Visual acuity in optic atrophy: a quantitative clinicopathological analysis (original) (raw)
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Asian Journal of Medical Sciences
Background: Optic atrophy is a clinical presentation in which the optic disc appears pale due to irreversible damage of retinal ganglion cells and axons in the anterior visual pathway. Aims and Objectives: The aim of this study was to determine the profile of optic atrophy cases in the neuro-ophthalmology department of a tertiary eye hospital and to identify the common causes and associated visual impairments. Materials and Methods: This was a cross-sectional study conducted from January 2021 to December 2021, using convenience sampling method for data collection. Demographic data, medical history, and examinations were conducted on all included patients. Optic atrophy secondary to glaucomatous optic nerve damage was excluded. This study included both children and adults with both congenital and acquired patients with optic atrophy. Best-corrected visual acuity (BCVA) was recorded and anterior segment examinations were conducted using a torchlight to assess pupillary reaction and sl...
Physiological evidence for impairment in autosomal dominant optic atrophy at the pre-ganglion level
2013
Background Functional studies in patients with autosomal dominant optic atrophy (ADOA) are usually confined to analysis of physiological and clinical impact at the ganglion cell (GG) and post GC levels. Here we aimed to investigate the impact of the disease at a pre-GC level and its correlation with GC/post-GC related measures. Methods Visual function was assessed in a population of 22 subjects (44 eyes) from 13 families with ADOA submitted to OPA1 mutation analysis. Quantitative psychophysical methods were used to assess konio and parvocellular chromatic pathways (Cambridge Colour Test) and distinct achromatic spatial frequency channels (Metropsis Contrast Sensitivity Test). Preganglionic and GC measures were assessed with the Multifocal Electroretinogram (mfERG) and Pattern Electroretinogram (PERG) respectively. Global Pattern and Multifocal VEP (visual evoked potentials) were used to assess retinocortical processing, in order to characterize impaired processing at the post GC level. Perimetric sensitivity, retinal and ganglion cell nerve fibre layer (RNFL) thickness measurements were also obtained. Results Chromatic thresholds were significantly increased for protan, deutan and tritan axes (p<<0.001 for all comparisons) and achromatic contrast sensitivity (CS) was reduced for all studied six spatial frequency channels (p<<0.001). We observed significant decreases in peripapillary (p≤0.0008), macular (ring2: p00.02; ring 3: p<0.0001) RNFL, as well as in overall retinal thickness (p<0.0001 in all regions, except the central one). Interestingly, we found significant decreases in pre-ganglionic multifocal ERG response amplitudes (P1wave: p≤0.005) that were correlated with retinal thickness (ring 2: r00.512; p00.026/ring 3: r00.583; p00.011) and visual acuity (r00.458; p00.03, central ring 1). Reductions in GC and optic nerve responses amplitude (PERG: p<0.0001, P50 and N95 components; Pattern VEP: p<0.0001, P100) were accompanied by abnormalities of the MfVEP, primarily in central locations (ring 1: p00.0007; ring 2: p00.012). Conclusions In the ADOA model of ganglion cell damage, parvo-, konio-and magnocellular pathways are concomitantly affected. Structural changes and physiological impairment also occurs at a preganglionic level, suggesting a retrograde damage mechanism with a significant clinical The authors have full control of all primary data, and they agree to allow Graefe's Archive for Clinical and Experimental Ophthalmology to review their data upon request.
Clinical Assessment and Etiological Evaluation of Optic Nerve Atrophy
Nepalese journal of ophthalmology : a biannual peer-reviewed academic journal of the Nepal Ophthalmic Society : NEPJOPH, 2021
INTRODUCTION Optic atrophy results from the disease process that cause irreversible damage to the ganglion cells and the anterior visual pathway, but may also result from posterior visual pathway involvement. The etiology causing this condition is vast and regardless of underlying cause it carries bad visual prognosis and at times may be life threatening. The study aims to assess patients with optic nerve atrophy presenting to B.P. Koirala lions centre for ophthalmic studies and identify the underlying etiology. MATERIALS AND METHODS This is a descriptive study conducted at B.P. Koirala Lions Centre for Ophthalmic studies. All cases of optic atrophy who presented to our outpatient department from March 2016 to March 2017 were included in the study. In addition to detailed evaluation, assessment of visual acuity, color vision, contrast sensitivity and visual field were done if feasible. Other relevant investigations were conducted to establish the underlying etiological cause. RESULT...
