The Neuro-Ophthalmic Examination

Liu, Grant T.; Volpe, Nicholas J.; Galetta, Steven

doi:10.1016/b978-0-323-34044-1.00002-x

Cited by 10 publications

(16 citation statements)

References 61 publications

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“…8 By ophthalmoscopy, the creases correspond to what is commonly called “high water marks”. 9 The current report also describes what occurs to these creases over the same six month interval.…”

Section: Methodsmentioning

confidence: 87%

“…PPW, the OCT demonstration of surface “Paton’s lines,” 8,9 appear to be a consequence of combined internal compressive forces of the ONH and tensile hoop stress at the disc margin as the optic nerve head that radially expands into the vitreous and surrounding retina. 1 The correlation between PPW and ONH volume, observed at presentation, decreased over time due to the delayed appearance of wrinkles as papilledema resolved.…”

Section: Discussionmentioning

confidence: 99%

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The Effect of Treatment of Idiopathic Intracranial Hypertension on Prevalence of Retinal and Choroidal Folds

Kupersmith

Sibony

Feldon

et al. 2017

American Journal of Ophthalmology

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Purpose We described 3 types of folds in the retina and a crease in the outer retina associated with papilledema due to idiopathic intracranial hypertension (IIH) at presentation. We report the change in folds relative to treatment of IIH over the six months. Design/Study Subjects Substudy of a randomized clinical trial. Methods Study eyes of subjects assigned to acetazolamide (ACZ, n=44) or placebo (PLB, n=43) had spectral domain optical coherence tomography (SDOCT) images of the optic disc and macula regions at baseline, 3 and 6 months. Images were evaluated for peripapillary wrinkles (PPW), retinal folds (RF), choroidal folds (CF), and creases using transaxial and en face views. The optic nerve head (ONH) shape, retinal nerve fiber layer (RNFL) thickness, ONH volume, and papilledema grade were measured. Outcome Determination of the presence or absence of PPW, RF, CF and creases. Results At presentation, except for an increase of PPW in ACZ eyes (64% vs 28%); both treatment groups were matched for all OCT features. At 6 months, ACZ-treated, but not PLB-treated, eyes had fewer folds of all types (p < 0.01), with a 57% reduction in frequency of RF. Creases did not resolve. Resolution of RF, but not of PPW and CF, was associated with significant reduction in RNFL thickness, ONH volume and papilledema grade. Conclusions The various types of retinal folds associated with papilledema reflect biodynamic processes and show an ACZ treatment effect. Persistence of these folds despite marked improvement in ONH swelling suggests permanent changes in the affected retinal tissues. Trial registration: clinicaltrials.gov identifier: NCT01003639

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Section: Methodsmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

The Effect of Treatment of Idiopathic Intracranial Hypertension on Prevalence of Retinal and Choroidal Folds

Kupersmith

Sibony

Feldon

et al. 2017

American Journal of Ophthalmology

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“…A lthough optic neuritis (ON) has been well studied in adults, 1 there are limited prospective data on this condition in children. 2 The Optic Neuritis Treatment Trial 3 provided valuable knowledge regarding the cause, management, and prognosis of ON, as well as subsequent diagnosis of multiple sclerosis (MS) in affected adults.…”

mentioning

confidence: 99%

“…10 However, because clinical trials of uncommon diseases often have difficulty enrolling a sufficient number of participants, we launched a prospective pilot study of children with ON. The study had 2 primary aims: (1) to obtain estimates of clinically important outcomes in a prospectively enrolled cohort and ( 2) to determine the feasibility of sufficient enrollment for a randomized clinical treatment trial.…”

