Deficits in Visual Function after Resolution of Optic Neuritis

Fleishman, John A.; Beck, Roy W.; Linares, Oscar A.; Klein, James W.

doi:10.1016/s0161-6420(87)33349-4

Cited by 96 publications

(44 citation statements)

References 19 publications

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“…Neurodegenerative diseases that are not well known for their effects on vision also manifested VCS deficits. Multiple sclerosis patients displayed VCS deficits that were orientation specific, suggesting cortical rather than retinal or optic nerve damage (88,89). A primarily low spatial-frequency VCS deficit was present in Parkinson (83) and Alzheimer (90)(91)(92)(93) patients, the latter of whom showed an extent of cognitive impairment predicted by VCS scores (93).…”

Section: Discussionmentioning

confidence: 98%

Apartment residents' and day care workers' exposures to tetrachloroethylene and deficits in visual contrast sensitivity.

Schreiber¹,

Hudnell²,

Geller³

et al. 2002

Environ Health Perspect

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Tetrachloroethylene (also called perchloroethylene, or perc), a volatile organic compound, has been the predominant solvent used by the dry-cleaning industry for many years. The U.S. Environmental Protection Agency (EPA) classified perc as a hazardous air pollutant because of its potential adverse impact on human health. Several occupational studies have indicated that chronic, airborne perc exposure adversely affects neurobehavioral functions in workers, particularly visual color discrimination and tasks dependent on rapid visual-information processing. A 1995 study by Altmann and colleagues extended these findings, indicating that environmental perc exposure at a mean level of 4,980 microg/m(3) (median=1,360 microg/m(3)) alters neurobehavioral functions in residents living near dry-cleaning facilities. Although the U.S. EPA has not yet set a reference concentration guideline level for environmental exposure to airborne perc, the New York State Department of Health set an air quality guideline of 100 microg/m(3). In the current residential study, we investigated the potential for perc exposure and neurologic effects, using a battery of visual-system function tests, among healthy members of six families living in two apartment buildings in New York City that contained dry-cleaning facilities on the ground floors. In addition, a day care investigation assessed the potential for perc exposure and effects among workers at a day care center located in the same one-story building as a dry-cleaning facility. Results from the residential study showed a mean exposure level of 778 microg/m(3) perc in indoor air for a mean of 5.8 years, and that perc levels in breath, blood, and urine were 1-2 orders of magnitude in excess of background values. Group-mean visual contrast sensitivity (VCS), a measure of the ability to detect visual patterns, was significantly reduced in the 17 exposed study participants relative to unexposed matched-control participants. The groups did not differ in visual acuity, suggesting that the VCS deficit was of neurologic origin. Healthy workers in the day care investigation were chronically exposed to airborne perc at a mean of 2,150 microg/m(3) for a mean of 4.0 years. Again, group-mean VCS, measured 6 weeks after exposure cessation, was significantly reduced in the nine exposed workers relative to matched controls, and the groups did not differ significantly in visual acuity. These results suggested that chronic, environmental exposure to airborne perc adversely affects neurobehavioral function in healthy individuals. Further research is needed to assess the susceptibility of the young and elderly to perc-induced effects, to determine whether persistent solvent-induced VCS deficits are a risk factor for the development of neurologic disease, and to identify the no observable adverse effect level for chronic, environmental, perc exposure in humans.

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Section: Discussionmentioning

confidence: 98%

Apartment residents' and day care workers' exposures to tetrachloroethylene and deficits in visual contrast sensitivity.

Schreiber¹,

Hudnell²,

Geller³

et al. 2002

Environ Health Perspect

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“…[3][4][5][6][7][8][9] Patients may remain impaired for edge detection (e.g., walking stairs), night vision, stereopsis, and motion detection. Further, when factors known to precipitate Uhthoff phenomena are present, VA can be compromised.…”

mentioning

confidence: 99%

Effect of 4-aminopyridine on vision in multiple sclerosis patients with optic neuropathy

Horton

Conger

et al. 2013

Neurology

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Objective: The objective of this randomized, double-blind, placebo-controlled, crossover study was to examine if patients with optic neuropathy would derive a therapeutic benefit from 4-aminopyridine (4-AP) treatment. Furthermore, the study was intended to determine if patients with certain P100 latencies or retinal nerve fiber layer (RNFL) measures would be more likely to respond to therapy.Methods: Patients were enrolled in a randomized, placebo-controlled, double-blind, crossover study of 10 weeks duration. Patients underwent visual evoked potentials (VEP), optical coherence tomography (OCT), and visual acuity before starting 5 weeks of either placebo or 4-AP. After 5 weeks, they completed a second evaluation (VEP, OCT, and visual acuity) and were crossed over between treatment arms. Five weeks later, they had their final evaluation. All investigators were blinded to treatment arm until after data analysis.Results: On average, patients had faster P100s on 4-AP when compared to placebo. A subset of patients had distinct responses to 4-AP as measured by improvements in visual acuity. Finally, eyes with an RNFL measure between 60 and 80 mm had the highest response rate.Conclusions: 4-Aminopyridine is useful for improving vision in patients with demyelinating optic neuropathy. Future clinical trials may be able to enrich a patient population for potential responders using OCT and VEP measures. Selecting patients for future trials should use RNFL measures as part of inclusion/exclusion criteria.

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“…73 However, many patients who are able to score well on the Snellen chart still have residual deficits of low contrast acuity, impaired color vision, and visual field defects. 74 Most patients report that their vision is not quite as good as it was before, 75 and this may impact on quality of life. 76 No associations have been found between the degree of visual recovery and age, gender, ethnicity, abnormalities on brain MRI, 25 visual evoked potential (VEP) parameters during the acute stage, 77 or optic nerve MRI measures of myelination.…”

Section: Visual Prognosismentioning

confidence: 99%

New developments in the treatment of optic neuritis

Jenkins

Toosy

2010

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Acute optic neuritis (ON) has various etiologies. The most common presentation is inflammatory, demyelinating, idiopathic, or "typical" ON, which may be associated with multiple sclerosis. This must be differentiated from "atypical" causes of ON, which differ in their clinical presentation, natural history, management, and prognosis. Clinical "red flags" for an atypical cause of ON include absent or persistent pain, exudates and hemorrhages on fundoscopy, very severe, bilateral, or progressive visual loss, and failure to recover. In typical ON, steroids shorten the duration of the attack, but do not influence visual outcome. This is in contrast to atypical ON associated with conditions such as sarcoidosis and neuromyelitis optica, which require aggressive immunosuppression and sometimes plasma exchange. The visual prognosis of typical ON is generally good. The prognosis in atypical ON is more variable. New developments aimed at designing better treatments for patients who fail to recover are discussed, focusing on recent research elucidating mechanisms of damage and recovery in ON. Future therapeutic directions may include enhancing repair processes, such as remyelination or adaptive neuroplasticity, or alternative methods of immunomodulation. Pilot studies investigating the safety and proof-ofprinciple of stem cell treatment are currently underway.

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Deficits in Visual Function after Resolution of Optic Neuritis

Cited by 96 publications

References 19 publications

Apartment residents' and day care workers' exposures to tetrachloroethylene and deficits in visual contrast sensitivity.

Apartment residents' and day care workers' exposures to tetrachloroethylene and deficits in visual contrast sensitivity.

Effect of 4-aminopyridine on vision in multiple sclerosis patients with optic neuropathy

New developments in the treatment of optic neuritis

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