Optic Nerve Head Volumetry by Optical Coherence Tomography in Papilledema Related to Idiopathic Intracranial Hypertension.

Purpose: Idiopathic intracranial hypertension (IIH) leads to optic nerve head swelling and optic atrophy if left untreated. We wanted to assess an easy to perform volumetric algorithm to detect and quantify papilledema in comparison to retinal nerve fiber layer (RNFL) analysis using optical coherence tomography (OCT). Methods: Participants with and without IIH underwent visual acuity testing at different contrast levels and static perimetry. Spectralis-OCT measurements comprised standard imaging of the peripapillary RNFL and macular ganglion cell layer (GCL). The optic nerve head volume (ONHV) was determined using the standard segmentation software and the 3.45 mm early treatment diabetic retinopathy study (ETDRS) grid, necessitating manual correction within Bruch membrane opening. Three neuro-ophthalmologists graded fundus images according to the Frisén scale. A mixed linear model (MLM) was used to determine differences between study groups. Sensitivity and specificity was evaluated using the area under the receiver-operating characteristic (ROC). Results: Twenty-one patients with IIH had an increased ONHV of 6.46 ± 2.36 mm3 as compared to 25 controls with 3.20 ± 0.25 mm3 (P < 0.001). The ONHV cutoff distinguishing IIH from controls was 3.97 mm3 (i.e. no patient with IIH had an ONHV below and no healthy individual above this value). The area under the curve (AUC) for ONHV was 0.99 and for the RNFL at 3.5 mm 0.90. The Frisén scale grading correlated higher with the ONHV (r = 0.90) than with the RNFL thickness (r = 0.68). ONHV measurements were highly reproducible in both groups (coefficient of variation <0.01%). Conclusions: OCT-based volumetry of the optic nerve head discriminates very accurately between individuals with and without IIH. It may serve as a useful adjunct to the rating with the subjective and ordinal Frisén scale. Translational Relevance: A simple OCT protocol run on the proprietary software of a commercial OCT device can reliably discriminate between normal optic nerve heads or pseudo-papilledema and true papilledema while being highly reproducible. Our normative data and OCT preset may be used in further clinical studies.

A Pilot Study on the Efficacy and Safety of 0.01% Atropine in German Schoolchildren with Progressive Myopia.

INTRODUCTION: Although the interest is growing in topical low-dose atropine to control myopia in schoolchildren worldwide, its use in children of European ancestry remains controversial and solid evidence is sparse. The Oxford Centre for Evidence Based Medicine (OCEBM) classifies the evidence for this therapy as level I for East Asian populations, but only level IV in non-Asian populations. METHODS: Fifty-six children, aged a median of 11 years (range 6-17), were analysed after 12 months of topical treatment with 0.01% preservative-free atropine in both eyes at bedtime every day. Efficacy was assessed during treatment every 6 months. In a subset of 20 patients, treatment of the second eye was delayed by 1 day to enable a controlled safety assessment of side effects such as pupil dilation, hypoaccommodation, and near vision reduction. RESULTS: Prior to treatment, the mean myopic progression was estimated as 1.05 D/year; after 12 months of treatment with 0.01% atropine, it was 0.40 D/year (p < 0.0001). The only consistently measurable side effect was the induction of 1 mm pupil dilatation, which was only noticeable in comparison to the non-treated eye during the safety investigation. CONCLUSIONS: Topical low-dose atropine appears to be safe and efficacious also in a cohort of European schoolchildren. These data should motivate researchers to conduct more randomised clinical trials.

[Amblyopia and refractive error]. / Update Augenheilkunde ­ Amblyopie und Refraktionsfehler.

Myopia is on the increase worldwide and will become a major challenge over the next decades in terms of secondary ophthalmologic complications. There are effective therapeutic options available to slow or prevent the progression of myopia. So far, it has not been investigated whether there are possible additive effects of these interventions. Further investigations - especially in Caucasian populations - are necessary to verify the study results available from Asia. There is limited data on how long further progression of myopia is preventable. A therapy appears reasonable as long as a progression of myopia is detectable.Consistent childhood amblyopia screening provides a cost-effective measure for the prevention of visual disturbances over the course of life. How this can be best integrated into the existing system of "U-investigations", must be clarified by the cost-bearers and professional associations. This discourse should be supported by close interdisciplinary exchange and further studies on the prevalence of different degrees of amblyopia. In addition, sensitive and specific or even multi-stage tests should be developed in order to implement an early detection that is cost-effective and saves resources.

Terson's Syndrome: Diagnostic Comparison of Ocular Sonography and CT.

BACKGROUND AND PURPOSE: To assess the accuracy of ocular B-mode sonography and of standard head computed tomography (CT) as screening tools for intraocular hemorrhages related to subarachnoid hemorrhage (SAH). METHODS: 46 patients with spontaneous SAH were examined using ocular B-mode sonography and underwent funduscopy as gold standard for detection of ocular hemorrhages (OH). Additionally, all head CT scans done during the hospital stay of the study population were rated by a neuroradiologist for the presence of OH. RESULTS: Funduscopy revealed vitreous and/or preretinal hemorrhages in ten eyes and retinal hemorrhages in nine eyes. In comparison with funduscopy, ocular sonography showed a sensitivity and specificity for the detection of vitreous and/or preretinal hemorrhages of 100%, while identification of retinal hemorrhages was less reliable with a sensitivity/specificity of 44%/100%. Standard head CT showed a lower sensitivity/specificity of 60%/96% for vitreous and/or preretinal hemorrhages, and 32%/95% for the diagnosis of any ocular bleeding. CONCLUSION: Ocular sonography identifies SAH-related preretinal and vitreous hemorrhages with high accuracy and is superior to standard head CT. It may be considered as new and useful bedside diagnostic tool for routine clinical care of patients with SAH.