ABSTRACT
Retinal nerve fiber layer (RNFL) photographs from 26 patients with Alzheimer's disease and 23 normal, age-matched, control subjects were reviewed for quality and abnormalities by two observers. A higher proportion of Alzheimer's patients showed RNFL abnormalities when compared to control subjects. There was some disagreement between the two observers regarding quality and frequency of abnormalities, reflecting suboptimal quality of the photographs obtained in patients with advanced Alzheimer's disease. Although these findings add to the clinical and histopathological evidence that ganglion cell degeneration occurs in Alzheimer's disease, the difficulty in obtaining and evaluating retinal nerve fiber layer photographs, especially in advanced cases, may limit the clinical usefulness of retinal nerve fiber layer analysis in such patients.
Subject(s)
Alzheimer Disease/pathology , Nerve Fibers/pathology , Optic Nerve/pathology , Retina/pathology , Aged , Aged, 80 and over , Aging , Alzheimer Disease/classification , Alzheimer Disease/complications , Fundus Oculi , Humans , Middle Aged , Observer Variation , PhotographyABSTRACT
1. One of the roles of the Ophthalmic Medical Assistant (OMA) is to provide the physician with as much clinical information as possible to assist in the diagnosis and management of patients whose chief complaint is "double vision". 2. Because diplopia can be associated with a variety of medical causes, it is important to obtain a very detailed medical, neurologic, and ocular history, along with examination of ocular motor function. 3. The OMA plays an important role in the evaluation of diplopia. The evaluation of diplopia can be complex, but, with proper assessment of the patient, most causes can be identified in the office.
Subject(s)
Diplopia/diagnosis , Diplopia/etiology , Ophthalmic Assistants , Cranial Nerve Diseases/diagnosis , Diplopia/physiopathology , Humans , Visual AcuityABSTRACT
PURPOSE: The authors retrospectively analyzed changes in the retinal nerve fiber layer in patients with idiopathic intracranial hypertension and studied their relation to visual field loss to determine the clinical usefulness of retinal nerve fiber analysis in the clinical management of patients with papilledema. METHODS: Retinal nerve fiber layer photographs and visual fields from 36 eyes of 21 patients with papilledema due to idiopathic intracranial hypertension were analyzed for abnormalities in a masked fashion. RESULTS: Nerve fiber layer changes were found in 67% of eyes studied. Superior areas within the nerve fiber layer were affected 5.4 times more frequently than inferior regions. Visual field loss was more prevalent in eyes with diffuse nerve fiber layer loss (89%) than in eyes with slit defects (29%). The location of the nerve fiber layer changes correlated with corresponding areas of visual field loss. Nerve fiber layer changes were as common in mild to moderate as in atrophic papilledema; however, slit defects predominated in patients with mild to moderate papilledema, and diffuse loss predominated in atrophic papilledema. CONCLUSIONS: Changes in the retinal nerve fiber layer observed in patients with idiopathic intracranial hypertension provide objective information regarding the status of their optic nerve and may improve their clinical management.
