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Purpose: This study uses deep neural network-generated rim-to-disc area ratio (RADAR) measurements and the disc damage likelihood scale (DDLS) to measure the rate of optic disc rim loss in a large cohort of glaucoma patients. Methods: A deep neural network was used to calculate RADAR and DDLS for each optic disc photograph (ODP). Patient demographics, diagnosis, intraocular pressure (IOP), and mean deviation (MD) from perimetry were analyzed as risk factors for faster progression of RADAR. Receiver operating characteristic (ROC) curves were used to compare RADAR and DDLS in their utility to distinguish glaucoma from glaucoma suspect (GS) and for detecting glaucoma progression. Results: A total of 13,679 ODPs with evidence of glaucomatous optic nerve damage from 4106 eyes of 2407 patients with glaucoma or GS were included. Of these eyes, 3264 (79.5%) had a diagnosis of glaucoma, and 842 (20.5%) eyes were GS. Mean ± SD baseline RADAR of GS and glaucoma were 0.67 ± 0.13 and 0.57 ± 0.18, respectively (P < 0.001). Older age, greater IOP fluctuation, baseline MD, right eye, and diagnosis of secondary open-angle glaucoma were associated with slope of RADAR. The mean baseline DDLS of GS and glaucoma were 3.78 and 4.39, respectively. Both RADAR and DDLS showed a less steep slope in advanced glaucoma. In glaucoma, the change of RADAR and DDLS correlated with the corresponding change in MD. RADAR and DDLS had a similar ability to discriminate glaucoma from GS and detect disease progression. Area under the ROC curve of RADAR and DDLS was 0.658 and 0.648. Conclusions: Automated calculation of RADAR and DDLS with a neural network can be used to evaluate the extent and long-term rate of optic disc rim loss and is further evidence of long-term nerve fiber loss in treated patients with glaucoma. Translational Relevance: Our study provides a large clinic-based experience for RADAR and DDLS measurements in GS and glaucoma with a neural network.
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Progresión de la Enfermedad , Glaucoma , Presión Intraocular , Redes Neurales de la Computación , Disco Óptico , Curva ROC , Humanos , Disco Óptico/patología , Disco Óptico/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana Edad , Presión Intraocular/fisiología , Glaucoma/diagnóstico , Glaucoma/fisiopatología , Anciano , Fotograbar , Enfermedades del Nervio Óptico/diagnóstico , Campos Visuales/fisiología , Pruebas del Campo Visual/métodos , Adulto , Estudios RetrospectivosRESUMEN
INTRODUCTION: Visual loss secondary to a vascular loop or atherosclerotic carotid has been a controversial topic for many years with contemporary data supporting its existence. The role of surgery in the management of this entity is not well defined. We performed a systematic review describing the different surgical techniques and outcomes. METHOD: A search strategy was devised in accordance with the 2020 Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) statement. An electronic search was performed from the databases Pubmed, Google scholar, Scopus and Web of Science databases. The search was performed from inception until the 10th of December 2023. RESULTS: A total of 2469 articles were screened with 15 articles describing 18 patients being included. Of these cases, eleven involved compression due to unilateral or bilateral dolichoectatic internal carotid artery (ICA), three for a dolichoectatic anterior cerebral artery (ACA), two for a combination of a dolichoectatic ICA with a dorsolateral ophthalmic artery and two for a combination of a dolichoectatic ICA and ACA. CONCLUSION: Two distinct compressive entities can be differentiated. Compressive optic neuropathy at the entrance of the optic canal due to pinching between an ectatic carotid and the falciform ligament. A second entity is due to compression of the cisternal optic nerve or chiasm secondary tot a vascular loop. A variety of surgical techniques have been described and include: unroofing of the optic canal with sectioning of the falciform ligament; microvascular decompression with a Teflon® pellet, a muscle patch or, rerouting of the offending vessel with a sling. Larger and prospective studies are needed to better define the role of surgery in this, probably, underreported pathology.
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Arteria Carótida Interna , Vías Visuales , Humanos , Vías Visuales/cirugía , Arteria Carótida Interna/cirugía , Arteria Oftálmica/cirugía , Arteria Cerebral Anterior/cirugía , Síndromes de Compresión Nerviosa/cirugía , Procedimientos Neuroquirúrgicos/métodos , Descompresión Quirúrgica/métodos , Enfermedades del Nervio Óptico/cirugíaRESUMEN
OBJECTIVES: Train an automatic retinal image analysis (ARIA) method to screen glaucomatous optic neuropathy (GON) on non-mydriatic retinal images labelled with the additional results of optical coherence tomography (OCT) and assess different models for the GON classification. METHODS: All the images were obtained from the hospital for training and 10-fold cross-validation. Two methods were used to improve the classification performance: (1) using images labelled with the additional results of OCT as the reference standard and (2) generating models using retinal features from the entire images, the region of interest (ROI) of the optic disc, and the ROI of the macula, and the combination of all the features. RESULTS: Overall, we collected 1338 images with paired OCT scans. In 10-fold validation, ARIA achieved sensitivities of 92.2 %, 92.7% and 85.7%, specificities of 88.8%, 86.7% and 80.2% and accuracies of 90.6%, 89.9% and 83.1% using the retinal features from the entire images, the ROI of the optic disc and the ROI of the macula, respectively. We found the model combining all the features has the best classification performance and obtained a sensitivity of 92.5%, a specificity of 92.1% and an accuracy of 92.4%, which is significantly different from other models (p<0.001). CONCLUSION: We used two methods to improve the classification performance and found the best model to detect glaucoma on colour fundus retinal images. It can become a cost-effective and relatively more accurate glaucoma screening tool than conventional methods.