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confidence: 99%

Assessment of Pediatric Optic Neuritis Visual Acuity Outcomes at 6 Months

et al. 2020

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IMPORTANCE Optic neuritis (ON) in children is uncommon. There are limited prospective data for visual acuity (VA) outcomes, associated diseases, and neuroimaging findings. Prospective data from a large sample would be useful for counseling families on treatment decisions and prognosis.OBJECTIVE To prospectively study children with a first episode of ON, describe VA after 6 months, and ascertain the network's (Pediatric Eye Disease Investigator Group and Neuro-Ophthalmology Research Disease Investigator Consortium) ability to enroll pediatric patients with ON prospectively. DESIGN, SETTING, AND PARTICIPANTSThis nonrandomized cohort study was conducted from September 20, 2016, to July 20, 2018, at 23 sites in the United States and Canada in pediatric ophthalmology or neuro-ophthalmology clinics. A total of 44 children (aged 3-15 years) presented with a first episode of ON (visual loss, pain on eye movements, or both) within 2 weeks of symptom onset and at least 1 of the following in the affected eye: a distance high-contrast VA (HCVA) deficit of at least 0.2 logMAR below age-based norms, diminished color vision, abnormal visual field, or optic disc swelling. Exclusion criteria included preexisting ocular abnormalities or a previous episode of ON.MAIN OUTCOMES AND MEASURES Primary outcomes were monocular HCVA and low-contrast VA at 6 months. Secondary outcomes were neuroimaging, associated diagnoses, and antibodies for neuromyelitis optica and myelin oligodendrocyte glycoprotein.RESULTS A total of 44 children (mean age [SD], 10.2 [3.5] years; 26 boys [59%]; 23 White individuals [52%]; 54 eyes) were enrolled in the study. Sixteen patients (36%) had bilateral ON. Magnetic resonance imaging revealed white matter lesions in 23 children (52%). Of these children, 8 had myelin oligodendrocyte glycoprotein-associated demyelination (18%), 7 had acute disseminated encephalomyelitis (16%), 5 had multiple sclerosis (11%), and 3 had neuromyelitis optica (7%). The baseline mean HCVA was 0.95 logMAR (20/200), which improved by a mean 0.76 logMAR (95% CI, 0.54-0.99; range, -0.70 to 1.80) to 0.12 logMAR (20/25) at 6 months. The baseline mean distance low-contrast VA was 1.49 logMAR (20/640) and improved by a mean 0.72 logMAR (95% CI, 0.54-0.89; range, -0.20 to 1.50) to 0.73 logMAR (20/100) at 6 months. Baseline HCVA was worse in younger participants (aged <10 years) with associated neurologic autoimmune diagnoses, white matter lesions, and in those of non-White race and non-Hispanic ethnicity. The data did not suggest a statistically significant association between baseline factors and improvement in HCVA. CONCLUSIONS AND RELEVANCEThe study network did not reach its targeted enrollment of 100 pediatric patients with ON over 2 years. This indicates that future treatment trials may need to use different inclusion criteria or plan a longer enrollment period to account for the rarity of the disease. Despite poor VA at presentation, most children had marked improvement by 6 months. Associated neurologic autoimmune diagnoses were common. ...

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“…[3] Clinically, comparison of recovery time between affected and unaffected eyes is most useful in distinguishing between asymmetric macular and optic nerve etiologies. [4] Ophthalmoscopy provides the ability to visualize abnormalities of the macula or optic nerve head. Macular pathology, including subretinal fluid, exudates, hemorrhages, or pigmentary changes suggest maculopathy, while optic nerve head abnormalities ranging from subtle mild pallor to marked optic disc swelling suggest optic neuropathy.…”

Section: Signs and Symptomsmentioning

confidence: 99%

Retinal Diseases that Can Masquerade as Neurological Causes of Vision Loss

Padungkiatsagul

Leung

Moss

2020

Curr Neurol Neurosci Rep

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Purpose of review.-This review aims to discuss retinal diseases that may masquerade as neurological causes of vision loss and highlights modern ophthalmic ancillary testing that can help to establish these diagnoses.Recent findings.-Retinal diseases with signs and symptoms overlapping with neurological causes of vision loss include central serous chorioretinopathy, retinal vascular insufficiency, acute macular neuroretinopathy, big blind spot syndrome, paraneoplastic retinopathy, retinal dystrophy, and toxic retinopathy. Diagnosis is facilitated by electrophysiologic studies and multimodal ophthalmic imaging including optical coherence tomography and fundus autofluorescence imaging. Looking into the future, translation of adaptive optics ophthalmoscopy into clinical practice may facilitate early detection of microscopic retinal abnormalities that characterize these conditions.Summary.-With conventional methods of physical examination, diagnosis of retinal diseases that may masquerade as neurological causes of vision loss can challenging. Current advance in multimodal ophthalmic imaging along with electrophysiologic studies enhance the provider's ability to make early diagnosis and monitor progression of these conditions.

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The Neuro-Ophthalmic Examination

Cited by 10 publications

References 61 publications

The Effect of Treatment of Idiopathic Intracranial Hypertension on Prevalence of Retinal and Choroidal Folds

The Effect of Treatment of Idiopathic Intracranial Hypertension on Prevalence of Retinal and Choroidal Folds

Assessment of Pediatric Optic Neuritis Visual Acuity Outcomes at 6 Months

Retinal Diseases that Can Masquerade as Neurological Causes of Vision Loss

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