Clinical Spectrum of Ocular and Visual Dysfunction in Children with Periventricular Leukomalacia: A Need for an Interdisciplinary Approach

2021 ◽  
Author(s):  
Zeynep Kayaarasi Ozturker ◽  
Sezin Akca Bayar ◽  
Sibel Oto ◽  
Sibel Aksoy ◽  
Imren Akkoyun ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Visual Field ◽  
Optic Disc ◽  
Periventricular Leukomalacia ◽  
Interdisciplinary Approach ◽  
Field Testing ◽  
Ocular Motility ◽  
Visual Disabilities ◽  
Median Birth Weight

AbstractThe study aimed to evaluate the ocular motility and visual and optic disc abnormalities in children diagnosed with periventricular leukomalacia (PVL). A retrospective analysis was performed on 51 consecutive children who had ophthalmic symptoms and were diagnosed with PVL by using magnetic resonance imaging. The patients were assessed for visual function, strabismus, cycloplegic refraction, fundus examination, and if appropriate, spectral-domain optical coherence tomography and visual field testing were applied. The primary outcome measures were the prevalence and visual and ocular motility dysfunctions. Mean age was 5.72 ± 2.6 years (range = 1–12), median birth weight was 2,740 g (range = 1,240–3,460), and median gestational age was 34 weeks (range = 28–38). In total, 21 patients (39.6%) had neurological deficit, 11 (21.5%) had intellectual disability, and 19 (37.2%) had no neurological symptom. In the spherical equivalent refractive error and cylinder power analysis, 10 patients had ≥3.0 D myopia, 15 had ≥3.0 D hyperopia, and eight had ≥2.50 D astigmatism. Thirteen (25.4%) children had a best-corrected visual acuity between 20/40 and 20/20 for Snellen card, while 9 (17.6%) had strabismic amblyopia and 6 (11.7%) had anisometropic amblyopia. Manifest strabismus was present in 35 patients (68.6%); of whom 12 had esotropia (23.5%), 16 had exotropia (31.3%) and 6 had vertical deviation (11.7%). Manifest or latent nystagmus was detected in 14 patients (27.4%). In 28 patients (54.9%), there was optic nerve abnormality. Two patients had hypoplastic disc, 14 had optic disc pallor, 7 had large cupping, and 5 had total optic atrophy. Six subjects underwent reliable visual field (VF) examinations, and all six had abnormal VFs, with inferior fields being most affected. Ocular motility disorders, optic nerve abnormalities, VF defects, and low visual acuity are common findings in this cohort of PVL patients and maybe the only presenting signs of the disease. The recognition of the visual disabilities and implementation of early rehabilitation may have a significant benefit in these children.

scholarly journals Retinal hemorrhages as one of complications of optic disc drusen during pregnancy

2014 ◽  
Vol 67 (5-6) ◽  
pp. 185-189
Author(s):  
Marija Trenkic-Bozinovic ◽  
Predrag Jovanovic ◽  
Gordana Zlatanovic ◽  
Dragan Veselinovic ◽  
Aleksandra Aracki-Trenkic ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Visual Field ◽  
Optic Disc ◽  
Optic Nerve Head ◽  
Ganglion Cells ◽  
Therapeutic Interventions ◽  
Visual Field Defects ◽  
Retinal Hemorrhages ◽  
Optic Disc Drusen

Introduction. Drusen of the optic nerve head are relatively benign and asymptomatic. They represent retinal hyaline corpuscles resulting from impaired axoplasmic transport of the retinal ganglion cells of optic nerve in front of the lamina cribrosa. They are usually detected accidentally, during a routine ophthalmologic examination. Most patients with optic disc drusen are not aware of the deterioration of their eyesight because of the slow progression of visual field defects. Damage in visual acuity due to optic disc drusen is rare. Case Report. A 27-year-old female patient in the sixth month of pregnancy visited an ophthalmologist because of a visual impairment described as the appearance of mist and shadows over her right eye. When first examined, her visual acuity in both eyes was 20/20. The retinal hemorrhages framing the bottom half of the optic nerve were seen. Complete laboratory and clinical testing as well as specific ophthalmic examinations (photofundus, computerized visual field, optical coherence tomography, and ultrasound) were performed to exclude systemic causes and they presented no risk for the pregnancy. Echosonographic examination confirmed the presence of bilateral optic nerve head drusen. Conclusion. Hemodynamic changes during pregnancy are possible factors for the development of optical disc and retinal hemorrhages. Since treatment of optic disc drusen is limited, recognition of optic nerve drusen as a cause of hemorrhage during pregnancy prevents unnecessary diagnostic and therapeutic interventions.