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Disco Óptico , Enfermedades del Nervio Óptico , Tomografía de Coherencia Óptica , Humanos , Tomografía de Coherencia Óptica/métodos , Enfermedades del Nervio Óptico/diagnóstico por imagen , Enfermedades del Nervio Óptico/diagnóstico , Disco Óptico/diagnóstico por imagen , Disco Óptico/patología , Femenino , Masculino , Persona de Mediana Edad , Fondo de Ojo , Glaucoma/diagnóstico por imagen , Anciano , Procesamiento de Imagen Asistido por Computador/métodos , Células Ganglionares de la Retina/patología , Fibras Nerviosas/patología , Presión Intraocular , Campos VisualesRESUMEN
PRCIS: A large disk, a large parapapillary delta zone and a long axial length may be used as screening criteria to detect glaucomatous optic neuropathy in highly myopic eyes. PURPOSE: To describe aspects for screening of glaucomatous optic neuropathy in dependence of refractive error, under special consideration of high myopia. METHODS/RESULTS: Studies on the anatomy of the myopic optic nerve head and results of investigations on the relationship between glaucomatous optic neuropathy and axial myopia were included. CONCLUSIONS: In the range from hyperopia to moderate myopia, refractive error is not a strong glaucoma risk factor and may not be included in glaucoma screening strategies. Care should be taken, that in moderate myopia, a shift of Bruch´s membrane opening usually into the temporal direction leads to parapapillary gamma zone and a corresponding shortening of the horizontal disk diameter. In these moderately myopic eyes, a secondarily small optic disk with a correspondingly small optic cup should not lead to an overlooking of intrapapillary glaucomatous changes. Prevalence of glaucomatous or glaucoma-like optic nerve atrophy (GOA) steeply increases with longer axial length in highly myopic eyes (cutoff approximately -8 diopters/axial length 26.5 mm), with prevalences higher than 50% in extremely high myopia. Besides longer axial length, morphological parameters associated with GOA in highly myopic eyes are a secondarily enlarged disk and large parapapillary delta zone. Both parameters, together with long axial length, may be used as screening criteria in high myopia for GOA. The latter is characterized by an abnormal neuroretinal rim shape, that is, vessel kinking close to the intrapapillary disk border. Factors associated with nonglaucomatous optic neuropathy are larger gamma zone and longer axial length, potentially due to an axial elongation-related retinal nerve fiber stretching.
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Miopía , Disco Óptico , Humanos , Disco Óptico/patología , Disco Óptico/diagnóstico por imagen , Miopía/diagnóstico , Miopía/complicaciones , Glaucoma/diagnóstico , Glaucoma/complicaciones , Longitud Axial del Ojo/patología , Enfermedades del Nervio Óptico/diagnóstico , Errores de Refracción/diagnóstico , Presión Intraocular/fisiología , Factores de Riesgo , Atrofia Óptica/diagnósticoRESUMEN
OBJECTIVE: This study aimed to develop and test a model for predicting dysthyroid optic neuropathy (DON) based on clinical factors and imaging markers of the optic nerve and cerebrospinal fluid (CSF) in the optic nerve sheath. METHODS: This retrospective study included patients with thyroid-associated ophthalmopathy (TAO) without DON and patients with TAO accompanied by DON at our hospital. The imaging markers of the optic nerve and CSF in the optic nerve sheath were measured on the water-fat images of each patient and, together with clinical factors, were screened by Least absolute shrinkage and selection operator. Subsequently, we constructed a prediction model using multivariate logistic regression. The accuracy of the model was verified using receiver operating characteristic curve analysis. RESULTS: In total, 80 orbits from 44 DON patients and 90 orbits from 45 TAO patients were included in our study. Two variables (optic nerve subarachnoid space and the volume of the CSF in the optic nerve sheath) were found to be independent predictive factors and were included in the prediction model. In the development cohort, the mean area under the curve (AUC) was 0.994, with a sensitivity of 0.944, specificity of 0.967, and accuracy of 0.901. Moreover, in the validation cohort, the AUC was 0.960, the sensitivity was 0.889, the specificity was 0.893, and the accuracy was 0.890. CONCLUSIONS: A combined model was developed using imaging data of the optic nerve and CSF in the optic nerve sheath, serving as a noninvasive potential tool to predict DON.
