to refer or not to refer for edt’s? dr peter good consultant clinical scientist
TRANSCRIPT
To refer or not to refer for EDT’s?
Dr Peter Good
Consultant Clinical Scientist
Why refer for EDT’s?
• Unexplained visual loss• Hereditary retinal dystrophy• Nystagmus• Visual Function in paediatrics• Opaque Media• Trauma• Drug Toxicity
Indications for EDT tests
Indication VEP ERG PERG EOG OCT
Visual Loss
Heredo-macular
Nystagmus
Opaque Media
Trauma
Drug Toxicity
Unexplained visual loss
Is visual loss genuine
FVER & PVER
Site of Lesion VER, ERG, PERG
Potential acuity PVEP with threshold spatial frequency
Hereditary Retinal Dystrophy
Hereditary v Acquired OCT, ERG, EOG
Rod/Cone, Cone/ Rod OCT, ERG, EOG
Macular Dystrophy OCT, ERG, PERG, ?EOG
Night Blindness OCT, ERG, EOG
X-Linked Heterozygote EOG/ERG
Please don’t ask for paediatric EDT’s when macular developed
Nystagmus
Albinism Apkarian VEP
Cone, Cone/Rod, Rod/Cone ERG, OCT
CSNB ERG
Congenital Idiopathic VEP/ ERG
Delayed Visual Maturation VEP
Foveoschisis ERG OCT
Optic Nerve Hypoplasia/ SOD
VEP, USG
Visual Loss in Childhood
Potential Acuity Pattern Offset/ onset VEP
Cortical Blindness VEP
Nystagmus VEP, ERG, USG
Metabolic Disorders ERG
Bulls Eye Maculopathy ERG, PERG, OCT, PERG
ONH VEP USG
DVM VEP, ERG
Night blindness OCT, ERG, EOG
Opaque Media
Lens/ Corneal/ Vitreous Opacity
fVEP, ERG, USG
Metal IOFB VEP, ERG, EOG, USG
Trauma
• Retinal or Optic Nerve Trauma?
With Opaque Media fVEP, ERG, USG
Without Opaque Media VEP (f&p), ERG, USG
Drug Toxicity
Pheniothiazines EOG/ERG
Chelators EOG, VEP, ERG, PERG
Vigabatrin ERG, Visual fields
Ethambutol VEP
Quinine EOG, ERG, VEP, Fields
Hydroxycholoroquine/ Chloroquine
Rarely but OCT only
Tamoxifen VER, ERG, EOG, OCT
Roaccutane ERG DA
When not to request EDT’s
Choroidal, Macular off Retinal Detachments
Cataract without RAPD
Before MRI/CT
Acute Optic Neuritis (VA < 6/36), unless Functional
EDT’s in young children where family history of heredo-macular dystrophy
If VA > 6/9 in occlusion therapy
How to request?
• By referral letter to – Dr Peter Good– Consultant Clinical Scientist
• Visual Function request card• Clinically urgent EDT’S to be discussed with Dr
Good• Do not routinely fax letters to us!
We don’t have a crystal ball!
• Please give all patient details• Summary of ophthalmic findings• Which is the affected eye• Inform patient why they are attending