Journal of Neuro-Ophthalmology最新文献

Background: Although neuro-ophthalmology specialists must complete a fellowship following either an ophthalmology or neurology residency, the impact of these distinct residency training pathways on professional characteristics, academic advancement, and research productivity remains underexplored. This analysis examines demographic, academic, leadership, and research trends among neuro-ophthalmology specialists based on their residency training type, aiming to determine whether training type(s) correlate with future career development in academic neuro-ophthalmology.

Methods: Data were collected from publicly accessible websites of US academic institutions and verified using the Fellowship and Residency Electronic Interactive Database. Variables included demographics (sex, additional advanced degrees, years since residency graduation), academic rank, leadership positions, and research productivity (publications, citations, and h-index). Statistical comparisons between training groups were conducted using chi-square tests for categorical variables and Kruskal-Wallis tests for continuous variables.

Results: Among 312 neuro-ophthalmology specialists, 224 (71.8%) were trained in ophthalmology residencies and 88 (28.2%) in neurology residencies. Most were male (64.1%) with no significant differences in sex between the groups. Ophthalmology-trained specialists had more years since residency (median: 19 vs 11, P = 0.003) and were more likely to have completed additional fellowships (36.2% vs 3.4%, P < 0.001). Since 2010, neurology-trained neuro-ophthalmologists have comprised a growing proportion of new practicing neuro-ophthalmologists. Academic rank distribution was similar between the groups, but leadership roles were more often held by ophthalmology-trained specialists (43.8% vs 30.7%, P = 0.20). Research productivity metrics, including publication count, citations and h-index, were comparable between the groups.

Conclusions: This study underscores differences in training, career entry, and leadership roles between ophthalmology- and neurology-trained neuro-ophthalmologists, offering insights for workforce planning amid ongoing physician shortages.

Background: Optic nerve sheath enhancement (ONSE) on MRI is associated with a range of pathological conditions but may also occur in individuals without optic nerve disease. This study aimed to determine the prevalence, sensitivity, and specificity of ONSE among patients with and without known optic nerve pathology and to assess the impact of MRI field strength and demographic factors on ONSE interpretation.

Methods: This retrospective study included 115 patients with either known pathologic enhancement or no pathology who underwent MRI of the orbits between January 2010 and June 2023 at a single academic center. MRI scans were reviewed by a blinded neuroradiologist for presence or absence of ONSE. Patient demographics and MRI technical details, including field strength (1.5T or 3T), were recorded. Diagnostic performance metrics (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], accuracy) were calculated overall and stratified by MRI strength.

Results: Among 115 patients (median age 63.2 years, 68% female, 90% White), ONSE was falsely identified in 7% of controls and missed in 13% of cases with known pathology. Overall, ONSE detection yielded a sensitivity of 87% and specificity of 93%. For 3T MRI, sensitivity was 100% and specificity was 90%; for 1.5T MRI, sensitivity was 75% and specificity 95%. PPV remained low across all groups, with highest NPV seen in 3T imaging (100%). No significant influence of age, sex, or race on ONSE detection was observed.

Conclusions: ONSE can be seen in a small proportion of patients without optic nerve pathology and may be missed in subtle disease, emphasizing the importance of clinical correlation. Higher field strength MRI may improve sensitivity for detecting pathologic ONSE but can have false positives. These findings underscore the need for cautious interpretation of ONSE, particularly in asymptomatic individuals or in the context of high-resolution imaging.

Background: We describe the outcomes and long-term follow-up of treatment with anterior orbitotomy with superior oblique myectomy and trochlear resection for superior oblique myokymia.

Methods: Single-center case report and long-term follow-up of 3 previously published cases of superior oblique myokymia treated with superior oblique myectomy and trochlear resection. Previously reported patients were contacted for long-term follow-up. A fourth patient's complex clinical course is detailed. The surgical procedure is described and contrasted with alternative approaches.