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Oftalmopatía de Graves , Enfermedades del Nervio Óptico , Nervio Óptico , Humanos , Masculino , Femenino , Persona de Mediana Edad , Nervio Óptico/diagnóstico por imagen , Nervio Óptico/patología , Oftalmopatía de Graves/líquido cefalorraquídeo , Oftalmopatía de Graves/diagnóstico por imagen , Enfermedades del Nervio Óptico/diagnóstico por imagen , Enfermedades del Nervio Óptico/líquido cefalorraquídeo , Enfermedades del Nervio Óptico/diagnóstico , Adulto , Estudios Retrospectivos , Curva ROC , Biomarcadores/líquido cefalorraquídeo , Líquido Cefalorraquídeo/diagnóstico por imagen , AncianoRESUMEN
Immunoglobulin G4 (IgG4)-related disease is a clinical entity characterized by elevated serum IgG4 concentrations and infiltration of IgG4-immunopositive plasmacytes in various organs, including ophthalmic lesions. Diagnostic criteria for IgG4-related ophthalmic disease (IgG4-ROD) were established in 2014 and describe the most affected ocular adnexal tissues such as lacrimal glands, trigeminal nerves and extraocular muscles, but do not mention optic neuropathy, the most severe indication of ophthalmic lesions. We reviewed published case reports of optic neuropathy in IgG4-related disease (n = 44), and in many cases, decreased visual acuities recovered well following treatment such as systemic corticosteroids, rituximab, and orbital surgery. However, some patients did not recover, especially when pretreatment visual acuities were as low as light perception or less. Herein, we propose a 2023 revised diagnostic criteria for IgG4-ROD, which include a reminder not to overlook optic neuropathy. The 2014 diagnostic criteria specify mucosa-associated lymphoid tissue (MALT) lymphoma as an important differential diagnosis for the relationship between IgG4-ROD and orbital lymphoma. The 2023 revision directs physicians' attention toward lymphomas other than MALT lymphoma, considering that the 2014 criteria might have placed too much emphasis on MALT lymphoma.
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Enfermedad Relacionada con Inmunoglobulina G4 , Inmunoglobulina G , Humanos , Enfermedad Relacionada con Inmunoglobulina G4/diagnóstico , Inmunoglobulina G/sangre , Diagnóstico Diferencial , Oftalmopatías/diagnóstico , Enfermedades del Nervio Óptico/diagnóstico , Enfermedades del Nervio Óptico/inmunologíaRESUMEN
BACKGROUND: Peripapillary hyperreflective ovoid mass-like structures (PHOMS) are a recently defined optical coherence tomography (OCT) finding. The purpose of this study was to characterize the presence of PHOMS and their visual significance in pediatric patients with and without optic nerve pathologies. METHODS: This retrospective study evaluated 400 patients (<18 years of age) including normal control subjects and patients with optic neuritis, papillitis, optic nerve head drusen (ONHD), and papilledema. Information on demographics, visual function, and structural parameters were obtained. RESULTS: PHOMS were found in 7 of 258 normal control eyes (2.7%), 9 of 59 eyes with optic neuritis (15.3%), 58 of 76 eyes with ONHD (76.3%), 3 of 11 eyes with papillitis (27.3%), and 180 of 308 eyes with papilledema (58.4%). PHOMS were more prevalent in the papilledema (P < 0.001), ONHD (P < 0.001), and optic neuritis (P = 0.028) eyes than in control eyes. We identified 5 cases where PHOMS developed de novo. This occurred over an average of 2.3 years (range, 0.2-7.4 years). Sixteen cases of PHOMS resolved over an average of 1.1 years (range, 0.3-4.0 years). Cross-sectionally, PHOMS were not associated with visual acuity (P = 0.551), retinal nerve fiber layer thickness (P = 0.068), ganglion cell volume (P = 0.375), or visual field mean deviation (P = 0.795). CONCLUSIONS: PHOMS are present in a majority of children with papilledema or ONHD. PHOMS are dynamic and may form de novo over time with optic nerve pathology and may resolve either through treatment or atrophy. There was no relationship between the presence of PHOMS and poor visual function in our study cohort.
