First-line therapy in the United States usually consists ofmedical therapy with surgical intervention reserved foradvanced cases. However, management becomes compli-cated during pregnancy secondary to the potential sideeffects of the medication to the fetus. Selective laser trabe-culoplasty (SLT) is an alternative treatment that may delayor eliminate the need for medication and minimize the riskof pharmaceutical side effects to the fetus.Case Report: A 30-year-old woman in her first gestationaltrimester came to us for a baseline glaucoma evaluation.The patient’s history revealed ocular trauma at age 11 andrefractive amblyopia O.S. Her medical history was notablefor several miscarriages. Best-corrected visual acuities were20/20 O.D. and 20/60 O.S. Highest pre-treatment IOP were33 mmHg O.D. and 30 mmHg O.S. with Goldmann appla-nation tonometry. The cup-to-disk ratios were 0.75/0.75O.D. and 0.5/0.5 O.S. Humphrey 30-2 Sita Standard visualfield showed a superior nasal arcuate defect O.D. andsuperior nasal step O.S. She was diagnosed with primaryopen-angle glaucoma and was followed without treatmentbecause of concerns for her baby’s health. Eventually SLTwas performed O.D., which lowered her IOP to the mid-20’s mmHg.Methods: After delivery, Alphagan was initiated, butproved to be ineffective. Therefore, SLT was performedO.S. The patient’s IOP currently remains in the low 20’smmHg following SLT OU in conjunction with Timolol.Additional glaucoma medications will be considered oncethe patient discontinues nursing.Conclusion: Glaucoma is rare during pregnancy secondaryto the physiological changes in the eye that cause a decreasein IOP. In pregnant patients, the management and treatmentfor glaucoma becomes difficult secondary to the risk ofadverse side effects to the fetus. This case report examinestreatment options and the role of the optometrist in themanagement of glaucoma during pregnancy.

LOW VISION

Poster 31

A Case Study of Adult Domestic AbuseJames Miller, O.D., and Katherine Hand, O.D., MichiganCollege of Optometry at Ferris State University, 1310Cramer Circle, Big Rapids, Michigan 49307

Background: Adult domestic abuse can include a spectrum ofphysical, sexual, psychological, emotional, and/or financialbehaviors intended to gain power and control over anotherperson. Ninety-five percent of spousal or partner abuse isdirected at women. Adult domestic abuse is the most frequentcrime in the United States, occurring once every 15 seconds.Nationally, the most frequent cause of injury to women isdomestic battering, which exceeds the combined injury ratesfor women from car accidents, muggings, and rape. Strategiesfor providing care for victims of adult domestic abuse will bediscussed from an optometric viewpoint.Case Report: A 25-year-old woman came to us reporting ablack eye O.D., with flashes and floaters. Clinical evaluation

revealed ecchymosis and lid swelling O.D., and a largecorneal abrasion O.D. Visual acuities were 20/40 O.D. and20/20 O.S. All other findings were normal. The patientadmitted that the black eye and abrasion were the result ofphysical abuse from her husband. The patient was given aprescription for antibiotic drops and ointment. Patient edu-cation was provided regarding the healing process of theabrasion and ecchymosis, as well as the symptoms of aretinal detachment. She was asked to call us if any symp-toms worsened. Patient education was also given regardingthe domestic violence. She was advised to seek assistancefor herself and her 2 sons (ages 4 years and 6 days). She wasgiven phone numbers for legal, emotional, and tangiblesupport. She was also encouraged to call the clinic if sheneeded someone to talk to and did not feel comfortabletalking to another source. The results from followup carewill be reported.Conclusion: Victims of adult domestic abuse can present aschallenging patient care encounters for health care profes-sionals. Optometrists should care for the symptoms of thephysical abuse, take appropriate steps to investigate theunderlying causes, and provide advocacy and support ifappropriate.

Poster 32

High-powered Optical Options for Reading: A Leber’sOptic Neuropathy CaseAna Perez, O.D., and Erika Andersen, M.Ed., Universityof Houston, College of Optometry, 505 J. DavisArmistead Building, Houston, Texas 77204

Background: Leber’s hereditary optic neuropathy(LHON) is a mitochondrial DNA disorder that results inoptic nerve damage and loss of the papillomacular nervefiber layer. The clinical symptoms are typically demon-strated in males in their late 20s. Symptoms includesymmetrical loss of central acuity, dyschromatopsia, andcentrocecal visual-field defects. Due to the fact that thiscondition expresses itself in early adulthood, LHON hasa significant and adverse impact on a person’s profes-sional and vocational lifestyle. Optimization of func-tional vision with low vision rehabilitation should beincluded in the standard treatment of LHON.Case Report: RP is a 60-year-old neuropsychologist, diag-nosed with LHON by mitochondrial DNA analysis approx-imately 22 years ago. He had noted gradual decrease incentral vision in the right eye at age 16, which progressed toa central scotoma over 6 to 8 months. Subsequently, asimilar gradual, but less severe decrease in vision developedin the left eye. His best visual acuities have been stable at5/350 O.D. and 5/200�1 O.S. He has been using a �40 DVolk lens for more than 15 years for reading, specificallywhen he is away from his CCTV. Unfortunately, this systemis no longer commercially available. This case illustrates analternative high-power microscope used to optimize readingperformance.

