Interpretation of the Visual Field in Neuro-ophthalmic Disorders.

PURPOSE OF REVIEW: In this review, we will describe current methods for visual field testing in neuro-ophthalmic clinical practice and research, develop terminology that accurately describes patterns of field deficits, and discuss recent advances such as augmented or virtual reality-based perimetry and the use of artificial intelligence in visual field interpretation. RECENT FINDINGS: New testing strategies that reduce testing times, improve patient comfort, and increase sensitivity for detecting small central or paracentral scotomas have been developed for static automated perimetry. Various forms of machine learning-based tools such as archetypal analysis are being tested to quantitatively depict and monitor visual field abnormalities in optic neuropathies. Studies show that the combined use of optical coherence tomography and standard automated perimetry to determine the structure-function relationship improves clinical care in neuro-ophthalmic disorders. Visual field assessment must be performed in all patients with neuro-ophthalmic disorders affecting the afferent visual pathway. Quantitative visual field analysis using standard automated perimetry is critical in initial diagnosis, monitoring disease progression, and guidance of therapeutic plans. Visual field defects can adversely impact activities of daily living such as reading, navigation, and driving and thus impact quality of life. Visual field testing can direct appropriate occupational low vision rehabilitation in affected individuals.

Seizures as the Initial Manifestation of Idiopathic Intracranial Hypertension Spectrum Disorder.

Idiopathic intracranial hypertension (IIH) is a syndrome of isolated elevated intracranial pressure of unknown aetiology. The IIH spectrum has evolved over the past decade making the diagnosis and management more challenging. The neurological examination in IIH is typically normal except for papilloedema and possible cranial nerve 6 palsy. Recent publications have highlighted skull base thinning and remodelling in patients with chronic IIH. Resulting skull base defects can cause meningo-encephalocoeles, which are potential epileptogenic foci. We describe the clinical and radiological characteristics of five IIH patients with seizures and meningo-encephalocoeles as the presenting manifestations of IIH spectrum disorder.

Optical coherence tomography as a marker of vision in children with optic pathway gliomas.

PURPOSE: Optic pathway gliomas (OPG) represent an important cause of visual loss in pediatric population. The indication of treatment is based on clinical or neuroimaging progression. Visual acuity loss is the most important symptom of disease progression, but children with OPG are frequently unable to complete the testing of visual function. Optical coherence tomography (OCT) was suggested as an objective tool for visual assessment. A literature review was performed in order to determine the role of retinal OCT as a surrogate marker of vision in children with OPG. METHODS: The search was performed using PubMed, Embase, and Web of Science databases and was restricted to articles published in English between 2000 and 2016, with a minimum of ten participants enrolled. RESULTS: Eleven studies met the eligibility criteria and were included in the present review. Both neurofibromatosis-1 associated and sporadic OPG were investigated. CONCLUSIONS: Retinal OCT is a promising tool to be considered as a screening or follow-up test in children with OPG, and further multicenter research is encouraged.

Optical coherence tomography impacts the evaluation of visual pathway tumors.

The objective of this systematic literature review is to assess the role of retinal optical coherence tomography (OCT) in the evaluation of patients with tumors of the visual pathway. We performed a PubMed database search according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The search was restricted to articles published in English between 2000 and 2016, with at least 10 human adult participants enrolled. Twenty-seven articles met the eligibility criteria. All studies investigated tumors of the anterior visual pathway. Both time-domain and spectral-domain OCT technologies were used and the role of OCT as diagnostic and/or prognostic tool was studied. Retinal OCT provides structural information about ganglion cell axon integrity and is complementary to visual function examination. OCT is a prognostic factor for post-operative visual outcome.

[Immunoglobulin-G4-related disease: a challenging diagnosis]. / Boala legata de imunglobulinele G4: provocare diagnostica.

