Neuro-Ophthalmology

Case 18

Contributor:
Arshia Eshtiaghi (University of Toronto Medical Student)

Patient Presentation: A 28-year-old man reported blurred vision in his right eye with dimming of colors, and mild pain with eye movements. Ten days later, he noticed that his left eye also became blurry. On examination, his visual acuity was CF OD and 20/80 OS and there was a right RAPD. Humphrey 24-2 SITA-Fast visual fields and optic nerve photographs are shown below. He denies any associated neurological symptoms.

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Question: Based on the fundus photographs, what would be expected on OCT RNFL analysis?

Question: Based on the fundus photographs, what would be expected on OCT GCL-IPL analysis at presentation?

Question: What is the best next investigation for this patient?

Question: The patient returns 1 month after initial examination and the vision has returned to 20/20 in both eyes and Humphrey visual fields are normal, what do you expect to see on OCT RNFL and GCL-IPL analysis?

Question: The patient returns 1 year after initial examination, what do you expect OCT RNFL and GCL-IPL analysis to show?

References:

  1. Brodsky M, Nazarian S, Orengo-Nania S, et al. Multiple sclerosis risk after optic neuritis: Final optic neuritis treatment trial follow-up. Arch Neurol. 2008. doi:10.1001/archneur.65.6.727

  2. Petzold A, de Boer JF, Schippling S, et al. Optical coherence tomography in multiple sclerosis: A systematic review and meta-analysis. Lancet Neurol. 2010. doi:10.1016/S1474-4422(10)70168-X

  3. Huang-Link YM, Al-Hawasi A, Lindehammar H. Acute optic neuritis: retinal ganglion cell loss precedes retinal nerve fiber thinning. Neurol Sci. 2015. doi:10.1007/s10072-014-1982-3

Learning Objectives:

1. Recognize the classical presentation and initial OCT features of typical optic neuritis.
2. Describe the expected vision and OCT outcomes in eyes with a prior episode of typical optic neuritis.