Neuro-ophthalmology

October 2019, Volume 25, Issue 5
BROWSE ISSUES

Neuro-ophthalmology

October 2019, Vol.25, No.5

Guest Editor:

Marc Dinkin, MD

Editor-in-Chief:

STEVEN L. LEWIS, MD, FAAN

ISSN: 1080-2371

Online ISSN: 1538-6899

REVIEW ARTICLES
The Pupil
Bouffard, Marc A.
CONTINUUM: Lifelong Learning in Neurology
October 2019 - Volume 25 - Issue 5, Neuro-ophthalmology - p 1194-1214
doi: 10.1212/CON.0000000000000771
Ischemic Optic Neuropathy
Morrow, Mark J.
CONTINUUM: Lifelong Learning in Neurology
October 2019 - Volume 25 - Issue 5, Neuro-ophthalmology - p 1215-1235
doi: 10.1212/CON.0000000000000767
Optic Neuritis
Bennett, Jeffrey L.
CONTINUUM: Lifelong Learning in Neurology
October 2019 - Volume 25 - Issue 5, Neuro-ophthalmology - p 1236-1264
doi: 10.1212/CON.0000000000000768
Toxic-Metabolic and Hereditary Optic Neuropathies
Oliveira, Cristiano
CONTINUUM: Lifelong Learning in Neurology
October 2019 - Volume 25 - Issue 5, Neuro-ophthalmology - p 1265-1288
doi: 10.1212/CON.0000000000000769
Idiopathic Intracranial Hypertension
Thurtell, Matthew J.
CONTINUUM: Lifelong Learning in Neurology
October 2019 - Volume 25 - Issue 5, Neuro-ophthalmology - p 1289-1309
doi: 10.1212/CON.0000000000000770
Chiasmal and Postchiasmal Disease
Moss, Heather E.
CONTINUUM: Lifelong Learning in Neurology
October 2019 - Volume 25 - Issue 5, Neuro-ophthalmology - p 1310-1328
doi: 10.1212/CON.0000000000000785
Higher Cortical Visual Disorders
Prasad, Sashank; Dinkin, Marc
CONTINUUM: Lifelong Learning in Neurology
October 2019 - Volume 25 - Issue 5, Neuro-ophthalmology - p 1329-1361
doi: 10.1212/CON.0000000000000774
Approach to Diplopia
Glisson, Christopher C.
CONTINUUM: Lifelong Learning in Neurology
October 2019 - Volume 25 - Issue 5, Neuro-ophthalmology - p 1362-1375
doi: 10.1212/CON.0000000000000786
Nystagmus and Saccadic Intrusions
Rucker, Janet C.
CONTINUUM: Lifelong Learning in Neurology
October 2019 - Volume 25 - Issue 5, Neuro-ophthalmology - p 1376-1400
doi: 10.1212/CON.0000000000000772
Paraneoplastic Syndromes in Neuro-ophthalmology
Gordon, Lynn; Dinkin, Marc
CONTINUUM: Lifelong Learning in Neurology
October 2019 - Volume 25 - Issue 5, Neuro-ophthalmology - p 1401-1421
doi: 10.1212/CON.0000000000000788
Infectious Optic Neuropathies
Eggenberger, Eric R.
CONTINUUM: Lifelong Learning in Neurology
October 2019 - Volume 25 - Issue 5, Neuro-ophthalmology - p 1422-1437
doi: 10.1212/CON.0000000000000777
Imaging in Neuro-ophthalmology
Costello, Fiona; Scott, James N.
CONTINUUM: Lifelong Learning in Neurology
October 2019 - Volume 25 - Issue 5, Neuro-ophthalmology - p 1438-1490
doi: 10.1212/CON.0000000000000783
Editor's Preface
Articles
Key Points
Abbreviations
Appendix
Issue Overview

Issue Overview

CONTINUUM: Lifelong Learning in Neurology October 2019 - Volume 25 - Issue 5, Neuro-ophthalmology -10.1212/01.CON.0000603872.80964.07 doi: 10.1212/01.CON.0000603872.80964.07

Issue Overview

Neuro-ophthalmology, Volume 25, Number 5, August 2019

Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills.

