PEPS Ancillary Testing

FBS, HbA1c

r/o diabetes

BP

r/o malignant HTN

CBC

r/o anemia/infection

ESR

r/o inflammation

ONH OCT

r/o glaucomatous changes

r/o disc edema

HVF 24-2 or 30-2

r/o glaucomatous VF defects

r/o neurological field defects

gonio

r/o angle closure, PDS, PAS

pachs

evaluate risk factors for glaucoma

mac OCT

r/o macular changes (such as: AMD, CME, CNV)

b scan

r/o RD when cannot visualize post seg

evaluate risk factors for melanoma

r/o ONH drusen

IVFA

r/o non-perfusion, neovascularization, CME, CSCR

FAF

r/o GA

r/o ONH drusen

corneal topography

r/o irregular cyl, KCN, corneal ectasia

cycloplegic refraction

r/o latent hyperopia

vertical Madodx rod

r/o vertical deviation

fundus photos

document lesion, document lesion to monitor for changes over time

BAT

assess glare effect of cataracts

forced duction

r/o muscle entrapment

CT in 9 gazes

evaluate EOM fxn

parks 3 step

evaluate EOM fxn, determine paretic muscle

TBUT

evaluate TF quality

NaFl

r/o corneal staining

Seidel

r/o globe penetration

adeno + immunoassay

r/o adenovirus/EKC

lyme titer

r/o lyme disease

FTA-ABS, RPR/VDRL

r/o syphilis

ice pack test, tensilon test

r/o MG

thyroid panel

r/o TED

culturing

determine causative pathogen and sensitivity

MRI of brain & orbits w/ and w/o contrast

r/o demyelinating disease

r/o brain lesion/mass

CT of head & orbit without contrast

r/o orbital fracture

HLA-B27, ANA, RF

r/o autoimmune conditions (such as ankylosing spondylitis, rheumatoid arthritis, reactive arthritis, psoriatic arthritis, lupus)

HLA-B51

r/o Behcet’s

PPD, chest CT

r/o TB

ACE/lysozyme, chest CT

r/o sarcoidosis

IgE panel

confirm allergic component

ESR, CRP, platelet, temporal artery biopsy

r/o GCA

carotid doppler

r/o carotid obstruction/stenosis

phenylephrine 2.5%

r/o episcleritis

apraclonidine 0.5%

r/o Horner’s syndrome (Horner’s pupil will dilate)

hydroxyamphetamine 1%

localize Horner’s lesion (dilates OU if 1st or 2nd order neuron affected)

vergence ranges

evaluate the binocular system

MEM

evaluate acc response

NRA/PRA

evaluate acc system

toxoplasma gondii antibody

r/o toxoplasmosis

bartonella antibody

r/o cat scratch dz

serum uric acid & synovial fluid analysis

r/o gout

sacroiliac xray

r/o ankylosing spondylitis

serum alkaline phosphatase & urine calcium levels

r/o Paget’s

full field ERG

r/o rod cone dystrophy

EOG

r/o Best’s disease

SSA, SSB

r/o primary Sjogren’s