SCLERAL LENS COMPRESSION

The patient in the photo below presented with the complaint of red eyes while wearing his scleral contact lens. A scleral contact lens is a rigid gas permeable lens that vaults the cornea and is supposed to land softly on the conjunctiva.  If it lands too steep it will compress blood vessels causing congestion and inflammation.  This patient was refit successfully into a scleral lens that had a much softer landing and the redness subsided. 

VITREORETINAL TRACTION

The above picture is an optical coherence tomography of the macular area of a patient with vitreomacular traction.  You can see the clear vitreous membrane detached from most of the macular area but tightly adherent to the inner limiting membrane at the fovea.  It pulls ont he membrane causing a small underlying cystic space.

CHORIORETINAL SCAR

Below is a chorioretinal scar in the macula of the right eye.  differential diagnosis includes presumed ocular histoplasmosis syndrome (POHS) and toxoplasmosis, toxocara, macular coloboma among others. 

RPE DETACHMENT

Below is an OCT of the right eye macula.  An OCT takes a cross-sectional view of the retina.  The macula is the part of the retina that serves the center of your vision.  You can see the dome-shaped space under the retina by the fovea (the exact center of the macula).  This dome-shaped space is focal detachment of the retinal pigment epithelium.  The patient see's 20/20.  Below that is an RPE detachment from another patient.  Notice the double dome. 

OCT IN GLAUCOMA

Optical Coherence Tomography (OCT) measures the thickness of the nerve fiber layers, which are thinned in glaucoma.  The image below shows what glaucoma does to the nerve fiber layer around the optic nerve (top graphs) and the ganglion cell layer around the macula area. 

OPTIC DISC DRUSEN

Here's a picture of optic disc drusen lifting up the optic nerve.  Notice the globulated look to the optic nerve rim. 

GEOGRAPHIC ATROPHY

Here's a good picture of geographic atrophy from macular degeneration.