Learning Objectives

Upon completion of this Continuum: Lifelong Learning in Neurology Neuro-ophthalmology issue, participants will be able to:

  • Define the anatomy and physiology of the pupil and its innervation, leveraging that knowledge of proper function to comprehensively approach abnormal pupillary function
  • Describe the diagnosis, treatment, and prognosis of anterior and posterior ischemic optic neuropathy and identify giant cell arteritis as a cause of these conditions
  • Differentiate, diagnose, and treat inflammatory optic nerve injuries
  • Discuss the features and underlying mechanism of toxic-metabolic and hereditary optic neuropathies
  • Discuss the diagnostic criteria, clinical features, imaging findings, differential diagnosis, and management approach for idiopathic intracranial hypertension
  • Describe the symptomatic, examination, and evaluation implications of neurologic diseases affecting the optic chiasm, optic tracts, optic radiations, and occipital lobes
  • Describe the anatomic regions responsible for higher visual processing and discuss the spectrum of symptoms that may accompany disorders of these regions
  • Systematically use elements of the history and examination to localize and develop a differential diagnosis to guide further confirmatory testing in patients with diplopia
  • List the most common types of nystagmus and saccadic intrusions, discuss the most common etiologies and mechanisms for abnormal spontaneous eye movements, and initiate the pharmacologic management of oscillopsia
  • Recognize the wide range of neuro-ophthalmic clinical manifestations of paraneoplastic disease and discuss the diagnostic and therapeutic approaches to patients with these diseases
  • Describe the clinical features and management of infectious optic neuropathies
  • Discuss how various imaging modalities can be used to refine the diagnosis and management of neuro-ophthalmic disorders

Core Competencies

This Continuum: Lifelong Learning in Neurology Neuro-ophthalmology issue covers the following core competencies:

  • Patient Care
  • Medical Knowledge
  • Practice-Based Learning and Improvement
  • Interpersonal and Communication Skills
  • Professionalism
  • Systems-Based Practice

Contributors

Marc Dinkin, MD, Guest Editor

Associate Professor, Departments of Neurology, Ophthalmology, and Neurosurgery; Director of Neuro-ophthalmology, Weill Cornell Medical College, New York, New York

Relationship Disclosure: Dr Dinkin serves as an associate editor for the Journal of Neuro-Ophthalmology and as an editor for Practical Neurology and has received compensation for travel for speaking engagements from The American Austrian Foundation and research/grant support from the Helen and Robert Apel Foundation. Dr Dinkin has provided depositions and expert testimony on medicolegal cases involving idiopathic intracranial hypertension, ischemic optic neuropathy, and head trauma.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Dinkin discusses the unlabeled/investigational use of azathioprine for cancer-associated retinopathy; corticosteroids for bilateral diffuse uveal melanocytic proliferation, cancer-associated retinopathy, melanoma-associated retinopathy, opsoclonus-myoclonus syndrome, and paraneoplastic optic neuropathy; IV immunoglobulin (IVIg) for cancer-associated retinopathy, melanoma-associated retinopathy, and opsoclonus-myoclonus syndrome; lenalidomide for POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, and skin changes); mycophenolate mofetil for cancer-associated retinopathy and paraneoplastic optic neuropathy; and rituximab for cancer-associated retinopathy.

Jeffrey L. Bennett, MD, PhD, FAAN

Gertrude Gilden Professor for Neurodegenerative Disease Research, Professor of Neurology, Ophthalmology, and Immunology Program in Neuroscience, University of Colorado School of Medicine, Aurora, Colorado

