Loss Of Acuity Research Articles

Progression of Age-Related Macular Degeneration Among Individuals Homozygous for Risk Alleles on Chromosome 1 (CFH-CFHR5) or Chromosome 10 (ARMS2/HTRA1) or Both

Age-related macular degeneration (AMD) is a common cause of irreversible vision loss among individuals older than 50 years. Although considerable advances have been made in our understanding of AMD genetics, the differential effects of major associated loci on disease manifestation and progression may not be well characterized. To elucidate the specific associations of the 2 most common genetic risk loci for AMD, the CFH-CFHR5 locus on chromosome 1q32 (Chr1) and the ARMS2/HTRA1 locus on chromosome 10q26 (Chr10)-independent of one another and in combination-with time to conversion to late-stage disease and to visual acuity loss. This case series study included 502 individuals who were homozygous for risk variants at both Chr1 and Chr10 (termed Chr1&10-risk) or at either Chr1 (Chr1-risk) or Chr10 (Chr10-risk) and who had enrolled in Genetic and Molecular Studies of Eye Diseases at the Sharon Eccles Steele Center for Translational Medicine between September 2009 and March 2020. Multimodal imaging data were reviewed for AMD staging, including grading of incomplete and complete retinal pigment epithelium and outer retinal atrophy. Hazard ratios and survival times for conversion to any late-stage AMD, atrophic or neovascular, and associated vision loss of 2 or more lines. In total, 317 participants in the Chr1-risk group (median [IQR] age at first visit, 75.6 [69.5-81.7] years; 193 women [60.9%]), 93 participants in the Chr10-risk group (median [IQR] age at first visit, 77.5 [72.2-84.2] years; 62 women [66.7%]), and 92 participants in the Chr1&10-risk group (median [IQR] age at first visit, 71.7 [68.0-76.3] years; 62 women [67.4%]) were included in the analyses. After adjusting for age and AMD grade at first visit, compared with 257 participants in the Chr1-risk group, 56 participants in the Chr1&10-risk group (factor of 3.3 [95% CI, 1.6-6.8]; P < .001) and 58 participants in the Chr10-risk group (factor of 2.6 [95% CI, 1.3-5.2]; P = .007) were more likely to convert to a late-stage phenotype during follow-up. This difference was mostly associated with conversion to macular neovascularization, which occurred earlier in participants with Chr1&10-risk and Chr10-risk. Eyes in the Chr1&10-risk group (median [IQR] survival, 5.7 [2.1-11.1] years) were 2.1 (95% CI, 1.1-3.9; P = .03) times as likely and eyes in the Chr10-risk group (median [IQR] survival, 6.3 [2.7-11.3] years) were 1.8 (95% CI, 1.0-3.1; P = .05) times as likely to experience a visual acuity loss of 2 or more lines compared with eyes of the Chr1-risk group (median [IQR] survival, 9.4 [4.1-* (asterisk indicates event rate did not reach 75%)] years). These findings suggest differential associations of the 2 major AMD-related risk loci with structural and functional disease progression and suggest distinct underlying biological mechanisms associated with these 2 loci. These genotype-phenotype associations may warrant consideration when designing and interpreting AMD research studies and clinical trials.

Invited Session III: Reawakening plasticity in visual cortex: Recovery from amblyopia in the adult mouse through dark exposure, light reintroduction and perisynaptic proteolysis

