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EW SHOW DAILY 36 ASCRS Symposia Sunday, April 15, 2018 Physicians typically use retinal volume and thickness to identify disease, but changes in a layer's reflectivity can also help physicians diagnose retinal problem, Dr. War- ren said. Hyperreflective areas could be indicative of epiretinal mem- branes, intraretinal hemorrhage, or retinal pigmented epithelium, while hyporeflectivity could indicate cysts, intraretinal fluid, or subretinal fluid. Areas with a shadowing effect usually mean blood is present, in the form of retinal vessels, retina edema or dense hemorrhage. Steve Charles, MD, Memphis, Tennessee, who moderated the ses- sion, added that physicians should look at black and white OCT scans and not color ones. Color OCT im- ages are created based on relatively normal anatomy, Dr. Charles said. A computer algorithm then uses that anatomy to guess what retinal layers are there, and the more complex the anatomy, the greater the error rate, he said. Anterior segment surgeons are used to using color from looking at understands the limitations of the technology, can afford the cost, and has no ocular comorbidities that limit vision, he said. OCT and anatomy OCT is a powerful tool that provides a high resolution image of retinal anatomy that cataract surgeons can use to their advantage, said Keith Warren, MD, Overland Park, Kansas. Dr. Warren described to attendees what physicians can and should see on an OCT scan and how to use those images to diagnose retinal disease. Current OCT scans provide much higher resolution images at faster speeds than previous versions of the technology. Physicians can now see almost all 10 individual layers of the retina on an OCT scan and should be able to identify when they look healthy versus when they look diseased, Dr. Warren said. "It's important to understand the anatomy of the retina so that you can understand what happens in pathologic conditions," he said. corneal topography, so color OCT scans tend to look familiar, but the images can be easily misinterpreted, he added. "I always tell my residents: Everything that's thick is not edema, including your skull," Dr. Charles said. TASS versus endophthalmitis Toxic anterior segment syndrome (TASS) symptoms can resemble endophthalmitis, and it's important to be able to distinguish between the two because their management differs so dramatically, said Ron Adelman, MD, New Haven, Con- necticut. Because endophthalmitis can be vision-threatening, physi- cians can't risk not treating it, Dr. Adelman said. "Any time I personally think that it may be endophthalmitis, I'll treat it as endophthalmitis," he said. "I'll inject antibiotics and then we can start steroids, too. That way at least we have covered the one that can cause significant damage to the retina and intraocular tissues." Unfortunately, there is no way to differentiate between TASS and endophthalmitis 100% of the time. However, physicians can use some criteria to help them make a diag- nosis. TASS symptoms usually start 12–24 hours after surgery, while postoperative endophthalmitis usually presents within 2–7 days because it takes time for bacteria to proliferate. TASS is rarely painful, but lack of pain cannot rule out en- dophthalmitis, Dr. Adelman said. The hallmark of endophthal- mitis is vitritis and vitreous cultures are usually positive, he added. TASS cultures should always be negative. If you're at all suspicious that the patient's symptoms are endophthal- mitis, do not delay treatment, Dr. Adelman said. EW Editors' note: The physicians have no financial interests related to their comments. Retina continued from page 35 ascrs2018.questionpro.com Survey will close May 7, 2018. 1 2 3 Take the survey in our booth #1016 and enter the drawing for four gift cards each day at 12:00 p.m. on Saturday, Sunday, and Monday. OR Take the survey online to be entered in a drawing for a complimentary hotel suite in San Diego for the 2019 ASCRS•ASOA Annual Meeting. Second and third prize winners will receive an iPhone X. Take the survey online during the meeting and be eligible for daily drawings plus the online drawing! Take the survey online after the meeting but before May 7, 2018 and you will be entered into our online drawing! Take the survey onsite. The earlier you take it, the more chances you have to win $100 gift cards! Three options

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