Results: Four patients with refractory oscillopsia were treated. Symptom duration before presentation to the authors ranged from 10 to 22 years. All 4 patients had failed medical therapy; 3 of 4 had recurrent myokymia after prior superior oblique tenectomy; 1 of 4 had persistent symptoms despite 3 transcranial microvascular decompressions. After superior oblique myectomy and trochlear resection, all 4 patients reported sustained, complete resolution of oscillopsia in postoperative follow-up of 22, 17, 16, and 2 years. Three of 4 patients did not require additional strabismus surgery. Three of 4 patients reported mild postsurgical supra- and infratrochlear hypesthesia but deemed the symptoms not bothersome.

Conclusions: Superior oblique myectomy and trochlear resection is a surgical option for patients with superior oblique myokymia unresponsive to, or intolerant of, medical therapy. It can be used if superior oblique tenectomy fails, or it can be considered as primary surgical management. Further strabismus surgery may be required after this procedure. If used primarily, compensatory inferior oblique weakening should be planned, as it is following primary superior oblique tenectomy. In our view, the orbital approach is preferable to transcranial microvascular decompression.

Background: Virtual reality-based visual field testing may offer an alternative to traditional Humphrey visual field testing, but the performance of such tests in detecting visual field abnormalities for patients with neurosurgical diagnoses has not previously been established.

Methods: Patients presenting to neuro-ophthalmology clinic for visual field testing for neurosurgical diagnoses completed both the Humphrey Visual Field Analyzer (HVF) 30-2 SITA fast test and the Olleyes Advanced Vision Analyzer-Virtual Reality Perimeter (OE) 30-2 fast test during the same visit. Pearson correlation was used to compare mean deviation (MD) and pattern standard deviation (PSD) between the HVF and OE tests. A Bland-Altman analysis was performed, and 95% limits of agreement (LOA) were calculated to compare agreement of MD and PSD between OE and HVF tests. The sensitivity, specificity, positive predictive value, and negative predictive value of the OE test were calculated for detecting a clinically significant abnormal test on HVF testing.

Results: Of 47 subjects recruited, the mean (SD) age was 54 (15) years, with 25 men. HVF testing resulted in 24 clinically significant abnormal findings. The R-squared for the Pearson correlation of MD and PSD between the HVF and OE tests were 0.45 and 0.79, respectively. Bland-Altman analysis of 95% LOA of HVF and OE tests were -10.42 to 11.16 (bias 0.37) for MD and -4.48 to 4.30 (bias -0.09) for PSD. The OE test had a sensitivity of 83.8% (95% CI 65.5%-92.4%) and specificity of 94.4% (95% CI 74.2%-99.7%) for detecting a clinically significant abnormal visual field finding on HVF testing. The positive predictive value of a clinically significant abnormal finding on OE testing was 96% (95% CI 80.5%-99.8%), for finding a clinically significant abnormal finding on HVF testing. The negative predictive value of no clinically significant abnormal finding on OE testing was 77.3% (95% CI 56.6%-89.9%).

Conclusions: The OE device provides visual field results that correlate well with HVF testing and can be used as a screening test for visual field defects in patients with brain tumors. However, the moderate sensitivity for detecting a clinically relevant field deficit for the Olleyes tests warrants clinical discretion and potential repeat visual field testing with the gold standard HVF in patients with a high suspicion for visual field loss.

Background: The incidence and clinical characteristics of adult-onset abnormal spontaneous eye movements of central origin remain poorly defined.

Methods: We conducted a retrospective, population-based study using the Rochester Epidemiology Project to identify all adults (age ≥18 years) in Olmsted County, MN, diagnosed with nystagmus or saccadic intrusions between 1970 and 2019. Cases involving childhood-onset nystagmus, physiologic, or peripheral vestibular nystagmus, as well as those with insufficient diagnostic information, were excluded. Demographics, clinical, and imaging data were collected, including nystagmus types, characteristics, and outcomes.

