Ophthalmology & Optometry/Retina

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Question
Right Optomap
Right Optomap  
Left Optomap
Left Optomap  
QUESTION: Hi Dr. Dovie,
         My 6 y.o. daughter had her eyes checked annually last week. On her right eye optomap, her doctor found a long spot that looks like sausage along the blood vessel at 12 o'clock.  Compared with her last year optomap, this spot is larger.  I see another smaller spot at 9 o'clock.  Her doctor recommended to come back in 6 months.  I'm also concerned of some  white bright areas around her macula on both sides, they are more on the left side. Other than that her eyes are all normal. I'd like to know your opinion about those problems.  Thank you very much.
P.S. : I am attaching my daughter's optomap.

ANSWER: Chi,
Thanks for sending in your question and the retinal scans. The bright white areas around the macula are very normal. There is a shiny, reflective surface in the back of the eye that fades with time, but is very obvious in young children. That is all you're seeing there, reflection.
The darker area noted in the left eye, the sausage like appearance along a blood vessel does raise some concern for me.
The way the optomap works is it scans the retina with a green laser and a red laser, and reconstructs an image based on those reflections - it's not a 'true' photograph.  Because of that, we can get some retinal scans that look slightly different than they do in 'real life,' or if we were to look with a regular dilated exam, or use a true retinal photo.
The darker area is essentially a less reflective area, and we can get this for numerous reasons, but my concern is that because it's along the path of a blood vessel, we should make sure it's not edema, swelling, or inflammation.
In addition to the optomap scans, your daughter needs (and hopefully received) a true, full, dilated eye exam.  With the dilated exam it would be easier to tell what those shadows / darker areas are.
I apologize for not being able to describe more, but without a physical exam, it's too difficult to tell.
I would suggest asking more questions, getting her dilated, or getting a second opinion.  Monitor in six months may be fine, if there's a reason--but it sounds like the diagnosis was missing.  It could be that it's just an anomalous scan and there's nothing to look at at all.
Good Luck!
Dr.D

---------- FOLLOW-UP ----------

QUESTION: Hi Dr. Dovie,

Thank you very much for your prompt reply.  
Could you explain to me what you would mean "It could be that it's just an anomalous scan and there's nothing to look at at all."
The doctor said that she would dilate my daughter's eyes when she saw something wrong. That's the procedure this office practices.  But she didn't do it for my daughter and I forgot to request because at that time I was so bewildered by this finding.  The doctor said the darker area might be a freckle, but because it is larger than last year, she recommended to recheck in 6 months.
I'm going to get a second opinion.

Best Regards,
Mrs. Phan

Answer
Anomalous scan means that the scan / processing itself could have had a 'glitch.' Remember, this is not a photograph, but an artificial image put together from two laser scans. Almost like a computer putting together an mri, somethimes signals scramble, or get interference, etc.
I'm not an optomap expert, but again, nothing replaces a dilated exam.  When in doubt, dilate and look at it.  "Only dilate when something is wrong" seems approptiate - something new is in the retina, or at least on the scan it looks like there is.  Seems like an appropriate time to me.
I'm not the physician, and I don't have all of the facts, but it is very curious if there is something 'new' in the retina, that is unidentified, and the eye isn't dilated.  Maybe they have a good reason, but I can't think of one.
Dr.D

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John M. Dovie, OD, FAAO

Expertise

As a residency-trained Fellow of the American Academy of Optometry I am able to answer most questions regarding eye and vision health. Anything is welcome, ranging from dry or allergy eyes, bifocal contact lenses, or thoughts on LASIK surgery. As I am not a surgeon, detail-oriented surgical-related questions may be better answered by an ophthalmologist.

Experience

Selected to participate in the PCO residency program in Philadelphia at The Eye Institute, where I worked OD and MD specialists gaining invaluable experience in various clinics including glaucoma, cornea and cataract, oculo-plastics, retinal disease, neuro-ophthalmic disease, primary care, emergency medicine, and special populations. Have practiced and trained in numerous settings including hospital, academic, retail and private practice. I earned my Fellowship in the American Academy of Optometry (FAAO). There are currently only about 3000 active fellows worldwide, and there are only about 70 Fellows in the state of Virginia. I currently own and operate my own optometric practice/clinic.

Organizations
American Academy of Optometry, American Optometric Association (Contact Lens/Cornea Section member since 2001), Southwest Virginia Optometric Association, Virginia Tech Alumni Association

Publications
Seminars/Presentations:
“Nyctalopia as the Presenting Sign of Vitamin A Deficiency: A Late Complication of Gastric Bypass Surgery.” Clinical Case Study Poster presented at The American Academy of Optometry Denver, Colorado, December 2006, co-authored with Bradley Lane, OD.
“The Importance of Considering Paranasal Sinus Mucocele as a Differential Diagnosis in Diplopia.” Clinical Case Study Poster presented at The American Academy of Optometry San Diego, California, December 2005, co-authored with Kelly Malloy, OD, FAAO and Cherie Farkash, OD.
“Acute Onset of Halos and Glare: Bilateral Keratitis—An Atypical Presentation of Amiodarone Keratopathy.” Clinical Case Study Poster presented at The American Academy of Optometry Tampa, Florida December 2004. Also Presented to New Jersey Academy of Optometry, Neptune, New Jersey March 2005.
“The Opportunity for an Optometrist to Save a Life.” Clinical Case Study and Grand Rounds Presentation presented at The Pennsylvania College of Optometry, Philadelphia, Pennsylvania, September 2004.
Publications:
“Corneal whorls cause wonder.” Clinical Challenges Quiz, co-authored with Andrew Gurwood, OD, FAAO, Review of Optometry. Published 10/15/2006.
“Acute onset of halos and glare: bilateral corneal epithelial edema with cystic eruptions--atypical presentation of amiodarone keratopathy.” Co-authored with Andrew Gurwood, OD, FAAO. Published February, 2006, Optometry.
“Pondering the posterior polka-dots.” Clinical Challenges Quiz, co-authored with Andrew Gurwood, OD, FAAO, Review of Optometry. Published 5/15/2005.
Professional Involvement:
“AION: Amiodarone-Induced or Anterior Ischemic Optic Neuropathy?” Participated as a peer-review referee for Expert Review of Ophthalmology (London, UK); refereed 10/2006.

Education/Credentials
Bachelor of Science, Cum Laude, Virginia Tech. Bachelor of Science, Pennsylvania College of Optometry. Doctorate (OD), Pennsylvania College of Optometry Residency, Pennsylvania College of Optometry Fellow of the American Academy of Optometry

Awards and Honors
Winner, First Place, "Best Beside Manner" by Our Health Magazine: 2012, 2013, 2014 Winner, First Place, "Best Eye Doctor" by The Roanoke Times: 2013, 2014 Recognized as a Fellow of the American Academy of Optometry, December, 2006 Recipient of the Onofrey G. Rybachok Memorial Scholarship, 2000-2001 Member: The Golden Key International Honor Society Member: The National Biological Honor Society Member: The National Honor Society Eagle Scout awarded 1994

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