Acute Optic Neuritis: An Update on Approach and Management

This review discusses the physical examination and diagnostic tests necessary to diagnose optic neuritis (ON) and provides an update on the approach and management of acute ON. A comprehensive search of the PubMed database was conducted, limited to English-language journals and recent publications. A total of 160 articles were initially screened by title, of which 73 articles were included in the narrative synthesis. ON is an inflammation of the optic nerve that can be caused by different systemic and neurological disorders. It is commonly presented as a subacute unilateral painful vision loss, and based on its clinical manifestation, it can be classified as typical or atypical. Atypical ON is bilateral with visual acuity of worse than 20/200 or has an atypical demographic presentation for demyelination, such as a non-Caucasian male with optic disc swelling, for which neuromyelitis optica spectrum disorder (NMOSD), myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD), or other etiologies should be considered. Steroids and immunosuppressants are the main treatment options for ON, and timely treatment initiation is critical to preventing irreversible vision loss, especially in atypical cases

Influence of Near Vision Tasks on Intraocular Pressure in Normal Subjects and Glaucoma Patients

Purpose: To investigate the effect of static accommodative tasks on intraocular pressure (IOP) of glaucomatous and normal eyes. Methods: Four groups of subjects categorized as primary open-angle glaucoma (POAG), primary angle-closure suspects (PACS), normal age-matched controls, and normal young adults (NYA; age <40 years) were enrolled. The baseline IOPs were measured after the subjects were looking at a distant target for 15 min. Static accommodation was obtained by execution of near vision tasks (reading at 33 cm in daylight [300 lux] for 60 min). IOPs were measured at 15, 30, 45, and 60 min intervals while accommodating and then measured again after 15 min of relaxing accommodation while looking at a distant target. Results: One-hundred and eighteen eyes of 98 subjects were recruited. The study groups consisted of the following categories: 25 POAG (46 eyes), 24 PACS (47 eyes), 25 matched controls (50 eyes), and 24 NYA (48 eyes). Within all groups, the mean IOP decreased throughout the accommodation period at all time points. Maximum IOP reduction after accommodation was detected at the 30-min time among the POAG subjects, at the 45-min time in the PACS and matched control groups, and at 15 min after the relaxation of accommodation in the NYA group. IOP reduction levels showed no statistically significant difference among POAG, PACS, and the normal matched groups in their response to accommodation. However, NYA had significantly lower IOP and greater IOP reduction after the resting period (relaxation of accommodation). Conclusion: Static accommodative tasks can significantly reduce IOP in normal, POAG, and PACS individuals. Encouraging glaucoma patients to practice periodical near vision tasks could be viewed as an adjunctive measure for glaucoma management

Effect of Combined Systemic Erythropoietin and Steroid, on Non-Arteritic Anterior Ischemic Optic Neuropathy (abstract)

To investigate the effect of combined intravenous erythropoietin and corticosteroid as well as systemic steroid alone for thetreatment of non-arteritic anterior ischemic optic neuropathy (NAION)

Effect of Combined Systemic Erythropoietin and Steroid, on Non-Arteritic Anterior Ischemic Optic Neuropathy (video)

To investigate the effect of combined intravenous erythropoietin and corticosteroid as well as systemic steroid alone for thetreatment of non-arteritic anterior ischemic optic neuropathy (NAION)

Sirolimus Induced Toxic Optic Neuropathy

ObjectiveTo describe a case of optic neuropathy after prolonged sirolimus therapy in the setting of cardiac transplant. BackgroundSirolimus is an immunosuppressant that inhibits Mechanistic Target of Rapamycin (mTOR) and blocks T-cell activation and B-cell differentiation by preventing response to Interleukin-2 (IL-2). Tacrolimus is another immunosuppressive agent, one of the known but uncommon side effects of which is bilateral optic neuropathy years after taking the medication. To the best of our knowledge, this is the first report of sequential optic neuropathy after years of treatment with sirolimus. Case PresentationA 69-year-old male with a history of cardiac transplantation presented with progressive, sequential, and painless vision loss. Visual acuity was 20/150 OD and 20/80 OS, with impaired color vision in both eyes (Ishihara 0/10) and bilateral disc pallor and mild optic disc edema in the left eye. Visual field was constricted in both eyes. The patient was on prolonged sirolimus therapy for over 7 years. Orbital MRI revealed bilateral chiasmatic thickness and FLAIR hyperintensity, without optic nerve enhancement post gadolinium. After extensive work up, other etiologies such as infectious, inflammatory, and neoplastic lesions were ruled out. Subsequently, sirolimus was substituted with cyclosporin that led to gradual improvement of vision and visual fields bilaterally. ConclusionOptic neuropathy is a rare side effect of tacrolimus, which has been seen as sudden, painless, and bilateral vision loss in post-transplant patients. Other concurrent medications influencing the cytochrome P4503A enzyme complexes may alter the pharmacokinetics of tacrolimus and increase the likelihood of toxicity. Discontinuation of offending agent has been shown to improve visual defects. We presented a rare case of optic neuropathy in a patient on sirolimus, whose visual defects improved upon discontinuation of sirolimus and switching to cyclosporin