Automated Perimetry in Glaucoma

Visual Fields ◽  
2010 ◽  
Author(s):  
Hylton R. Mayer ◽  
Marc L. Weitzman
Keyword(s):  
Optic Nerve ◽  
Visual Field ◽  
Nerve Fiber ◽  
Optic Disc ◽  
Structural Damage ◽  
Visual Field Defects ◽  
Fiber Layer ◽  
Glaucomatous Damage ◽  
Retinal Fibers ◽  
Field Defects

Clinical experience and multiple prospective studies, such as the Collaborative Normal Tension Glaucoma Study and the Los Angeles Latino Eye Study, have demonstrated that the diagnosis of glaucoma is more complex than identifying elevated intraocular pressure. As a result, increased emphasis has been placed on measurements of the structural and functional abnormalities caused by glaucoma. The refinement and adoption of imaging technologies assist the clinician in the detection of glaucomatous damage and, increasingly, in identifying the progression of structural damage. Because visual field defects in glaucoma patients occur in patterns that correspond to the anatomy of the nerve fiber layer of the retina and its projections to the optic nerve, visual functional tests become a link between structural damage and functional vision loss. The identification of glaucomatous damage and management of glaucoma require appropriate, sequential measurements and interpretation of the visual field. Glaucomatous visual field defects usually are of the nerve fiber bundle type, corresponding to the anatomic arrangement of the retinal nerve fiber layer. It is helpful to consider the division of the nasal and temporal retina as the fovea, not the optic nerve head, because this is the location that determines the center of the visual field. The ganglion cell axon bundles that emanate from the nasal side of the retina generally approach the optic nerve head in a radial fashion. The majority of these fibers enter the nasal half of the optic disc, but fibers that represent the nasal half of the macula form the papillomacular bundle to enter the temporal-most aspect of the optic nerve. In contrast, the temporal retinal fibers, with respect to fixation, arc around the macula to enter the superotemporal and inferotemporal portions of the optic disc. The origin of these arcuate temporal retinal fibers strictly respects the horizontal retinal raphe, temporal to the fovea. As a consequence of this superior-inferior segregation of the temporal retinal fibers, lesions that affect the superotemporal and inferotemporal poles of the optic disc, such as glaucoma, tend to cause arcuateshaped visual field defects extending from the blind spot toward the nasal horizontal meridian.

scholarly journals Ocular imaging findings of bilateral optic disc pit in a child

2013 ◽  
Vol 5 (2) ◽  
pp. 258-261 ◽  
Author(s):  
Abdullah Ozkaya ◽  
Z Alkin ◽  
AT Taylan ◽  
A Demirok
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Nerve Fiber ◽  
Optic Disc ◽  
Anterior Segment ◽  
Rare Condition ◽  
Optic Disc Pit ◽  
Fiber Layer ◽  
Retinal Nerve Fiber

