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Background: Multifocal visual evoked potentials (mfVEP) measure local response amplitude and latency in the field of vision. Objective: To compare the sensitivity of mfVEP, Humphrey visual field (HVF) and optical coherence tomography (OCT) in detecting visual abnormality in multiple sclerosis (MS) patients. Methods: mfVEP, HVF, and OCT (retinal nerve fiber layer [RNFL]) were performed in 47 MS-ON eyes (last optic neuritis [ON] attack ≥6 months prior) and 65 MS-no-ON eyes without ON history. Criteria to define an eye as abnormal were: (1) mfVEP amplitude/latency — either amplitude or latency probability plots meeting cluster criteria with 95% specificity; (2) mfVEP amplitude or latency alone (specificity: 97% and 98%, respectively); and (3) HVF and OCT, mean deviation and RNFL thickness meeting p < 0.05, respectively. Results: MfVEP (amplitude/latency) identified more abnormality in MS-ON eyes (89%) than HVF (72%), OCT (62%), mfVEP amplitude (66%) or latency (67%) alone. Eighteen percent of MS-no-ON eyes were abnormal for both mfVEP (amplitude/latency) and HVF compared with 8% with OCT. Agreement between tests ranged from 60% to 79%. mfVEP (amplitude/latency) categorized an additional 15% of MS-ON eyes as abnormal compared with HVF and OCT combined. Conclusions: mfVEP, which detects both demyelination (increased latency) and neural degeneration (reduced amplitude), revealed more abnormality than HVF or OCT in MS patients.

In patients with thyroid-associated ophthalmopathy, responses to treatment are rare and usually minor. Teprotumumab, an antibody to the insulin-like growth factor I receptor, led to significant responses in 69% of patients and to decreased proptosis. Medical therapies for moderate-to-severe thyroid-associated ophthalmopathy (Graves’ orbitopathy) that have proved to be effective and safe in adequately powered, prospective, placebo-controlled trials are lacking. This unmet need is due to the incompletely understood pathogenesis of the disease. 1 Current treatments are inconsistently beneficial and often associated with side effects, and their modification of the ultimate disease outcome is uncertain. 1 – 3 Previous clinical trials, which were rarely placebo-controlled, suggest that high-dose glucocorticoids, alone 3 – 5 or with radiotherapy, 6 , 7 can reduce inflammation-related signs and symptoms in patients with active ophthalmopathy. However, glucocorticoids and orbital radiotherapy minimally affect proptosis and can cause dose-limiting adverse . . .

Background: Neurodegeneration plays an important role in permanent disability in multiple sclerosis (MS). Objective: The objective of this paper is to determine whether progressive neurodegeneration occurs in MS eyes without clinically evident inflammation. Methods: Retinal nerve fiver layer thickness (RNFLT) and ganglion cell-inner plexiform layer thickness (GCIPT) were measured using Cirrus optical coherence tomography (OCT) in 133 relapsing–remitting MS (RRMS) patients (149 non-optic neuritis (ON), 97 ON eyes, last ON ≥6 months). Ninety-three patients were scanned at two visits. Percentages of abnormal GCIPT vs RNFLT (<5% of machine norms) in cross-sectional data were compared. Relations between RNFLT/GCIPT and MS duration (cross-sectional) and follow-up time (longitudinal) were assessed. Results: GCIPT was abnormal in more eyes than RNFLT (27% vs 16% p = 0.004 in non-ON, 82% vs 72% p = 0.007 in ON). RNFLT and GCIPT decreased with MS duration by −0.49 µm/yr (p = 0.0001) and −0.36 (p = 0.005) for non-ON; −0.52 (p = 0.003) and −0.41 (p = 0.007) for ON. RNFLT and GCIPT decreased with follow-up time by −1.49 µm/yr (p < 0.0001) and −0.53 (p = 0.004) for non-ON, −1.27 (p = 0.002) and −0.49 (p = 0.04) for ON. Conclusions: In RRMS eyes without clinically evident inflammation, progressive loss of RNFLT and GCIPT occurred, supporting the need for neuroprotection in addition to suppression of autoimmune responses and inflammation.

Purpose To establish reproducibility of multifocal visual evoked potential (mfVEP) and traditional pattern-reversal VEP (tVEP) in normals and relapsing–remitting multiple sclerosis (RRMS). Methods mfVEP (60-sector dartboard) was recorded twice within a month in 40 normals and 40 RRMS patients [25 eyes with last optic neuritis (ON) ≥6 months, 34 non-ON]. mfVEP amplitude and latency (ms) were calculated as mean logSNR and median relative latency, respectively, for all 60 sectors (global) and 9 regions. tVEP was recorded (15′, 60′ and 120′ checks) in subsets of 34 normals and 30 RRMS patients. tVEP N75–P100 amplitude (µV) and P100 latency (ms) were obtained. Reproducibility was evaluated using intraclass correlation coefficient (ICC) and test–retest variability (TRV). ICC ≥ 0.75 was considered good. Results ICCs for global and regional mfVEP were >0.80 in all groups. ICCs for tVEP were >0.75 for all except latency in ON (0.52–0.68). For mfVEP or tVEP, TRV for amplitude was similar among all groups; TRV for latency (ms) was larger in ON (5.3 for mfVEP global, 10.3 for 60′ tVEP) compared with non-ON (3.1, 8.3) and normal (2.3, 5.7) ( p  < 0.05 for all). When tVEP was analyzed using similar methods as mfVEP (logSNR and relative latency), mfVEP global measures showed better ICC and TRV than tVEP in all groups. Conclusions mfVEP and tVEP showed good reproducibility in normals and RRMS. TRV for mfVEP latency was larger in ON than normal or non-ON. mfVEP global latency’s TRV was about half the respective values for tVEP in all groups, due to averaging of multiple responses.