An imbalance in the quality of visual input across the two eyes during development induces amblyopia, a disorder affecting up to 6% of the world's population. In animal models, severe deprivation amblyopia can be induced by early-onset, chronic monocular occlusion, and is manifest as a loss of spatial acuity through the deprived eye and a decrease in the strength of neuronal responses evoked by deprived eye stimulation. In all species, amblyopia is highly resistant to reversal in adulthood, due in part to the decline in synaptic plasticity in the primary visual cortex with age. However, we have previously demonstrated that visual deprivation (dark exposure) followed by light reintroduction (LRx) rejuvenates plasticity in the adult amblyopic cortex. The reactivation of plasticity triggered by DE/LRx is mediated by an increase in the activity of a matrix metalloproteinase (MMP9), that is perisynaptic, specific to thalamocortical synapses, and results in degradation of trans-synaptic adhesion proteins. Furthermore, live imaging of MMP activity in the mouse visual cortex demonstrates that DE lowers the threshold for MMP activation, enabling weak visual input through the amblyopic pathway to engage perisynaptic proteolysis. In amblyopic adult mice, the reactivation of synaptic plasticity by this novel and dynamic signaling pathway can be harnessed to promote full recovery of visually-evoked neuronal responses and spatial acuity.

Profiling of visual acuity and genotype correlations in RP2 patients: a cross-sectional comparative meta-analysis between carrier females and affected males.

X-linked retinitis pigmentosa (XLRP) is the most severe form of retinitis pigmentosa (RP) and accounts for 15-20% of all RP cases. In this study, we investigated the progression of visual acuity loss across age groups in female carriers and compared it to affected males. A PubMed literature search was conducted, and RP2 cases were included based on specific inclusion criteria. Visual acuity (VA), refractive error spherical equivalent (SE), and retinal findings were recorded. Cross-sectional analyses investigated the relationship between VA and age in carrier females and affected males. Genotype-phenotype VA correlations were studied using t-tests. 35 carrier females and 28 affected males with confirmed RP2 mutations were collected from 13 studies. The mean age and logMAR VA of carrier females were 44.2 ± 17.4 years, and 0.5 ± 0.5, respectively. 78.8% of carrier females showed abnormal XLRP-related fundus findings and had significantly reduced VA compared to those with normal fundi (0.6 ± 0.5 vs. 0.1 ± 0.1; p = 0.03). Compared to affected males, no statistical correlation was found between logMAR VA and advancing age in carrier females (p = 0.75). Statistically significant linear correlations were found between logMAR VA and SE in each of carrier females (p = 0.01). There were no observed differences in logMAR VA based on mutation type (p = 0.97) or mutation location (p = 0.83). Anisometropia was observed in 38% of carrier females and 68% of affected males; these prevalence numbers are statistically significant between the two groups (1.7 ± 0.3 vs. 3.9 ± 10.9 dioptres; p = 0.03). RP2 carrier females generally maintain good VA throughout their lifetime, as opposed to affected males, whose vision progressively declines. Our study provides important VA prognostic data that is crucial for patient counseling.

Long-term oncological outcomes after haemorrhagic apoplexy in pituitary adenoma managed operatively and non-operatively.

Depending on severity of presentation, pituitary apoplexy can be managed with acute surgery or non-operatively. We aim to assess long-term tumour control, visual and endocrinological outcomes following pituitary apoplexy with special emphasis on patients treated non-operatively. Multicentre retrospective cohort study. All patients with symptomatic pituitary apoplexy were included. Patients were divided into 3 groups: group 1: surgery within 7days; group 2: surgery 7days-3months; group 3: non-operative. Further intervention for oncological reasons during follow-up was the primary outcome. Secondary outcome measures included visual and endocrinological function at last follow-up. One hundred sixty patients were identified with mean follow-up of 48months (n = 61 group 1; n = 34 group 2; n = 64 group 3). Factors influencing decision for surgical treatment included visual acuity loss (OR: 2.50; 95% CI: 1.02-6.10), oculomotor nerve palsy (OR: 2.80; 95% CI: 1.08-7.25) and compression of chiasm on imaging (OR: 9.50; 95% CI: 2.06-43.73). Treatment for tumour progression/recurrence was required in 17%, 37% and 24% in groups 1, 2 and 3, respectively (p = 0.07). Urgent surgery (OR: 0.16; 95% CI: 0.04-0.59) and tumour regression on follow-up (OR: 0.04; 95% CI: 0.04-0.36) were independently associated with long-term tumour control. Visual and endocrinological outcomes were comparable between groups. Urgent surgery is an independent predictor of long-term tumour control following pituitary apoplexy. However, 76% of patients who successfully complete 3months of non-operative treatment may not require any intervention in the long term.