Results: A total of 208 patients were identified for the 50-year period, yielding a median annual incidence of 4.65 per 100,000 adults. The mean age at diagnosis was 56.2 ± 19.2 years and 43.3% were female. Gaze-evoked nystagmus (46.2%) was the most frequent subtype, followed by torsional (25.0%), downbeat (11.5%), and upbeat nystagmus (8.7%). The cerebellum was the most commonly affected region on neuroimaging, and strokes/transient ischemic attacks were the leading etiology. Specific lesion-nystagmus correlations included pendular and abducting nystagmus with pontine lesions (P = 0.009 and <0.001, respectively), convergence-retraction nystagmus with midbrain (P = 0.036), and thalamic lesions (P = 0.007). Torsional nystagmus was most frequently associated with ischemic strokes (P = 0.045), downbeat nystagmus (DBN) with central nervous system malformations (P = 0.008), and abducting nystagmus with demyelinating diseases (P < 0.001). At follow-up visits, approximately 60% of cases showed complete or partial improvement. Factors independently associated with nystagmus recovery included skew deviation (adjusted hazard ratio [aHR] 2.667 [95% confidence interval [CI], 1.234-5.768])), toxic-metabolic cause (aHR 3.378 [95% CI, 1.816-6.284]), absence of DBN (aHR 0.142 [95% CI, 0.050-0.407]), and absence of neurodegeneration (aHR 0.050 [95% CI, 0.007-0.372]).

Conclusions: This is the first population-based study describing the incidence and characteristics of adult-onset central nystagmus and saccadic intrusions in North America. Distinct anatomical and etiologic associations were identified across nystagmus subtypes. Poorer recovery was linked to neurodegenerative diseases, and DBN, whereas nystagmus improvement was associated with toxic-metabolic cause and presence of skew deviation.

Background: To evaluate whether proliferative diabetic retinopathy (PDR) is associated with an increased risk of nonarteritic anterior ischemic optic neuropathy (NAION) and whether pan-retinal photocoagulation (PRP) alters that risk.

Methods: A retrospective cohort study was conducted using the TriNetX global health research network. Adults (18 years and older) with ≥3 years of follow-up and no prior NAION were included. In Analysis 1, patients with PDR were compared with those with diabetes mellitus without diabetic retinopathy. In Analysis 2, patients with PDR who underwent PRP were compared with those who did not. Propensity score matching was controlled for demographics and comorbidities. The primary outcome was incident NAION within 3 years.

Results: After matching, 30,588 patients were included in each group for Analysis 1. At 3 years, NAION incidence was significantly higher in the PDR cohort than the DM without DR group (0.24% vs 0.09%; HR 2.81, 95% CI 1.80-4.40; P < 0.001). In Analysis 2, 8,126 patients were included in each group. No significant difference in NAION risk was observed between PRP and No PRP cohorts at any time point (3-year incidence: 0.34% vs 0.31%; HR 1.12, 95% CI 0.65-1.92; P = 0.680).

Conclusions: PDR is associated with increased NAION risk, suggesting a role for local microvascular changes. PRP does not significantly alter NAION risk, supporting its safety in this context. Further studies with imaging data are warranted to clarify underlying mechanisms.

Background: CN III is a pure motor cranial nerve that innervates the majority of the extraocular muscles. CN III palsy is the most common cranial nerve palsy with an incidence of 3-4 cases per 100,000.

Evidence acquisition: High-resolution, 3-dimensional, skull base MRI allows for high spatial resolution and high signal-to-noise ratio allowing for optimal evaluation of CN III pathology by segment.

Results: A systemic approach is used to describe the segmental anatomy of CN III, its vascular supply, clinical pathologic manifestations, and imaging correlate.

Conclusions: We present a segmental approach to high-resolution 3-dimensional MRI of the oculomotor nerve from nuclear to extraforaminal segments.