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Approach to “Visual Loss”
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Aastha Takkar Kapila, Monika Singla, Vivek Lal
Acute visual loss is a devastating symptom seen in clinical practice. The first step for the clinician is to anatomically localize the defect to anterior eye structures, retina, optic nerve, optic chiasma, the posterior visual pathways or the visual cortex. Initial approach to a patient with visual loss can be simplified into the following four steps. Step 1. Is the visual loss unilateral (or monocular) or bilateral?Step 2. Is the visual loss acute?Step 3. If acute, is the visual loss transient or persistent?Step 4. Is the visual loss progressive?Step 1. Is the visual loss unilateral or bilateral?
Transvitreal optic neurotomy for the management of nonarteritic anterior ischemic optic neuropathy
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
Masoud Soheilian, Shahin Yazdani, Mozhgan Rezaie Kanavi
Nonarteritic anterior ischemic optic neuropathy (NAION) is a dysfunction of the optic nerve due to insufficient blood supply.1 It is the most common cause of acute visual loss with an optic nerve etiology in patients over age 50, with a yearly incidence of up to 50 cases per 100 000.1,2 NAION has been reported in patients from 11 to 90 years of age; the mean age is 60.1,2 The visual loss is often severe; 35–54% of cases present with initial visual acuity worse than 20/200.1–;3 According to the Ischemic Optic Neuropathy Decompression Trial (IONDT) Research Group’s report on patients’ characteristics, 12.6% of patients had baseline visual acuity in the ‘off-chart’ category (i.e. counting fingers, hand motions, or light perception) and 12.1% had initial visual acuity of 20/500–20/1000.4 The initial visual loss could worsen during subsequent days or weeks and optic atrophy ensue after a few weeks. Only 47% of untreated cases experienced significant visual improvement (doubling of the visual angle in the logMAR scale) over a period of 6 months.5
Eye
Published in A. Sahib El-Radhi, Paediatric Symptom and Sign Sorter, 2019
Visual loss may be acute or gradual, temporary or permanent. Acute visual loss is a frightening experience not only for children and their parents but also for clinicians. Conditions causing acute visual loss in paediatrics are collectively uncommon (incidence estimated to be 2–5 cases per 10,000 births). It is due to either abnormalities within the ocular structure (cornea, lens, vitreous and retina) or neural visual pathways in the central nervous system (optic nerve, chiasm and cortical area). Visual loss within the eyes is easy to detect, e.g. corneal opacity, cataract or optic atrophy. Most causes of cortical visual loss occur in children with neurodisability such as asphyxia at birth, in association with seizures, spasticity or hypotonia. Rarely cortical visual loss occurs as an isolated neurological phenomenon. This section discusses acute and transient visual loss only.
Anti-Neutrophil Cytoplasmic Antibody-Associated Ocular Manifestations in Japan: A Review of 18 Patients
Published in Ocular Immunology and Inflammation, 2021
Masaru Miyanaga, Hiroshi Takase, Kyoko Ohno-Matsui
In conclusion, this study revealed that 20% patients positive for serum ANCAs had ocular manifestations, and optic nerve involvement was the most frequent ocular manifestation. Most patients with optic nerve involvement were MPO-ANCA positive, whereas most patients with anterior segment involvement were PR3-ANCA positive. AAV is a rare disease with high mortality, and most patients require aggressive immunosuppressive therapy to prevent further progression of systemic and ocular manifestations. Moreover, ocular manifestations such as optic nerve involvement, peripheral ulcerative keratitis, and scleritis may be serious. Optic nerve involvement presents as acute visual loss or central visual field loss. Peripheral ulcerative keratitis and scleritis may cause severe visual impairment following corneal perforation or scleral melt. Biological therapy with infliximab23 or rituximab24,25 may be effective in patients not responding to conventional immunosuppressive treatment. Further accumulation of data regarding the ocular involvement of AAV is necessary to ensure early and accurate diagnosis and treatment of these manifestations by ophthalmologists. In addition, close cooperation between ophthalmologists and rheumatologists may be necessary to treat ocular manifestations in patients positive for ANCAs.
Corticosteroid Usage in Giant Cell Arteritis
Published in Neuro-Ophthalmology, 2021
Amritha Kanakamedala, Mariam Hussain, Ashwini Kini, Bayan Al Othman, Andrew G. Lee
Our results suggest that a large proportion (50%) of respondents prefer the IV route of corticosteroid therapy for patients with acute visual loss in GCA, but a significant percentage (40%) prefer either an IV or oral route. In question 3, when asked to choose the daily dosage of therapy for patients with acute visual loss, 75% chose the IV route of administration. These results could be a result of the 40% of respondents in question 1 who chose either IV or oral being split among answers in question 3. When forced to choose a dosage in question 3, about half of the 40% of respondents from question 1 plus the 50% of respondents choosing IV in question 1 could have resulted in 75% choosing the IV route in question 3. Only 27% of respondents chose an oral route of treatment in question 3, approximately half of the 40% of respondents in question 1 who answered either IV or oral. It is important to note that our survey was de-identified, so these observations are speculative, and it is not possible to track individual respondent’s answers to questions.
The Effect of Age on Dexamethasone Intravitreal Implant (Ozurdex®) Response in Macular Edema Secondary to Branch Retinal Vein Occlusion
Published in Seminars in Ophthalmology, 2018
Orhan Altunel, Altan Göktaş, Necati Duru, Ayşe Özköse, Hasan Basri Arifoğlu, Mustafa Ataş
Retinal vein occlusion (RVO) is the second most common cause of vision loss in retinal vascular diseases.1 Macular edema is a major complication of vein occlusions, and it is the main reason for acute visual loss.2 The visual acuity of patients with RVO varies depending on the size of the affected macular region and the presence of common vascular damage and ischemia. Various therapies, including grid laser photocoagulation, anti-vascular endothelial growth factors (anti-VEGF), triamcinolone injection, and dexamethasone intravitreal implants, have been investigated for the treatment of macular edema associated with branch RVO (BRVO).3–7 More recently, a dexamethasone intravitreal implant (Ozurdex®, Allergan, Inc., Irvıne, CA, USA) therapy has become a new treatment modality to reduce macular edema and to improve visual acuity in central RVO (CRVO) and BRVO.8 Ozurdex is made of a polylactic acid-glycolic acid matrix that is gradually converted into carbondioxide and water in vivo and eliminated by ocular tissues. As the matrix dissolves, impragnated dexamethasone is slowly released into the vitreous and retina.9