Rapid Fire: Retinal Diagnoses, What You Need to Know
On April 14th, Retina Consultants of Texas presented a virtual CE webinar on some interesting cases that highlighted the nuances involved in diagnosing ocular and retinal conditions. Hosted by Dr. James Major, the webinar was split between two speakers: Dr. Richard Fish and Dr. Kelly Larkin.
Yesterday and Today: An RCTX Quiz of the Best Photos from 29 Years of Retina Calendars
An ardent lover of classic rock, Dr. Fish kicked things off with a little bit of Beatles Trivia, which served as a framework for the rest of his presentation, which consisted of images of some of the most interesting cases he’s treated over the years. In an homage to “Who Wants to Be a Millionaire,” Dr. Fish’s presentation was set up like a rapid-fire quiz show, with the audience sending in their answers via the Zoom chat and Dr. Sagar Patel acting as the audience’s “Phone-a-Friend” lifeline.
The quiz started easy but became progressively more difficult with each slide, as Dr. Fish presented stunning images of conditions such as retinal detachments and congenital hypertrophy of the retinal pigment epithelium (CHRPE). Some of the cases presented were very rare or unique. For each slide, Dr. Fish provided a brief overview of the specific case.
Scleritis: Diagnosis and Management
From there, Dr. Larkin gave a presentation on a case study of scleritis that highlighted interesting aspects of the diagnosis process. The case was about a 45-year-old man who presented with a severe case of scleritis, as well as auditory symptoms. The patient was otherwise in good health and was certain that the scleritis had been caused by a bacterial infection rather than a systemic issue.
However, as a uveitis and ocular immunologist, Dr. Larkin knew that the cause needed to be fully investigated. She went on to explain that many cases of scleritis are associated with systemic diseases, some of which are life-threatening or vision-threatening. About 37% of scleritis cases are caused by some type of rheumatic disease, with rheumatoid arthritis being the most common.
Of that 37%, about 78% of patients have already been diagnosed with a systemic disease before the presentation of scleritis. For about 14% of patients, systemic diseases are only discovered and diagnosed because of their case of scleritis. The remaining 8% end up developing a systemic illness during follow-up.
Dr. Larkin also touched on scleritis associated with systemic vasculitis (inflammation of the blood vessels), specifically highlighting granulomatosis with polyangiitis (GPA), which has a high mortality rate without treatment. Alarmingly, only 59.1% of patients with scleritis caused by some form of vasculitis are diagnosed with the systemic illness before developing scleritis, which underlines the importance of performing a full workup when diagnosing and treating scleritis.
Dr. Larkin gave a thorough overview of the diagnostic criteria for rheumatoid arthritis, lupus, and GPA, stressing the importance of leaving no stone unturned and discussing all findings with patients. She also gave a breakdown of the various laboratory tests that are necessary when investigating a case of scleritis. Circling back to her specific case, it turned out that the patient did in fact have a systemic issue, specifically GPA. Thanks to Dr. Larkin’s comprehensive systemic workup, she was able to diagnose a serious condition and assist in finding a proper treatment regimen.
We invite you to watch the full video of our “Rapid Fire: Retinal Diagnoses, What You Need to Know” presentation on our YouTube Channel. To attend Retina Consultants of Texas’s next CE Zoom event, please register here for updates.