April 20, 2022

The most important ophthalmology research updates, delivered directly to you.

In this week's issue

  • Patient symptoms may help assist in diagnosis between glaucoma and glaucoma suspect.
  • Even though hispanic neonates are more likely to have ROP than non-hispanic neonates, this relationship does not exist when controlling for socioeconomic factors.
  • A small prospective study showed that a majority of children who presented with an isolated optic neuritis episode had improvement in vision over a two-year period

Communication is Key: Symptoms Predict Glaucoma Severity


Your history taking skills are more important than you may think. A cross-sectional study examined the relationship between patient-reported symptoms, visual field (VF) defects, and retinal nerve fiber layer (RNFL) thickness among in the assessment of glaucoma. A group of 170 patients (75 glaucoma patients, 95 glaucoma suspects) answered a series of questionnaires regarding ocular and visual symptoms and underwent OCT imaging and perimetric testing. Glaucoma patients reported certain symptoms at a higher frequency than glaucoma suspects, including: better vision in one eye, cloudy vision, little peripheral vision, missing patches, and vision worsening. Interestingly, these symptoms, along with sociodemographic features, explained 62% of the variance in VF damage. On the other hand, worse-eye RNFL and sociodemographic features accounted for 42% of the variance in VF damage. These findings underscore the importance of considering patients’ visual symptoms when determining glaucoma severity along with objective measurements. However, one must be aware that patients may report symptoms that are not truly present, may misunderstand how certain symptoms might manifest, or may have disease progression in the absence of changing symptoms.

ROP and Social Determinants of Health 

JAMA Ophthalmology

Retinopathy of prematurity (ROP) is a leading cause of permanent visual impairment in children and is associated with gestational age <30 weeks or low birth weight (<1500 g). Studies have suggested that race and ethnicity may be associated with risk for developing ROP; however, these studies have not investigated the role of socioeconomic factors in these relationships. This retrospective cohort study of neonates with gestational age <30 weeks or weight <1500 g and analyzed median household income, health insurance status, race, and ethnicity as they relate to ROP severity. Hispanic neonates were more likely to be both diagnosed with ROP (OR 1.70, 95% 1.20-2.42) and have more severe ROP (OR 2.24, 95% CI 1.21-4.15), compared with non-Hispanic neonates. However, these associations vanished when adjusting for socioeconomic factors and gestational age (OR 1.12 95% CI 0.68-1.82). This study demonstrates the importance of considering disparities associated with race and ethnicity in the context of other sociodemographic factors.


The Pediatric Optic Neuritis Prospective Outcomes Study - Two-Year Results 


Pediatric optic neuritis is one of the most common symptoms of acquired demyelinating syndromes in childhood, and visual outcomes are poorly characterized after a first episode of optic neuritis in children. This prospective study followed 28 children (ages 3 to 16) who presented with an isolated episode of optic neuritis over a two year period. The main outcome was visual acuity, with secondary outcomes including neuroimaging findings and final diagnosis. The two most common diagnoses included isolated optic neuritis, and myelin oligodendrocyte glycoprotein - associated demyelination. Despite poor visual acuity at presentation, most children have a significant improvement in visual acuity by 6 months, and this improvement is maintained over two years. Subsequent episodes of optic neuritis occurred in 18% of children. Overall, this study suggests a favorable prognosis for children with optic neuritis. 


Nonsurgical Management in Orbital Subperiosteal Abscess in Adults


Kids aren’t just small adults!  Orbital cellulitis can progress to the formation of a subperiosteal abscess (SPA), a vision-threatening complication that occurs in 11.5-56.7% of cases. Although there are evidence-based guidelines for surgical and non-surgical SPA management in children, it remains unclear whether these guidelines are applicable to adolescents and adults. This study was a retrospective cohort study that compared the outcomes of 76 adolescent and adult patients with orbital SPA who were treated surgically or non-surgically. Length of hospitalization was significantly higher in patients managed surgically (8.8 days vs 3.7 days, p = 0.01). A best-corrected visual acuity of 20/50 or better was present in 100% of patients managed non-surgically and 92.5% of patients managed surgically; this difference was not statistically significant. Visual prognosis was favorable in both groups.  This study was limited by its small non-surgical cohort size (n = 12) and its retrospective design, especially as less severe presentations of SPA are more likely to be treated non-surgically. This is the largest cohort study of orbital SPA patients and suggests a role for non-surgical management of orbital SPA in specific adolescents and adults.

Question of the Week

A 6 year old boy is brought to the clinic because of blurred vision and headaches for the past 2 months. His mother notices he sometimes tilts his head back to look straight ahead. The patient also had an 8 lb unintentional weight loss over the past 6 months. Physical exam reveals equal pupils that do not react to light. When he attempts to look upwards, there is nystagmus and eyelid retraction.
Which of the following additional findings would you most likely expect in this patient?

A. Blindness
B. Diabetes insipidus
C. Migraine 
D. Precocious Puberty
Keep scrolling for answer or click here

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