|An OCT is an advanced technology that has proven to be indispensable to our office (shown here is Zeiss Meditec’s CIRRUS HD-400).|
|OCT enabled us to diagnose Torpedo Maculopathy in this 4-year-old patient.|
These two cases illustrate how technology can provide fast answers for practitioners and patients
Earlier this year, a 4-year-old girl presented to our office for an annual eye evaluation. She had failed a vision screening at school. It is the custom in our office for new pediatric patients to have a cycloplegic examination.
All findings were within normal limits before dilation; she was seeing 20/20 in each eye, but the retinal examination revealed a small, 1 DD flat retinal area of hypopigmentation surrounded by retinal pigment epithelium (RPE) hyperplasia next to the macula in her right eye. Its shape was ovoid, and there were two small areas of hyperpigmentation next to the lesion. Since her mother did not report previous findings with past eye exams, we opted to do testing with our Carl Zeiss Meditec, Inc.’s Cirrus-HD 400 optical coherence tomographer (OCT) to determine perimacular integrity and contour.
We diagnosed “Torpedo Maculopathy,” a typically stable condition throughout life. It is often found on routine testing, and does not affect vision in a significant way. OCT in these cases is helpful in determining lack of elevation or excavation of the retina overlying the hypopigmentation. This is a relatively new diagnosis that appears as a solitary area of RPE attenuation on OCT.
OCT was especially helpful in this case. It gave us baseline data that allows us to monitor the condition over time.
A 64-year-old woman returned to our office for an evaluation to monitor bilateral epiretinal membranes. She denied any Amsler defects per self-monitoring at home, and she was seeing 20/20 in each eye upon presentation. Her ocular history was also significant for well-controlled pseudoexfoliative glaucoma.
Fundoscopy revealed a relatively extensive “sheen” over both maculae with characteristic surrounding venous tortuosity. In patients with macular irregularity, OCT has nearly become the standard of care. Macular changes barely visible to the naked eye with biomicroscopy suddenly become very obvious on OCT.
Epiretinal membranes occur most commonly as a result of posterior vitreous detachments. They are formed by glial tissue proliferation on the retinal surface and appear on OCT scans as superficial tractional change of the retina. Often, a thin, uneven band of hyper-reflectance is present. In more significant cases, the underlying retina may also appear highly irregular. OCT is especially beneficial in determining between an intact retina and early stage 1 or 2 macular holes. In our patient, both retinas had fully intact layers with no breaks, and we elected to monitor.
OCT not only provides highly detailed images of the different layers of the retina and the optic nerve; it also serves as an additional source of income for our office, easily offsetting the cost of the instrument. During the course of owning an OCT for the past two years, we have already scanned hundreds of patients. OCT has proven to be indispensable to our office.
Katherine Shen is an associate at Specialty Eyecare Group in Seattle and Kirkland, WA. Alison Bozung is a fourth-year student at Southern College of Optometry interning at Specialty Eyecare Group.
WHERE TO FIND IT:
Carl Zeiss Meditec, Inc.