Charles Bonnet syndrome as first manifestation of occipital infarction.

To describe a case of Charles Bonnet syndrome as the first manifestation of occipital infarction in a patient with preserved visual acuity. We report a 78-year-old man followed in our department with a two-month-long history of visual hallucinations based on the vision of flowers and fruits intermittently, being perceived as unreal images. Best-corrected visual acuity was stable in the follow-up time being 20/20 in the right eye and 20/25 in the left eye. Extraocular muscle function testing, pupillary reflexes, biomicroscopy, fundus and optical coherence tomography examinations did not reveal any interesting findings. In order to rule out occipital pathology, orbital-cerebral magnetic resonance imaging was performed, showing an image compatible with the chronic ischemic right occipital lesion. The patient was diagnosed with Charles Bonnet syndrome secondary to occipital infarction and neurology decided that no treatment was required. 24-2 and 10-2 visual field tests showed no remarkable alterations and Full-field 120 point screening test showed nonspecific peripheral defects. Hallucinations improved over the months, being described as not annoying and increasingly infrequent. Charles Bonnet syndrome is a condition characterized by the presence of recurrent and complex visual hallucinations in patients with visual pathway pathologic defects. Visual acuity or visual field loss is not a requirement for diagnosis. Charles Bonnet syndrome should be suspected in all patients with non-disturbing visual hallucinations, even though they present good visual acuteness. It will be essential to perform complementary explorations to identify the underlying pathology that allows the starting of a correct treatment option.

Experimental Models of Glaucoma

Optic nerve pits are a mono- or bilateral congenital anomaly represented by optic disc depressions of various sizes. In half of the cases, the pits are complicated by edema, central retinal detachment and retinoschisis, and cause visual function decrease. Visual acuity losses can be either insignificant or pronounced. Optic discs pits have been investigated massively over the last century and a half, but their etiology is still underresearched. In recent years, however, due to the development of digital scanning and data processing technologies and the emergence of non-invasive highly informative diagnostic methods, it has become possible to reveal structural and functional changes of the optic disc in vivo, in addition to the traditional detection of histological changes in cadaveric eyes.Glaucomatous process modeling is one of the challenges in ophthalmology. And this is due primarily to the fact that, so far, the main reasons for the onset and progression of glaucoma. Numerous works on experimental research in its core model ocular. However, there are forms of glaucoma, which are independent of the level of intraocular pressure. Ideal model of glaucoma is considered a model with the development of the characteristic symptom in which a key symptom is a slowly progressive excavation of the optic nerve. But given the new knowledge in the pathogenesis of neurodegenerative changes in glaucoma in this model should be added and the opportunity to study the brain, vascular factors of progression, the level of neurotransmitters, trophic factors, etc. Therefore, we tried to make the analysis of models of glaucoma in various experimental animals and determine the most appropriate model for studying the pathogenesis of glaucoma.

Historical aspects and current views of the etiopathogenesis and clinical manifestations of optic nerve pits

Optic nerve pits are a mono- or bilateral congenital anomaly represented by optic disc depressions of various sizes. In half of the cases, the pits are complicated by edema, central retinal detachment and retinoschisis, and cause visual function decrease. Visual acuity losses can be either insignificant or pronounced. Optic discs pits have been investigated massively over the last century and a half, but their etiology is still underresearched. In recent years, however, due to the development of digital scanning and data processing technologies and the emergence of non-invasive highly informative diagnostic methods, it has become possible to reveal structural and functional changes of the optic disc in vivo, in addition to the traditional detection of histological changes in cadaveric eyes.