Background: To report a rare condition of bilateral optic disc pit in a child. Case description: A ten-year-old female was admitted with a complaint of headache. Visual acuity was 20/20 in both eyes (OU). Anterior segment examination was normal in OU. Fundus examination revealed optic disc pit (ODP) located temporally with a diameter of 1/5 disc diameter in OU. Intraocular pressure was within normal limits in both eyes. Macular optical coherence tomography (OCT) showed a loss of retinal tissue at the site corresponding to the ODP in both eyes. Retinal nerve fiber OCT revealed decreased RNFL thickness at the temporal side of the optic nerve, corresponding to the ODP in both eyes. The patient and patient’s parents were informed about the disease and called for follow-up examinations every 6 months. In addition, the family was informed about optic pit maculopathy (OPM) and, they were told to return immediately if the patient ever complained of decreased vision in either of her eyes. After a follow-up period of 12 months, visual acuity remained stable, and no complications secondary to ODP were detected. Conclusion: Optic disc pit is diagnosed incidentally unless it is complicated with OPM. The retinal nerve fiber layer thickness is decreased at the side of the optic nerve corresponding to the ODP. Nepal J Ophthalmol 2013; 5(10): 258-261 DOI: http://dx.doi.org/10.3126/nepjoph.v5i2.8739

Clinical and Etiological Profile of Patients with Optic Disc Edema in Tertiary Care Centre of Nepal

2019 ◽  
Vol 41 (1) ◽  
pp. 24-30
Author(s):  
Ritish K Shah
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Optic Neuritis ◽  
Color Vision ◽  
Optic Disc ◽  
Optic Neuropathy ◽  
Tertiary Care ◽  
Ischemic Optic Neuropathy ◽  
Optic Disc Edema ◽  
Disc Edema

Introduction: Optic disc edema can be a manifestation of various neurological disorders. Identification of those causes is possible in most cases using tests like visual acuity, color vision, visual field and suitable radiological imaging. Study in Nepalese population with regard to optic disc edema is scarce. Hence this study aims to act as a guideline for evaluation of such cases and help in further studies in this regard. Methods: A descriptive, cross-sectional study was conducted in all cases of optic disc edema presenting to neuro-ophthalmology clinic of B.P. Koirala Lions Centre for Ophthalmic Studies from January 2011 to June 2012. A detailed history was obtained and proper ocular and nervous examination was done by ophthalmologist and neuro-physician. Assessment of visual acuity, color vision, contrast sensitivity and visual field along with radiological tests were done in all possible cases. Results: Out of all the cases evaluated, 38 cases where causes of optic disc edema could be established were included in the study. The commonly affected age group was 31 to 40 years (26.3%) and most of them were males. The commonest cause observed was optic neuritis (36.8%). Others were papilledema, idiopathic intracranial hypertension, toxic optic neuropathy, non-arteritic anterior ischemic optic neuropathy (NA-AION), compressive and traumatic optic neuropathy. Conclusion: Optic neuritis and papilledema should be considered as common differential diagnosis in patients with optic disc edema. NA-AION is a relatively uncommon disease among Nepalese population.

A classic temporal optic disc pit showing progression in the corresponding optic nerve fiber and visual field defects

2012 ◽  
Vol 57 (3) ◽  
pp. 263-267 ◽  
Author(s):  
Akihiko Tawara ◽  
Rie Miyamoto ◽  
Norihiko Tou ◽  
Shingo Ishibashi ◽  
Hiroyuki Kondo
Keyword(s):  
Optic Nerve ◽  
Visual Field ◽  
Nerve Fiber ◽  
Optic Disc ◽  
Visual Field Defects ◽  
Optic Disc Pit ◽  
Optic Nerve Fiber ◽  
Field Defects

scholarly journals Different IOP, different diseases?

2016 ◽  
Vol 1 (2) ◽  
pp. 97-102
Author(s):  
Michele Iester ◽  
Elisa D’Alessandro
Keyword(s):  
Intraocular Pressure ◽  
Optic Nerve ◽  
Visual Field ◽  
Optic Disc ◽  
Progressive Disease ◽  
Clinical Findings ◽  
Nerve Fibers ◽  
Visual Field Defects ◽  
Chronic Progressive Disease ◽  
Field Defects

Glaucoma is a chronic, progressive disease characterized by typical optic nerve head changes and visual field defects. These alterations are caused by an intraocular pressure (IOP) being too high for the wellbeing of the specific optic disc. Typical clinical findings in glaucoma patients include thinning of the optic disc rim (Fig. 1), loss of retinal nerve fibers in the inferior sector with subsequent visual field defects in the superior sector.

