Case Series: Glioblastoma Highlighting the Eye Care Provider's Role.

SIGNIFICANCE: Although the incidence of glioblastoma is relatively low, patients presenting with this malignant central nervous system tumor will typically experience visual symptoms. Eye care providers are uniquely positioned to assist with the diagnosis of glioblastoma and to manage its associated visual symptoms. PURPOSE: This case series will review the pathophysiology, diagnosis, treatment, and management of glioblastoma while highlighting the eye care provider's role over the course of the disease process. CASE REPORTS: Three patients with glioblastoma are presented: a 63-year-old White man with new onset of headache and blurred vision upon awakening, a 65-year-old White man with a weeklong history of peripheral vision deficit and neurological symptoms, and a 65-year-old White woman with visual field deficit and visual perception difficulties related to a known history of glioblastoma. CONCLUSIONS: It is incumbent upon eye care providers to recognize examination findings such as new neurological symptoms and/or visual field defects that may warrant additional workup. In addition, eye care providers can serve a palliative role by maximizing the patient's remaining visual function and thereby quality of life.

Thyroid eye disease: a review.

Thyroid eye disease is a multifactorial autoimmune disease with a spectrum of signs and symptoms. Oftentimes, the diagnosis of thyroid eye disease is straightforward, based upon history and physical examination. The purpose of this review is to assist the eye-care practitioner in staging the severity of thyroid eye disease (mild, moderate-to-severe and sight-threatening) and correlating available treatment modalities. Eye-care practitioners play an important role in the multidisciplinary team by assessing functional vision while also managing ocular health.

Arteriole tortuosity associated with diabetic retinopathy and cholesterol.

PURPOSE: Earlier identification of diabetic eye disease is an important research effort. Retinopathy is widely acknowledged but retinal vessel changes are not evaluated as stringently. Here, we create a multivariate model for the association between retinal vessel tortuosity (RVT) and other health factors in patients with diabetes. METHODS: Three hundred eyes of 150 patients with diabetes were included. Three investigators independently reviewed telemedicine fundus photographs and scored the level of diabetic retinopathy (DR) and RVT. These scores were evaluated for agreement and averaged. Also collected were age, duration of diabetes, presence or absence of diabetic nephropathy or neuropathy, blood pressure, total cholesterol, and hemoglobin A1c. A regression model evaluating the association of tortuosity with other factors was created. RESULTS: There was very high agreement between the three graders for level of DR (κ = 0.84). Agreement between the three graders for RVT varied substantially: poor for venous tortuosity (κ = 0.23) and fair for arteriole tortuosity (κ = 0.44) and overall gut tortuosity (κ = 0.42). The overall gut tortuosity was the most reproducible for the graders with a correlation coefficient of 0.923. There were univariate associations between arteriole tortuosity and venous tortuosity, DR level, and cholesterol. The selected best multivariate model found arteriole tortuosity to be associated with DR and cholesterol levels. CONCLUSIONS: First, RVT, particularly for venules, is difficult to grade consistently; therefore, future studies examining tortuosity should focus on arterioles. Second, the model indicates that there is an association between vessel changes, DR, and systemic cholesterol levels. Although DR and RVT are readily available to assess concurrently on a photograph, the addition of cholesterol to this model indicates that patients with RVT may warrant further follow-up on health factors, such as cholesterol levels.

Zonisamide-induced angle closure and myopic shift.

PURPOSE: To present a previously unreported case of angle closure secondary to the sulfonamide derivative zonisamide, to introduce eye care providers to zonisamide, and to review sulfonamide-induced angle closure. Zonisamide is a relatively new sulfonamide derivative indicated for epilepsy and used off-label for migraines. Although angle closure secondary to systemic medications such as topiramate and other sulfonamide derivatives is well documented, this is the first case of zonisamide-induced angle closure and myopic shift to be reported. CASE REPORT: A 39-year-old Hispanic woman presented with sudden vision loss OU with a concurrent bilateral frontal headache. No changes in health were reported other than initiating zonisamide for refractory migraines 2 weeks prior. Ocular history was significant only for low myopia. Entering visual acuities were 20/400 OD, OS. Manifest refraction revealed a 3-diopter myopic shift OU with best-corrected visual acuities of 20/20 OD, OS. On slit lamp examination, the anterior chamber angles were narrow OU and gonioscopy confirmed partially occluded angles OU. The intraocular pressures were elevated OU. B-scan ultrasonography exhibited peripheral choroidal effusion OU. With discontinuation of zonisamide, the patient experienced full recovery. CONCLUSIONS: With increasing use of zonisamide, practitioners should be aware of its sulfonamide derivative properties and the risk of secondary angle closure.