OCT Biomarkers in neuro-ophthalmic disorders
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OCT Biomarkers in neuro-ophthalmic disorders EOS 2024 Mohamed Ahmed ELShafie lecturer of ophthalmology mansoura- kafrelsheikh- portsaid
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OCT Biomarkers in neuro-ophthalmic disorders
- 1. OCT biomarkers in Neuro-ophthalmic Disorders Mohamed Ahmed ELShafie MD, HMS alumni
- 2. Swelling and elevation of optic nerves due to elevated ICP 1ST Papillede ma
- 3. 3 COVID19 IN CHILDREN 1 2 3 Grading of Papilledema (Frisen Grading Scale) 4 5
- 4. 32 y/o Woman • C/o progressive headaches am > pm • BMI: 41 • BCVA: 20/20 OU
- 5. 0 1 0 2 OCT Analysis of Papilledema Increased NFL/MRW thickness Elevation of nerve head (>0.8 mm from RPE to apex) 0 3 0 4 Maintenance of central cup (until late disease) Inward deflection of RPE/BM (N>T) Subretinal hyporeflective space between photoreceptor layer and RPE (recumbent “lazy V”) 0 5 0 6 Peripapillary inner retinal folds (T>N)
- 6. 40 y/o Woman • C/o chronic daily HAs + synchronous pulsatile tinnitus • BMI = 44 • BCVA: 20/40 OU
- 7. Champagne cork or dome like sign
- 8. 32 y/o Woman • c/o progressive, debilitating headaches x 2 mos. • Normal neurologic exam • BCVA: 20/20 OU • BMI: 38
- 11. F/U x 6 mos • Rx acetazolamide (500 mg BID) • Weight loss (approx. 25 lbs.) • Improvement in headaches F/U x 14 mos • D/C Diamox x 3 months • More weight loss • Headache free Baseline
- 12. F/U x 14 mos Baseline
- 13. Pseudopapilledema • An anomalous elevation of one or both optic nerve without optic disc swelling with a small or absent optic cup Optic Disc Drusen • Colloid bodies within substance of optic nerve head Due to Degeneration of NFL axons • NFL may be thickened (< 7 clock hours) or thinned
- 14. 0 1 0 2 OCT Analysis of ODD Always located above lamina cribrosa Always have hyporeflective core with hyper- reflective margin (most prominent superiorly) 0 3 0 4 PHOMS represent bulging axons (should not be considered as ODD) Hyper-reflective horizontal lines (precursor to ODD or artifact) Normal blood vessels (superficial, hyperreflective core, shadow) 0 5
- 15. 33 y/o Woman • Normal neurologic exam • Consult for evaluation of ODE OS • BVA: 20/20 OU
- 16. 29 y/o woman • BCVA: 20/20 OU • History of migraine headaches • No synchronous pulsatile tinnitus, diplopia or transient vision loss • Normal neurologic exam • Consult for evaluation of papilledema
- 20. 0 1 0 2 OCT Analysis of Retrochiasmal Lesions Ipsilateral temporal GCIPL thinning Contralateral nasal GCIPL thinning
- 22. • Pre-geniculate lesion = rapid GCIPL thinning (1 month) • Post-geniculate lesion=delayed GCIPL thinning (5-6 months)
- 23. Multiple sclerosis: RNFL & GCL-IPL thinning 20% - 40% X 3 months Optic Neuritis 5TH
- 24. 45 y/o Woman • Recent-onset optic neuritis OS • BCVA: 20/20 OD 20/500 OS
- 25. July 2022 Sep 2022 Feb 2023 April 2023
- 26. 31 y/o Woman • 10-year Hx of MS • Meds: Ocrevus (ocrelizumab) • Prior optic neuritis OD • BVA: 20/20 -1 OD 20/20 OS
- 27. 30 y/o Woman • 1-year Hx of MS • Meds: Ocrevus (ocrelizumab) Baclofen • No prior history of optic neuritis • BVA: 20/20 OU
- 28. • Thinning of RNFL & GCIPL occurs over time with MS in absence of optic neuritis (thinning of 12%)
- 29. Reduction in retinal dopamine levels → R NFL thinning Parkinson’s disease 6TH
- 30. RNFL thinning Temporal > RNFL thinning in PD associated with visual hallucinations & with PD duration and severity
- 31. Alzheimer’s disease 7TH German 1906: PROGREESIVE DECLINE OF COGNETIVE FUNCTION
- 32. 0 1 0 2 OCT Analysis of Alzheimer’s disease RNFL & paramacular thinning. GCIPL thinning
Editor's Notes
- C-shaped halo of optic disc edema with sparing of the temporal papillomacular bundle Circumferential halo of optic disc edema obscuration of major vessels as they leave the disc obscuration of major vessels on the surface of the disc obscuration of all vessels on the surface of the disc
- >40 morbid obesity Rt g 3 lt splinter hge Mri empty sella sign increase icp
- Minimum rim width Hyperreflectivity of complex is pushed by subretinal fluid so Angle ( ) normal curvature of rpe bm below & inward deflection above Hyporeflective temporal and nasal Wrinkles of inner retinal layers temporal d2 more fluids in subretinal space
- G5
- . Complete filling of cup
- Rt G3 lt g3 encroach g4 relatively pink suggesting very well perfused
- Flatting of sclera, kinking of optic nerve d2 dilatatin of subretinal spaces Lt t1 empty sella sign (flatting of pituitary gland against floor of sella) with icp rt t2
- 6 signs
- Normal flatting of optic nerve
- Narrow canal crowdening of nerve fibers
- الأسهم drusen سهم من تحت Peripapillary hyper-reflective ovoid mass-like structures evident 360 degrees-corresponding “blurred” disc margins Associated with CRVO, myopic disc tilt, optic neuritis
- Elevated disc, no central cup السهم برتقالي odd nasal, temporal السهم ازرقhorizontal سهم بنفسجي blood vessel
- Elevated disc no cup blood vessels not obscured … no clinical evidence of disc oedema Ovoid area ODD
- Pitautary adenoma compressing chaisma Vf: starting temporal hemianopia Oct: binasal thinning of ganglion cell complex
- Contralateral “bow tie” optic atrophy and RAPD Contralateral homonymous hemianopia
- Contralat rt ipsilat lt homonemous thinning
- Glaucomatous patient with thinning GCL.. Rt homonemous GCL thinning .. Contralateral retroch lesion Mri: very large cyst in lt side Vf: arcuate scotoma of glaucoma … rt HH
- Rt normal lt Optic neuritis July slightly theckining
- semptember fibraury progressive thinning
- Rt temporal wedge of pallor lt normal Rt thinning is accepted but why in lt eye without neuritis
- Mri multiple lesions of MS BI temporal thinning even with no ON
- T>N as MS
- POSTMORTAM
- Significant Thinning of RNFL , GCC Poor visual performance (low contrast acuity)