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Drusas del Disco Óptico , Disco Óptico , Enfermedades del Nervio Óptico , Papiledema , Tomografía de Coherencia Óptica , Agudeza Visual , Humanos , Estudios Retrospectivos , Tomografía de Coherencia Óptica/métodos , Niño , Femenino , Masculino , Agudeza Visual/fisiología , Adolescente , Prevalencia , Papiledema/diagnóstico , Papiledema/fisiopatología , Disco Óptico/patología , Disco Óptico/diagnóstico por imagen , Preescolar , Enfermedades del Nervio Óptico/diagnóstico , Enfermedades del Nervio Óptico/fisiopatología , Drusas del Disco Óptico/fisiopatología , Drusas del Disco Óptico/diagnóstico , Campos Visuales/fisiología , Fibras Nerviosas/patología , Células Ganglionares de la Retina/patología , Neuritis Óptica/fisiopatología , Neuritis Óptica/diagnóstico , LactanteRESUMEN
BACKGROUND: Handheld optical coherence tomography (HH-OCT) can image awake, young children but lacks integrated segmentation/analysis software. OCT imaging of eyes with optic neuropathies demonstrates ganglion cell layer (GCL) and ganglion cell complex (GCC) thinning, with a normal or thickened inner nuclear layer (INL). We compared pediatric normative data with GCL/INL and GCC/INL ratios from HH-OCT macular scans of awake young children with clinically diagnosed optic neuropathies. METHODS: Macular HH-OCT from awake children with optic neuropathies was prospectively obtained using Bioptigen (Leica Microsystems, Wetzlar, Germany). The GCL, GCC, and INL were manually measured by two readers using ImageJ from single-line macular scans at the thickest points nasal and temporal to the fovea, respectively, and the GCL/INL and GCC/INL ratios were calculated and compared with normative data. RESULTS: HH-OCT images from 17 right eyes of 17 children (mean age, 4.3 ± 2.9 years) with optic neuropathies were analyzed. Mean nasal (17 eyes) and temporal (16 eyes) GCL/INL ratios with optic neuropathies were 0.44 ± 0.38 (95% CI, 0.26-0.62) and 0.26 ± 0.22 (95% CI, 0.15-0.36), respectively. Corresponding normative GCL/INL ratios are 1.26 ± 0.20 (95% CI, 1.19-1.34) and 1.23 ± 0.27 (95% CI, 1.13-1.33), respectively (P < 0.0001). Severe thinning precluded GCL measurements in 2 eyes nasally and 5 eyes temporally, resulting in GCL measurements of zero. Mean nasal (17 eyes) and temporal (16 eyes) GCC/INL ratios were 1.93 ± 0.70 (95% CI,1.60-2.27) and 1.67 ± 0.44 (95% CI,1.46-1.87). Corresponding normative ratios are 2.85 ± 0.38 (95% CI, 2.71-2.99) and 2.87 ± 0.42 (95% CI, 2.70-3.03), respectively (P < 0.0001). CONCLUSIONS: GCL/INL and GCC/INL ratios calculated from single-line macular HH-OCT scans in awake young children with optic neuropathies differ significantly from normative values and may thus have utility in helping to establish a diagnosis of optic neuropathy.
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Enfermedades del Nervio Óptico , Células Ganglionares de la Retina , Tomografía de Coherencia Óptica , Humanos , Tomografía de Coherencia Óptica/métodos , Preescolar , Masculino , Femenino , Células Ganglionares de la Retina/patología , Lactante , Enfermedades del Nervio Óptico/diagnóstico , Enfermedades del Nervio Óptico/diagnóstico por imagen , Estudios Prospectivos , Niño , Fibras Nerviosas/patología , Vigilia , Mácula Lútea/diagnóstico por imagen , Mácula Lútea/patologíaRESUMEN
Optical coherence tomography (OCT) is a non-invasive imaging technology, which may be used to generate in vivo quantitative and qualitative measures of retinal structure. In terms of quantitative metrics, peripapillary retinal nerve fiber layer (pRNFL) thickness provides an indirect evaluation of axonal integrity within the optic nerve. Ganglion layer measures derived from macular scans indirectly reflect retinal ganglion cell status. Notably, ganglion layer indices are platform dependent and may include macular ganglion cell inner plexiform layer (mGCIPL), ganglion cell layer (GCL), and ganglion cell complex (GCC) analyses of thickness or volume. Interpreted together, pRNFL thickness and ganglion layer values can be used to diagnose optic neuropathies, monitor disease progression, and gauge response to therapeutic interventions for neuro-ophthalmic conditions. Qualitative assessments of the optic nerve head, using cross-sectional transverse axial, en face, and circular OCT imaging, may help distinguish papilledema from pseudopapilloedema, and identify outer retinal pathology. Innovations in OCT protocols and approaches including enhanced depth imaging (EDI), swept source (SS) techniques, and angiography (OCTA) may offer future insights regarding the potential pathogenesis of different optic neuropathies. Finally, recent developments in artificial intelligence (AI) utilizing OCT images may overcome longstanding challenges, which have plagued non-vision specialists who often struggle to perform reliable ophthalmoscopy. In this review, we aim to discuss the benefits and pitfalls of OCT, consider the practical applications of this technology in the assessment of optic neuropathies, and highlight scientific discoveries in the realm of optic nerve imaging that will ultimately change how neuro-ophthalmologists care for patients.
