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14-year-old was seen in the office on September 13, 2012. He was referred by his optometrist, who saw optic nerve swelling. His vision is fine. He doesn’t have any headaches. He is in excellent health. He has had a little bit of sinus difficulty lately and he has been feeling a little cruddy. VISUAL ACUITY: OD 20/20, OS 20/32. IOP: OD 15, OS 12. SLIT EXAMINATION: The lenses are clear. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.0. The nerve does look swollen and elevated. OS: Vertical C/D ratio is 0.0. The nerve is swollen and elevated. FUNDUS PHOTOGRAPHY - AUTO FLUORESCENCE: The image shows no calcified drusen in the optic nerve head. The color images and the infra red images show blurring of the optic nerve border. SPECTRALIS-SD-OCT SCAN: The nerve fiber layer scan shows swelling of the nerve fiber layer in both eyes. The average thickness in the right eye is 187 microns, and specifically the nasal portion is only slightly swollen. The average nerve fiber layer thickness in the left eye is 141 microns and that nasal thickness is nearly normal. The line scan over the surface of the optic nerve using the spectral domain OCT scan in the right eye shows a loss of the integrity of the deep retinal layers. The entire retinal thickness looks to be swollen. It does not look like the retina is going up and over drusen and there is no evidence of any buried drusen inside the optic nerve head. The line scan over the nerve in the left eye similarly shows swelling of all layers of the retina as it goes into the optic nerve head with no evidence of any buried drusen. IMPRESSION: 1. PROBABLE PAPILLEDEMA – BOTH EYES DISCUSSION: I explained to the patient and the family from the testing I have, it looks most consistent with papilledema. I even looked at both parent’s eyes, because optic nerve drusen and pseudo papilledema does tend to run in families and their optic nerves both looked fine. He will be seeing you today or tomorrow for a comprehensive evaluation. He probably should have neuroimaging and lumbar puncture. I told him to return here for a check in about four to six weeks or sooner should he notice a problem. Addendum: MRI showed dilated ventricles, opening pressure LP = 37

isde_09131201.png
Papilledema - Spectral Domain OCT used for Diagnosis - 14 year old Child417 zobrazení14-year-old was with optic nerve swelling asymptomatic - picked up during routine eye exam. OD 20/20, OS 20/32
SD-OCT is used to differentiate optic disc edema from optic nerve head drusen (which are not yet calcified in children).
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(0 hlas(ů))
isde_09131202.png
Papilledema - Spectral Domain OCT used for Diagnosis - 14 year old Child316 zobrazení14-year-old was with optic nerve swelling asymptomatic - picked up during routine eye exam. OD 20/20, OS 20/32
SD-OCT is used to differentiate optic disc edema from optic nerve head drusen (which are not yet calcified in children).
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(0 hlas(ů))
isde_09131203.png
Papilledema - Spectral Domain OCT used for Diagnosis - 14 year old Child260 zobrazení14-year-old was with optic nerve swelling asymptomatic - picked up during routine eye exam. OD 20/20, OS 20/32
SD-OCT is used to differentiate optic disc edema from optic nerve head drusen (which are not yet calcified in children).
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(0 hlas(ů))
isde_09131204.png
Papilledema - Spectral Domain OCT used for Diagnosis - 14 year old Child293 zobrazení14-year-old was with optic nerve swelling asymptomatic - picked up during routine eye exam. OD 20/20, OS 20/32
SD-OCT is used to differentiate optic disc edema from optic nerve head drusen (which are not yet calcified in children).
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(0 hlas(ů))
isde_09131205.jpg
Papilledema - Spectral Domain OCT used for Diagnosis - 14 year old Child - FAF330 zobrazení14-year-old was with optic nerve swelling asymptomatic - picked up during routine eye exam. OD 20/20, OS 20/32
SD-OCT is used to differentiate optic disc edema from optic nerve head drusen (which are not yet calcified in children).
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(0 hlas(ů))
isde_09131206.jpg
Papilledema - Spectral Domain OCT used for Diagnosis - 14 year old Child - FAF313 zobrazení14-year-old was with optic nerve swelling asymptomatic - picked up during routine eye exam. OD 20/20, OS 20/32
SD-OCT is used to differentiate optic disc edema from optic nerve head drusen (which are not yet calcified in children).
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(0 hlas(ů))
isde_09131207.jpg
Papilledema - Spectral Domain OCT used for Diagnosis - 14 year old Child - IR Photo358 zobrazení14-year-old was with optic nerve swelling asymptomatic - picked up during routine eye exam. OD 20/20, OS 20/32
SD-OCT is used to differentiate optic disc edema from optic nerve head drusen (which are not yet calcified in children).
