Diplopia and Lamellar Macular Holes
Neuro-ophthalmologist, Dr. Subramanian will spend the first half-hour investigating diplopia and its' complexities and evaluation approaches. Vitreoretinal Specialist, Dr. Shukla will wrap up the course with an in-depth review of management and treatment options surrounding lamellar macular holes.
PART ONE: Prem Subramanian, MD: Diplopia: Recognizing Urgent Cases and Fellow Travelers. Patients often present to an eye care provider with new onset diplopia, and the provider must determine the urgency of obtaining additional investigations including blood tests and neuroimaging. Additionally, further history and examination beyond the typical eye exam may be needed to arrive at a diagnosis. Once a cause is found, treatment may require a multidisciplinary approach both acutely and long-term. An approach to evaluating the patient with diplopia will be presented in a case-based format with emphasis upon both “red flags” that should lead to rapid workup and “green flags” that are typically reassuring signs.
PART TWO: Salil Shukla, MD: Lamellar Macular Holes. In the OCT era the lamellar macular hole has been observed as a distinct clinical entity, albeit overlapping with vitreomacular interface disorders and degenerative macular disease. The diagnosis of lamellar macular hole is nuanced, with imaging findings often out of proportion to symptoms and concurrent macular diagnoses often present on OCT. Management options are limited as surgical intervention does not reliably improve vision. We will discuss the pathophysiology, presentation, diagnosis, and management of lamellar macular holes with an emphasis on OCT.