Approach to the diagnosis and management of nutritional optic neuropathies.

PURPOSE OF REVIEW: Nutritional deficiency is an under-recognized cause of optic neuropathy. The purpose of this review is to discuss how to identify, diagnose, and appropriately manage patients with nutritional optic neuropathy. RECENT FINDINGS: Nutritional deficiencies have long been thought to be more prevalent in the developing countries. However, with the advent of bariatric surgery, restrictive/selective diets, and the increase in alcohol dependence, it is not uncommon to see nutritional optic neuropathies in the developed world. SUMMARY: Although nutritional optic neuropathy can cause severe and debilitating vision loss, it is often reversible when it is diagnosed and treated in a timely manner.

Paracentral Acute Middle Maculopathy in Pregnancy.

ABSTRACT: A 31-year-old previously healthy, pregnant woman presented with acute, unilateral, painless paracentral vision loss in the left eye. The results of neuroimaging studies were normal. Hypercoagulable workup was negative, and fundus examination showed no retinal emboli and no retinal vascular abnormalities. The patient had well-controlled blood pressure and did not have eclampsia/preeclampsia. Although a presumptive referral diagnosis of "optic neuritis" was made, optical coherence tomography (OCT) of the macula showed a hyperreflective band involving the inner nuclear layer, consistent with paracentral acute middle maculopathy (PAMM). Furthermore, OCT angiography (OCT-A) showed flow attenuation of the outer retinal capillary plexus, further supporting a diagnosis of PAMM in pregnancy. Clinicians should be aware of the benefit of OCT-A as a complement to macular OCT in the evaluation of acute monocular vision loss mimicking retrobulbar optic neuropathy, particularly when signs and findings of other retinal vasculopathy are absent. PAMM should be considered in pregnant patients with acute visual changes.

Optic Perineuritis Distinguishing Arteritic Ischaemic from Amiodarone-Associated Optic Neuropathy.

Giant cell arteritis (GCA) is a common medium to large vessel vasculitis of the elderly that can lead to permanent vision loss. Neuroimaging in GCA may reveal optic nerve sheath enhancement, which is a cardinal finding of optic perineuritis (OPN). The clinical manifestations of GCA can mimic that of other ocular disorders including amiodarone-associated optic neuropathy (AAON). We report a case of biopsy-proven GCA in a patient initially suspected to have AAON. This patient presented with bilateral optic disc oedema in conjunction with subacute predominately monocular vision loss and enhancement of the corresponding optic nerve sheath on neuroimaging. Clinicians should recognise that clinical and neuroimaging findings of GCA can mimic a variety of ocular and orbital pathologies including idiopathic OPN and AAON.

Bitemporal hemianopsia secondary to ischemic chiasmopathy following mechanical thrombectomy.

PURPOSE: To report a case of bitemporal hemianopsia due to ischemic chiasmopathy after mechanical thrombectomy of a right distal internal carotid artery (ICA) occlusion. OBSERVATIONS: A 60-year-old female presented with left sided weakness and difficulty speaking and was found to have suffered a right internal carotid artery occlusion 10 days after tricuspid valve replacement for severe symptomatic tricuspid valve disease. She underwent mechanical thrombectomy and in hospital and at further follow ups was noted to have a bitemporal hemianopsia, consistent with an ischemic optic chiasmopathy. CONCLUSIONS AND IMPORTANCE: The optic chiasm is vascularized by multiple arteries of the Circle of Willis. As such, ischemic optic chiasmopathy is rare. Clinicians should consider ischemic chiasmopathy following cardiac and other surgical procedures including mechanical thrombectomy of the ICA or its branches.

Physiological effects of inactivation and the roles of Elovl3/ELOVL3 in maintaining ocular homeostasis.

Recently, elongase of very long chain fatty acids-3 (ELOVL3) was demonstrated to play a pivotal role in physiology and biochemistry of the ocular surface by maintaining a proper balance in the lipid composition of meibum. The goal of this study was to further investigate the effects of ELOVL3 ablation in homozygous Elovl3-knockout mice (E3hom) in comparison with age and sex matched wild-type controls (E3wt). Slit lamp examination of the ocular surface of mice, and histological examination of their ocular tissues, highlighted a severe negative impact of Elovl3 inactivating mutation on the Meibomian glands (MG) and conjunctiva of mice. MG transcriptomes of the E3hom and E3wt mice were assessed and revealed a range of up- and downregulated genes related to lipid biosynthesis, inflammation, and stress response, compared with E3wt mice. Heat stage polarized light microscopy was used to assess melting characteristics of normal and abnormal meibum. The loss of Elovl3 led to a 8°C drop in the melting temperature of meibum in E3hom mice, and increased its fluidity. Also noted were the excessive accumulation of lipid material and tears around the eye and severe ocular inflammation, among other abnormalities.