Optical coherence tomography analysis of axonal loss in band atrophy of the optic nerve
2004
Aims: To measure axonal loss in patients with band atrophy of the optic nerve caused by optic chiasm compression using optical coherence tomography and to evaluate its ability in identifying this pattern of retinal nerve fibre layer (RNFL) loss. Methods: Twenty eyes from 16 consecutive patients with band atrophy of the optic nerve and permanent temporal hemianopia due to chiasmal compression, and 20 eyes from an age and sex matched control group of 16 healthy individuals, were studied prospectively. All patients were submitted to an ophthalmic examination including perimetry and evaluation of the RNFL using optical coherence tomography. Mean RNFL thickness around the optic disc was compared between the two groups. Results: The mean (SD) peripapillary RNFL thickness of eyes with band atrophy was 101.00 (9.89) mm, 62.21 (12.71) mm, 104.89 (12.60) mm, and 50.13 (16.88) mm in the superior, temporal, inferior, and nasal regions, respectively. The total RNFL mean was 79.94 (7.17) mm. In the control group, the corresponding values were 140.10 (16.06) mm, 86.50 (12.17) mm, 144.60 (15.70) mm, and 97.94 (16.02) mm. The total RNFL mean was 117.72 (9.53) mm. The measurements were significantly different between the two groups. Measurements in each of twelve 30d ivisions provided by the equipment also showed significantly different values between eyes with band atrophy and normal controls. Conclusions: Optical coherence tomography was able to identify axonal loss in all four quadrants as well as in each of the twelve 30˚segments of the disc. Thus, it seems to be a promising instrument in the diagnosis and follow up of neuroophthalmic conditions responsible for RNFL loss, even if predominantly in the nasal and temporal areas of the optic disc.
Predictors of visual acuity and the relative afferent pupillary defect in optic neuropathy
Documenta Ophthalmologica, 1998
The relationships among visual acuity (log MAR), diagnostic category, age, the magnitude of a relative afferent pupillary defect (RAPD) in log units, photopic foveal thresholds to white and colored light (dB), and the mean deviation on the Humphrey visual field (dB) were studied in patients with various optic neuropathies. All acuity and dB values were expressed as interocular differences, the majority of cases having normal acuity in the fellow eye. In multiple regression analyses, acuity and RAPD were alternately chosen as the dependent or response variable with all remaining variables serving as the predictors or independent variables. The main finding was that the only significant predictor of a RAPD was the interocular mean deviation difference on the Humphrey field and the only significant predictor of acuity was the foveal threshold to white light. Redundant and insignificant variables were therefore identified with multiple regression analysis. Subsidiary findings include: (a) although diagnostic group was not a significant predictor in the above, simple linear regression line slopes relating RAPD magnitude to the Humphrey mean deviation were significantly different between optic neuritis and compression categories; (b) for a given level of acuity, foveal thresholds were substantially worse in these cases with neuronal damage than in strabismic amblyopia, refractive error, or corneal damage; and (c) sensitivity losses for red vs. blue light were similar.
Decreased retinal sensitivity and loss of retinal nerve fibers in multiple system atrophy
Graefe's Archive for Clinical and Experimental Ophthalmology, 2013
Background and aim In a previous study, retinal nerve fiber layer thickness (RNFLT) loss was shown as part of the neurodegenerative process in multiple system atrophy (MSA). Here, we investigate in a larger cohort of MSA patients whether the RNFLT loss translates into respective visual field defects. Methods Spectral domain optical coherence tomography was performed in 20 MSA patients (parkinsonian subtype012, cerebellar subtype08) to quantify peripapillary RNFLT. Visual field (90°) was analyzed by automated static perimetry to investigate retinal structure/function relationship. Eight data sets did not meet stringent quality criteria, and only 12 data sets were further analyzed. Results Compared to healthy controls, MSA patients demonstrated a significant reduction of RNFLT in the nasal sectors (p nasal-superior 00.02, p nasal 00.03, p nasal-inferior <0.01), while changes in temporal RNFLT measures (p temporal-superior 0 0.42, p temporal 00.34, p temporal-inferior 00.25) were not statistically significant compared to healthy controls (ANOVA). MSA patients featured a significant global mean deviation (2.74 dB; p<0.01) without predominant peripheral visual field defects. Statistical analysis of mean defect in the central (0-30°), peripheral (30-90°) or global (0-90°) visual field revealed no significant correlation (r 2 central 00.11, r 2 peripheral 0 0.04, r 2 global 00.07) with nasal RNFLT in MSA patients. Conclusion MSA patients feature significant reduction in nasal RNFLT and global mean deviation when compared to healthy controls, consistent with the multi-systemic nature of this neurodegenerative disorder. This finding provides first evidence for two independent deteriorations of the visual system in MSA.