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Fibras Nerviosas , Enfermedades del Nervio Óptico , Células Ganglionares de la Retina , Tomografía de Coherencia Óptica , Tomografía de Coherencia Óptica/métodos , Humanos , Células Ganglionares de la Retina/patología , Enfermedades del Nervio Óptico/diagnóstico por imagen , Enfermedades del Nervio Óptico/diagnóstico , Fibras Nerviosas/patología , Nervio Óptico/diagnóstico por imagen , Nervio Óptico/patología , Disco Óptico/diagnóstico por imagen , Disco Óptico/patologíaRESUMEN
AIMS: To investigate the alterations of the optic nerve and visual cortex in dysthyroid optic neuropathy (DON), a subgroup of thyroid eye disease (TED). METHODS: Multiple orbital imaging biomarkers related to optic nerve compression and the amplitude of low-frequency fluctuations (ALFF) of the brain were obtained from 47 patients with DON, 56 TED patients without DON (nDON), and 37 healthy controls (HC). Correlation analyses and diagnostic tests were implemented. RESULTS: Compared with HC, the nDON group showed alterations in orbital imaging biomarkers related to optic nerve compression in posterior segments, as well as ALFF of the right inferior temporal gyrus and left fusiform gyrus. DON differed from nDON group mainly in the modified muscle index of the posterior segment of optic nerve, and ALFF of orbital part of right superior frontal gyrus, right hippocampus, and right superior temporal gyrus. Orbital and brain imaging biomarkers were significantly correlated with each other. Diagnostic models attained an area under a curve of 0.80 for the detection of DON. CONCLUSION: The combined orbital and brain imaging study revealed alterations of the visual pathway in patients with TED and DON as well as provided diagnostic value. The initiation of alterations in the visual cortex in TED may precede the onset of DON.
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Oftalmopatía de Graves , Imagen por Resonancia Magnética , Enfermedades del Nervio Óptico , Corteza Visual , Humanos , Masculino , Femenino , Persona de Mediana Edad , Oftalmopatía de Graves/diagnóstico por imagen , Oftalmopatía de Graves/complicaciones , Corteza Visual/diagnóstico por imagen , Adulto , Imagen por Resonancia Magnética/métodos , Enfermedades del Nervio Óptico/diagnóstico por imagen , Órbita/diagnóstico por imagen , Nervio Óptico/diagnóstico por imagen , AncianoRESUMEN
The current primary approach to the therapeutic and surgical management of glaucoma is limited to lowering intraocular pressure (IOP). While normalization of IOP stabilizes some functional parameters, there is still potential for further restoration of lost visual function in the post-operative period while maintaining the "therapeutic window". Neuroprotection refers to the modification of retinal ganglion cells and the neuronal microenvironment to promote their survival and function. Numerous studies have identified effective neuroprotective methods for glaucoma; however, their implementation into clinical practice remains a significant challenge. This review presents the most clinically significant treatment strategies, as well as the latest therapeutic advances in physiotherapy.
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Glaucoma , Enfermedades del Nervio Óptico , Modalidades de Fisioterapia , Humanos , Glaucoma/cirugía , Glaucoma/fisiopatología , Glaucoma/etiología , Enfermedades del Nervio Óptico/etiología , Enfermedades del Nervio Óptico/diagnóstico , Enfermedades del Nervio Óptico/terapia , Presión Intraocular/fisiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/terapia , Células Ganglionares de la Retina/patologíaRESUMEN
PRCIS: Diagnosis of glaucoma through telemedicine demonstrates moderate agreement with in-person ophthalmologist (MD) and in-person optometrist (OD) diagnosis, providing evidence that telemedicine is a timely, accurate screening method in settings where an in-person visit may not be feasible. OBJECTIVE: To compare diagnostic agreement of glaucoma between in-person MD, in-person OD, and a simulated telemedicine program. PATIENTS AND METHODS: A cross-sectional study of patients with normal optic nerve structural and functional imaging and new patients referred for glaucoma evaluation examined in-person by an MD for glaucoma with a dilated examination and structural and functional optic nerve testing (optical coherence tomography, photos, and visual field); examined in person by an OD with a dilated examination and optic nerve testing; and structural and functional optic nerve testing reviewed separately by 2 ophthalmologists [telemedicine ophthalmologist reviewer 1 (TMD1), telemedicine ophthalmologist reviewer 2 (TMD2)] with masking of prior MD and OD diagnoses. Interrater agreement between each diagnostic method (MD, OD, TMD1, and TMD2) of normal versus disease (open angle glaucoma, normal tension glaucoma, other types of glaucoma, other optic nerve disorders, ocular hypertension, and glaucoma suspect) for each eye was calculated (Cohen unweighted kappa). RESULTS: A total of 100 patients with a median age of 66 years (interquartile range: 59-72), male (40%) and white (62%) were analyzed. There was moderate agreement between MD and telemedicine [TMD1 kappa 0.49 (95% CI: 0.37-0.61), TMD2 kappa 0.44 (95% CI: 0.32-0.56)] and between MD and OD diagnosis [0.41 (95% CI: 0.28-0.54)] and fair-moderate agreement between OD and telemedicine [TMD1: 0.46 (95% CI: 0.34-0.58), TMD2: 0.61 (95% CI: 0.50-0.72)]. CONCLUSIONS: The simulated telemedicine approach had comparable levels of agreement in glaucoma diagnosis with in-person fellowship-trained ophthalmologists, presenting a crucial complementary role in screening and increasing access to care, particularly in rural or underserved settings.