Postinfectious Optic Neuritis After Hand-Foot-Mouth Disease.

ABSTRACT: A 33-year-old man presented with acute painless loss of vision in his right eye after hand-foot-mouth disease (HFMD). Examination confirmed a right optic neuropathy. Neuroimaging and routine evaluations for alternative causes for an optic neuropathy were negative. He was treated with high dose corticosteroids and made an almost complete visual recovery. Postinfectious optic neuritis has been reported after a vast array of infections including: varicella zoster virus, influenza virus, herpes simplex virus, Epstein-Barr Virus, Lyme disease, and many others. Although Coxsackie virus infections are a known cause of HFMD and have been reported to cause maculopathy, to the best of our knowledge, this is the first reported case of optic neuritis after HFMD in the English language ophthalmic literature.

Neuro-Ophthalmic Manifestations of Mollaret Meningitis.

ABSTRACT: Mollaret meningitis (MM) refers to benign recurrent aseptic meningitis usually following herpes simplex virus 2 (HSV-2) infection. Neuro-ophthalmic manifestations associated with MM are rarely reported. We present a case of recurrent HSV-2 meningitis with the neuro-ophthalmic presentation of papilledema and sixth nerve palsy. To our knowledge, this is the first such description in the English language ophthalmic literature.

Targeted Cancer Therapy and Its Ophthalmic Side Effects: A Review.

Targeted cancer therapy agents are the latest development in cancer therapeutics. Although the spectrum of their use continues to expand, ocular side effects are frequently encountered with the use of cancer therapeutics. This review describes the ocular side effects of targeted cancer therapy agents.

Optical Coherence Tomography Findings in the Junctional Scotoma of Traquair.

ABSTRACT: A 43-year-old woman presented with a right-sided visual field defect in the right eye. The visual acuity was normal and there was a right relative afferent pupillary defect. Formal visual field testing revealed a junctional scotoma of Traquair. The fundus examination showed optic atrophy in the right eye and optical coherence tomography demonstrated unilateral band atrophy. Neuroimaging revealed a sellar and suprasellar cystic pituitary adenoma for which she underwent a transsphenoidal drainage. We demonstrate the clinical and radiographic features of the junctional scotoma of Traquair and describe the differentiating features vs the junctional scotoma.

Examining the Relationship between Altmetric Score and Traditional Bibliometrics in the Ophthalmology Literature for 2013 and 2016 Cohorts.

Background In this study, we reviewed a select sample of ophthalmology literature to determine if there was a correlation between Altimetric and traditional citation-based and impact factor metrics. We hypothesized that Altmetric score would more closely correlate with impact factor and citations in 2016. Methods Journal Citation Reports for the year 2013 was used to find the 15 highest impact factor ophthalmology journals in 2013. Then Elsevier's Scopus was used to identify the 10 most cited articles from each journal for the years 2013 and 2016. Metrics for all identified articles were collected using the Altmetric Bookmarklet, and date of Twitter account creation was noted for journals with such an account. Altmetric scores, impact factor, and citation counts were tabulated for each article. Pearson's correlation coefficient ( r ) determined correlation of independent variables (number of citations or impact factor) with dependent variable (Altmetric score). For our Twitter analysis, account age was the independent variable and calculated correlation coefficients ( r ) were the dependent variable. Proportion of variance was determined with a coefficient of determination ( R 2 ). Results This study included 300 articles, evenly split between 2013 and 2016. Within the 2013 cohort, three journals had significant positive correlations between citation count and Altmetric score. For the 2016 cohort, both Altmetric score and citation count ( r = 0.583, p < 0.001) and Altmetric score and impact factor ( r = 0.183, p = 0.025) revealed significant positive correlations. In 2016, two journals were found to have significant correlations between Altmetric score and citation number. Neither year revealed a significant correlation between the age of a journal's Twitter profile and the relationship between Altmetric score and citation count. In each year, Twitter accounted for the highest number of mentions. Conclusion The findings suggest that correlation between Altmetric score and traditional quality metric scores may be increasing. Altmetric score was correlated with impact factor and number of citations in 2016 but not 2013. At this time, Altmetrics are best used as an adjunct that is complementary but not an alternative to traditional bibliometrics for assessing academic productivity and impact.

Compressive Optic Disc Edema and Contralateral Papilledema: Type 2 Foster Kennedy Variant Syndrome.

ABSTRACT: A 43-year-old woman presented with progressive anosmia, self-neglect, and lethargy for 1 year. Brain MRI demonstrated a mass that was compressing the optic nerve in the right eye and had a significant mass effect and cerebral edema producing increased intracranial pressure. Examination revealed the patient to have a variant of Foster Kennedy syndrome involving ipsilateral compressive optic neuropathy with superimposed optic disc edema and contralateral papilledema.