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Sanjeev Nath, Sarah MacIver, Marc Sherman, Juliana E. Boneta, Dan Epshtein, Jeremy Whitney, Samantha Slotnick, Jerome Sherman; Does Serial Optos Panoramic Imaging Improve Differential Diagnosis Of Glaucomatous RNFL Defects From Physiological RNFL "Slits"?. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1033.
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To demonstrate that RNFL defects can be imaged with optos p200 C, and to determine the prevalence of such defects and determine whether serial imaging is helpful.
A prospective study of images from 500 consecutive patients seen from Jan to Oct in 2010 in a private practice setting. A scale of assessing RNFL defects was established: Category (C) 1: defects that were no wider than retinal veins and that did not fan out towards the periphery were classified as likely physiological ("slits"). C2-5: Pathological ("true") defects, were wider than retinal veins, and did fan out towards the periphery (C2: subtle focal defects, up to C5: profound focal and widespread.) SD OCT and GDx as well as 24-2 SS VF and disc assessment were used to confirm the Dx. Previous optos images (available in 290 patients) were also reviewed, for progression.
434 of the 1000 eyes reviewed had RNFL defects: 380 were C1 (slits). In 40 of these, confident placement into C1 (and not C2) was quite difficult. 24 were C2 (subtle) and 30 were C3-5 (well defined). In C3-5, all eyes showed defects on either OCT, GDx or VF. In C2, 50% had corresponding defects. 21 of the eyes in C2-5 had slits as well as true defects (see image). Follow-up optos imaging was available in 24 of the eyes with true defects; 4 demonstrated apparent progression. These 4 eyes were in 3 patients who reported good compliance with drops. 2 of these eyes initially showed RNFL bundle defects with sharp borders; the borders became less well defined over follow up. In C1 eyes, no slits appear to have progressed.
RNFL defects can be imaged with optos p200C. Slits were far more common than true defects. GDx, OCT and VF defects showed a positive correlation with increasing RNFL defect severity. All slits were stable on serial imaging; some eyes with true defects progressed. As with fundus photography, serial imaging with optos has clinical utility.
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