scholarly journals Complex Therapy Response in Treatment of Partial Optic Atrophy of Various Origins

Medicina ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 1-9
Author(s):  
A. D. Chuprov ◽  
◽  
S. M. Kim ◽  
N. V. Korshunova ◽  
A. V. Fomenko ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Nerve Fiber ◽  
Layer Thickness ◽  
Optic Disc ◽  
Optic Atrophy ◽  
Fiber Layer ◽  
Nerve Fiber Layer Thickness ◽  
Group I ◽  
Complex Therapy

Regional drugs injection is а promising method of partial optic atrophy treatment. The therapy involves the introduction of drugs into the microcirculation region on the side of the affected organ, in the area corresponding to the topographic projection of the lymph node. Purpose: To evaluate the effectiveness of treatment of partial optic atrophy of various origins using regional combination therapy. Material and Methods: Complex therapy was applied in hospital environment of The S. Fyodorov Eye Microsurgery Federal State Institution in treatment of 38 patients (38 eyes) with partial optic atrophy of various origins. The patients were divided into two groups: group I (27 eyes), diagnosed with partial optic atrophy of glaucomatous origin, group II (11 eyes), diagnosed with partial optic atrophy of mixed genesis. Before and after treatment, all the patients passed standard ophthalmological examination, as well as optical coherence tomography (OCT).The parameters of the optic disk were assessed using Cirrus 5000 retinal tomograph by Carl Zeiss Meditecinc (Germany). Results: After 12 months of complex treatment, administered 2 times a year and included injections in the pterygopalatine fossa and submastoid region, in patients of group I the following indices were registered: an increase in visual acuity by 0.1-0.2, a decrease in relative scotoma number by13%, stability of the nerve fiber layer thickness and excavation of the optic disc. Total visual field expanded up to 220-335. After 12 months of treatment, administered 2 times a year in patients of group II the following indices were registered: an increase in visual acuity by 0.1-0.3, a decrease in relative scotoma number by 9%, stability of the nerve fiber layer thickness and excavation of the optic disc. The total visual field after treatment expanded up to 310-450. Conclusion: the application of complex therapy in treatment of patients with partial optic atrophy of various origins has positive effect on visual function.

scholarly journals Nonarteritic Anterior Ischemic Optic Neuropathy following COVID-19 Vaccination: Consequence or Coincidence

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Rika Tsukii ◽  
Yuka Kasuya ◽  
Shinji Makino
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Optic Disc ◽  
Optic Neuropathy ◽  
Visual Field Defect ◽  
Anterior Ischemic Optic Neuropathy ◽  
Ischemic Optic Neuropathy ◽  
Optic Disc Swelling ◽  
The Right ◽  
Field Defect

To report a patient with nonarteritic anterior ischemic optic neuropathy (NA-AION) occurring soon after the COVID-19 vaccination. A 55-year-old woman presented with a 4-day history of inferior visual field disturbance in the right eye 7 days after receiving the first dose of Pfizer-BioNTech COVID-19 vaccine. Examination revealed a best-corrected visual acuity of 20/20 in both eyes. A relative afferent pupillary defect was observed in the right eye. Fundoscopy revealed diffuse optic disc swelling in the right eye, which was prominent above the optic disc. Goldmann visual field testing identified an inferior altitudinal visual field defect with I/2 isopter in the right eye. Although typical complete inferior visual field defect was not detected, a diagnosis of NA-AION was made. The patient was followed without any treatment. During the 2-month follow-up period, the optic disc swelling was gradually improved, and visual acuity was maintained 20/20; however, the optic disc looked diffusely pale in the right eye. Although it is uncertain whether the development of NA-AION after COVID-19 vaccination was consequential or coincidental, we speculate that the close temporal relationship with COVID-19 vaccination suggests the possibility of vasculopathy on the microvascular network of optic nerve head as background of inflammatory or immune-mediated element to the timing of the onset of NA-AION. The aim of this case report is to present this biological plausibility and to elucidate potential ophthalmological complications.

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