Factors Associated to Cataract Surgery Failure at Kankan Regional Hospital

Introduction: Cataract surgery has undergone many changes with the size of incision progressively decreasing over time with an incision of 12.0 mm for intracapsular cataract extraction to 2.2 - 2.8 mm in phacoemulsification. However, phacoemulsification due to high cost and equipment maintenance cannot be employed widely in developing countries. The phacoalternative or Manual small-incision cataract surgery (MSICS) offers similar advantages with the merits of wider applicability, less time consuming, a shorter learning curve, and lower cost. Haven’t not being without complications like any other surgery We have identified the factors influencing the outcome of phacoalternative cataract surgery in order to improve our quality of care for our patients suffering from blindness induced by the world’s first leading cause of legal blindness. We have identified the factors influencing the outcome of cataract surgery. Patients and Methods: This was a prospective observational study of the descriptive type lasting six (6) months from March 1 to August 30, 2020 including all patients operated on for cataracts and having lower visual acuity at 3/10. The operating form included demographic data, the patient’s personal ophthalmological history, postoperative visual acuity, per and postoperative complications and the type of pathology involved. The analysis was carried out using epi-info 7.2.0.1 software. Results: During this study period, we collected 61 cases of failure of cataract surgery out of a total of 1182 operated eyes, i.e. a frequency of 5.16%. Women represented more than half of the sample with 74%. Almost all of our patients, i.e. 96.72%, were over the age of 60. Loss of visual acuity was the main complaint in all our patients, i.e. 100% followed by photophobia with 24.4% of cases. Arterial hypertension present in 8.20% of patients was the most common comorbidity in our series followed by diabetes with 4.92%. 18 patients (29.5%) presented early postoperative complications such as corneal edema in 15 patients (24.6%) and hyphema in 3 patients (4.9%). Late postoperative complications were dominated by capsular fibrosis encountered in 42.89% of our patients. The causes of failure after cataract surgery were dominated by selection errors which accounted for 36.06% followed by late postoperative complications 34.43%. Conclusion: Like any surgery, cataract surgery can often be marred by various complications often occurring during the intraoperative or postoperative period. These complications in addition to negligence and/or non-deep analysis of certain cases (selection) are often associated with poor functional recovery.

Ethambutol-Induced bilateral retrobulbar neuritis with cecocentral scotoma in cervical tuberculous lymphadenitis patient: A case report with estimated plasma level consideration

Ethambutol is considered to be safest first-line antitubercular drug, and patient acceptability is rather good in both intensive and continuation phase of the tuberculosis treatment with daily regimen. The important adverse effect associated with ethambutol is optic neuritis, resulting in loss of visual acuity, color vision, and field defects. The incidence of optic neuritis is generally directly proportional to the dose and duration of ethambutol therapy and rarely reported in a low standard dose. Here, we report a case of a 40-year-old female patient with complaints of progressive diminished vision (especially during day time) with a low daily dose (15 mg/kg/day) of ethambutol. She got diagnosed with cervical tuberculous lymphadenitis and was receiving isoniazid, rifampicin, ethambutol, and levofloxacin. In rare instances, ethambutol ocular toxicity may present with cecocentral scotoma. In rare instances, plasma levels are performed. An estimated plasma level of ethambutol was found to be in higher end (5.6 μg/ml) of the reported therapeutic range (2–6 μg/ml). Bilateral retrobulbar neuritis with cecocentral scotoma adverse effect due to ethambutol can be seen in plasma therapeutic range.

