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• W1491106036 abstract "The innovative technology of optic nerve and retinal nerve fibre layer (RNFL) imaging has had a major impact not only on ophthalmological research but also in clinical practice. Glaucoma specialists as well as comprehensive ophthalmologists rely on optic disc imaging as part of the routine ongoing care of glaucoma patients. Currently, the technologies most used in glaucoma are Heidelberg retinal tomography (HRT) and scanning laser polarimetry (SLP), which concentrate on defining the characteristics of the optic disc and cup. Ocular coherence tomography (OCT), on the other hand, has been used more as a modality to image the retina and has become a very important tool to retinal specialists. The widespread use of OCT in caring for retinal patients has resulted in a marked decrease in the number of intravenous fluorescein angiograms performed worldwide. Do any of these imaging technologies have a role in the care of the neuro-ophthalmological patient? Although the literature on the use of these technologies in neuro-ophthalmic disorders is not as vast as in glaucoma or retinal disease, we are beginning to see a trend where these technologies may be useful and where they are, at least at present, of no help. Elevation of the optic disc can occur in a variety of neuro-ophthalmic problems. One of the major clinical issues is to distinguish if optic disc elevation is acquired and due to intraocular, intraorbital or intracranial pathology, or whether the disc elevation is a congenital characteristic and of no pathological significance. Congenital optic disc elevation may be due to the presence of intrapapillary hyaline bodies (drusen). Often these drusen are visible on ophthalmoscopic examination but at times are buried within the structure of the optic disc and are not visible. OCT, like ocular echography, is an excellent method of detecting these buried drusen. However, apart from this clinical situation, OCT or other methods of ocular imaging cannot consistently distinguish between acquired optic disc elevation and congenital disc elevation that is not due to buried drusen.1 Anterior ischaemic optic neuropathy (AION) is the most frequent optic neuropathy in patients over age 50 apart from glaucoma. It always begins as optic disc elevation and visual dysfunction is detected at onset or soon thereafter. Optic disc imaging has been performed in acute AION to evaluate its usefulness in predicting the ultimate visual outcome. However, only when the optic disc oedema has disappeared completely are ocular imaging techniques useful in documenting visual field loss, which corresponds to standard automated perimetery (SAP). It therefore adds very little to the management of AION. Several studies have attempted to use SLP and HRT to investigate the underlying cause of non-arteritic ischaemic optic neuropathy (NAION). It is known that acute arteritic AION (AAION) is a result of vascular occlusion in the posterior ciliary circulation; however, it has never been shown that NAION is caused in a similar fashion, in fact some believe that it may not be primarily an arterial circulation phenomenon.2 Although the clinical appearance of NAION and AAION are individually distinctive, retinal imaging in the acute phase of both shows similar patterns. However, both SLP and HRT show that there is more acquired optic disc excavation following AAION than NAION, which may lend further support to the concept of different aetiologies in the two optic neuropathies.3,4 Ocular coherence tomography has been used extensively in investigating patients with multiple sclerosis both with and without clinical optic neuritis. Studies have shown that OCT is normal at the time of the acute event but the OCT becomes abnormal approximately 3 months later, showing loss of RNFL.5 Indeed, at times RNFL loss may be present in the absence of an overt visual field deficit. Multiple sclerosis patients who have not suffered an episode of acute optic neuritis may also show RNFL loss suggesting that multiple sclerosis may affect the axons of the optic nerve independent of an acute event.6 This intriguing finding has sparked investigation into whether OCT may be a biomarker for axonal loss in multiple sclerosis even in the absence of optic neuritis, and may therefore be used to document drug efficacy in therapeutic clinical trials for multiple sclerosis. Visual loss from compressive chiasmal lesions (pituitary tumour, craniopharyngioma, meningioma and aneurysm) is treatable usually by surgery. The recovery of vision following successful surgery, however, is not predictable. Patients are routinely told that the goal of surgery is to prevent further visual loss and any return of vision is an additional but unpredictable benefit. In a collaborative prospective study from the University of Auckland, The Royal Melbourne Hospital, the Wills Eye Institute in Philadelphia and Baylor Medical College, Houston, Texas, patients with chiasmal compression underwent neuro-ophthalmological examination that included SAP and OCT pre- and postoperatively. The preoperative OCT was found to be an excellent predictor of visual acuity, colour vision and SAP recovery.7,8 The findings of these initial studies were later corroborated in another study of patients with pituitary tumours only.9 These important observations may be useful in determining if surgery should be used in a patient with chiasmal compression and marked loss of the RNFL. Thus the use of retinal and optic disc imaging, to date, is not as useful in neuro-ophthalmology as it has been in the evaluation and treatment of patients with glaucoma or retinal disorders. However, further studies and advancements in RNFL technologies, in all likelihood, will result in their greater utility in neuro-ophthalmic diagnosis and management in the future." @default.
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• W1491106036 date "2009-08-01" @default.
• W1491106036 modified "2023-09-28" @default.
• W1491106036 title "The role of contemporary ocular imaging in neuro-ophthalmology" @default.
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• W1491106036 doi "https://doi.org/10.1111/j.1442-9071.2009.02097.x" @default.
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