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Glaucoma , Presión Intraocular , Oftalmólogos , Optometristas , Telemedicina , Tomografía de Coherencia Óptica , Campos Visuales , Humanos , Estudios Transversales , Masculino , Femenino , Persona de Mediana Edad , Tomografía de Coherencia Óptica/métodos , Anciano , Campos Visuales/fisiología , Glaucoma/diagnóstico , Presión Intraocular/fisiología , Reproducibilidad de los Resultados , Pruebas del Campo Visual/métodos , Enfermedades del Nervio Óptico/diagnóstico , Glaucoma de Ángulo Abierto/diagnósticoRESUMEN
Purpose: To investigate the potential causal association between COVID-19 exposure and optic nerve and visual pathway disorders through a two-sample bidirectional Mendelian randomization (MR) analysis, and to provide empirical support for the lung-brain axis. Methods: This MR analysis utilized publicly accessible summary-level data from genome-wide association studies on COVID-19 (n=158,783) and optic nerve and visual pathway diseases (n=412,181), primarily involving individuals of European descent. The random-effect inverse-variance weighted estimation was applied as the main analytical approach, complemented by MR-Egger, weighted median, and weighted mode methods. The heterogeneity and pleiotropy of the instrumental variables were assessed using Cochran's Q test, leave-one-out sensitivity analysis, MR-Egger intercept test, MR-PRESSO, and funnel plot evaluations. Results: In the forward analysis, the inverse-variance weighted method identified a significant causal effect of COVID-19 on optic nerve and visual pathway disorders (odds ratio = 1.697, 95% confidence interval: 1.086-2.652, p = 0.020). Directionally consistent results were also observed with MR-Egger regression, weighted median, and weighted mode approaches. Conversely, the reverse analysis revealed no causal effects of optic nerve and visual pathway disorders on COVID-19 susceptibility. Conclusion: Our findings suggest that COVID-19 exposure may increase the risk of developing optic nerve and visual pathway disorders, supporting the lung-brain axis hypothesis. These results underscore the importance of vigilant monitoring of the visual system in patients recovering from COVID-19 and suggest potential avenues for future therapeutic strategies.
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COVID-19 , Estudio de Asociación del Genoma Completo , Análisis de la Aleatorización Mendeliana , SARS-CoV-2 , Humanos , COVID-19/genética , SARS-CoV-2/fisiología , Pulmón/virología , Nervio Óptico , Encéfalo/virología , Enfermedades del Nervio Óptico/genética , Vías Visuales , Predisposición Genética a la Enfermedad , Polimorfismo de Nucleótido SimpleRESUMEN
Purpose: To determine the microstructure of the lamina cribrosa (LC) associated with microvasculature dropout (MvD) of the deep optic nerve head (ONH) in primary open-angle glaucoma (POAG) and to identify factors related to the presence of MvD. Methods: POAG eyes that exhibited MvD in the LC (MvD-LC) or MvD in the peripapillary choroid (MvD-PC) underwent optical coherence tomography and optical coherence tomography angiography (OCTA) to evaluate the structure and microvasculature of the deep ONH, respectively. The presence of MvD-LC or MvD-PC was determined using en face OCTA images of the deep ONH. The sectoral LC thickness (LCT) and LC curvature index (LCCI) (at MvD-LC site, when applicable), the mean LCT and LCCI of the global ONH, and other clinical characteristics were measured and compared between eyes with and without MvD-LC. Results: The study included 93 eyes with and 51 without MvD-LC. The presence of MvD-LC was associated with lower sectoral LCT (odds ratio [OR] = 0.96, P < 0.001) and mean LCT (OR = 0.97, P = 0.032), larger visual field pattern standard deviation (PSD; OR = 1.20, P = 0.038), and higher pretreatment intraocular pressure (IOP; OR = 1.22, P = 0.012). Fifteen percent of the eyes with MvD-LC (14/93) did not present MvD-PC. Those eyes had younger age (P = 0.043), thicker juxtapapillary choroid (P = 0.018), larger sectoral LCCI (P = 0.040), thicker retinal nerve fiber layer (P = 0.024), smaller PSD (P = 0.008), and higher pretreatment IOP (P = 0.006) than those with both MvD-LC and MvD-PC. Conclusions: MvD-LC was associated with a localized morphologic alteration of the LC, and eyes with MvD-LC tended to have a higher pretreatment IOP. The clinical implications of MvD-LC should differ from those of MvD-PC in eyes with POAG.
