Radiologically isolated aquaporin-4 antibody neuromyelitis optica spectrum disorder

Aquaporin-4 antibody (AQP4-Ab) Neuromyelitis Optica Spectrum Disorder (NMOSD) is a rare neuroinflammatory syndrome presenting predominantly with optic neuritis and transverse myelitis. We report a case of radiologically isolated longitudinally extensive optic neuritis in an asymptomatic 12-year-old female with positive serum AQP4-Ab, with resolution of imaging changes after immune therapy. By contrast to patients with radiologically isolated syndrome, of which some will never convert to multiple sclerosis, the pathogenicity of AQP4-Ab in the context of sub-clinical disease, supported treatment in our patient. Given the severe morbidity in AQP4-Ab NMOSD, prognostic biomarkers for disease severity are required to guide optimal therapy for patients

Dramatic Course and Remarkable Improvement in Visual Function in a Child With Craniopharyngioma

Craniopharyngiomas are tumors with benign histology and malignant behavior. Here we describe a dramatic visual course secondary to craniopharyngioma

Real-World Translation of Artificial Intelligence in Neuro-Ophthalmology: The Challenges of Making an Artificial Intelligence System Applicable to Clinical Practice

1. Lin D, Xiong J, Liu C, Zhao L, Li Z, Yu S, Wu X, Ge Z, Hu X, Wang B, Fu M, Zhao X, Wang X, Zhu Y, Chen C, Li T, Li Y, Wei W, Zhao M, Li J, Xu F, Ding L, Tan G, Xiang Y, Hu Y, Zhang P, Han Y, li J, Wei L, Zhu P, Liu Y, Chen W, Ting D, Wong T, Chen Y, Lin H. Application of Comprehensive Artificial intelligence Retinal Expert (CARE) system: a national real-world evidence study. Lancet Digit Health. 2021;3:e486-e495. 2. Xie Y, Nguyen Q, Bellemo V, Yip M, Lee M, Hamzah H, Lim G, Hsu W, Lee ML, Wang JJ, Cheng CY, Finkelstein EA, Lamoureux EL, Tan GSW, Wong T. Cost-Effectiveness analysis of an artificial intelligence-assisted deep learning system implemented in the national tele-medicine diabetic retinopathy screening in Singapore. Invest Ophthalmol Vis Sci. 2019;60:5471. 3. Gulshan V, Peng L, Coram M, Stumpe MC, Wu D, Narayanaswamy A, Venugopalan S, Widner K, Madams T, Cuadros J, Kim R, Raman R, Nelson PC, Mega JL, Webster DR. Development and validation of a deep learning algorithm for detection of diabetic retinopathy in retinal fundus Photographs. JAMA. 2016;316:2402-2410. 4. van der Heijden AA, Abramoff MD, Verbraak F, van Hecke M, Liem A, Nijpels G. Validation of automated screening for referable diabetic retinopathy with the IDx-DR device in the Hoorn Diabetes Care System. Acta Ophthalmol. 2018;96:63-68. 5. Milea D, Najjar RP, Jiang Z, Ting D, Vasseneix C, Xu X, Aghsaei Fard M, Fonseca P, Vanikieti K, Lagrèze WA, La Morgia C, Cheung CY, Hamann S, Chiquet C, Sanda N, Yang H, Mejico LJ, Rougier MB, Kho R, Tran THC, Singhal S, Gohier P, Vignal-Clermont C, Cheng Cy, Jonas JB, Yu-Wai-Man P, Fraser CL, Chen JJ, Ambika S, Miller NR, Liu Y, Newman NJ, Wong TY, Biousse V. Artificial intelligence to detect papilledema from ocular fundus Photographs. New Engl J Med. 2020;382:1687-1695

Postural stability and visual impairment: Assessing balance in children with strabismus and amblyopia.

