Michael S. Lee

Idiopathic intracranial hypertension (IIH) is characterized by sustained elevation of intracranial pressure (ICP) in the absence of an identifiable structural or infectious etiology. Clinically, it...

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Background: Previous studies have determined a signficant correlation between, foveal threshold on automated visual field perimetry and best-corrected visual acuity. To our knowledge, these correlations have not been studied using the Octopus (Haag-Streit, Köniz, Switzerland) perimeter. Methods: Patients underwent Octopus automated visual field testing using the glaucoma tendency–oriented perimetry protocol where a foveal threshold value was collected. Visual acuity was determined in the patient's current refractive glasses and/or with pinhole acuity. Visual acuity was converted from Snellen to logarithm of the minimum angle of resolution (logMAR) for statistical analysis. Spearman correlation coefficient was used to determine correlation between visual acuity and foveal threshold value. Results: A total of 332 eyes (243 diseased eyes and 89 healthy eyes) were assessed. A statistically significant negative correlation was found between visual acuity and foveal threshold ( P < 0.001). The estimated foveal threshold was statistically significantly decreased by 1.2 dB per every 0.1 logMAR increase of visual acuity ( P < 0.001). A foveal threshold of 27.47 or higher predicted a visual acuity of 20/40 or better with 90% confidence. Conclusions: Patient best-corrected logMAR visual acuity has a negative correlation with foveal threshold in automated (Octopus) visual field testing. Our findings suggest that foveal threshold may predict measured visual acuity. We created a website application to predict visual acuity based on foveal threshold, age, and presence or absence of ocular pathology. Foveal threshold may represent a surrogate estimate of acuity for patients who are unable to read the Snellen chart and for patients with functional vision loss.

Purpose This retrospective case-control study from 2008 to 2022 aimed to determine the effect of adjunctive sodium bicarbonate (NaHCO₃) on treatment outcomes of and side effects of acetazolamide (ACZ) for the treatment of idiopathic intracranial hypertension (IIH). Subjects/Methods Retrospective data was collected via chart review. 288 eyes of 144 patients with IIH, including those taking ACZ alone (control group, n = 89) vs. ACZ and NaHCO₃ (treatment group, n = 56). The primary outcome measure was time to IIH resolution. Secondary outcomes included retinal nerve fibre layer thickness (RNFL), visual field mean deviation (VFMD), visual acuity (VA), discontinuation ACZ, and patient-reported side effects of ACZ. Results Cox proportional hazards model for the primary outcome yielded a hazard ratio of 0.800, which was statistically insignificant (95% CI, 0.57–1.13; p = 0.200). There was no significant difference between groups when comparing RNFL, VFMD, VA, surgical intervention, or discontinuation of ACZ. The treatment group was more likely to experience side effects from ACZ prior to starting sodium bicarbonate therapy (p < 0.001). Among the treatment group, 92.7% remained on NaHCO₃ until IIH resolution, and 9 of 12 (75%) subjects reported significant improvement in ACZ-related side effects. Conclusion Sodium bicarbonate does not appear to impact treatment outcomes in patients taking acetazolamide for IIH. Sodium bicarbonate may represent a reasonable adjunctive medication to help mitigate acetazolamide-related side effects in this group of patients.

Binocular diplopia limits quality of life by hampering visual function. There are several treatment options with individual advantages and drawbacks. Contact lenses have recently emerged as an attractive treatment delivery mechanism due to advances in lens manufacturing and imaging modalities. Contact lenses can offer better comfort, efficacy, and cosmetic appeal compared to alternative treatments such as spectacles. They also present unique challenges due to risks of inflammation, infection, and intolerability. This review will explore the management of binocular diplopia using several types of contact lenses including base down prism in contact lenses, scleral lenses, occlusive lenses, and monovision lenses. Increased awareness of differing contact lens will help providers and patients make better informed decisions about diplopia management.

The primary symptom of visual snow syndrome (VSS) is the unremitting perception of small, flickering dots covering the visual field. VSS is a serious but poorly understood condition that can interfere with daily tasks. Several studies have provided qualitative data about the appearance of visual snow, but methods to quantify the symptom are lacking. Here, we developed a task in which participants with VSS adjusted parameters of simulated visual snow on a computer monitor until the simulation matched their internal visual snow. On each trial, participants (n = 31 with VSS) modified the size, density, update speed, and contrast of the simulation. Participants’ settings were highly reliable across trials (intraclass correlation coefficients > 0.89), and they reported that the task was effective at stimulating their visual snow. On average, visual snow was very small (less than 2 arcmin in diameter), updated quickly (mean temporal frequency = 18.2 Hz), had low density (mean snow elements vs. background = 2.87%), and had low contrast (average root mean square contrast = 2.56%). Our task provided a quantitative assessment of visual snow percepts, which may help individuals with VSS communicate their experience to others, facilitate assessment of treatment efficacy, and further our understanding of the trajectory of symptoms, as well as the neural origins of VSS.

Purpose To determine a potential threshold optic nerve diameter (OND) that could reliably differentiate healthy nerves from those affected by optic atrophy (OA) and to determine correlations of OND in OA with retinal nerve fiber layer (RNFL) thickness, visual acuity (VA), and visual field mean deviation (VFMD). Methods This was a retrospective case control study. Magnetic resonance (MR) images were reviewed from individuals with OA aged 18 years or older with vision loss for more than 6 months and an OA diagnosis established by a neuro-ophthalmologist. Individuals without OA who underwent MR imaging of the orbit for other purposes were also collected. OND was measured on coronal T2-weighted images in the midorbital section, 1cm posterior to the optic disc. Measurements of mean RNFL thickness, VA and VFMD were also collected. Results In this study 47 OA subjects (63% women, 78 eyes) and 75 normal subjects (42.7% women, 127 eyes) were assessed. Healthy ONDs (mean 2.73 ± 0.24 mm) were significantly greater than OA nerve diameters (mean 1.94 ± 0.32 mm; P < 0.001). A threshold OND of ≤2.3 mm had a sensitivity of 0.92 and a specificity of 0.93 in predicting OA. Mean RNFL (r = 0.05, p = 0.68), VA (r = 0.17, p = 0.14), and VFMD (r = 0.18, p = 0.16) were not significantly associated with OND. Conclusion ONDs are significantly reduced in patients with OA compared with healthy nerves. A threshold OND of ≤2.3 mm is highly sensitive and specific for a diagnosis of OA. OND was not significantly correlated with RNFL thickness, VA, or VFMD.