Practical Implementation of an Emergency Department Non-Mydriatic Fundus Camera: Pearls and Pitfalls

The FOTO-ED Study previously demonstrated the feasibility of Emergency Department (ED) fundus photography and the enhanced detection of relevant abnormalities in patients presenting with headache, amongst other indications. Yet, this practice is not widespread - perhaps due to cost, training, feasibility, medical liability concerns. In this observational study, we describe our experience with implementation of an ED fundus photo project

The Controversy of Chronotherapy in the Management of Systemic Hypertension and its Implications for NAION: A Systematic Review

The notion that nocturnal hypotension may represent the final insult in a multifactorial process that causes nonarteritic ischemic optic neuropathy (NAION) is controversial. Although this notion has not been prospectively proven, the standard of care has remained to recommend avoidance of antihypertensive medications at night in patients who have had NAION. There is a growing body of evidence in the cardiovascular literature that the timing at which medications are taken (i.e. "chronotherapy") has potentially significant systemic implications; in fact, some researchers have argued that taking anti-hypertensive medications at bedtime improves blood pressure control and decreases the risk of stroke and myocardial infarction. This review highlights this clinically relevant emerging controversy

Idiopathic Intracranial Hypertension (IIH) in the Aftermath of COVID-19

We describe three cases of fulminant IIH seen at our walk-in clinic in New York City, the epicenter of the pandemic in the United States, and highlight challenges that influenced their clinical course

The Emerging Controversy of Chronotherapy: Nocturnal Hypotension and Non-Arteritic Ischemic Optic Neuropathy

‘Blindness upon awakening' occurs in a significant proportion of patients with non-arteritic anterior ischemic optic neuropathy (NAION). This observation has lead to a notion that nocturnal hypotension is a significant contributor factor to the development of NAION, as has been proposed in other ischemic events like strokes, myocardial infarction, and ischemic rest pain. Hayreh's 1994 and 1999 prospective studies of NAION reported an extreme dipping pattern in nocturnal systolic blood pressure compared to reported normal values. An extension of this concept has lead to the recommendation that patients who have experienced NAION should avoid taking blood pressure medications at bedtime. Two other studies, however, did not find a similar extreme dipping pattern in NAION patients. Furthermore, mounting evidence in the cardiology literature suggests that nocturnal hypertension is associated with increased risk of cardiovascular morbidity, which has lead to a recommendation for nocturnal antihypertensive dosing, contrary to Hayreh's recommendation. This review will highlight this emerging controversy

Know Your Onions: A Case of Angiocentric Eosinophilic Fibrosis

Angiocentric eosinophilic fibrosis (EAF) is an indolent, tumefactive variant of IgG4-related disease that rarely manifests as an orbital process. Diagnosis is based on clinical presentation with involvement of typical organs, subacute onset, and response to immunosuppressive therapy and classic histologic findings. Elevated serum IgG4 and plasmablast levels are supportive. Treatment includes steroids, surgical debulking or complete excision, and immunosuppression. IgG4-RD responds to treatment but incomplete responses and relapses are common

Visual Field Outcomes in Optic Pathway Glioma After Bevacizumab Therapy

Systemic bevacizumab is a promising therapy for optic pathway glioma (OPG) radiographic tumor burden1, but little is known about its impact on visual function2,3. Our objective is to characterize visual field outcomes associated with bevacizumab-based therapy (BBT) for OPG