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Glaucoma de Ángulo Abierto , Presión Intraocular , Microvasos , Disco Óptico , Tomografía de Coherencia Óptica , Campos Visuales , Humanos , Tomografía de Coherencia Óptica/métodos , Glaucoma de Ángulo Abierto/fisiopatología , Disco Óptico/irrigación sanguínea , Disco Óptico/patología , Disco Óptico/diagnóstico por imagen , Femenino , Masculino , Microvasos/patología , Microvasos/diagnóstico por imagen , Persona de Mediana Edad , Presión Intraocular/fisiología , Anciano , Campos Visuales/fisiología , Células Ganglionares de la Retina/patología , Angiografía con Fluoresceína/métodos , Fibras Nerviosas/patología , Enfermedades del Nervio Óptico/fisiopatología , Enfermedades del Nervio Óptico/diagnóstico , Estudios Retrospectivos , Vasos Retinianos/patología , Vasos Retinianos/diagnóstico por imagen , Coroides/irrigación sanguínea , Coroides/patología , Coroides/diagnóstico por imagen , Estudios TransversalesRESUMEN
Purpose: The purpose of this study was to investigate the effect of globe and optic nerve (ON) morphologies and tissue stiffnesses on gaze-induced optic nerve head deformations using parametric finite element modeling and a design of experiment (DOE) approach. Methods: A custom software was developed to generate finite element models of the eye using 10 morphological parameters: dural radius, scleral, choroidal, retinal, pial and peripapillary border tissue thicknesses, prelaminar tissue depth, lamina cribrosa (LC) depth, ON radius, and ON tortuosity. A central composite face-centered design (1045 models) was used to predict the effects of each morphological factor and their interactions on LC strains induced by 13 degrees of adduction. Subsequently, a further DOE analysis (1045 models) was conducted to study the effects and potential interactions between the top five morphological parameters identified from the initial DOE study and five critical tissue stiffnesses. Results: In the DOE analysis of 10 morphological parameters, the 5 most significant factors were ON tortuosity, dural radius, ON radius, scleral thickness, and LC depth. Further DOE analysis incorporating biomechanical parameters highlighted the importance of dural and LC stiffness. A larger dural radius and stiffer dura increased LC strains but the other main factors had the opposite effects. Notably, the significant interactions were found between dural radius with dural stiffness, ON radius, and ON tortuosity. Conclusions: This study highlights the significant impact of morphological factors on LC deformations during eye movements, with key morphological effects being more pronounced than tissue stiffnesses.
Asunto(s)
Análisis de Elementos Finitos , Disco Óptico , Humanos , Disco Óptico/patología , Fenómenos Biomecánicos , Enfermedades del Nervio Óptico/fisiopatología , Enfermedades del Nervio Óptico/etiología , Fijación Ocular/fisiología , Esclerótica/patología , Ojo , Modelos BiológicosRESUMEN
BACKGROUND: Stem cell therapy has emerged as a potential therapeutic avenue for optic neuropathy patients. To assess its safety and efficacy, we conducted a systematic review and meta-analysis, focusing on the latest evidence pertaining to the improvement of visual acuity (VA) through stem cell therapy. METHODS: We analyzed Each database from its inception until June 2024. PubMed, Scopus, and Google Scholar were systematically searched to identify the included studies. Data were extracted regarding the year of publication, the name of the first author, sample size, VA (Log Mar), and Retinal Nerve Fiber Layer (RNFL) thickness. PRISMA protocol was used as a guide to perform this meta-analysis. STATA 16 was used for statistical analysis. RESULTS: A total of 66 eyes were examined in seven papers. Based on the meta-analysis, the mean VA (Log MAR) of patients with optic neuropathy improved from 0.90 to 0.65 following stem cell therapy intervention (p-value = 0.001). The thickness of the RNFLs did not demonstrate a significant change (p-value was 0.174). CONCLUSION: According to this systematic review and meta-analysis, stem cell therapy may improve the visual acuity of patients with optic neuropathy. Aside from the traditional therapy that can be provided to patients with optic neuropathy, stem cell therapy may also be beneficial.
Asunto(s)
Trasplante de Células Madre Mesenquimatosas , Fibras Nerviosas , Enfermedades del Nervio Óptico , Células Ganglionares de la Retina , Agudeza Visual , Humanos , Agudeza Visual/fisiología , Células Ganglionares de la Retina/patología , Enfermedades del Nervio Óptico/terapia , Enfermedades del Nervio Óptico/fisiopatología , Trasplante de Células Madre Mesenquimatosas/métodos , Fibras Nerviosas/patología , Tomografía de Coherencia ÓpticaRESUMEN
Optic neuropathy can be of infectious or non-infectious/idiopathic aetiology. Many infectious organisms can cause optic neuropathy that can be of varied presentation including papillitis, retrobulbar optic neuritis, neuroretinitis, and optic perineuritis. Detailed history, ocular, systemic/neurologic examination along with appropriate laboratory evaluation can help clinicians to identify the infectious agent causing optic neuropathy. In spite of recent advanced techniques in serological testing and molecular diagnostics like polymerase chain reaction (PCR), the identification of these pathogens is still a diagnostic challenge. It is ideal to have an infectious disease (ID) consultant in the management team, as most of these infections are multisystem involving diseases. Most infectious agents can be effectively treated with specific antibiotics, with or without corticosteroid therapy, but visual recovery is highly variable and depends entirely on early diagnosis of the causative agent. This review article will provide an overview of common pathogens involved in ION and will describe their management paradigms.
