurate method of following our glaucoma and macular degeneration patients utilizing this equipment. 

 

Just a reminder, we also have selective laser trabeculoplasty (SLT) available at Capital Eye Consultants.  Please consider referring patients for this technology if you have not met a therapeutic goal with topical medications or if the patients are poorly compliant or complain of the cost of their medications.  The procedure typically reimburses at under $400 through insurance and, therefore, the co-pay on the procedure can be less than the cumulative co-pays for medication.  The majority of patients we treat have a good response to this laser, however, it should be pointed out that not all patients respond to SLT, just as was the case with earlier ALT.  Similar to PI treatment, we can provide same-day treatment to patients if the referring doctor has pre-cleared that through Dr. Powers, Dr. Baldinger, or Dr. Mattern.

 

 

James E. Powers, O.D

 

 

 

The presenting clinical features:  tearing, injection, petechial hemorrhages, sub-epithelial infiltrates(can be there for up to a year), light sensitivity, membranes/pseudomembranes, and, ipsilateral palpable preauricular node.   Almost all of these patients present with acute redness/discomfort starting in one eye.  This will often spread to the other eye in 2-5 days.  Often, a recent history of an eye examination or exposure from children or other family members is present.

 

The incubation period is 2-14 days, and the person may remain infectious for 10-14 days after symptoms develop. Symptoms tend to last for 7-21 days. The fellow eye tends to be involved in more than 50% of the cases within 7 days of onset. The signs and symptoms are typically less severe in the fellow eye.

EKC is a viral conjunctivitis caused by a group of adenoviruses. This family of adenoviruses contains 51 serotypes that can also cause pharyngoconjunctival fever and nonspecific follicular conjunctivitis. Flulike symptoms may precede the "pink eye" (fever, malaise, respiratory symptoms, nausea, vomiting, diarrhea, and myalgia).

 

If you are uncertain, the RPS Adeno Detector (www.rpstests. com) may be helpful in diagnosis as it is over 90% accurate and can give you the result in less than 10 minutes in your office (supposed to be billable).

When we see a patient with EKC, we generally offer the following treatment :

By history, rule out any allergy or sensitivity to iodine.

1. Instill a drop of 0.5% proparacaine.
2. Instill a drop or two of a topical NSAID.
3. Instill four to five drops of Betadine onto the eye.
4. Ask the patient to gently close the eyes and roll them around to ensure thorough distribution of the Betadine across the ocular surfaces.  Also do the lashes and lid margins.
5. After one minute, lavage out the Betadine  with any sterile ophthalmic irrigating solution.
6. Instill another drop or two of the NSAID
7. Lotemax or Pred Forte QID for four days..

If there is a membrane present, it should be removed whether treating or not (prior to treatment if treated).  Membranes bleed upon removal, pseudo-membranes do not.  Remember, this treatment does not cure EKC, but it does shorten the duration by reducing/eliminating the viral load.  Often times, the patient feels as if the eye is worse for the first 1-8 hours after the treatment.

We then sterilize everything including doorknobs, pens, and chairs in the waiting room.  If you are so inclined, you can sign up at http://www.betadineforekc.com to participate in a study to track the outcomes of the treatment.

 

                                    James Mattern, O.D

 

As was mentioned in past email blasts, the ceceyes.com website is up and running..Visit our website

Our site is different than other ophthalmic sites in that we provide features to enhance your patients knowledge (Eyemagination Videos, Newsletters, Forms Archives  ) AND features to enhance our referring doctors practices (Newsletter Archives, Forms Archives, Classified ads and Professional Opportunities). Feel free to link to our site and direct your patients to the site for knowledge. Call us or email LSK542007@yahoo.com if you want to post a classified ad.

 

Founded in 1986 by doctors of optometry in Northern Virginia, Capital Eye Consultants has provided 25 years of quality and comprehensive consultative/surgical co-management services for the optometrists and their patients in the Northern Virginia area.