Band Atrophy Research Articles

Comparison of the GDx VCC scanning laser polarimeter and the stratus optical coherence tomograph in the detection of band atrophy of the optic nerve

To compare the ability of scanning laser polarimeter (SLP) with variable corneal compensation (GDx VCC) and optical coherence tomograph (Stratus OCT) to discriminate between eyes with band atrophy (BA) of the optic nerve and healthy eyes. The study included 37 eyes with BA and temporal visual field (VF) defects from chiasmal compression, and 29 normal eyes. Subjects underwent standard automated perimetry (SAP) and retinal nerve fibre layer (RNFL) scans using GDx VCC and Stratus OCT. The severity of the VF defects was evaluated by the temporal mean defect (TMD), calculated as the average of 22 values of the temporal total deviation plot on SAP. Receiver operating characteristic (ROC) curves were calculated. Pearson's correlation coefficients were used to evaluate the relationship between RNFL thickness parameters and the TMD. No significant difference was found between the ROC curves areas (AUCs) for the GDx VCC and Stratus OCT with regard to average RNFL thickness (0.98 and 0.99, respectively) and the superior (0.94; 0.95), inferior (0.96; 0.97), and nasal (0.92; 0.96) quadrants. However, the AUC in the temporal quadrant (0.77) was significantly smaller (P<0.001) with GDx VCC than with Stratus OCT (0.98). Lower TMD values were associated with smaller RNFL thickness in most parameters from both equipments. Adding VCC resulted in improved performance in SLP when evaluating eyes with BA, and both technologies are sensitive in detecting average, superior, inferior, and nasal quadrant RNFL loss. However, GDx VCC still poorly discriminates RNFL loss in the temporal quadrant when compared with Stratus OCT.

Diagnostic Ability of Optical Coherence Tomography with a Normative Database to Detect Band Atrophy of the Optic Nerve

To evaluate the diagnostic ability of stratus optical coherence tomography (OCT) with a normative database to detect band atrophy (BA) of the optic nerve. Cross-sectional study. StratusOCT retinal nerve fiber layer thickness scans were obtained in 37 eyes with BA and permanent temporal visual field defect and 37 healthy eyes. The categorization of eyes according to the normative database of the instrument and sensitivity and specificity values were reported. The average thickness parameter demonstrated the highest sensitivity for detection of abnormalities in eyes with BA, followed by the parameters related to the temporal and nasal quadrants. Values of sensitivity were relatively lower for the 30 degree segments. StratusOCT with a normative database performed well in detecting retinal nerve fiber layer (RNFL) loss in eyes with BA. Clinicians should be aware of possible detection failure in the 30 degree segmental analysis, particularly at the 3 o'clock meridian.

Evaluation of Macular Thickness Measurements for Detection of Band Atrophy of the Optic Nerve Using Optical Coherence Tomography

To evaluate the ability of optical coherence tomography (OCT) macular thickness parameters to differentiate between eyes with band atrophy (BA) of the optic nerve and healthy eyes. Cross-sectional study. The study included 1 eye of each of 40 consecutive patients with BA of the optic nerve and permanent temporal hemianopic visual field (VF) defects owing to chiasmal compression and 31 age- and gender-matched healthy subjects. All patients underwent VF assessment with kinetic Goldmann perimetry and Humphrey 24-2 full-threshold standard automated perimetry (SAP). Macular and retinal nerve fiber layer (RNFL) thickness scans were obtained using the commercially available Stratus OCT. The severity of VF defect in patients with BA was evaluated by the temporal mean defect (TMD), calculated as the average of the 22 values of the temporal total deviation plot of the SAP 24-2 test, excluding the 2 points immediately above and below the blind spot. Receiver operating characteristic (ROC) curves and sensitivities at fixed specificities were calculated for each parameter. Spearman's rank correlation coefficients were used to evaluate the relationship between RNFL and macular thickness parameters and severity of VF loss as measured by the TMD. The macular thickness parameters related to the nasal hemiretina had the best performance to detect damage in BA eyes. No statistically significant difference (P = 0.19) was found between the ROC curve areas (AUCs) for the best macular thickness parameter (temporal/nasal macular thickness, AUC = 0.96) and the best RNFL parameter (average thickness, AUC = 0.99). Lower values of TMD, indicating more severe VF loss, were associated with lower macular thickness measurements. The highest correlation was observed for the parameter nasal average macular thickness (rho = 0.693, R2 = 48%, P<0.001). Eyes with BA of the optic nerve show significant thinning of the retinal thickness on the nasal macular area, which is associated with the severity of VF damage in these eyes. Macular thickness measurements could potentially be used to evaluate the amount of ganglion cell loss in patients with BA of the optic nerve and could prove clinically useful for detection of damage and for monitoring these patients.

