Established patient returns to the eye clinic for a visual field and DFE secondary to BRVO follow up in the left eye ^ CC: Patient states no changes in vision at all. No blurred vision, diplopia, flashes, floaters, sudden vision loss. Patient states here for follow up Ocular Medications: -OTC ATs PRN OU The patient was last seen/last complete exam 07/18/2017 with Dr. Stronz The patient is being followed for: 1. Branched retinal vein occlusion OS without macular edema; new 2. Diabetes without retinopathy OU; no macular edema OU; stable 3. Hypertension with mild angiopathy OU; stable 4. Mild mixed cataracts OU; stable 5. Refractive error with presbyopia OU; stable REVIEW OF SYSTEMS [-]Constitutional [+]ENT: hearing loss [+]Cardiovascular: CAD, HTN, paroxysmal atrial fibrillation, s/p MI 2013 [+]Respiratory: COPD [+]Gastrointestinal: GERD [-]Genitourinary [-]Musculoskeletal [-]Integumentary [+Neurologic: peripheral neuropathy [-]Psychiatric [-]Endocrine [-]Hematologic/Lymphatic [-]Autoimmune/Allergic PAST OCULAR HX: [-]Trauma: [-]Surgery: [-]Strabismus: [-]Other: FAM. OC HX: [-]Glaucoma [-]Macular Degeneration [-]Blindness [-]Retinal Detachment Other: PSHX: [+]Tobacco: 1 ppd [+]ETOH: 2 beers/day Current Medications Reviewed Allergies - MEDROL, CEPHALEXIN, LOVASTATIN, BENADRYL, SIMVASTATIN, ROSUVASTATIN ORIENTATION: Time/Person/Place MOOD AND AFFECT: Appropriate CURRENT SPECTACLE RX: OD: +2.25 sphere OS: +2.00 -0.25 x 040 ADD: +2.50 OU VISUAL ACUITY: With Correction DIST OD: 20/20 OS: 20/20 EOM: Smooth and full w/o Diplopia/Pain Hirschberg Alignment: no apparent tropia OD/OS PUPILS: PERRL: Yes; (-)APD SLIT LAMP EXAM: Ocular Adnexa: Clear OU Lids/Lashes: Clear OU Sclera/Conjunctiva: Clear and quiet OU Cornea: (Epithelium, Stroma, Endothelium, Tear film): Arcus OU Anterior Chamber: Deep and quiet OU; no cells or flare OU Iris: Flat and intact OU; no rubeosis OU TONOMETRY: OD: 13 mmHg OS: 13 mmHg TIME: 9:35 DILATION: 1 GTT Tropicamide (1.0%) OU 1 GTT Phenylephrine (2.5%) OU INTERNAL (78/90, 20D BIO): LENS: (anterior/posterior capsule, cortex, nucleus) OD: 2 cortical, 1+ NS OS: 2 cortical, 1+ NS VITREOUS: OD: syneresis OS: syneresis NERVE: (-) NVD OU OD: 0.15/0.15 cup/disc ratio (horiz/vert) Normal Color/Margins OS: 0.20/0.20 cup/disc ratio (horiz/vert) Normal Color/Margins MACULA: (-) clinically significant macular edema OU OD: Flat and intact; no blood, fluid or exudates OS: Flat and intact; no blood, fluid or exudates BLOOD VESSELS: (-) NVE OU OD: tortuosity and crossing changes OS: tortuosity and crossing changes; several hemorrhages inferior arcades/temporal arcades, operculum inferior temporal to macula with no hole PERIPHERY: OD: No holes, tears or detachments OS: No holes, tears or detachments ADDITIONAL TESTS: (+) VISUAL FIELD EVALUATION: Octopus 32/TOP OD: Reliability - reliable, pos 0/4, neg 0/4, 76/0 Indices: MD: 0.4 LV: 4.0 Pattern of defect: none, few scattered spots Quadrants involved: 2 Central four points involved: 0 Crosses midline (horizontal / vertical): no/yes Repeatability (comparing to baseline and last) - baseline OS: Reliability - reliable, pos 0/4, neg 0/4, 74/0 Indices: MD: 6.5 LV: 46.6 Pattern of defect: superior nasal quadrantanopsia with nasal defects, corresponds with inferior temporal BRVO Quadrants involved: 3 Central four points involved: 3 Crosses midline (horizontal / vertical): yes/yes Repeatability (comparing to baseline and last) - baseline (+) GONIOSCOPY: Disposable 3/4-Mirror OD: Open to CBB 360, Gr 1+ pigment, (-)NVA/PAS/Recession OS: Open to CBB 360, Gr 1+ pigment, (-)NVA/PAS/Recession ASSESSMENT: 1. Branched retinal vein occlusion OS; no macular edema; stable -patient said he noticed cloud across vision OS sometime about 3 months ago, lasted for 1 month -patient currently taking aspirin daily -Carotid ultrasound: OD 0-49% blockage, OS 50-69% blockage. Radiologist wants to repeat carotid ultrasound in 6 months PLAN: 1. Educated patient on today's findings. Discussed importance of continued follow up care and testing to ensure no further progression. Patient voiced understanding. Advised patient to call 911 or go to the emergency room ASAP if any sudden painless transient monocular loss of vision, jaw pain, temple/scalp pain, sudden muscle weakness or confusion. Monitor 3 months with DFE/photos. RTC 12/2017 for DFE/photos RTC 07/2018 for complete/photos