A brief review of the clinical anatomy of the vestibular-ocular connections—how much do we know?

This is an accepted manuscript of an article published by Springer Nature in Eye on 21/11/2014, available online: https://doi.org/10.1038/eye.2014.262 The accepted version of the publication may differ from the final published version.The basic connectivity from the vestibular labyrinth to the eye muscles (vestibular ocular reflex, VOR) has been elucidated in the past decade, and we summarise this in graphic format. We also review the concept of ‘velocity storage’, a brainstem integrator that prolongs vestibular responses. Finally, we present new discoveries of how complex visual stimuli, such as binocular rivalry, influence VOR processing. In contrast to the basic brainstem circuits, cortical vestibular circuits are far from being understood, but parietal-vestibular nuclei projections are likely to be involved

Update on the evaluation of transient vision loss

John H Pula,1 Katherine Kwan,2 Carlen A Yuen,3 Jorge C Kattah4 1Department of Neurology, 2Department of ophthalmology, NorthShore University HealthSystem, Evanston IL, USA; 3University of Illinois College of Medicine at Peoria, 4Department of Neurology, University of Illinois College of Medicine at Peoria, Peoria, IL, USA Abstract: Transient vision loss may indicate underlying vascular disease, including carotid occlusion and thromboembolism, or it may have a more benign etiology, such as migraine or vasospasm. This review focuses on the differential diagnosis and workup of patients presenting with transient vision loss, focusing on several key areas: the relationship to thromboembolic vascular disease, hypercoagulable testing, retinal migraine, and bilateral vision loss. The objective is to provide the ophthalmologist with information on how to best manage these patients. Thromboembolic etiologies for transient vision loss are sometimes managed with medications, but when carotid surgery is indicated, earlier intervention may prevent future stroke. This need for early treatment places the ophthalmologist in the important role of expediting the management process. Hospital admission is recommended in patients presenting with transient symptoms within 72 hours who meet certain high-risk criteria. When the cause is giant cell arteritis, ocular ischemic syndrome, or a cardioembolic source, early management of the underlying condition is equally important. For nonthromboembolic causes of transient vision loss such as retinal migraine or retinal vasospasm, the ophthalmologist can provide reassurance as well as potentially give medications to decrease the frequency of vision loss episodes. Keywords: transient vision loss, TVL, amaurosis fugax, retinal migraine, ocular migraine, retinal vasospas

Ability of a neuro-ophthalmologist to estimate retinal nerve fiber layer thickness

John H Pula,1 Jorge C Kattah,1 Hauping Wang,1 John Marshall,1 Eric R Eggenberger21University of Illinois College of Medicine at Peoria, Illinois Neurologic Institute, Peoria, IL, USA; 2Michigan State University, East Lansing, MI, USABackground: Qualitative description of the optic disc has clinical value, but optical coherence tomography (OCT) has provided the ability to quantify retinal nerve fiber layer (RNFL) thickness.Methods: We asked three neuro-ophthalmologists of at least 20 years’ experience to estimate the average OCT RNFL thickness of 37 eyes based on fundus photos.Results: The overall correlation coefficient for RNFL thickness estimation variance between two physicians and between physician and OCT was 0.53. The likelihood that the RNFL thickness estimation between physicians, or between physician and OCT, was within 10 µm of each other was 47%–62%. All physicians had disparities in RNFL thickness estimation greater than 30 µm.Conclusion: This study provides information on the ability of an experienced neuro- ophthalmologist to estimate the RNFL thickness based on fundus photos.Keywords: optical coherence tomography, OCT, RNFL, retinal nerve fiber, estimatio

Neuro-ophthalmological emergencies: which ocular signs or symptoms for which diseases?

There are five possible ocular signs or complaints of a life or sight threatening neuro-ophthalmological condition: diplopia, isolated anisocoria, transient visual loss, severe pain in head or neck (with or without photophobia) and oscillopsia/nystagmus. In this review, the ocular signs and symptoms of neuro-ophthalmological emergencies are described together with their practical work-up and the risks associated with missing the diagnosis. Concerning diplopia, the associated signs pointing to a possible threatening condition are emphasized. Six focus points resuming core messages are displayed throughout this review.JOURNAL ARTICLESCOPUS: re.jinfo:eu-repo/semantics/publishe