Evolution of practice and management of neovascular glaucoma: a landmark review

AbstractPurposeA comprehensive systematic review (SR) was completed evaluating patient outcomes following medical and surgical interventions targeted at controlling iris neovascularization (NVI) and neovascular glaucoma (NVG).MethodsData sources used were MEDLINE, EMBASE and Web of Science. Studies included both surgical and medical treatments in patients with NVI and NVG. Outcomes measured were intraocular pressure (IOP) lowering, failure rates, loss of visual acuity and disease regression. The SR was registered with PROSPERO.ResultsThe majority of studies retrieved during this time period were population based. A total of 159 studies were included with 148 studies being population based. 59.5% of studies were retrospective in nature and 40.5% were prospective. There were 7 randomised controlled trials and 4 non‐randomised controlled trials. The mean number of patients and eyes studied were 39 ± 42 (range 3–386) and 40 ± 47 (3–428) respectively. The mean follow‐up for all studies was 18.2 ± 24.1 (range 0.25–216) months. Significant differences were observed between glaucoma drainage devices (GDDs), diode laser and trabeculectomy in IOP lowering efficacy and failure rates; particularly with the advent of Anti‐VEGFs.ConclusionsThe unpredictable, uncommon nature of NVG is a significant limitation to high‐quality evidence on the subject. Our findings are primarily based on real‐life, non‐RCT data. We present a necessary update on the medical and surgical treatment of neovascular glaucoma particularly with increased incidence in the era of COVID‐19.

Investigation of Demyelination and Remyelination Processes of the Compressed Optic Chiasm: An Experimental Model.

To demonstrated demyelination and remyelination of the optic nerve histologically by electron microscopy in an experimental model similar to the compression of pituitary adenomas on the optic chiasm. The rats were fixed to a stereotaxic device under deep anesthesia, and a balloon catheter was placed under the optic chiasm through a burr hole which was in front of the bregma in accordance with the brain atlas of rats. The animals were divided into five groups (n=8): control, mild compression demyelination, severe compression demyelination, mild compression remyelination, severe compression remyelination. The fine structures of the tissues obtained were evaluated using electron microscopy. We found a significant difference in the severity of degeneration when comparing group 1 with group 5 (p < 0.001); there was no degeneration in group 1 rats and severe degeneration in all of the group 5 rats. Oligodendrocytes were found in all rats in group 1 and none of the rats in no group 2. The nuclei were preserved in the group 1 rats but damaged in all of the group 5 rats. There were no lymphocytes or erythrocytes in group 1 and all positives in group 5. This technique, which induced degeneration without causing damage to the optic nerve with toxic or chemical agents, revealed Wallerian degeneration similar to tumoral compression. After compression relief, the optic nerve remyelination process can be better understood, particularly for sellar lesions. In our opinion, this model may guide future experiments to identify protocols to induce and accelerate remyelination.

Detrimental Effects of Traffic Noise in Traffic Policemen as Assessed by Auditory Brainstem Evoked Response: A Cross-sectional Observational Study

Introduction: Loud noise is a global occupational health hazard with substantial social and physiological impacts, especially pronounced in traffic policemen who are engaged at heavy traffic junctions. Apart from its overt effect on sensorineural hearing, loud noise has been also implicated, albeit covertly, as a causative factor for disturbances in sleep, learning and depression. Due to the insidious nature of hearing impairment, manifestations are often masked and hence testing through Auditory Brainstem Evoked Response (ABER) should be resorted to, for assessment of functional status of auditory pathway objectively. Aim: To assess and compare the effect of traffic noise in traffic policemen with age matched apparently healthy males using ABER. Materials and Methods: The present study was a crosssectional, comparative type of observational research conducted in the Department of Physiology, SMS Medical College, Jaipur, Rajasthan, India, from June 2019 to May 2020, on 45 apparently healthy male traffic policemen, aged 25-40 years, engaged at heavy traffic junctions of Jaipur city, with an average field posting of five years or more. An equal number of age and sex matched apparently healthy subjects living in Jaipur city, were recruited as controls. Before commencing with the test procedure, ethical clearance was obtained from the institute’s ethics committee and research review board and written informed consent was obtained from all the participants. ABER assessment was done via RMS EMG SALUS 2C machine on each subject using click stimuli presented mono-aurally via an overhead headphone resulting in harvest of variables in form of absolute wave latencies (I to V) and Interpeak Latencies (IPL) (I-III, I-V and III-V). Unpaired Student’s t-test was used to derive the level of significance using Statistical Package for the Social Sciences (SPSS) version 16.0. Level of significance was set at p-value &lt;0.05. Results: The results obtained in the present study demonstrated pronounced delay (p-value&lt;0.01) in all absolute wave latencies (I to V) in both ears in traffic policemen. A statistically significant delay was also observed in IPL I-V (p-value&lt;0.01) when a comparison of left ABER was made between traffic policemen and controls. Conclusion: The findings of the present study indicate that the hidden footprints of loss in auditory acuity in traffic policemen exposed to traffic noise can be unearthed objectively via using ABER assessment and therefore periodic ABER assessment along with usage of preventive equipment should be the strategy for prevention of imminent hearing loss.

