Overview of optical coherence tomography in neuro-ophthalmology

Optical coherence tomography(OCT)is a widely used non-invasive medical imaging technology that has revolutionized clinical care in ophthalmology.New developments,such as OCT angiography(OCTA)are expected to contribute even further to the widespread use of OCT-based imaging devices in the diagnosis and monitoring of patients with ophthalmic diseases.In recent years,many of the disadvantages such as limited field of view and imaging artefacts have been substantially reduced.Similar to the progress achieved in the assessment of retinal disorders,OCT is expected to change the approach to patients seen in the neuro-ophthalmology clinic.In this article,we review the technical features of OCT and OCT-based imaging techniques,highlighting the specific factors that should be taken into account when interpreting OCT in the field of neuro-ophthalmology.

Pediatric neuro-ophthalmology:not simply neuro-ophthalmology for small adults

Pediatric neuro-ophthalmology is a subspecialty within neuro-ophthalmology.Pediatric neuro-ophthalmic diseases must be considered separate from their adult counterparts,due to the distinctive nature of the examination,clinical presentations,and management choices.This manuscript will highlight four common pediatric neuro-ophthalmic disorders by describing common clinical presentations,recommended management,and highlighting recent developments.Diseases discussed include pediatric idiopathic intracranial hypertension(IIH),pseudopapilledema,optic neuritis(ON)and optic pathway gliomas(OPG).The demographics,diagnosis and management of common pediatric neuro-ophthalmic disease require a working knowledge of the current research presented herein.Special attention should be placed on the differences between pediatric and adult entities such that children can be appropriately diagnosed and treated.

Myasthenia gravis

Myasthenia gravis(MG)is an autoimmune antibody-mediated disorder which causes fluctuating weakness in ocular,bulbar and limb skeletal muscles.There are two major clinical types of MG.Ocular MG(OMG)affects extra ocular muscles associated with eye movement and eyelid function and generalized MG results in muscle weakness throughout the body.Patients with OMG have painless fluctuating extra ocular muscles weakness,diplopia and ptosis accompanied by normal visual acuity and pupillary function.Frequently,patients with OMG develop generalized MG over 24 months.Pure OMG is more often earlier in onset(<45 years)than generalized MG.It can also occur as part of an immune-genetic disorder or paraneoplastic syndrome related to thymus tumors.Diagnosis is based on clinical manifestations,laboratory findings,electrophysiological evaluation and pharmacologic tests.Therapeutic strategies for MG consist of symptom relieving medications(e.g.,acetylcholine esterase inhibitors),immunosuppressive agents,and surgical intervention(e.g.,thymectomy).

Visual findings as primary manifestations in patients with intracranial tumors

· AIM: To evaluate the visual findings as primary manifestations in patients with intracranial tumors.·METHODS: The medical charts of the patients with intracranial tumors who initially admitted to the Neuro-ophthalmology and Strabismus Department with ocular complaints between August 1999 and December 2012 were reviewed retrospectively. The detailed clinical history and the findings of neuro-ophthalmologic examination were recorded. Ocular symptoms and signs,the types and locations of intracranial tumors, and the duration of symptoms before the diagnosis were evaluated.·RESULTS: The mean age of 11 women(61.1%) and 7men(38.9%) was 42.2±11.0(range 20-66y) at the time of intracranial tumor diagnosis. Initial symptoms were transient visual obscurations, visual loss or visual field defect in 16 cases(88.9%), and diplopia in 2 cases(11.1%). Neuro-ophthalmologic examination revealed normal optic discs in both eyes of 6 patients(33.3%),paleness, atrophy or edema of optic disc in 12 patients(66.7%), and sixth cranial nerve palsy in 2 patients(11.1%). Visual acuity ranged between normal vision and loss of light perception. Cranial imaging demonstrated craniopharyngioma(n =1), plasmacytoma(n =1),meningioma(n =6; olfactory groove and tuberculum sellae, pontocerebellar angle, anterior cranial fossa,frontal vertex, suprasellar region), and pituitary macroadenoma(n =10). The mean duration between the onset of visual disturbances and the diagnosis of intracranial tumor was 9.8±18mo(range 3d-6y).·CONCLUSION: The ophthalmologist is frequently the first physician to encounter a patient with clinical manifestations of intracranial tumors that may cause neurological and ocular complications. Neuro-ophthalmologic findings should be carefully evaluated to avoid a delay in the diagnosis of intracranial tumors.