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• W4252012007 abstract "We thank the authors for their feedback. They present several critiques of our submission: “unimpressive” ganglion cell layer thickness loss, the fact that our case does not fall into 1 of the 2 commonly described causes of optic tract syndrome, and the need for further clinical information. We address each of the criticisms. The authors cite a study by Mwanza et al1Mwanza J.-C. Durbin M.K. Budenz D.L. et al.Profile and predictors of normal ganglion cell-inner plexiform layer thickness measured with frequency-domain optical coherence tomography.Invest Ophthalmol Vis Sci. 2011; 52: 7872-7879Crossref PubMed Scopus (176) Google Scholar in support of their claim that the ganglion cell complex (GCC) thickness of 68 μm is normal. Specifically, they cite this study as documenting a range of GCC thickness between 68.0 μm and 74.8 μm. However, the results of this article actually document a mean GCC thickness of 82.1 ± 6.2 μm. Mwanza et al cite other studies in their manuscript as the source of the estimates of mean GCC thickness in the 68.0–74.8 range, and proceed to discuss their limitations, most notably their small sample size.1Mwanza J.-C. Durbin M.K. Budenz D.L. et al.Profile and predictors of normal ganglion cell-inner plexiform layer thickness measured with frequency-domain optical coherence tomography.Invest Ophthalmol Vis Sci. 2011; 52: 7872-7879Crossref PubMed Scopus (176) Google Scholar Estimates of normal variation of the GCC complex vary with the instrument used, as well as the population from which they were sampled. For example, a study of young Chinese subjects2Zhou M. Lu B. Zhao J. et al.Interocular symmetry of macular ganglion cell complex thickness in young Chinese subjects.PLoS One. 2016; 11e0159583PubMed Google Scholar revealed mean GCC thickness of 98.16 ± 5.53 μm2. The same study suggests that an asymmetry between 2 eyes, as seen in our case, may be unusual. Loss of 4% to 9% of retinal ganglion cells is likely to be clinically significant. Le et al3Le P.V. Tan O. Chopra V. et al.Regional correlation among ganglion cell complex, nerve fiber layer, and visual field loss in glaucoma.Invest Ophthalmol Vis Sci. 2013; 54: 4287-4295Crossref PubMed Scopus (46) Google Scholar demonstrated that for every 1% of GCC loss in inferior macular GCC one can expect to lose 2.12% of the corresponding superior arcuate visual field, as measured by total deviation in mean dB. Similarly, a careful analysis of GCC thickness and sensitivity of four central test points on 24-2 visual field in normal eyes by Araie et al4Araie M. Saito H. Tomidokoro A. et al.Relationship between macular inner retinal layer thickness and corresponding retinal sensitivity in normal eyes.Invest Ophthalmol Vis Sci. 2014; 55: 7199-7205Crossref PubMed Scopus (16) Google Scholar showed that for every 2.2 μm of change in GCC, approximately 2.1 dB change in total deviation can be expected. We want to highlight that a wide variety of pathologies can affect the optic tract. The original report of optic tract syndrome using Goldmann perimetry by Savino et al5Savino P.J. Paris M. Schatz N.J. et al.Optic tract syndrome. A review of 21 patients.Arch Ophthalmol. 1978; 96: 656-663Crossref PubMed Scopus (64) Google Scholar reported a wide variety of lesions that can cause optic tract syndrome that cannot be sufficiently captured by the type 1 “incidentaloma” and type 2 “demyelination” categorization. In fact, demyelinating disease was seen in only 1 of their 21 cases. Other etiologies included trauma, suprasellar tumors, temporal lobe tumor, aneurysm, meningioma, pinealoma, and malignant astrocytoma,5Savino P.J. Paris M. Schatz N.J. et al.Optic tract syndrome. A review of 21 patients.Arch Ophthalmol. 1978; 96: 656-663Crossref PubMed Scopus (64) Google Scholar which can hardly be called “incidentalomas.” In addition, the aforementioned report by Savino et al5Savino P.J. Paris M. Schatz N.J. et al.Optic tract syndrome. A review of 21 patients.Arch Ophthalmol. 1978; 96: 656-663Crossref PubMed Scopus (64) Google Scholar included a case of unilateral hemianopia (case #14 secondary to aneurysm), as well as a spectrum of incongruous homonymous hemianopias. In optic tract lesions, homonymous hemianopia and unilateral hemianopia are 2 possible extremes of the spectrum of visual field defects. The limit of 100 words on the Pictures & Perspectives submission did not permit for a full description of the case. The patient we described presented with persistent neck pain. Magnetic resonance angiography of the brain and neck revealed multiple aneurysms, including the 5-mm carotid aneurysm compressing left optic tract. The patient’s best-corrected visual acuity was 20/25 in the right eye and 20/20 on the left. There was no obvious relative afferent pupillary defect. This finding is similar to the recent report by Lee et al,6 where central vision was not affected and there was no relative afferent pupillary defect in all patients with unilateral homonymous hemianopia secondary to an optic tract lesion. We made no claim as to whether the aneurysm was at high risk of rupture. Rather, we wished to highlight the possibility of isolated compression of nasal fibers in the optic tract, as documented by a selective unilateral nasal deficit on ganglion cell analysis and corresponding temporal visual field defect in our patient. In conclusion, we agree that in neuro-ophthalmology the clinical picture should be evaluated in the context of pertinent neuro-radiological and ophthalmic imaging data, and this is precisely what we aimed to demonstrate in our short submission. Re: Zaslavsky et al.: Unilateral temporal hemianopsia and nasal ganglion cell loss secondary to optic tract compression (Ophthalmology. 2020;127:176)OphthalmologyVol. 128Issue 3PreviewThe authors noted some unusual aspects of the article by Zaslavsky and Margolin.1 Full-Text PDF" @default.
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