This patient will continue to be seen twice a year. Specialists are 99% certain that the eye was the primary lesion; however, she will need to be free of any cancer cells for the next 20 years before she is considered to be in full remission.
The parents credit the optomap® Retinal Exam for discovering the melanoma that may have goneundetected with results that could have been fatal.
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LYME DISEASE
Reason for Visit:
An asymptomatic 6 year old child presented at Jacqueline Campisi’s office for a back-to-school eye exam. In the course of her comprehensive examination, Dr. Campisi compared last year's Optomap® to this year and noticed swollen optic nerves on the current year's optomap® images. Dr. Campisi referred the child to a pediatric ophthalmologist and pediatric neurologist at Children’s Hospital for a complete work-up. A CAT scan and Lumbar puncture were performed and the child was admitted. The child was diagnosed with papillitis aseptic meningitis due to Lyme disease which caused the bilateral swelling of the brain and optic nerves. He washospitalized for three days and discharged with an IV pack. The child’s visual acuities were 20/25 in both eyes and his history was unremarkable except that he had complained of leg pain. In addition to his eye exam, the child had seen his pediatrician recently and nothing was diagnosed or noted during his physical examination. Lyme disease is an illness caused by a spirochete bacteria, Borrelia burgdorferi, which is transmitted through the bite of infected ticks. The disease is reported worldwide and throughout the United States, however, the states of New York, Massachusetts, Connecticut, Rhode Island and New Jersey account for the majority of cases in the United States. In about 50% of cases, a characteristic rash or lesion is seen, however, it is often confused with poison ivy, spider or insect bits or ringworm. When the rash appears, flu like symptoms are also often present. If ignored, the early symptoms may disappear, but more serious problems can develop months to years later. Lyme disease is treated with antibiotics. Timely treatment increases chances of recovery and may lessen the severity of any later symptoms.
optomap® Impact:
optomap® Exam, however, ultra-widefield images are quickly and non-invasively captured, enabling the patient, patient’s family and the doctor to interactively review the images. Because Dr. Campisi recommends an annual optomap® for every patient, she was able to immediately compare last year's images to this year by placing them side by side in v2 software, which highlighted the swollen nerves.
Because the child was light sensitive and uncooperative, he kept shutting his eyes whenever Dr. Campisi tried to use an ophthalmoscope. A dilated manual exam would have been quite difficult to perform effectively. With the
Treatment:
Dr. Campisi remained in touch with the child’s parents and physicians during his recovery. She surmised that the child’s hyperopia may have been induced by the disease.
Follow-up care:
She recommended that the parents wait to fill his glasses prescription. Dr. Campisi requested that the child return for another Optomap, visual fields test and refraction in 3 to 6 months.
Dr. Campisi and the child’s parents credit the Optomap with the early detection of Lyme disease symptoms and perhaps more acute complications from the disease later on.
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Systemic Disease - von Hippel Lindau Disease
Lesions Indicate von Hippel Lindau Disease
Reason for Visit:
A healthy 15-year old male presented for routine examination with symptoms of floaters, intermittent headacheswhile reading, and mildly blurred vision for two months. Dr.Walborn performed an
The patient’s past medical and family histories were unremarkable for von Hippel Lindau disease. VHL is a disease with systemic implications including brain, spinal, and abdomen tumors which if left undiagnosed may be fatal.
Small retinal capillary clusters are often overlooked until feeder vessels develop. In this patient, these lesions were causing fluid to pool around the macula resulting in decreased and distorted vision, but unnoticed by the patient himself. The patient’s eye at time of diagnosis was at risk for non-rhegmatogenous retinal detachment and vitreous hemorrhage.
optomap® Impact:
optomap® Retinal Exam allowed for an immediate visual assessment as to the extent of macular involvement and number of lesions in the retina. The optomap® images provided useful information as to the extent of retinal infiltration and served as a basis in treatment selection involving both laser and cryotherapy.
The Treatment:
The patient underwent successful photocoagulation and cryotherapy on all lesions with an improvement in acuity to 20/40 after four weeks. Fortunately, the size of the intracranial lesion was still relatively small and the neurosurgeon elected surgery for removal with good prognosis for a complete recovery.
Follow-up care:
This patient will undergo lifelong MRI scans to ensure early detection of recurrent intracranial and systemic lesions. At this time no tumors have been found in his family. Genetic testing and counseling were recommended for all family members as VHL may be asymptomatic for decades. Dr. Walborn credits the early detection of these tumors in diagnosing an often complex and multi-systemic disease.
Optomap® Retinal Exam and then dilated to confirm the observation of three elevated orange-red lesions with enlarged feeder vessels consistent with retinal capillary hemangiomas in the right eye along with subretinal fluid and a circinate ring of hard exudates and edema in the macula. An optic nerve hemangioma was also viewable in the patient’s left eye. As the characteristic lesions and feeder vessels were suggestive of von Hippel Lindau syndrome, both genetic testing and neurological consults were obtained to rule out the disease. Using T1 and T2 weighted MRI, an inferior cerebellar hemangioblastoma was discovered. At the time of imaging, there was no compression from the tumors and the presence of the relatively small intracranial lesion confirmed a diagnosis of von Hippel Lindau disease.