Title (Eg. Retina Case #1)

Authors: John Smith MD (1), Jane Smith MD (1)

Affiliations: (1) University of Canada

Ophthalmic Nurses and Technicians Involved: Joe Smith, COMT

ID: 82F, F and F x 4 weeks

Past Ocular History: NPDR previously, followed annually by optometrist

Ocular gtts: None

Relevant Medical History: Hypertension (uncontrolled), Diabetes (HbA1c 9.2%)

Relevant Medications: Perindopril, Metformin, Insulin

All IVFAs must have:

  • Copy right label in white font and times new roman font.

  • Time stamp in seconds or minutes in white font and times new roman font.

  • If multiple features/patterns are being described, numeric numbering as shown above. (white numbering, times new roman font)

  • IVFA OS/OD at “__” seconds

    Phase:

    Describe the pattern of abnormal fluorescence in bullet point form.

    If multiple features are present, please insert small white numbers in numeric form label the corresponding description.

    • Ex. Posterior pole and peripheral hypofluoresence from hypoperfusion secondary to capillary drop out (2)

Please submit each phase of the IVFA . Each photo must be submitted with the requirements above, and have a description in the same format as above.

  • Diagnosis:

  • Please list your differential diagnosis in bullet point format.

  • Please describe the clinical indication for an IVFA.

    What clinical question did ordering an IVFA answer?

  • Please have your citations in Vancouver format, with in-text numerical citations. List references in order of appearance in the above submission.