INTRODUCTION: Immunglobulin G4 (IgG4)-related disease was recently described and represents a systemic lymphoproliferative disorder. The orbital form of the disease manifests as chronic lid swelling and proptosis. Visual disturbances may occur due to apical orbital lesions. CASE REPORT: A 65-year old pacient presents with the impossibility of maintaining his right eye open due to a progressive swelling of the upper lid. The general clinical examination shows adenopathy at 3 lymph node stations of the head. On ophthalmologic examination, a large tumor of the upper lid is observed in the right eye and proptosis and central retinal vein occlusion are noted in the left eye. The serum levels of the IgG are very high. A lymph node biopsy was performed. DISCUSSION: The differential diagnosis between the IgG4-related orbital disease and non-Hodgkin lymphoma is discussed. CONCLUSION The diagnosis criteria for IgG4-related disease are both the high serum levels of IgG4 and the specific immunohistochemistry stains.

Macular OCT's Proficiency in Identifying Retrochiasmal Visual Pathway Lesions in Multiple Sclerosis-A Pilot Study.

Optical coherence tomography (OCT) is a non-invasive imaging technique based on the principle of low-coherence interferometry that captures detailed images of ocular structures. Multiple sclerosis (MS) is a neurodegenerative disease that can lead to damage of the optic nerve and retina, which can be depicted by OCT. The purpose of this pilot study is to determine whether macular OCT can be used as a biomarker in the detection of retrochiasmal lesions of the visual pathway in MS patients. We conducted a prospective study in which we included 52 MS patients and 27 healthy controls. All participants underwent brain MRI, visual field testing, and OCT evaluation of the thicknesses of the peripapillary retinal nerve fiber layer (pRNFL), macular ganglion cell layer (GCL), and macular inner plexiform layer (IPL). OCT measurements were adjusted for optic neuritis (ON). VF demonstrated poor capability to depict a retrochiasmal lesion identified by brain MRI (PPV 0.50). In conclusion, the OCT analysis of the macula appears to excel in identifying retrochiasmal MS lesions compared to VF changes. The alterations in the GCL and IPL demonstrate the most accurate detection of retrochiasmal visual pathway changes in MS patients.

Homonymous Hemiatrophy of Macular Ganglion Cell Layer as a Marker of Retrograde Neurodegeneration in Multiple Sclerosis-A Narrative Review.

Retrograde axonal neurodegeneration along the visual pathway-either direct or trans-synaptic-has already been demonstrated in multiple sclerosis (MS), as well as in compressive, vascular, or posttraumatic lesions of the visual pathway. Optical coherence tomography (OCT) can noninvasively track macular and optic nerve changes occurring as a result of this phenomenon. Our paper aimed to review the existing literature regarding hemimacular atrophic changes in the ganglion cell layer identified using OCT examination in MS patients without prior history of optic neuritis. Homonymous hemimacular atrophy has been described in post-chiasmal MS lesions, even in patients with normal visual field results. Temporal and nasal macular OCT evaluation should be performed separately in all MS patients, in addition to an optic nerve OCT evaluation and a visual field exam.

[Compliance of treatment in glaucoma patients]. / Complianta la tratament a pacientilor cu glaucom.

PURPOSE: To evaluate the treatment compliance level of glaucoma patients and the correlation between the compliance level and a series of patient's demographic characteristics. METHODS: We conducted an observational study in which we studied 100 glaucoma patients who answered the questions we included into a questionnaire. We defined and calculated a broad compliance score and a narrow score, and we investigated the connection between the first score and age, gender, demographic location (urban versus rural), education level, current occupation and duration of disease respectively. RESULTS: The mean of the broad compliance score was 9.64 +/- 1.72, which represents 80% of the maximum value of the score, and the mean of the narrow compliance score was 4.73 +/- 1.12, (78% of the maximum value). The correlation coefficient between score and age was z = -0.09 (p value = 0.19), the Z value for the evaluation of the connection between score and gender was -1.16 (p value = 0.24), and for the connection between compliance score and demographic location Z value = -2.42 (p value = 0.01). Chi-square value for the evaluation of the relation between the score and education level was 14.66 (p value = 0.001), and for the current occupation Chi-square value = 3.47 (p value = 0.06). The correlation coefficient between score and disease duration was tau = 0.09 (p value = 0.23). DISCUSSIONS: According to the answers the patients gave, we identified the parameters that require more attention in the ophthalmologist - glaucoma patient communication: genetic transmission of glaucoma, treatment's side effects, number of visits to the ophthalmologist, awareness of the life-long gradului period of treatment. CONCLUSIONS: In this study, the compliance level of glaucoma patients is relatively high and we observe a correlation between the compliance level and demographic location, and between the compliance level and patient's education level respectively.,

Ocular Optical Coherence Tomography in the Evaluation of Sellar and Parasellar Masses: A Review.