278 Optometry, Vol 77, No 6, June 2006

Conclusion: RP preferred and performed best with a 14�full-diameter wide-angle system. It provided a similar mag-nification through relative distance magnification (RDM),but it also allowed him an increase in the magnificationpower that enabled him to read continuous text 0.5 M print@ 4 cm. Issues that were notably different were the periph-eral distortions. This poster will also provide a summary ofthe benefits and limitations of the available optical optionswhen having to deal with powers greater than 6� forreading tasks.

Poster 33

Low Vision Management of a Patient with Leber’sOptic NeuropathyNicole Patterson, O.D., Nova Southeastern University,College of Optometry, 3200 South University Drive, Ft.Lauderdale, Florida 33328

Background: Leber’s optic neuropathy is marked by a rapid,painless, progressive visual loss of both eyes, typically withone eye loss within days to months of the other eye. Thedisease is marked by mild swelling of the optic disk,progressing over weeks to optic atrophy. The disease usu-ally occurs in men ages 15 to 30 years. Leber’s is transmit-ted by mitochondrial DNA through the mother. Fifty to 70%of males and 10% to 15% of carriers manifest the disease.Visual acuity is 20/200 to counting fingers with a cecocen-tral visual-field defect. Low vision evaluation and manage-ment is essential to ensure patients maintain their quality oflife. Management should include necessary referrals tosupport services.Method: A 44-year-old woman came to us with visionloss OU secondary to Leber’s optic neuropathy. Enteringvisual acuities were 3/300 O.D. and 3/225 O.S., asmeasured with Feinbloom. On presentation, the patienthad not accepted vision loss, and evaluation had to beterminated secondary to patient frustration. Much of theexamination time was spent counseling the patient. Thepatient was referred for counseling and classes at a localcenter for the blind. After receiving support services, thepatient returned. She returned to us 3 months later withsimilar acuities and stated goals. At that visit she wasprescribed a 28 D microscope for near tasks and an 8 �20 telescope for spotting. She underwent training withthe devices and was able to achieve her goals. Shecurrently volunteers biweekly at the center for the blindwhere she received her counseling.Conclusion: Leber’s causes a sudden rapid loss of vision.Vision loss is devastating to patients. The devastation iscompounded when the loss is sudden in active individu-als, leaving little or no time for adaptation. Achievingmaximum visual potential is the goal of the low visionevaluation. This case report emphasizes the importanceof patient acceptance of vision loss before visual poten-tial can be reached.

Poster 34

Low Vision Rehabilitation of a Patient withVogt–Koyanagi–Harada SyndromeTuan Du, O.D., M.S., The Center for the PartiallySighted, 12301 Wilshire Boulevard, Suite 600, LosAngeles, California 90025

Background: Vogt–Koyanagi–Harada syndrome (VKH) ischaracterized by bilateral, granulomatous panuveitis. It isbelieved to be caused by an auto-immune response directedagainst melanocytes. The visual prognosis is generally fair.However, complications like cataracts, exudative retinaldetachment, and choroidal neovascularization can causesignificant vision loss.Case Report: A 47-year-old woman was referred to ourcenter for a low vision evaluation. She manifested visualacuities of NLP O.D. and 2/600 O.S., with severe visualfield restriction. The patient denies any significant ocularconditions, aside from a history of bilateral cataract extrac-tion and retinal detachment O.D. Communication with thepatient’s ophthalmologist revealed that she has Vogt–Koy-anagi–Harada syndrome.Methods: On low vision evaluation, the patient was correct-able to 10/225 O.S. and 1.5 M print. Based on the patient’svisual goals and examination findings, the following lowvision aids were recommended: tinted spectacle correction,an illuminated hand magnifier, and a CCTV. In addition, thepatient was referred for orientation and mobility, indepen-dent living skills, and lighting evaluation to assist with otheraspects of her life.Conclusion: Despite having a fair visual prognosis, Vogt–Koyanagi–Harada syndrome can cause significant visualsymptoms. In these cases, a low vision referral is indicatedto help the patient maximize visual function and promoteindependence.

Poster 35

Characteristics of Children with Visual Impairment inthe State of OregonJohn Lowery, O.D., and Julene Pena, O.D., PacificUniversity, College of Optometry, 2043 College Way,Forest Grove, Oregon 97116

Background: The purpose of this study was to create auseful overview of the population of children who are likelyto be treated by the optometrist specializing in low vision.Methods: Case history, examination findings, and treatmentplans were analyzed from 410 children and adolescents(ages 6 months to 21 years) who were evaluated in apediatric low vision clinic in the State of Oregon from 1999to 2004.Results: The most prevalent primary visual diagnoses were:cortical vision impairment (32%), optic atrophy (12%),ROP (9.5%), albinism (7%), optic nerve hypoplasia (4.8%),and congenital efferent nystagmus (4.8%). It was found that71.7% of the subject population was multiply handicapped.

279Poster Presentations