Notification Procedures for Other Ocular Lesions, FPRC

Exhibit 8

Notification Procedures for Other Ocular Lesions

Grading Item	Letter?	Suggested language	Referral to ophthalmologist?
Central artery occlusion	Consult with Retinal Reading Center ophthalmologist about occlusive processes. Possible outcomes are: 1) Retinal alert for fresh vein occlusion, or vein occlusion with associated macular edema. 2) Routine notification for old arteriolar or venous occlusion. 3) No letter for old occlusion of a very small branch.	Language as suggested by Reading Center ophthalmologist.	Referral as suggested by Reading Center ophthalmologist.
Branch arteriole occlusion
Central vein occlusion
Branch vein occlusion
Hollenhorst plaque	Routine notification for definite Hollenhorst plaque, and possibly for questionable Hollenhorst plaque. Consult with Reading Center ophthalmologist.	Language as suggested by Reading Center ophthalmologist.	None Information may be of interest to primary care physician.
Asteroid hyalosis	No letter.
Large cup/disc ratio	No letter for questionable large cup/disc ratio (< 0.70). Routine notification for definite large cup/disc ration of 0.70 with appearances such as undercutting. Routine notification for cup/disc ratio > 0.80.	". . . the optic disc exhibits a moderately large cup-to-disc ratio of 0.70, which could indicate glaucoma." Similar to above.	"Routine evaluation by an ophthalmologist may be advisable." Same as above.
RH within disc margin	Routine notification.	". . . exhibits a retinal hemorrhage on the optic disc. This is sometimes seen in eyes with glaucoma."	"Routine evaluation by an ophthalmologist may be advisable."
Peripapillary atrophy	No letter for most cases. Consult the Reading Center ophthalmologist if unsure of significance, or if associated with angioid streaks.	Language as suggested by Reading Center ophthalmologist.	Referral as suggested by Reading Center ophthalmologist.
Other disc abnormality	No letter for: oblique insertion, scleral crescent, nerve head drusen, minor vessel anomalies. Possible letter for: some vessel anomalies, marked disc pallor. Consult with the Reading Center ophthalmologist about severity of vessel anomalies or disc pallor, or other disc appearances of unknown significance.	Language as suggested by Reading Center ophthalmologist.	Referral as suggested by Reading Center ophthalmologist.
Glial/vitreous thickening	No letter for: glial tissue small vitreous thickenings. Consult the Reading Center ophthalmologist if any vitreous opacity suggests vitreous hemorrhage or an inflammatory reaction of the vitreous.	Language as suggested by Reading Center ophthalmologist.	Referral as suggested by Reading Center ophthalmologist.
Medullated nerve fibers	No letter.
Cellophane reflex	No letter.
Surface wrinkling retinopathy	No letter if the surface wrinkling retinopathy encircles less than 180^o of the macula, and the center of the macula is unaffected. Routine notification if the surface wrinkling retinopathy fully encircles the macula, or if the macula is dragged or crossed by tension lines and vision may be affected. Consult the Reading Center ophthalmologist about borderline cases.	". . . exhibits mild retinal distortion due to an epiretinal membrane in the macular area (surface wrinkling retinopathy). " Similar to above.	"The participant may be aware of this condition. If not, routine evaluation by an ophthalmologist may be advisable." Similar to above.
Soft drusen RPE depigmentation Hyperpigmentation	No letter for most cases of early maculopathy. Consult the Reading Center ophthalmologist regarding routine notification if extensive soft drusen are present, or if abnormalities involve the center of the macula and may affect vision. Hyperpigmentation associated with POHS, fundus flavimaculatus other degenerative processes, or possible inflammatory processes may require routine notification. Consult with the Reading Center ophthalmologist.	Language as suggested by Reading Center ophthalmologist. Language as suggested by Reading Center ophthalmologist.	Referral as suggested by Reading Center ophthalmologist. Referral as suggested by Reading Center ophthalmologist.
SSR detachment Subretinal hemorrhage Subretinal fibrosis Geographic atrophy	Consult the Reading Center ophthalmologist regarding notification for all end-stage maculopathy.	Language as suggested by Reading Center ophthalmologist.	Referral as suggested by Reading Center ophthalmologist.
Chorioretinal scar	No letter for most small, peripheral chorioretinal scars. Notification for: 1) Toxoplasmosis scars, or other large scars suggesting an old inflammatory process. 2) Chorioretinal scars involving the macula, affecting vision. 3) POHS, as suggested by any two of the following appearances: a) round, "punched out" chorioretinal scars in the periphery, b) chorioretinal scars in the macular area, c) scarring around the optic disc.	Language as suggested by Reading Center ophthalmologist.	Referral as suggested by Reading Center ophthalmologist.
Nevus	No letter for a nevus which appears flat, and has even pigmentation and regular or diffuse margins. Routine notification for a nevus which may be elevated, or has uneven pigmentation and/or irregular margins. Possible notification if only a small portion of what is clearly a larger lesion extends into the photographic field. Consult Reading Center ophthalmologist.	Language as suggested by Reading Center ophthalmologist.	Referral as suggested by Reading Center ophthalmologist.
Retinal detachment	Consult Reading Center ophthalmologist regarding retinal alert or routine notification.	Language as suggested by Reading Center ophthalmologist.	Referral as suggested by Reading Center ophthalmologist.
Other	Other conditions which may require notification: macular hole choroidal folds angioid streaks fundus flavimaculatus POHS (see description under chorioretinal scars).	Language as suggested by Reading Center ophthalmologist.	Referral as suggested by Reading Center ophthalmologist.

Return to Light Box Grading Protocol

2/17/98