Underwater Images Enhancement by Revised Underwater Images Formation Model

In this paper, we proposed the efficient and appealing technique for underwater images enhancement. Underwater images often suffer from haze, color distortion, low contrast and loss of the human acuity due to light scattering and absorption. To tackle these issues, proposed precise model is presented expressively showed that: (1) the estimation of the transmission map in atmospheric scatter model is divided into two cases, which are more applicable to underwater images in different situations, and make the enhanced results more robust; (2) model not only removes haze but also restores lost colors of underwater images in the image de-hazing step instead of color correction. First, we proposed a revised underwater dehazing model aiming to eliminate the color of water directly while solving the problem of haze in the underwater images. Then proposed color correction method can adaptively address the problem of color shifting without any additional information. Furthermore, we design a multi-scale illumination fusion to reveal more details and low illumination parts of the image. Experimental results demonstrate that our proposed method outperforms other methods significantly with 5%~77% quantitative improvement on all four evaluation performance indices and shows more obvious detailed underwater images. Our method can be applied to underwater detection and exploration as the pre-processing step.

Relationship between depressive symptoms, social isolation, visual complaints and hearing loss in middle-aged and older adults.

The prevalence of chronic diseases, especially depression, has been increasing worldwide. Health professionals have an important role in screening and early detection of the disorder, to prevent possible damage such as disability and dependence. With aging, sensory impairments can occur, such as visual and hearing losses, which can lead to isolation contributing to the development of depressive symptoms. The objective of this study was to analyze the relationship between depressive symptoms, social isolation, and self-perception of visual complaints and hearing loss in middle-aged and older adults. It was a cross-sectional quantitative study, in Três Lagoas, state of Mato Grosso do Sul, Brazil, with 300 participants of both sexes, aged 45 years and over, registered in the Primary Health Care network. Data were collected using a structured questionnaire with sociodemographic data and the questions "Do you consider yourself socially isolated?", "Do you have a vision and/or a hearing problem capable of stopping you from performing a daily life activity?" and "If yes, do you use a hearing aid and/or glasses or contact lenses?". Depressive symptoms were assessed using the Center for Epidemiological Studies - Depression (CES-D) scale with a cut-off score adapted for age. Data were analyzed with binary logistic regression, with the presence of depressive symptoms being the dependent variable. Values of p≤0.05 were considered significant. The majority of the sample were women (65.7%), with an average age of 60.9 years, 56.7% were classified with depressive symptoms, 27.0% considered themselves socially isolated, 84.7% reported visual acuity loss (70.7% used glasses) and 17.3% reported hearing loss (2.3% used hearing aids). Social isolation (OR = 6.0), visual complaints (OR = 3.85), and hearing loss (OR = 4.67) were related to the presence of depressive symptoms. Moreover, being married (OR = 0.51) was a protective factor in these participants. The results showed the importance of early diagnosis of depressive symptoms. The correction of visual and hearing deficits is highlighted, as these may be related to symptoms of depression. Health professionals in Primary Health Care should be able to monitor depressive symptoms, visual and hearing complaints, and to promote social interaction.

