I.
II.
III.
IV.
Occult Retinal Diseases
A. Localized
1. Acute Zonal Occult Outer Retinopathy (AZOOR)
2. Occult Macular Dystrophy
3. Rod Monochromatism
4. Cancer Associated Retinopathy (CAR)
5. Plaquenil Toxicity (Early)
6. Heavy metal toxicity (ex. Lead)
7. MEWDS (after transient onset)
8. Peripapillary Retinoschisis (RS)
9. Macula RS, RS in the arcades and parapillary RS
10. Shallow Retinal Detachment
B. Diffuse
1. Congenital Stationary Night Blindness (CSNB) w/o fundus
changes
2. Cone-Rode dystrophy
3. Retinitis Pigmentosa sine pigmento
4. Leber’s Congenital Amaurosis (early)
5. Retinal degenerations as part of syndromes
a. Usher’s syndrome
b. Laurence-Moon-Biedl syndrome
Functional Testing
A. Visual Field
B. Micro-perimetry with SLO and eye position monitoring 25times/sec
C. Electro diagnostics ( VEP, ERG, and mf ERG)
Advanced Fundus Photography
A. Fundus Autofluorescence and Panoramic FAF
B. Fluorescein Angiography and ICG Angiography
C. Multi-spectral fundus image analysis (ARIS and Annidis)
D. Panoramic FAF and FA
Structural Testing
A. Time Domain OCT vs Spectral Domain OCT in retinal disease
1. Differences and case examples between TD-OCT and SD-OCT
2. Importance of IS/OS junction (photoreceptor integrity line or
PIL)
B. SD-OCT in occult retinal disease and application of the PIL
1. AZOOR- 2 cases, 1 with successful treatment with Imuran
2. Incomplete rod monochromatism- 2 case examples
3. Complete rod monochromatism- 4 examples (genetically
confirmed)
4. Cone-Rode dystrophy- 3 examples
5. Posterior Pole retinoschisis- 3 examples
6. Occult macular dystrophy- 1 case example
7. CSNB- 1 case example
C. B-scan Ultrasound
1. Shallow retinal detachment and shallow RS
V.
VI.
Correlating functional and structural tests
Differential Diagnosis
A. How to approach the patient with symptoms and/or reduced vision and no
obvious retinal abnormality
1. Clinical examination findings
2. OCT- to confirm or rule out optic nerve involvement
3. mfERGs- to confirm or rule our central retinal disorders
4. VEP-to confirm or rule out visual pathway disorders
5. Other functional and structural tests and genetic testing
VII. Genetic Testing
A. Genetic testing, diagnosis, and possible treatment
B. What tests are availed and which labs are offering testing?
C. What do the results mean?
D. Availed treatment for LCA patients with the RPE 65 gene
E. New oral med from QLT for LCA and RP
F. Anticipated available treatment for other retinal disorders
VIII. Conclusion/ Discussion
A. Clinical application of structural vs. functional testing
1. Structural testing can be performed quickly and reliably
2. Predictive value of SD-OCT
B. Improvements in OCT technology
1. Ultra-High resolution OCT
C. Will structural testing replace functional?
D. Will genetic testing become routine in the near future?