Journal of Neuro-Ophthalmology最新文献

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.

Background: Patients with craniosynostosis are at high risk of developing elevated intracranial pressure (ICP) causing papilledema and secondary optic atrophy. Diagnosing and monitoring optic neuropathy is challenging because of multiple causes of vision loss including exposure keratopathy, amblyopia, and cognitive delays that limit examination. Peripapillary hyperreflective ovoid mass-like structures (PHOMS) are an optical coherence tomography (OCT) finding reported in association with papilledema and optic neuropathy. We investigated the prevalence of PHOMS in patients with syndromic craniosynostosis and the relationship with known risk factors of optic neuropathy.

Methods: This was a cross-sectional retrospective study was performed at Boston Children's Hospital and included 118 eyes (60 patients) with syndromic craniosynostosis that had at least one good quality optic nerve OCT volumetry scan between January 2010 and December 2023. Testing was reviewed by 2 neuro-ophthalmologists to determine the presence of PHOMS. Information collected included demographics, and clinical course including possible Chiari malformation, obstructive sleep apnea (OSA), history of elevated ICP, best-corrected visual acuity (VA), spherical equivalent (SE), retinal nerve fiber layer thickness, macular ganglion cell layer volume, and funduscopic examination. Our primary outcome measure was presence of PHOMS, and secondary outcome measure was the relationship between clinical characteristics and the presence of PHOMS.

Results: Mean age at imaged OCT was 9.8 ± 5.2 years and 41/60 (68.3%) patients were female. The prevalence of PHOMS was 17/60 patients (28.3%) or 26/118 eyes (22.0%), higher than previously reported in children without craniosynostosis ( P < 0.001). PHOMS were significantly associated with a history of elevated ICP (odds ratio [OR] 14.4, 95% CI: 1.9-111.0, P < 0.001) and with concurrent papilledema (OR 40.4, 95% CI: 6.6-248.0, P < 0.001). OSA, Chiari malformation, best-corrected VA, craniosynostosis variant, and SE were not independently associated with PHOMS.

Conclusions: Eyes in children with craniosynostosis had a higher prevalence of PHOMS than reported in children without craniosynostosis. PHOMS were significantly more common with a history of elevated ICP and with concurrent papilledema. PHOMS may serve as a clinically useful indicator of optic neuropathy, and of recurrence of papilledema in patients with craniosynostosis and in other populations characterized by multiple sources of vision loss and cognitive changes that limit evaluation.

In this issue, of JNO, Drs. Deborah I. Friedman and Mark L. Moster discuss the following 4 journal articles: Jonzzon S, Price A, Troung N, Naftel RP, Phillips PH, Wellons JC, Isaacs AM. Neuro-ophthalmological findings in pediatric ventricular shunt failure: a systematic review. J Neurosurg Pediatr. 2025;36:29-35. doi: 10.3171/2024.12.PEDS24397.Barton JJS, Özturan G. The varieties of junctional scotoma: 17 cases, a review, and a taxonomy. Eye (Lond). 2025;39:1673-1687. doi: 10.1038/s41433-025-03789-z.Shah SK, Indurkar A, Patel BK. Surgical management and visual outcomes of optic-pathway cavernous malformations: A comprehensive literature review of 80 reported cases (1979-2025). Clin Neurol Neurosurg. 2025;256:108988. doi: 10.1016/j.clineuro.2025.108988.Ko J, Lee MJ, Khwarg SI, Yoon JS, Yang SW, Son J, Kim N, Lew H; Multicenter Study Committee of the Korean Society of Ophthalmic Plastic and Reconstructive Surgery. Immunoglobulin G4-related ophthalmic disease: A Nationwide Multicenter Study in Korea. Ophthalmology. 2025;132:995-1004. doi: 10.1016/j.ophtha.2025.04.031.