Axonal loss occurs early in dominant optic atrophy
Acta Ophthalmologica, 2009
This study set out to investigate retinal nerve fibre layer (RNFL) thickness and best corrected visual acuity (BCVA) in relation to age in healthy subjects and patients with OPA1 autosomal dominant optic atrophy (DOA). Methods: We carried out a cross-sectional investigation of RNFL thickness and ganglion cell layer density in 30 healthy subjects and 10 patients with OPA1 DOA using optical coherence tomography (OCT). We then performed a regression analysis of RNFL thickness and BCVA versus age. Results: Both healthy subjects and DOA patients demonstrated a gradual reduction in RNFL thickness with age; the relationship was best described statistically by a model that assumed a constant offset between the two groups. Best corrected VA decreased significantly with age in DOA patients, in whom BCVA was correlated with peripapillary RNFL thickness in the inferior and superior peripapillary quadrants and with total macular thickness at eccentricities of 500-3000 lm. The observations were best described by a constant offset of 41.9 lm separating the two groups and an annual decrease in RNFL thickness of 0.48 lm (p < 0.0001). In patients with DOA, increasing age was associated with decreasing BCVA (p = 0.046). Conclusions: This cross-sectional study found evidence of comparable agerelated decreases in RNFL thickness in healthy subjects and in DOA patients, where the deficit in DOA patients is best described using a model that assumes the deficit between the groups does not vary with age. The gradual reduction of BCVA with age may be a consequence of a relative deficit in RNFL thickness that is established before the second decade of life.
An aetiological profile of optic atrophy
Acta Ophthalmologica, 2009
484 cases of optic atrophy were studied for the distribution pattern and significance of various etiological factors in different age groups of both sexes. Bilateral optic atrophy was found to be two and a half times as common as unilateral optic atrophy. Intracranial neoplasm (29.5%) was the most frequent known cause of bilateral optic atrophy in either sex and the most common tumor was chromophobe adenoma (48% of intracranial tumors) with highest incidence over 20 years of age. Craniopharyngioma was the most frequent tumor responsible for bilateral optic atrophy before 20 years of age. Intracranial glioma also emerged as an important cause of bilateral optic atrophy. Head injury due to road accidents and periocular trauma were the most common causes of unilateral optic atrophy in males, whereas no definite factor could be elucidated in unilateral optic atrophy in females. Vascular factors were the usual cause of optic atrophy after 40 years of age, highlighting the significance of thorough systemic evaluation. Key words: optic nerveoptic atrophyintracranial neoplasmshead injurymeningitisvascular lesionsoptic neuritispapilledemacongenital lesions.
Clinical Ophthalmology, 2015
The aim of this study was to compare the asymmetrical light reflex of the control subjects and patients with optic nerve disease and to evaluate the relationships among the relative afferent pupillary defect (RAPD), visual acuity (VA), central critical fusion frequency (CFF), ganglion cell complex thickness (GCCT), and circumpapillary retinal nerve fiber layer thickness (cpRNFLT) using spectral-domain optical coherence tomography. Materials and methods: Using a pupillography device, the RAPD scores from 15 patients with unilateral optic nerve disease and 35 control subjects were compared. The diagnostic accuracy of the RAPD amplitude and latency scores was compared using the area under the receiver operating characteristic curve. Thereafter, we assessed the relationships among the RAPD scores, VA, central CFF, GCCT, and cpRNFLT. Results: The average RAPD amplitude score in patients with optic nerve disease was significantly higher than that of the control subjects (P,0.001). The average RAPD latency score in patients with optic nerve disease was significantly higher than that of the control subjects (P=0.001). The area under the receiver operating characteristic curve for the RAPD amplitude score was significantly higher than that for the latency score (P=0.010). The correlation coefficients for the RAPD amplitude and latency scores were 0.847 (P,0.001) and 0.874 (P,0.001) for VA,-0.868 (P,0.001) and-0.896 (P,0.001) for central CFF,-0.593 (P=0.020) and-0.540 (P=0.038) for GCCT, and-0.267 (P=0.337) and-0.228 (P=0.413) for cpRNFLT, respectively. Conclusion: Our results suggest that pupillography is useful for detecting optic nerve disease.