Staging glaucoma using Stratus OCT in a U.S. veteran population.

PURPOSE: This study examines the ability of time domain optical coherence tomography (Stratus OCT) of the retinal nerve fiber layer (RNFL) to discriminate between normal patients and patients with three stages of glaucomatous vision loss in a US veteran population. METHODS: A review of consecutive patients who underwent automated perimetry and Stratus OCT Fast RNFL scanning within a 6-month period was conducted. Patients with nonglaucomatous ocular disease that might affect the RNFL or perimetry results were excluded. Glaucomatous eyes were staged using the Hodapp-Parrish-Anderson grading system. Average, quadrant, and individual clock hour RNFL thicknesses and normative results between all groups were compared. RESULTS: A total of 247 normal subjects and 157 glaucoma subjects were included. Significant differences in RNFL thickness measurements were observed between all groups (p < 0.05). Receiver operating curve analysis of highest area under the curve showed average RNFL for normal versus mild glaucoma (0.86), inferior quadrant for mild versus moderate glaucoma (0.80), and superior quadrant for moderate versus severe disease (0.86). Normative results for individual parameters demonstrated high specificity but low sensitivity for mild disease versus normal control subjects with increasing sensitivity and decreasing specificity in subsequent stages of disease. The number of OCT parameters classified as borderline or abnormal increased with advancing disease, but a combination of high sensitivity and specificity was not detected for any stage. CONCLUSIONS: Optical coherence tomography RNFL thickness measurements, individual parameter normative results, and the number of parameters classified as borderline or abnormal poorly distinguished between severities of disease. Significant RNFL thickness overlap and lack of normative parameters demonstrating both high sensitivity and specificity between consecutive stages of disease highlighted the wide variability of structural findings using time domain OCT in the staging of glaucoma.

Topographical analysis of the optic nerve in migraine patients.

PURPOSE: Vascular dysfunction appears related to the development of migraines and has been associated with pressure-independent glaucoma. The purpose of this study is to investigate possible topographical differences in the optic nerve between migraine sufferers and normal age-matched control subjects. The identification of optic disc topographical differences between migraine and non-migraine sufferers may help clinicians determine if the presence of migraine influences the development and progression of glaucoma. METHODS: Sixty consecutively seen patient-volunteers (30 subjects in migraine group: mean age 37.7 years, range from 19 to 66 years, 28 females and 2 males; 30 subjects in the control group: mean age 37.6 years, range from 19 to 61 years, 29 females and 1 male) were categorized as either migraine patients or control group subjects. All migraine subjects had been medically diagnosed with a migraine syndrome and were being treated with prophylactic medication. Optic nerve head topographical analysis was performed using a confocal scanning laser ophthalmoscope. The data was evaluated using generalized estimating equations, a priori and post hoc power analysis. RESULTS: No significant differences were found in any of the optic nerve parameters examined between the two groups. CONCLUSIONS: This study indicates that the optic nerve parameters as measured by the Heidelberg retinal tomograph II do not differ between migraine sufferers and age-matched control subjects.

Pupil sparing incomplete third nerve palsy secondary to a cavernous sinus meningioma: challenges in management.

BACKGROUND: The diagnosis of incomplete third nerve palsy can be clinically challenging because the aetiologies, as well as presentations, can be variable and subtle. The optometric clinician should be familiar with the association of third nerve palsy with compressive lesions, including the clinical presentations and management of these patients. CASE REPORT: We present a 68-year-old hypertensive male complaining of intermittent diplopia for the previous six months. Neurological examination revealed a mild deficit in adduction, reduced range of vertical motility and questionable ptosis, all limited to the OD. No pupillary involvement was noted. MRI revealed a cavernous sinus meningioma. The patient elected against surgery, choosing MRI every six months. CONCLUSION: Due to the subtle clinical presentation of incomplete pupil sparing third nerve palsy, this ophthalmoplegia may be easily overlooked. The associated aetiologies of palsy of cranial nerve three (CN3) carry increased risk of morbidity and mortality. Management should include evaluation for mass lesions and/or vascular aetiologies, regardless of pupillary involvement.