What Are Patients Asking Online About Strabismus? An Analysis of the Strabismus Subreddit

BACKGROUNDReddit is particularly popular due to its anonymity and discussion forum-type format. As an increasing number of patients seek medical advice on social media online, understanding patients' activity regarding strabismus on Reddit will help assess their concerns and guide patient education.METHODSA cross-sectional study of Reddit posts (www.reddit.com/r/strabismus/) was conducted from July 2021 to July 2022. Posts were sorted by date, type, content, emotional tone, and users' sex and age (when available).RESULTSA total of 709 posts were analyzed. Of the 164 (23%) posts in which users identified sex, 85 (52%) were female. The average age of patients to whom the post regarded was 23.7 ± 11.4 years (range 1-60 years). The most common content was surgical treatment (453, 63.9%), non-surgical treatment (263, 37%), seeking a diagnosis of their condition (190, 26.8%), and sharing personal journeys (136, 19.2%). Of the 289 (41%) posts that conveyed a clear emotional tone, the most common were anxiety (48, 18.3%), happiness (31, 11.8%), insecurity (24, 9.2%), frustration (22, 8.4%), and excitement (22, 8.4%). "Anxiety" posts had a significantly greater association with pre-surgery concerns whereas "happy" posts had a significantly greater association with post-operative updates (p = .003).CONCLUSIONSPatients with strabismus who post on Reddit tend to be young adults interested in surgical treatment options. Although the pre-operative tone was anxiety, post-operative posts tended to be happy

Trends in Sports-Related Ocular Trauma in United States Emergency Departments from 2010 to 2019: Multi-Center Cross-Sectional Study

Traumatic eye injury is one of the leading causes of visual impairment in the United States, but there is limited information available in the literature about ocular trauma related to sports. To evaluate the primary ocular diagnosis, type of sport, seasonal prevalence, and injury severity following ocular sports-related trauma. Cross-sectional study United States (US) hospital emergency departments (ED). Patients with sports-related ocular injuries in the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP) database from January 1, 2010 to December 31, 2019. To identify and compare the type of sport, primary diagnosis of ocular injury, and injury severity. For 4,671 sports-related ocular injuries identified, the mean age of injury was 19.4±15.2 years (median: 15.0 years, 79% male). The largest proportion of injuries occurred in the 12-17 years of age cohort (38.6%), occurring during summer months (P< .001). The most common sports associated with eye injury were basketball (37.8%), baseball (13.8%),, and football (12.3%). There were 3,214 injuries (68.8%) deemed 'minor' anterior segment injuries, 359 injuries (7.7%) deemed 'major' anterior segment injuries, 31 injuries (0.7%) deemed 'minor' posterior segment injuries, 77 injuries (1.7%) deemed 'major' posterior segment injuries, and 990 injuries (21.2%) of unknown severity. Basketball-related ocular trauma had a greater frequency of corneal/scleral abrasions than baseball (P < .001), soccer (P < .001), tennis (P = .03), softball (P = .001), and paintball (P = .02). Baseball-related ocular trauma had a greater frequency of contusions than basketball (P < .001), football (P < .001), soccer (P < .001), volleyball (P< .001). Paintball and soccer were more associated with 'major' anterior and posterior ocular injuries than basketball (P < .001, for both). Sports-related trauma remains a highly prevalent cause of eye-related visits to the emergency room, particularly in young male adolescents in the spring and summertime. While most diagnoses were deemed 'minor' injuries with basketball associated with corneal/scleral abrasions and baseball with contusions, paintball, and soccer were more significantly associated with 'major' anterior and posterior ocular injuries