Relationship Disclosure: Dr Bennett serves on the editorial boards of the Journal of Neuro-Ophthalmology, Multiple Sclerosis and Neurology: Neuroimmunology & Neuroinflammation and as a consultant for AbbVie Inc; Alexion; Chugai Pharmaceutical Co, Ltd; Clene Nanomedicine; EMD Serono, Inc; Equillium, Inc; Frequency Therapeutics; Genentech, Inc; MedImmune; and SanofiGenzyme. Dr Bennett has received research/grant support from EMD Serono, Inc; the Guthy-Jackson Charitable Foundation; Mallinckrodt Pharmaceuticals; the National Eye Institute (R01EY022936);the National Institute of Allergy and Infectious Diseases (UM1AI110498); and Novartis AG. Dr Bennett receives publishing royalties from UpToDate, Inc, and has received personal compensation for serving as a medicolegal consultant on medical cases involving neuroinflammatory and neuro-ophthalmologic disorders.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Bennett discusses the unlabeled/investigational use of plasma exchange and apheresis for the treatment of optic neuritis.

Marc A. Bouffard, MD

Instructor in Neurology, Harvard Medical School; Codirector of Neuro-Ophthalmology, Beth Israel Deaconess Medical Center, Boston, Massachusetts

Relationship Disclosure: Dr Bouffard serves as a consultant for the US Department of Justice Vaccine Injury Compensation Program.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Bouffard reports no disclosure.

Fiona Costello, MD, FRCPC

Associate Professor, Departments of Clinical Neurosciences and Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

Relationship Disclosure: Dr Costello has served on advisory boards for Frequency Therapeutics and Alexion Canada and receives research/grant support from the Hotchkiss Brain Institute and the MS Research Program.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Costello reports no disclosure.

Eric R. Eggenberger, DO, FAAN

Professor of Ophthalmology, Neurology, and Neurosurgery, Mayo Clinic College of Medicine and Science, Jacksonville, Florida

Relationship Disclosure: Dr Eggenberger reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Eggenberger reports no disclosure.

Christopher C. Glisson, DO, MS, FAAN

Medical Director, Neuro-Ophthalmology, Mercy Health Hauenstein Neurosciences, Grand Rapids, Michigan; Assistant Professor, Department of Neurology and Ophthalmology, Michigan State University, East Lansing, Michigan

Relationship Disclosure: Dr Glisson reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Glisson reports no disclosure.

Lynn Gordon, MD, PhD

Professor of Ophthalmology, Stein Eye Institute; Senior Associate Dean, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California

Relationship Disclosure: Dr Gordon serves on the board of trustees of the American Academy of Ophthalmology and on the editorial boards of Ophthalmology Retina, Ocular Immunology and Inflammation, and the Journal of Neuro-Ophthalmology. Dr Gordon receives licensing fees from the University of California Los Angeles for epithelial membrane protein 2.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Gordon discusses the unlabeled/investigational use of azathioprine for cancer-associated retinopathy; corticosteroids for bilateral diffuse uveal melanocytic proliferation, cancer-associated retinopathy, melanoma-associated retinopathy, opsoclonus-myoclonus syndrome, and paraneoplastic optic neuropathy; IV immunoglobulin (IVIg) for cancer-associated retinopathy, melanoma-associated retinopathy, and opsoclonus-myoclonus syndrome; lenalidomide for POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, and skin changes); mycophenolate mofetil for cancer-associated retinopathy and paraneoplastic optic neuropathy; and rituximab for cancer-associated retinopathy.

Mark J. Morrow, MD, FAAN

Chair, Department of Neurology, Harbor-University of California Los Angeles Medical Center; Clinical Professor of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California

Relationship Disclosure: Dr Morrow reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Morrow discusses the unlabeled/investigational use of medications for the treatment of ischemic optic neuropathy, none of which are approved by the US Food and Drug Administration.

Heather E. Moss, MD, PhD, FAAN

Assistant Professor of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California; Assistant Professor of Neurology and Neurological Sciences, Stanford University, Stanford, California

Relationship Disclosure: Relationship Disclosure: Dr Moss serves on the board of directors of the North American Neuro-Ophthalmology Society and as a review editor for Current Eye Research, an associate editor for Frontiers in Neurology, a section editor for the Journal of Neuro-Ophthalmology, and a special section editor for Neuro-Ophthalmology. Dr Moss receives research/grant support from the Myelin Repair Foundation, the National Institutes of Health/National Eye Institute (K23 EY024345, P30 EY 026877), and Research to Prevent Blindness and publishing royalties from Elsevier. Dr Moss has served as a legal consultant providing record review and deposition on neuro-ophthalmic diseases.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Moss reports no disclosure.

