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Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.

On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.

A dilated fundus examination was performed demonstrating the following:

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Retina

Case 15

Patient Presentation: A 75-year-old male with history of hypertension and hyperlipidemia experienced sudden, painless vision loss in his right eye 1 year ago. He saw an ophthalmologist who diagnosed him with a central retinal vein occlusion in his right eye. He was treated with anti-VEGF injections for macular edema, but despite treatment, his vision has remained poor. He presents to clinic today for second opinion regarding his poor vision in his right eye. On examination, his vision is 20/400 OD and 20/20 OS. Slit lamp examination is normal with no signs of neovascularization of the iris/angle. Fundus examination and OCT are shown below:

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Question: DRIL is an OCT parameter that is increasingly used in retinal vascular disorders like diabetes and retinal vein occlusions (RVO). What does DRIL stand for?

A. Discordance of the retina and inner plexiform layer

B. Disorganization of the retinal inner layers

C. Disruption of the retinal inner nuclear layers

D. None of the above

Question: What is the significance of DRIL?

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Learning Objectives:

1. DRIL stands for disorganization of the retinal inner layers.

2. DRIL occurs in patients with a variety of retinal vascular diseases, and has been found to correlate with worse visual outcomes.

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