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Enfermedades del Nervio Óptico , Humanos , Enfermedades del Nervio Óptico/diagnóstico , Enfermedades del Nervio Óptico/microbiología , Enfermedades del Nervio Óptico/tratamiento farmacológico , Antibacterianos/uso terapéutico , Neuritis Óptica/diagnóstico , Neuritis Óptica/microbiología , Neuritis Óptica/tratamiento farmacológico , Infecciones del Ojo/diagnóstico , Infecciones del Ojo/microbiología , Infecciones del Ojo/tratamiento farmacológicoAsunto(s)
Disco Óptico , Tomografía de Coherencia Óptica , Campos Visuales , Humanos , Tomografía de Coherencia Óptica/métodos , Campos Visuales/fisiología , Disco Óptico/patología , Disco Óptico/diagnóstico por imagen , Reproducibilidad de los Resultados , Presión Intraocular/fisiología , Pruebas del Campo Visual , Progresión de la Enfermedad , Glaucoma/diagnóstico , Glaucoma/fisiopatología , Glaucoma de Ángulo Abierto/diagnóstico , Glaucoma de Ángulo Abierto/fisiopatología , Enfermedades del Nervio Óptico/diagnóstico , Enfermedades del Nervio Óptico/fisiopatología , Células Ganglionares de la Retina/patologíaRESUMEN
This article describes the main visual electrodiagnostic tests relevant to neuro-ophthalmology practice, including the visual evoked potential (VEP), and the full-field, pattern and multifocal electroretinograms (ffERG; PERG; mfERG). The principles of electrophysiological interpretation are illustrated with reference to acquired and inherited optic neuropathies, and retinal disorders that may masquerade as optic neuropathy, including ffERG and PERG findings in cone and macular dystrophies, paraneoplastic and vascular retinopathies. Complementary VEP and PERG recordings are illustrated in demyelinating, ischaemic, nutritional (B12), and toxic (mercury, cobalt, and ethambutol-related) optic neuropathies and inherited disorders affecting mitochondrial function such as Leber hereditary optic neuropathy and dominant optic atrophy. The value of comprehensive electrophysiological phenotyping in syndromic diseases is highlighted in cases of SSBP1-related disease and ROSAH (Retinal dystrophy, Optic nerve oedema, Splenomegaly, Anhidrosis and Headache). The review highlights the value of different electrophysiological techniques, for the purposes of differential diagnosis and objective functional phenotyping.
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Electrorretinografía , Potenciales Evocados Visuales , Enfermedades del Nervio Óptico , Vías Visuales , Humanos , Potenciales Evocados Visuales/fisiología , Electrorretinografía/métodos , Enfermedades del Nervio Óptico/diagnóstico , Enfermedades del Nervio Óptico/fisiopatología , Vías Visuales/fisiopatología , Enfermedades de la Retina/diagnóstico , Enfermedades de la Retina/fisiopatología , Electrodiagnóstico/métodosRESUMEN
PURPOSE OF REVIEW: Degeneration of the maculopapillary bundle (MPB) is a prominent feature in a spectrum of optic neuropathies. MPB-selective degeneration is seen in specific conditions, such as nutritional and toxic optic neuropathies, Leber hereditary optic neuropathy (LHON), and dominant optic atrophy (DOA). Despite their distinct etiologies and clinical presentations, which encompass variations in age of incidence and monocular or binocular onset, these disorders share a core molecular mechanism: compromised mitochondrial homeostasis. This disruption is characterized by dysfunctions in mitochondrial metabolism, biogenesis, and protein synthesis. This article provides a comprehensive understanding of the MPB's role in optic neuropathies, emphasizing the importance of mitochondrial mechanisms in the pathogenesis of these conditions. RECENT FINDINGS: Optical coherence tomography studies have characterized the retinal nerve fiber layer changes accompanying mitochondrial-affiliated optic neuropathies. Selective thinning of the temporal optic nerve head is preceded by thickening in early stages of these disorders which correlates with reductions in macular ganglion cell layer thinning and vascular atrophy. A recently proposed mechanism underpinning the selective atrophy of the MPB involves the positive feedback of reactive oxygen species generation as a common consequence of mitochondrial dysfunction. Additionally, new research has revealed that the MPB can undergo degeneration in the early stages of glaucoma, challenging the historically held belief that this area was not involved in this common optic neuropathy. A variety of anatomical risk factors influence the propensity of glaucomatous MPB degeneration, and cases present distinct patterns of ganglion cell degeneration that are distinct from those observed in mitochondria-associated diseases. This review synthesizes clinical and molecular research on primary MPB disorders, highlighting the commonalities and differences in their pathogenesis. KEY POINTS (BOX): 1. Temporal degeneration of optic nerve fibers accompanied by cecocentral scotoma is a hallmark of maculopapillary bundle (MPB) degeneration. 2. Mechanisms of MPB degeneration commonly implicate mitochondrial dysfunction. 3. Recent research challenges the traditional belief that the MPB is uninvolved in glaucoma by showing degeneration in the early stages of this common optic neuropathy, yet with features distinct from other MPB-selective neuropathies. 4. Reactive oxygen species generation is a mechanism linking mitochondrial mechanisms of MPB-selective optic neuropathies, but in-vivo and in-vitro studies are needed to validate this hypothesis.