Comparação entre o polarímetro de varredura a laser, a tomografia de coerência óptica 1 e o Stratus-oct na detecção da perda axonal da atrofia em banda do nervo óptico

To compare the abilitiy of scanning laser polarimetry (GDx), optical coherence tomography (OCT) 1 and Stratus- optical coherence tomography to discriminate between healthy eyes and eyes with band atrophy of the optic nerve and temporal hemianopsia. Twenty-three eyes with band atrophy of the optic nerve and 23 eyes from healthy subjects were included in this observational prospective case-control study. All eyes underwent retinal nerve fiber layer (RNFL) thickness analysis using GDx, optical coherence tomography-1 and Stratus-optical coherence tomography. Mean values obtained with each equipment were compared between band atrophy and normal eyes. Receiver operating characteristic (ROC) curves and sensitivities at fixed specificities (80% e 95%) were calculated for each parameter calculated with each equipment and compared. When compared with healthy subjects, the parameters corresponding to the global average as well as each of the four quadrant retinal nerve fiber layer thickness in eyes with band atrophy were significantly smaller (p<0.05), than in normal eyes, with the exception of GDx's temporal thickness parameter. Comparison of the areas under ROC curves (AUCs) of the parameters from the three equipments revealed significantly greater values for the Stratus-OCT when compared to the OCT-1 in the global average and in the temporal quadrant thickness measurement. Stratus-OCT was significantly more sensitive than GDx in the global average as well as in the temporal, nasal and inferior quadrant. OCT-1 was superior to GDx only in the temporal quadrant. All three equipments revealed a similar ability to identify retinal nerve fiber layer reduction in the superior quadrant. The Stratus OCT showed the best ability to discriminate between eyes with band atrophy of the optic nerve and healthy eyes although all three equipments were able do identify most of the abnormal eyes. OCT-1 was inferior to Stratus-OCT and superior do GDx in the temporal quadrant. Although GDx was able identify some abnormality in most studied eyes, the equipment showed poor sensitivity in the detection of axonal loss in the nasal and temporal aspect of the optic disc and should be used with caution in neuro-ophthalmic diseases that cause retinal nerve fiber layer loss in those areas of the optic disc.

Retinal nerve fiber layer loss documented by Stratus OCT TM in patients with pituitary adenoma: case report

To report abnormalities of retinal nerve fiber layer (RNFL) thickness using optical coherence tomography (Stratus OCT) in patients with pituitary adenoma. Two patients with long-standing bitemporal visual field defects and optic nerve band atrophy were submitted to optical coherence tomography examination (Stratus OCT). Both patients with band atrophy revealed diffuse loss of the retinal nerve fiber layer on Stratus OCT, with severe reduction in the nasal and temporal areas of the optic disc. Retinal nerve fiber layer loss correlated well with visual field loss and with previous histological studies of band atrophy of the optic nerve. Stratus optical coherence tomography can provide useful information in the diagnosis of band atrophy from chiasmal lesions such as pituitary adenomas.

Comparison of retinal nerve fibre layer measurements using optical coherence tomography versions 1 and 3 in eyes with band atrophy of the optic nerve and normal controls

To compare retinal nerve fibre layer (RNFL) measurements were carried out with two different versions of an optical coherence tomography device in patients with band atrophy (BA) of the optic nerve and in normal controls. The RNFL of 36 eyes (18 with BA and 18 normals) was measured using an earlier version of an optical coherence tomography device (OCT-1). The measurements were repeated using a later version of the same equipment (OCT-3), and the two sets of measurements were compared. Using OCT-1, the peripapillary RNFL thickness (mean+/-SD, in microm) in eyes with BA measured 80.42+/-6.94, 99.81+/-14.00, 61.69+/-13.02, 101.70+/-12.54, and 57.36+/-16.52 corresponding to the total RNFL average, superior, temporal, inferior, and nasal quadrants, respectively. Using OCT-3, the corresponding measurements were 63.11+/-6.76, 81.22+/-13.34, 39.50+/-8.27, 86.72+/-15.16, and 45.05+/-8.03. Each of these measurements was significantly smaller with OCT-3 than with OCT-1. In normal eyes, RNFL average and temporal quadrant OCT-3 values were significantly smaller than OCT-1 values, but there was no significant difference in measurements from the superior, inferior, and nasal quadrant. RNFL measurements were smaller with OCT-3 than with OCT-1 for almost all parameters in eyes with BA and in the global average and temporal quadrant measurements in normal eyes. Investigators should be aware of this fact when comparing old RNFL measurement with values obtained with later versions of the equipment.