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(0 hlas(ů))
isde_09131208.jpg
Papilledema - Spectral Domain OCT used for Diagnosis - 14 year old Child305 zobrazení14-year-old was with optic nerve swelling asymptomatic - picked up during routine eye exam. OD 20/20, OS 20/32
SD-OCT is used to differentiate optic disc edema from optic nerve head drusen (which are not yet calcified in children).
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(0 hlas(ů))
isde_09131209.jpg
Papilledema - Spectral Domain OCT used for Diagnosis - 14 year old Child - Line Scan over Nerve Shows Retinal Edema763 zobrazení14-year-old was with optic nerve swelling asymptomatic - picked up during routine eye exam. OD 20/20, OS 20/32
SD-OCT is used to differentiate optic disc edema from optic nerve head drusen (which are not yet calcified in children).
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(0 hlas(ů))
isde_09131210.jpg
Papilledema - Spectral Domain OCT used for Diagnosis - 14 year old Child - Line Scan over Nerve Shows Retinal Edema701 zobrazení14-year-old was with optic nerve swelling asymptomatic - picked up during routine eye exam. OD 20/20, OS 20/32
SD-OCT is used to differentiate optic disc edema from optic nerve head drusen (which are not yet calcified in children).
00000
(0 hlas(ů))
isde_09131211.jpg
Papilledema - Spectral Domain OCT used for Diagnosis - 14 year old Child - Nerve Fiber Layer Scan shows swelling760 zobrazení14-year-old was with optic nerve swelling asymptomatic - picked up during routine eye exam. OD 20/20, OS 20/32
SD-OCT is used to differentiate optic disc edema from optic nerve head drusen (which are not yet calcified in children).
00000
(0 hlas(ů))
isde_09131212.jpg
Papilledema - Spectral Domain OCT used for Diagnosis - 14 year old Child - Nerve Fiber Layer Scan shows swelling474 zobrazení14-year-old was with optic nerve swelling asymptomatic - picked up during routine eye exam. OD 20/20, OS 20/32
SD-OCT is used to differentiate optic disc edema from optic nerve head drusen (which are not yet calcified in children).
00000
(0 hlas(ů))
isde_09131213.jpg
Papilledema - Spectral Domain OCT used for Diagnosis - 14 year old Child - Nerve Fiber Layer Scan shows swelling406 zobrazení14-year-old was with optic nerve swelling asymptomatic - picked up during routine eye exam. OD 20/20, OS 20/32
SD-OCT is used to differentiate optic disc edema from optic nerve head drusen (which are not yet calcified in children).
00000
(0 hlas(ů))
isde_09131214.jpg
Papilledema - Spectral Domain OCT used for Diagnosis - 14 year old Child - Nerve Fiber Layer Scan shows swelling503 zobrazení14-year-old was with optic nerve swelling asymptomatic - picked up during routine eye exam. OD 20/20, OS 20/32
SD-OCT is used to differentiate optic disc edema from optic nerve head drusen (which are not yet calcified in children).
00000
(0 hlas(ů))
   
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14-year-old was seen in the office on September 13, 2012. He was referred by his optometrist, who saw optic nerve swelling. His vision is fine. He doesn’t have any headaches. He is in excellent health. He has had a little bit of sinus difficulty lately and he has been feeling a little cruddy. VISUAL ACUITY: OD 20/20, OS 20/32. IOP: OD 15, OS 12. SLIT EXAMINATION: The lenses are clear. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.0. The nerve does look swollen and elevated. OS: Vertical C/D ratio is 0.0. The nerve is swollen and elevated. FUNDUS PHOTOGRAPHY - AUTO FLUORESCENCE: The image shows no calcified drusen in the optic nerve head. The color images and the infra red images show blurring of the optic nerve border. SPECTRALIS-SD-OCT SCAN: The nerve fiber layer scan shows swelling of the nerve fiber layer in both eyes. The average thickness in the right eye is 187 microns, and specifically the nasal portion is only slightly swollen. The average nerve fiber layer thickness in the left eye is 141 microns and that nasal thickness is nearly normal. The line scan over the surface of the optic nerve using the spectral domain OCT scan in the right eye shows a loss of the integrity of the deep retinal layers. The entire retinal thickness looks to be swollen. It does not look like the retina is going up and over drusen and there is no evidence of any buried drusen inside the optic nerve head. The line scan over the nerve in the left eye similarly shows swelling of all layers of the retina as it goes into the optic nerve head with no evidence of any buried drusen. IMPRESSION: 1. PROBABLE PAPILLEDEMA – BOTH EYES DISCUSSION: I explained to the patient and the family from the testing I have, it looks most consistent with papilledema. I even looked at both parent’s eyes, because optic nerve drusen and pseudo papilledema does tend to run in families and their optic nerves both looked fine. He will be seeing you today or tomorrow for a comprehensive evaluation. He probably should have neuroimaging and lumbar puncture. I told him to return here for a check in about four to six weeks or sooner should he notice a problem. Addendum: MRI showed dilated ventricles, opening pressure LP = 37