1 / 51

Optical Coherence Tomography and Investigation of Optic Neuropathies

Optical Coherence Tomography and Investigation of Optic Neuropathies. Dina Mohammed Abdulmannan Umm Al- Qura University. Optic Neuropathies. Demyelinating Compressive Ischemic Toxic/Nutritional Traumatic Hereditary Inflammatory/Infectious. Optic Neuropathies and OCT.

cole
Download Presentation

Optical Coherence Tomography and Investigation of Optic Neuropathies

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Optical Coherence Tomography and Investigation of Optic Neuropathies Dina Mohammed Abdulmannan Umm Al-Qura University

  2. Optic Neuropathies • Demyelinating • Compressive • Ischemic • Toxic/Nutritional • Traumatic • Hereditary • Inflammatory/Infectious

  3. Optic Neuropathies and OCT • To monitor loss of retinal nerve fiber layer (RNFL) thickness • RNFL thickness is a reflection of axonal integrity in response to injury

  4. Case 1: Anterior Ischemic Optic Neuropathy • 70-year old gentleman • “Blurred vision” in the right eye upon awakening • No Giant Cell Arteritis Symptoms • Vascular risk factors: Diabetes, Hypertension, and Dyslipidemia

  5. Case 1: AION • Visual Acuity:20/40 OD 20/25 OS • Pupils:RAPD OD • IOP:19 mm Hg in both eyes • Fundus:Optic disc edema in the right eye. Absent physiological cup in the left eye

  6. Case 1: AION Clinical Course • Vision worsened in the right eye after a week - Count fingers • No Symptoms of GCA • ESR = 6 mm per hour

  7. OS OD Fundus Photos Optic disc edema (OD)

  8. OS OD Case 1: AION and VF • MD -25.80 dB • Greater loss in superior field • MD -3.60 dB

  9. Fast RNFL Thickness (3.4) 3.4 mm 1.92 seconds

  10. Case 1: RNFL findings Mean RNFL = 52 µ • RNFL thinning in the right eye relative to the left eye • Greatest loss in inferior region correlating with superior VF loss Mean RNFL = 82 µ

  11. Case 1: Anterior Ischemic Optic Neuropathy • OCT done 6 months following ischemic onset • What is timeline for axon loss to occur? • Does timeline differ across other optic neuropathies?

  12. Case 2: Recurrent Optic Neuritis • 20-year old young woman • Developed “blurring” in the right eye • Pain with extraocular movements

  13. Case 2: Recurrent Optic Neuritis Past Medical History • Bilateral optic neuritis in 1993 • treated with IV steroids • Cranial MRI scan normal • CSF analysis normal • No antecedent illness • Residual vision loss 20/40 OD and color vision deficit

  14. Case 2: Recurrent Optic Neuritis • Recurrent optic neuritis in the right eye in 2000 • Repeat MRI scan normal • Vision recovered to baseline • Recurrence of optic neuritis in right eye in spring 2003

  15. Case 2: Recurrent Optic Neuritis • Present Visual Acuity: 20/40 OD 20/20 OS • Pupils: Right RAPD • Fundus: Bilateral optic atrophy (temporal pallor)

  16. OD OS Case 2: Visual Fields • MD -3.81 dB • MD -10.39 dB • Central loss greater in OD

  17. OD OS RNFL Thickness • Bilateral RNFL thinning • worse in OD

  18. Case 1: Recurrent Optic Neuritis • Few reserve axons remaining in OD • Following 3 bouts of optic neuritis • What extent of axonal loss will predict a permanent deficit in vision?

  19. Case 3: Optic Neuritis • 32-year old woman • Diagnosed with MS in 1992 • Reported 6 recurrent bouts of optic neuritis affecting both eyes • Denied active optic neuritits at the time of examination

  20. Case 3: Optic Neuritis • Visual Acuity: 20/25 OU • Pupils: left RAPD • Color Vision: 9/16 Ishihara plates in the right eye, and 6/16 plates in the left eye • Fundus: Bilateral optic atrophy

  21. OD OS Case 3: Optic Neuritis MD -4.31 dB MD -3.03 dB

  22. OS OD Case 3: Optic Neuritis • Residual central field depression OU • Greater in left eye

  23. OD RNFL Thickness OS • RNFL thinning in the left eye relative to the right

  24. RNFL vs Visual Field Loss • How well does the pattern of RNFL loss reflect or correlate with visual field loss in these patients?