Hemiretinal artery occlusion as a variant of retinal arterial occlusive disease

Central retinal artery occlusion is an established and potentially blinding ocular condition. It is the most common presentation of the spectrum comprising retinal arterial occlusive diseases. The presence of a hemicentral retinal artery is an anatomical variation and few reports on its occlusion are noted in literature. Here, we present the case of a 45-year-old male who was diagnosed with hemiretinal artery occlusion occurring secondary to an embolus from the carotid artery. He was also noted to have systemic hypertension at presentation along with dyslipidemia. The visual acuity loss improved over a follow-up period of 1 week post presentation before the patient was lost to follow-up. This case report highlights the role of a thorough systemic evaluation and prompt referral to an internist of the patient presenting with retinal arterial occlusive disease. It also showcases an uncommon presentation retinal arterial occlusion that may occur as an anatomical variant much as the case of a hemiretinal vein occlusion.

12-Month Follow Up of Combined Cataract Surgery with Schlemm's Canal Scaffolding for the Treatment of Primary Angle Closure Glaucoma

The pathophysiology of angle closure glaucoma is characterized by the peripheral iris coming into contact with the trabecular meshwork, in either an appositional (intermittent) or synechial (permanent) manner. Irido-trabecular contact may significantly decrease aqueous outflow through the conventional outflow pathway (i.e. through the trabecular meshwork and Schlemm's canal), thereby elevating intraocular pressure (IOP). Severe or chronically elevated IOP can lead to glaucomatous optic neuropathy and associated visual field and visual acuity loss.

Clinical Manifestations, Neuroimaging Findings, and Treatment of Idiopathic Intracranial Hypertension in a Nepalese Tertiary Centre

Introduction: Idiopathic Intracranial Hypertension is characterized by headache, visual impairment, papilledema, and increased cerebrospinal fluid opening pressure. We aim to evaluate clinical manifestations, neuroimaging findings, and treatment of Idiopathic Intracranial Hypertension in a Nepalese tertiary center. Materials and Methods: We retrospectively included patients with the diagnosis of Idiopathic Intracranial Hypertension who were admitted to the Neurology department of Tribhuvan University Teaching Hospital from 2019 June to 2021 May and presented to the Neuro-ophthalmology outpatient clinic of the hospital for follow-up. Results: Out of 16 Idiopathic Intracranial Hypertension patients, 12(75%) patients had either headache or ocular pain. Reduced visual acuity and progressive visual loss were found in 44% of patients. Normal CSF opening pressure was found in 19%, 44% had CSF opening pressure at a range of 20-30 cm H20 and &gt; 30 cm H20 in 37.5%. 15 Idiopathic Intracranial Hypertension patients (93.7%) were subtyped as Typical and 1 patient was diagnosed as Fulminant Idiopathic Intracranial Hypertension. Acetazolamide was used for treatment in 15 patients and 1 patient needed ventriculoperitoneal shunting. 56% Seven patients (44%) had some abnormal findings: partial empty sella (44%), and tortuous optic nerve (31%), flattened posterior eyeball (31%), and hypoplastic transverse sinus (19%). Conclusions: Idiopathic Intracranial Hypertension is an uncommon diagnosis but should be suspected in patients with chronic headaches with visual impairment. In low-resource settings, proper history along with neurological and ophthalmological examinations can even detect the early features and timely referral can save the vision and disability of Idiopathic Intracranial Hypertension patients.