BACKGROUND:Vision plays an important role in controlling posture and balance in children. Reduced postural control has been reported in children with strabismus, but little has been reported specifically in amblyopia. OBJECTIVE:To investigate whether children with amblyopia have reduced balance compared to both children with strabismus without amblyopia and healthy controls. STUDY DESIGN AND METHODS:In this cross-sectional study, a total of 56 patients and healthy controls were recruited from the Ophthalmology and Otolaryngology Clinics at The Hospital for Sick Children, Toronto. Participants were divided into three groups: (1) 18 with unilateral amblyopia (strabismic amblyopia or mixed mechanism); (2) 16 with strabismus only without amblyopia; and (3) 22 visually-normal controls. The primary outcome was the balance performance as measured by the balance subtest of the Bruininks-Oseretsky Test of Motor Proficiency 2 [BOT2]. RESULTS:The age and gender-adjusted BOT2 balance scores were significantly reduced in the amblyopia group (mean score 9.0 ± 3.1 SD) and the strabismus without amblyopia group (mean score 8.6 ± 2.4 SD) compared to visually normal controls (mean score 18.9 ± 4.2) (p<0.0001), but no statistical difference was demonstrated between the two patient groups (p = 0.907). Further subgroup analysis of the strabismus only group did not reveal a statistically significant difference in performance on BOT2 balance score between strabismus only patients with good stereopsis 60 sec or better (BOT2 mean score 9.8±3.0 SD) to patients with 3000 sec or no stereopsis (BOT2 mean score 7.9±1.7) (p = 0.144). CONCLUSION:Our findings suggest that normal vision plays an important role in the development and maintenance of balance control. When normal binocular vision is disrupted in childhood in strabismus and/or amblyopia, not only is the vision affected, but balance is also reduced. Our results indicate that the presence of even mild binocular discordance/dysfunction (patients with intermittent strabismus and good stereopsis) may lead to postural instability

Horizontal right optokinetic nystagmus

Visual depiction of the horizontal OKN drum test. The hand-held "optokinetic" drums or tapes that are used to elicit smooth movements primarily test the pursuit system. This video supplements Paediatric Neuro-ophthalmology: Visual Acuity Assessment Strategies: https://collections.lib.utah.edu/ark:/87278/s6vh9z9

Paediatric Neuro-ophthalmology: Visual Acuity Assessment Strategies

Assessing the visual function of a child can be challenging at times. When approaching a child one must understand visual development and accommodate to the child's capabilities, level of development and communication skills. The examining physician may need to apply more than one method to assess the child's visual acuity. Several techniques are presented here in an incremental fashion, demonstrating methods that are suitable from very early infancy to late childhood. The tools that are provided should assist the reader in becoming a more competent examiner. See accompanying videos: Induced Tropia Test: https://collections.lib.utah.edu/ark:/87278/s6090fs9; Horizontal right optokinetic nystagmus: https://collections.lib.utah.edu/ark:/87278/s6qr96mk; Vertical optokinetic nystagmus: https://collections.lib.utah.edu/ark:/87278/s6m3756

Vertical optokinetic nystagmus

Visual depiction of the vertical OKN drum test. The vertical optokinetic drum test is an exam used to elicit vertical optokinetic nystagmus (OKN) when there is horizontal nystagmus. The hand-held "optokinetic" drums or tapes that are used to elicit smooth movements primarily test the pursuit system. This video supplements Paediatric Neuro-ophthalmology: Visual Acuity Assessment Strategies: https://collections.lib.utah.edu/ark:/87278/s6vh9z9

Pediatric Visual Acuity Strategies: Induced Tropia Test

Induced Tropia Test. Using a 10-20 base-down prism, this exam demonstrates equal vision in both eyes. If there is evidence of ocular misalignment, prisms can be used to neutralize the movement and thereby measure the deviation, whether it is a heterotropia or heterophoria. Prisms are placed in front of either eye such that the apex of the prism is oriented in the direction of the deviation, and the prism strength is altered until the deviation is no longer observed. This video supplements Paediatric Neuro-ophthalmology: Visual Acuity Assessment Strategies: https://collections.lib.utah.edu/ark:/87278/s6vh9z9