  25. Case 4: Compressive Optic Neuropathy • 18 year old male • Developed headache and vision loss in both eyes • Diagnosed with TB Meningitis • Large suprasellar tuberculoma • Causing compression of right ON and optic chiasm

  26. Case 4: Compressive Optic Neuropathy • Visual Acuity: CF OD 20/25 OS • Pupils: Fixed pupil on right, with right RAPD (by reverse testing) • Ocular Motility: Right third nerve palsy with aberrant renervation • Fundi: Bilateral optic atrophy

  27. OS OD Case 4: Compressive Optic Neuropathy • Dense central scotoma OD • Temporal cut OS

  28. Case 4: Compressive Optic Neuropathy MRI: T1-weighted, post Gd Cystic Suprasellar Mass

  29. Case 4: Compressive Optic Neuropathy Mean=40µ • profound bilateral RNFL thinning • worse in the right eye • OCT findings correlated well functional measures of visual integrity Mean=53µ

  30. Case 5: Optic Neuritis? • 41-year old woman • Developed sudden onset vertigo and nausea in the fall of 2002 • Developed vision loss (nasal) and a floater and a “sparkle” in the right eye

  31. Case 5: Optic Neuritis? • Visual acuity measured 20/20 in both eyes • Right RAPD • Color Vision 16/16 Ishihara plates in both eyes • Fundi: Examination normal

  32. Case 5: Optic Neuritis? • The visual field defect persisted • Cranial MRI scan normal • Orbital CT scan normal • CSF analysis normal

  33. Case 5: Optic Neuritis? OS OD • Mean Deviation – 0.31dB • Normal field • Mean Deviation -7.55 dB • Nasal superior and inferior visual field loss

  34. Case 5: Multifocal ERGs mERG Trace Arrays Retinal view Retinal view OD OS • Multifocal ERG recordings from 61 regions in the central 45 degrees • mERG trace arrays appear reduced in inferior and superior temporal retina in OD • mERG trace arrays appear normal in OS

  35. Case 5: Multifocal ERGs Statistical Probability Maps OD OS SPM 85 normal eyes The Patient • Statistical probability mapping of response density was normal in OS • Reduced response density in inferior and superior temporal retina in OD • Correlates with visual field defect in OD

  36. RNFL • RNFL thickness within normal limits OU • Good RNFL symmetry between eyes

  37. Case 5: Optic Neuritis? • In May, 2003 the patient reported new “sparkles” in the left eye Summary: • Atypical Optic Neuritis • MS work-up negative • Lack of optic disc pallor • Persistent visual field defect • Positive visual phenomena and floaters in both eyes

  38. Case 5: Optic Neuritis? • Diagnosis: Acute Zonal Occult Outer Retinopathy

  39. Case 5: Optic Neuritis? • The clinical distinction between a retinal versus an optic nerve problem may be difficult • Ancillary studies such as OCT and mERG can be very useful in this regard

  40. Case 6: Traumatic Optic Neuropathy? • 61-year old woman was hit with a tennis ball in the left temple in October 2002 • Developed chronic headaches • Noted inferior visual field loss in the left eye • Referred to the Neuro-Ophthalmology Clinic in January 2003

  41. Case 6: Traumatic Optic Neuropathy? • Visual Acuity: 20/20 in the right eye and 20/25 in the left eye • Pupils: Equal with no RAPD • Color Vision: 15/16 Ishihara Plates in the right eye, and 12/16 plates in the left eye • Fundi: Normal

  42. Case 6: Traumatic Optic Neuropathy? • Serology Studies- Normal • Cranial/Orbital CT scan- Normal • Orbital Ultrasound- Normal

  43. Case 6: Traumatic Optic Neuropathy? • In April, 2003 the patient developed new visual field loss in the right eye • In May, 2003 she noted sparkles, flashes, and floaters in both eyes

  44. MD -6.91 dB MD -0.64 dB OD OS Case 6: Traumatic Optic Neuropathy • Visual Fields Obtained in March 2003 • OD-Normal • OS-defects in superior and inferior

  45. MD -7.81 dB MD -2.41 dB OS OD Case 6: Traumatic Optic Neuropathy? • Visual Fields obtained in April 2003 • OD- now developing VF defects • OS- visual defects worsened

  46. Case 6: Traumatic Optic Neuropathy? Repeat Examination • Visual acuity: 20/25 in both eyes • Pupils: equal with no RAPD • Color Vision: 12/16 Ishihara Plates in the right eye, and 7.5/16 plates in the left eye • Fundi: Normal

  47. Case 6: Traumatic Optic Neuropathy? mERG Trace Arrays Retinal view Retinal view OD OS • Multifocal ERGs from 61 regions in the central 45 degrees • mERGs from OD are diminished centrally extending to superior nasal retina • mERGs from OS show multiple patchy areas of abnormality

  48. Case 6: Traumatic Optic Neuropathy Statistical Probability Maps OD OS • Statistical probability mapping shows areas of significantly reduced response density centrally and in superior nasal retina in OD • OS shows much greater involvement in response density reduction in inferior and superior retina

  49. RNFL • RNFL thickness within normal limits OU • Good RNFL symmetry between eyes

  50. Case 6: Traumatic Optic Neuropathy? • Diagnosis: Acute Zonal Occult Outer Retinopathy • Para-neoplastic work-up was recommended by Retinal Specialist

More Related