Idiopathic Intracranial Hypertension: Current Neuroophthalmologic Points

Idiopathic intracranial hypertension (ICH) is a neuroophophthalmologic syndrome, the main ophthalmologic symptoms of which are vision loss and bilateral swelling of optic nerve disks (OD). The article provides a review covering various aspects of ICH. Epidemiology: ICH occurs mainly in women aged 20–45 years with body overweight. In this group of patients world incidence is 12–20 per 100 000 of population per year. In the total population it represents 0.5–2 cases per 100 000 of population per year. The eightfold gender predominance of women with ICH is observed. Etiology is not fully known until present time. The reliable connection between obesity in childbearing age women and menstrual cycle disorders as evidences of hormonal changes has been established. The probable mechanisms of increase of ICP are supposed: hyperproduction of and disturbances of its absorption, CSF mechanical pressure on the optic nerve sheath; restriction of venous outflow from the brain due to the pathology of venous sinuses; stimulating effect of abundant vitamin A in diet resulting in the fat tissue formation with the development of obesity; expression of the protein aquaporin, involved in the regulation of body mass and water metabolism in the subarachnoid space. Clinical manifestations. Ophthalmologic symptoms of ICH: transient visual impairment, sustained loss of visual acuity, photopsy, retrobulbar pain, diplopia. Non-ophthalmologic symptoms: headache, throbbing tinnitus, hearing loss, dizziness. Diagnostics. The valuable diagnostic data can be obtained by visual field investigation, ophthalmoscopic examination with revealing of bilateral OD-edema, OD and retinal optical coherent tomography, orbital ultrasound examination, brain MRI with venography. Treatment. Non-drug therapy: weight loss, lowcalorie diet with limited water and salt intake. Drug therapy: long-term oral use of carbonic anhydrase inhibitors (acetazolamide, topiramate). High doses of steroids (methylprednisone) are used for short-term treatment of patients with fulminant disease type before surgery. Surgery: bypass surgery, cerebral venous sinus stenting and fenestrations of the optic nerve sheath: bariatric surgery with reducing of stomach volume.

Impact of COVID-19 on the Management of Diabetic Retinopathy

Diabetic retinopathy (DR) is one of the most common causes of vision loss in people across the world. COVID- Despite the fact that early diagnosis and management guidelines for DR have considerably lowered burden of disease, 19 disease outbreak limitations have had an impact on actual world clinical management in the care of DR patients. This research includes the most latest treatment guidelines and outcomes for DR in the context of the outbreak.&#x0D; When contrasted to equivalent instants of time in 2019, intravitreal doses for DR have declined dramatically globally during the outbreak, spanning from around 30 percent to around 100percent reduction. After a substantial amount of time, several research on operational findings demonstrate a loss in visual acuity.&#x0D; In the treatment of DR, changing practice methods have led to lower intravitreal doses and cumulative loss of vision acuity during follow-up. It will be vital to continue reviewing practise guidelines as more COVID mutations arise.

The diagnostic accuracy and prognostic value of OCT for the evaluation of the visual function in children with a brain tumour: A systematic review.

PurposeTo systematically review the evidence on the diagnostic accuracy and prognostic value of retinal optical coherence tomography (OCT) to detect visual acuity (VA) or visual field (VF) loss in children with a brain tumour.MethodsPubMed, Embase and Cochrane Library databases were searched from inception to February 2021. We included studies evaluating retinal OCT and standard visual function parameters (VA and or VF) in children with a brain tumour. Two authors independently extracted data from each included study. They also assessed the methodological quality of the studies using the QUADAS-2 or QUIPS tool. The diagnostic accuracy of OCT was evaluated with receiver operating characteristic analysis, sensitivity, specificity, positive predictive value and negative predictive value. The prognostic value of OCT was evaluated with predictive measures (odds ratio).ResultsWe included five diagnostic studies, with a total of 186 patients, all diagnosed with optic pathway glioma. No prognostic studies were eligible for inclusion. Included studies evaluated either retinal nerve fiber layer (RNFL) thickness or ganglion cell layer—inner plexiform layer (GCL-IPL) thickness. There was considerable heterogeneity between OCT devices, OCT protocols, visual function parameters and threshold values. Sensitivity and specificity for RNFL thickness measurement ranged from 60.0% to 100.0% and 76.6% to 100%, respectively. For GCL-IPL thickness measurement, area under the curve ranged from 0.91 to 0.98 for different diameters.ConclusionThe literature regarding the diagnostic accuracy and prognostic value of OCT parameters in children with a brain tumour is scarce. Due to heterogeneity and a considerable risk of bias of included studies, we cannot draw solid conclusions regarding the accuracy of retinal OCT. Future research should investigate the potential of OCT as diagnostic and prognostic tool for the evaluation of the visual function and detection of visual impairment in children with any type of brain tumour.