Multifocal visual evoked potentials provide a topographic measure of visual response amplitude and latency. The objective of this study was to evaluate the sensitivity and specificity of the multifocal visual evoked potential technique in detecting visual abnormalities in patients with multiple sclerosis. Multifocal visual evoked potentials were recorded from 74 patients with multiple sclerosis with history of optic neuritis (MS-ON, n = 74 eyes) or without (MS-no-ON, n = 71 eyes), and 50 normal subjects (controls, n = 100 eyes) using a 60-sector pattern reversal dartboard stimulus (VERIS). Amplitude and latency for each sector were compared with normative data and assigned probabilities. Size and location of clusters of adjacent abnormal sectors (p < 0.05) were examined. Mean response amplitudes were (± SE) 0.39 ± 0.02, 0.53 ± 0.02, and 0.60 ± 0.01 for MS-ON, MS-no-ON, and control groups, respectively, with significant differences between all groups (p < 0.0001). Mean latencies (ms; ±SE relative to normative data) were 12.7 ± 1.3 (MS-ON), 4.3 ± 1.1 (MS-no-ON), and 0.3 ± 0.4 (controls); group differences again significant (p < 0.0001). Half the MS-ON eyes had clusters larger than five sectors compared with 13% in MS-no-ON and 2% in controls. Abnormal sectors were distributed diffusely, although the largest cluster was smaller than 15 sectors in two-thirds of MS-ON eyes. Cluster criteria combining amplitude and latency showed an area of 0.96 under the receiver operating characteristic curve, yielding a criterion with 91% sensitivity and 95% specificity. We conclude that the multifocal visual evoked potential provides high sensitivity and specificity in detecting abnormalities in visual function in multiple sclerosis patients.

Ethambutol (EMB) is one of the first-line antimycobacterial drugs used to treat tuberculosis and is also used to treat atypical mycobacterium infections. It is almost always used in combination with other antimycobacterial drugs. Ever since the drug's introduction in the 1960s, there have been descriptions of optic neuropathy associated with EMB. Despite a clear association of EMB-induced optic neuropathy, many questions remain unanswered, namely, which tests are more accurate to monitor toxicity, how often should they be performed and once the optic neuropathy is present, how much of it is reversible?

The facial nerve (cranial nerve VII) courses a long pathway beginning in the precentral gyrus and ending at the facial muscles, lacrimal and salivary glands, and structures of the inner ear. Lesions along this pathway, clinically divided into upper and lower motor neuron lesions, present with unique characteristics that assist the physician in identifying the lesion site. The sequelae particularly of peripheral CN VII palsies, may result in significant and chronic damage to the cornea that may be challenging for the physician and patient.

Thyroid orbitopathy is a complex disease that can produce severe functional and cosmetic complications. Prompt diagnosis and treatment during the active inflammatory phase is essential to decrease late sequels. Corticosteroids remain the main pillar in the treatment of the active phase. Other possibilities when steroids fail are radiotherapy, cyclosporine or new biological agents such as rituximab. Rehabilitative surgery can be performed to treat the functional and disfiguring sequels in the inactive phase. A review of the clinical manifestations, classifications and treatment, both medical and surgical, is presented.

We conducted a cross-sectional study examining potentially modifiable factors associated with cognitive impairments (mild or severe) in older whites, African Americans and Hispanics attending an outpatient eye clinic. In-clinic interviews and physical examinations assessed social, demographic and health information from 100 consecutive Hispanic, African-American and white adults aged > or = 55. Our primary outcome was presence of any cognitive impairment (mild or severe) using the St. Louis University Mental Status Examination (SLUMS) scale. Of the 100 subjects, 65 screened positive for cognitive impairments on the SLUMS cognitive instrument: 46 with mild cognitive impairment and 19 with severe impairment (possible dementia). African-American and Hispanic adults (nonwhites) were significantly more likely to have cognitive impairment compared to white adults (OR 2.80: 95% CI = 1.05-7.44), independent of age, years of education and systolic blood pressure. Subjects with diabetes also had increased odds of cognitive impairments (OR 3.28, 95% CI = 1.21-8.90) even after adjusting for relevant confounders. There was a nonsignificant trend between visual acuity impairment and cognitive impairment (p = 0.059). Sixty-five percent of adults aged > or = 55 attending the eye clinic screened positive for cognitive impairments, with higher rates among nonwhites and adults living with diabetes.