Twin and Triple Peaks Papilledema

To describe 2 adult patients who presented with papilledema after band atrophy (i.e., twin and triple peaks papilledema). Retrospective small case series. Two outpatients. Observations made on 2 patients whose cases were reviewed in the neuro-ophthalmology clinic. The first patient had a pituitary tumor presenting with papilledema, causing a triple peaks clinical sign. Color photographs, optical coherence tomograms, and magnetic resonance images are shown. The second patient developed twin peaks papilledema due to a chiasmal glioma causing secondary raised intracranial pressure. Twin peaks papilledema is a rare clinical sign that may develop in adults as well as in children. The first report and optical coherence tomography features of triple peaks papilledema illustrate a new clinical sign.

Optical coherence tomography detects characteristic retinal nerve fiber layer thickness corresponding to band atrophy of the optic discs

To analyze retinal nerve fiber layer (RNFL) thickness in eyes with band atrophy by use of optical coherence tomography (OCT) and to evaluate the ability of OCT to detect this characteristic pattern of RNFL loss. Cross-sectional, retrospective study. Thirty-four eyes of 18 patients with bitemporal hemianopia caused by optic chiasm compression by chiasmal tumors were studied. All eyes were divided into 3 groups according to visual field loss grading after Goldmann perimetry. Retinal nerve fiber layer thickness measurements with OCT. Retinal nerve fiber layer thickness around the optic disc was measured by OCT (3.4-mm diameter circle). Calculation of the changes in OCT parameters, including the horizontal (nasal + temporal quadrant RNFL thickness) and vertical values (superior + inferior quadrant RNFL thickness) was based on data from 160 normal eyes. Comparison between the 3 visual field grading groups was done with the analysis of variance test. The receiver operating characteristic (ROC) curve for the horizontal and vertical value were calculated, and the areas under the curve (AUC) were compared. Retinal nerve fiber layer thickness in eyes with band atrophy decreased in all OCT parameters. The reduction rate in average and temporal RNFL thickness and horizontal value was correlated with visual field grading. The AUC of horizontal value was 0.970+/-0.011, which was significantly different from AUC of vertical value (0.903+/-0.022). The degree of RNFL thickness reduction correlated with that of visual field defects. Optical coherence tomography was able to identify the characteristic pattern of RNFL loss in these eyes.

Postictal EEG suppression and hippocampal atrophy in temporal lobe epilepsy.

Postictal EEG suppression and slowing recorded with scalp electrodes in patients with partial epilepsy is often maximal over the cortical area of ictal onset. The aim of this study was to determine whether a quantitative relationship exists between immediate postictal EEG suppression and hippocampal atrophy. Immediate postictal EEG was analyzed in 31 scalp-recorded seizures obtained from 8 patients who underwent temporal lobectomy with seizure-free outcomes (2 left, 6 right). Quantitative EEG analysis was performed using a temporal power asymmetry index for each frequency band. The hippocampal asymmetry (left-to-right ratio) based on T1- and T2-weighted MR images was determined by hippocampal volumetric analysis. The relationship between the average temporal power asymmetry index and either T1 or T2 hippocampal asymmetry ratio was assessed for each frequency band using Pearson's correlation coefficient. Only correlations of the temporal power asymmetry index with T1 hippocampal asymmetry were significant for the total bands (r = 0.768, P < 0.026) and 8-bands (r = 0.728, P < 0.041). The findings suggest that a quantitative relationship exists between postictal EEG suppression in the 6-frequency band and hippocampal atrophy in temporal lobe epilepsy.

Detection of Isolated Occipital Lobe Anomalies During Early Childhood

The authors report two children with isolated occipital lobe anomalies detected by visual evoked potentials (VEPs) and confirmed by MRI and CT scanning. Both had a markedly asymmetrical occipital distribution of flash and pattern VEPs. One child had acuity reduced to 6/36, and testing on confrontation suggested an homonymous hemianopia. The second child was visually inattentive to one side during infancy. Neither child had band atrophy of the optic disc or an afferent pupillary defect. Isolated abnormalities of the occipital lobes are difficult to detect by clinical examination during infancy and early childhood. Recording VEPs from a horizontal array of occipital electrodes can be helpful in detecting subtle occipital lobe abnormalities.

Band atrophy of the optic nerve. The histology of temporal hemianopsia.

Cross sections of the orbital portion of the optic nerve, the decussating fibers of which underwent atrophy, have a distinctive histologic pattern. Distally, from the eyeball to the midportion of the optic nerve, this pattern of atrophy consists of a broad-based nasal and a narrow-based temporal sector that form a horizontal band. Proximally, near the optic canal, the pattern changes. The atrophic bundles occupy the nasal and central portions of the optic nerve only.