Comparison of Visual Acuity and Automated Perimetry Findings in Patients With Neuromyelitis Optica or Multiple Sclerosis After Single or Multiple Attacks of Optic Neuritis

Fernandes, Danilo B.; Ramos, Renata de Iracema Pulcheri; Falcochio, Carolina; Apóstolos‐Pereira, Samira Luísa; Callegaro, Dagoberto; Monteiro, Mário Luiz Ribeiro

doi:10.1097/wno.0b013e31823a9ebc

Cited by 65 publications

(49 citation statements)

References 19 publications

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“…For ON, these include patients with severe vision loss (<20/200) or visual field depression, poor visual recovery, severe and diffuse peripapillary retinal nerve fiber layer loss, and MRI findings of posterior optic nerve or chiasm involvement of extensive visual pathway lesions (11–17). For TM, the presence of a longitudinally extensive spinal cord lesion or central cord involvement should raise suspicion for NMO.…”

Section: Neuromyelitis Optica Diagnosismentioning

confidence: 99%

The Treatment of Neuromyelitis Optica

Kowarik¹,

Soltys²,

Bennett³

2014

Journal of Neuro-Ophthalmology

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Neuromyelitis optica (NMO) is an autoimmune disorder of the central nervous system directed against astrocytes. Initially diagnosed in individuals with monophasic or relapsing optic neuritis and transverse myelitis, NMO is now recognized as a demyelinating disorder with pleiotropic presentations due to the identification of a specific autoantibody response against the astrocyte water channel aquaporin-4 in the majority of individuals. As visual impairment and neurologic dysfunction in NMO are commonly severe, aggressive treatment of relapses and prophylactic immunomodulatory therapy are the focus of treatment. Although there are no approved treatments for NMO, medications and therapeutic interventions for acute and chronic treatment have been the subject of retrospective study and case reports. The goal of this review is to familiarize the reader with biologic and clinical data supporting current treatments in NMO and highlight future strategies based on advancements in our understanding of NMO pathogenesis.

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Section: Neuromyelitis Optica Diagnosismentioning

confidence: 99%

The Treatment of Neuromyelitis Optica

Kowarik¹,

Soltys²,

Bennett³

2014

Journal of Neuro-Ophthalmology

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“…However, standard high-contrast visual acuity measurements were also significantly worse in NMO-ON eyes relative to the other groups, and there was no significant difference among groups in RNFL thickness in non-ON eyes. A recent study (20) compared the results of automated perimetry in patients with NMO-related ON and MS-related ON and found that visual field mean deviation was significantly greater in the NMO-ON eyes than in the MS-ON eyes. Therefore, OCT in this setting may simply be another marker of incomplete visual recovery after ON, and it is unclear whether OCT measurements add any further prognostic information regarding the future development of NMO.…”

Section: Figmentioning

confidence: 96%

Should Optical Coherence Tomography Be Used to Manage Patients With Multiple Sclerosis?

Costello¹,

Stavern²

2012

Journal of Neuro-Ophthalmology

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Over the past decade, optical coherence tomography (OCT) has become widely used in neuro-ophthalmology, mostly to assess the thickness of the peripapillary retinal nerve fiber layer (RNFL) and macular volume (1,2). OCT allows for objective and quantitative assessment of structural damage in the visual pathways, with a multitude of clinical and research applications. Thinning of RNFL and loss of macular volume have been found in multiple sclerosis (MS) patients, both with and without distinct episodes of optic neuritis (ON) suggesting ongoing loss of axons and neurons within the anterior visual system (1-3). There is strong evidence that accrual of neurologic dysfunction in MS correlates best with axonal and neuronal loss (rather than demyelination), but the magnetic resonance imaging (MRI) techniques available to measure such loss are cumbersome, expensive, and time consuming. OCT has emerged as a noninvasive and relatively inexpensive technique for capturing what we infer to be loss of central nervous system (CNS) axons and neurons.Whether OCT should be used mostly as an outcome measure in clinical trials or routinely to evaluate and follow patients with optic neuropathies, particularly those with ON and demyelinating disease, remains debated, as illustrated by the case below.A 31-year-old Caucasian woman was evaluated in the neuro-ophthalmology clinic for subacute painful visual loss in the right eye. Her examination was consistent with an isolated right retrobulbar optic neuropathy. She was diagnosed with right optic neuritis, likely secondary to demyelinating disease. She reported episodes of tingling over her left arm, and her brain MRI demonstrated multiple white matter lesions, some of which enhance. The diagnosis of clinically definite MS was made. She received intravenous methylprednisolone and was started on immunomodulating treatment for MS. Her visual function recovered over a few weeks, and she developed mild right optic nerve pallor. The treating neurologist requests a baseline OCT of the peripapillary RNFL. PRO-OCT Should Be Obtained in This Patient: Fiona Costello, MD, FRCPIn my opinion, a baseline OCT should be obtained to better understand what the diagnoses of ON and MS may mean for this patient.In the case provided, the patient has experienced a clinical episode of ON in the right eye, whereas the left eye is presumed to be normal. Previous OCT studies have demonstrated that RNFL measurements and macular volumes are lower in both the ON eyes and presumed unaffected eyes of MS patients relative to healthy controls ( Fig. 1) (3-6). A recent systematic review and meta-analysis of time-domain OCT (TD-OCT) studies showed an estimated RNFL loss of 220.38 mm (95% confidence interval, 222.86 to 217.91) in the ON eyes of MS patients as compared to control eyes (6). In eyes with no evidence of ON, TD-OCT measured RNFL values were reduced by 27.08 mm relative to the eyes of healthy controls, and the estimated RNFL loss in ON eyes vs unaffected eyes of MS patients was -14.57mm (95% confidence interval, 21...

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“…After a single episode of ON, the VF tests were normal in only 2 of 36 eyes of patients with NMO compared with 17 of 35 eyes with MS (P = 0.001). 54 Another study reported a case of familial antiYaquaporin-4 antibodyYpositive NMO. Disease onset occurred at different ages, even within the same family.…”

Section: Optic Neuritis and Multiple Sclerosismentioning

confidence: 98%