Compression of the anterior visual pathways by sellar and parasellar masses can produce irreversible and devastating visual loss. Optical coherence tomography (OCT) is a noninvasive high-resolution ocular imaging modality routinely used in ophthalmology clinics for qualitative and quantitative analysis of optic nerve and retinal structures, including the retinal ganglion cells. By demonstrating structural loss of the retinal ganglion cells whose axons form the optic nerve before decussating in the optic chiasm, OCT imaging of the optic nerve and retina provides an excellent tool for detection and monitoring of compressive optic neuropathies and chiasmopathies due to sellar and parasellar masses. Recent studies have highlighted the role of OCT imaging in the diagnosis, follow-up, and prognostication of the visual outcomes in patients with chiasmal compression. OCT parameters of optic nerve and macular scans such as peripapillary retinal nerve fiber layer thickness and macular ganglion cell thickness are correlated with the degree of visual loss; additionally, OCT can detect clinically significant optic nerve and chiasmal compression before visual field loss is revealed on automated perimetry. Preoperative values of OCT optic nerve and macular parameters represent a prognostic tool for postoperative visual outcome. This review provides a qualitative analysis of the current applications of OCT imaging of the retina and optic nerve in patients with anterior visual pathway compression from sellar and parasellar masses. We also review the role of new technologies such as OCT-angiography, which could improve the prognostic ability of OCT to predict postoperative visual function.

Race Distribution in Nonarteritic Anterior Ischemic Optic Neuropathy.

PURPOSE: To describe the racial distribution of patients diagnosed with nonarteritic anterior ischemic optic neuropathy (NAION) in 2 large urban academic centers in the United States. DESIGN: Retrospective cross-sectional study. METHODS: All patients with NAION evaluated between 2014 and 2022 in tertiary neuro-ophthalmology services in Atlanta, GA, and New York, NY, respectively, were included. In order to assess the racial accessibility to our services, similar numbers of patients with idiopathic intracranial hypertension seen in the same services were included. Self-reported race at the time of neuro-ophthalmologic examination was collected for all patients. Results were compared with data published by the US Bureau of Census for Decennial Census in 2020 for the states of Georgia and New York, and for the total population of the United States. RESULTS: In both locations, the vast majority of patients with NAION reported being White (91.06% in Atlanta and 78.9% in New York). Only 7.27% of patients in Atlanta and 3% in New York reported being Black, and 1.24% of patients in Atlanta and 5.9% in New York reported being Asian. There were a much higher proportion of White people among NAION patients than in the group of patients with idiopathic intracranial hypertension and in each respective state and in the United States. CONCLUSIONS: Our results show that the majority of patients with NAION are White, followed by Black and Asian races, respectively, thus confirming the NAION race distribution reported by past clinical trials.

Parapapillary atrophy in optic neuropathies: Histology and clinical relevance.

Parapapillary atrophy is one of the parameters of the optic nerve head area which are assessed during the ophthalmoscopic examination particularly useful to characterize glaucomatous optic neuropathy. Optical coherence tomography evaluation provides high-resolution images of the optic nerve head and surrounding area, and can be used to study parapapillary atrophy. Different parapapillary atrophy zones were described depending on their histological features and research has been conducted to investigate the possible association between the presence and/ or size of parapapillary atrophy zones and several optic nerve disorders. In this review we discuss the histology and the clinical findings related to parapapillary atrophy in patients with glaucomatous optic neuropathy, non-glaucomatous optic neuropathies (e.g. arteritic and non-arteritic anterior ischemic optic neuropathies; suprasellar and parasellar tumors), and other ocular conditions (e.g. high myopia; age-related macular degeneration). Two different histologic classifications were identified. Parapapillary atrophy was demonstrated in glaucoma and glaucoma-like neuropathies, but not in other types of optic nerve disorders.

