Low Prevalence of Bilateral (Presumed Nutritional) Optic Neuropathy as a Cause of Blindness in The Gambia

Dalmar, Abdirisak; Hodson, Katherine; Plant, Gordon T.

doi:10.1097/wno.0b013e31829b4240

Journal of Neuro-Ophthalmology

2013

DOI: 10.1097/wno.0b013e31829b4240

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Low Prevalence of Bilateral (Presumed Nutritional) Optic Neuropathy as a Cause of Blindness in The Gambia

Abdirisak Dalmar

Katherine Hodson²,

Gordon T. Plant³

Abstract: Our data indicate that bilateral optic neuropathy is nonepidemic in The Gambia. Rare vitamin B12 and folate deficiencies reported in rural Gambians may explain the low prevalence because previous epidemics were due to nutrient deficiency. Our study is the only available estimate of epidemic optic neuropathy in The Gambia and, as such, provides an important contribution to our knowledge in identifying characteristics that may cause specific populations to be more susceptible to this public health burden.

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“…Hearing deficits have been noted in approximately 50% of the patients studied, and is typically described as sensorineural although some patients with conductive hearing loss have been described. 6 The hearing deficits and peripheral neuropathy in these patients or their association with inflammatory markers or potential envi-ronmental exposures has not been well-characterized.…”

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Unexplained multi-sensory neuropathy syndrome in young Tanzanian adults

Massawe

Moshi

Ren

et al. 2021

Journal of Global Health Reports

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BackgroundA unique syndrome affecting young adults of unexplained hearing loss often associated with uncorrectable poor visual acuity and lower extremity numbness is endemic in Dar es Salaam. This study characterised the hearing loss, associated it with other symptoms, and gathered information on potential causes. MethodsForty-seven patients (23 men, 24 women) <40 years old with a symptom consistent with the syndrome, negative syphilis test, and no head injury history were recruited from Muhimbili National Hospital. 18 controls (10 men, 8 women) were recruited from the same neighborhoods as patients. Hearing ability and cochlear outer hair cell function (distortion-product otoacoustic emissions (DPOAEs)) were assessed, as were visual acuity and colour vision. Peripheral neuropathy was evaluated using the Michigan Neuropathy Screening Instrument (MNSI), and physical examination. Blood C-reactive protein levels and toenail trace metal concentrations were measured. Environmental exposures were elicited using a questionnaire. Patients with at least two of the following signs were defined as having the syndrome: poor hearing with normal DPOAEs, vision not correctable to better than 20/30, or a MNSI score greater than 4. Results29 participants met the case definition. C-reactive protein (CRP) levels did not differ between groups but manganese, cobalt and tin levels were each greater in the cases than controls. No other environmental exposure differences were noted. ConclusionsToenail manganese, cobalt, and tin levels were higher in those with the syndrome. These metals are potential neurotoxins suggesting a possible environmental origin for this unique and debilitating syndrome.

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Unexplained multi-sensory neuropathy syndrome in young Tanzanian adults

Massawe

Moshi

Ren

et al. 2021

Journal of Global Health Reports

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Macular spectral domain optical coherence tomography findings in Tanzanian endemic optic neuropathy

Kisimbi

Shalchi

Mahroo

et al. 2013

Brain

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Bilateral optic neuropathy in Dar es Salaam is now considered endemic and is estimated to affect 0.3-2.4% of young adults. The condition is characterized by a subacute bilateral loss of central vision of unknown aetiology. Findings of spectral domain optical coherence tomography have not previously been reported for these patients. All patients diagnosed with endemic optic neuropathy over a 2-year period at the Muhimbili National Hospital underwent spectral domain optical coherence tomography macular imaging. Scans were graded qualitatively for severity of retinal nerve fibre layer loss as well as the presence of microcystic macular changes, which have not previously been described in this condition. Of the 128 patients included (54.7% male; median age 20 years), severe retinal nerve fibre layer loss was found in 185 eyes (74.0%). There was full concordance in retinal nerve fibre layer thickness between the two eyes in 113 (91.1%) patients. Microcystic macular spaces were found in 16 (12.5%) patients and were bilateral in nine (7.0%) individuals. These changes were typically more prominent in the nasal than the temporal macula, predominantly involving the inner nuclear layer, and often occurred in an annular configuration that was evident on en face infra-red imaging, though not discernible on colour fundus photography or clinically. All patients with microcystic macular changes had severe thinning of the retinal nerve fibre layer (P = 0.02). Four patients in whom cystic spaces were demonstrated had sequential scans, and there was no detectable alteration in the configuration of these changes over a period of up to 16 months. This is the first study to document optical coherence tomography findings in endemic optic neuropathy. We have observed symmetrical severe loss of the caeco-central projection (papillomacular bundle) with otherwise well-preserved macular architecture. Also, we have observed microcystic retinal changes in a significant proportion of patients, which were associated with severe retinal nerve fibre layer loss. Similar changes have recently been reported from optical coherence tomography images of patients with multiple sclerosis, relapsing isolated optic neuritis, dominant optic atrophy, Leber's hereditary optic neuropathy and a patient with a chronic compressive optic neuropathy, supporting the hypothesis that this may be a non-specific phenomenon secondary to ganglion cell death. The correspondence of the changes to an annulus discernible on infra-red en face imaging, but not using other conventional retinal imaging techniques highlights the potential usefulness of this modality.

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Low Prevalence of Bilateral (Presumed Nutritional) Optic Neuropathy as a Cause of Blindness in The Gambia

Cited by 2 publications

References 16 publications

Unexplained multi-sensory neuropathy syndrome in young Tanzanian adults

Unexplained multi-sensory neuropathy syndrome in young Tanzanian adults

Macular spectral domain optical coherence tomography findings in Tanzanian endemic optic neuropathy

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