Normative data for optical coherence tomography in children: a systematic review.

The purpose of this study is to systematically review the reported data of normal optical coherence tomography (OCT) results in the paediatric population. A systematic literature search was performed using the PubMed, Embase, and Web of Science databases, using the keywords "optical coherence tomography"; "normative data" or "healthy eyes"; "children" or "paediatric population". Studies with at least 50 participants were included, irrespective of the OCT equipment employed. We excluded the OCT angiography studies or the studies investigating the choroidal thickness. Seventy-four studies were included in the final analysis and information on study design, number of participants, demographic characteristics, type of OCT equipment, OCT parameters and results was collected. Due to the high variability of OCT instruments and parameters used, a meta-analysis was not feasible. We report the normative values for the peripapillary retinal nerve fibre layer thickness and the macular retinal thickness for each ETDRS quadrant, as provided by the studies included in the present analysis. We also report the influence of ethnicity, age, gender, eye laterality, ISNT rule, spherical equivalent, and axial length on OCT results.

Retinal Alteration Associated with an Arachnoid Cyst of the Pineal Region.

BACKGROUND: Retinal optical coherence tomography (OCT) is a noninvasive high-resolution imaging technique, which is considered a biomarker of neurodegeneration. Several intracranial lesions can induce retrograde neurodegeneration which can be assessed using OCT. The cysts of the pineal region are usually asymptomatic and most often are an incidental radiologic finding. CASE DESCRIPTION: We describe the case of a 50-year-old woman with an arachnoid cyst of the pineal region who complained of visual symptoms for 3 months. Bilateral macular thinning was demonstrated by OCT both on the preoperative and postoperative examinations, without any other clinical findings that could explain the results. CONCLUSIONS: We suggest that the retinal alteration is caused by retrograde neurodegeneration secondary to the pineal region mass.

Modeling Neurodegeneration in Patients with Visual Pathway Tumors by Retinal Optical Coherence Tomography.

OBJECTIVE: Optical coherence tomography (OCT) is a noninvasive, high-resolution imaging technique that was suggested to be a powerful biomarker of neurodegeneration. The objective of our study is to assess the pattern of retinal OCT changes in patients with visual pathway tumors. METHODS: A prospective clinical study was conducted and patients with single cerebral tumors with potential of compression on the visual pathway were included. Patients with multiple and/or metastatic tumors were excluded. Each patient underwent a neurosurgical and ophthalmologic evaluation, cranial-cerebral magnetic resonance imaging, and ocular OCT in both eyes. The OCT parameters included circumpapillary retinal nerve fiber layer thickness (average and sector thickness) and retinal thickness in the macular area (average and sector thickness). RESULTS: Fifty patients were investigated clinically and by magnetic resonance imaging, and 18 patients were excluded. Thirty-two patients were eligible for the study and completed the retinal OCT. Eighteen patients had tumors with compressive potential on the optic chiasm, 11 patients had tumors close to the optic radiations, and 3 patients had tumors in the occipital lobe. A specific pattern of OCT changes was found for each site. Regional parameters of both optic nerve and macula were altered. CONCLUSIONS: Retinal OCT is a promising tool for the in vivo assessment of the neurodegeneration pattern in patients with intracranial tumors. The evaluation of single intracranial tumors with compressive potential on the visual pathway is a good candidate for the study of neurodegeneration.

ANTERIOR CHAMBER SYNCHYSIS SCINTILLANS: A CASE REPORT.

Synchysis scintillans is a vitreous condition in which multiple golden brown opacities are formed as a result of chronic vitreous hemorrhage. Anterior chamber synchysis scintillans was described in patients with afakia or lens subluxation. We report a case of a 63-year-old man with a history of left eye trauma and complete loss of vision, who presented for left eye discomfort. The slit lamp examination revealed crystals of synchysis scintillans and rare inflammatory cells in the anterior chamber, stromal iris atrophy, circumferential posterior iris synechiae, and complete lens opacity. Total retinal detachment was observed on ocular ultrasonography. Intraocular pressure value was in normal range. The distinctiveness of this case is the mechanism of vitreous crystals mobilization into the anterior chamber through an atrophic iris while intraocular pressure remains normal.