Cristiano Oliveira, MD

Assistant Professor of Ophthalmology, Weill Cornell Medicine, New York, New York

Relationship Disclosure: Dr Oliveira reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Oliveira discusses the unlabeled/investigational use of gene therapy and idebenone for Leber hereditary optic neuropathy.

Sashank Prasad, MD

Associate Professor of Neurology, Harvard Medical School; Director, Harvard Brigham and Women’s Hospital–Massachusetts General Hospital Neurology Residency; Chief, Division of Neuro-ophthalmology, Brigham and Women’s Hospital, Boston, Massachusetts

Relationship Disclosure: Dr Prasad serves as an associate editor for the Journal of Neuro-Ophthalmology, receives publishing royalties from McGraw-Hill, and has provided expert medicolegal opinion on legal cases involving idiopathic intracranial hypertension, ischemic optic neuropathy, and traumatic brain injury.

Unlabeled/Investigational Use Disclosure: Dr Prasad reports no disclosure.

Janet C. Rucker, MD

Bernard A. and Charlotte Marden Professor of Neurology; Professor of Ophthalmology, New York University School of Medicine, New York, New York

Relationship Disclosure: Dr Rucker reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Rucker discusses the unlabeled/investigational use of medications for the management of abnormal eye movements, none of which are approved by the US Food and Drug Administration.

James N. Scott, MD, MSc

Clinical Associate Professor, Departments of Diagnostic Imaging and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

Relationship Disclosure: Dr Scott reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Scott reports no disclosure.

Matthew J. Thurtell, MBBS, MSc, FRACP

Associate Professor of Ophthalmology and Neurology; Director of Neuro-ophthalmology, University of Iowa, Iowa City, Iowa

Relationship Disclosure: Dr Thurtell serves on the editorial board of the Journal of Neuro-Ophthalmology, receives research/grant support from the National Eye Institute (U10-EY025990), and receives book royalties from Oxford University Press.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Thurtell discusses the unlabeled/investigational use of acetazolamide, furosemide, methazolamide, and topiramate for the treatment of idiopathic intracranial hypertension

Self-Assessment and CME Test Writers

Douglas J. Gelb, MD, PhD, FAAN

Professor of Neurology, University of Michigan, Ann Arbor, Michigan

Relationship Disclosure: Dr Gelb receives royalties from MedLink, Oxford University Press, and UpToDate, Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Gelb reports no disclosure.

James W. M. Owens Jr, MD, PhD

Associate Professor of Neurology, Adjunct Associate Professor of Pediatrics, University of Washington School of Medicine, Seattle, Washington

Relationship Disclosure: Dr Owens serves as CME co-editor for Neurology and receives publishing royalties from UpToDate, Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Owens reports no disclosure.

Methods of Participation and Instructions for Use

Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills. In Continuum, the process of absorbing, integrating, and applying the material presented is as important as, if not more important than, the material itself.

The goals of Continuum include disseminating up-to-date information to the practicing neurologist in a lively, interactive format; fostering self-assessment and lifelong study skills; encouraging critical thinking; and, in the final analysis, strengthening and improving patient care.

Each Continuum issue is prepared by distinguished authors who are acknowledged leaders in their respective fields. Six issues are published annually and are composed of review articles, case-based discussions on ethical and practice issues related to the issue topic, coding information, and comprehensive continuing medical education (CME) and self-assessment offerings. For detailed instructions regarding Continuum CME and self-assessment activities, visit continpub.com/CME.

The review articles emphasize clinical issues emerging in the field in recent years. Case reports and vignettes are used liberally, as are tables and illustrations. Audio interviews with the authors of Continuum articles are published alongside each article, and video material relating to the issue topic accompanies issues when applicable.

The text can be reviewed and digested most effectively by establishing a regular schedule of study in the office or at home, either alone or in an interactive group. If subscribers use such regular and perhaps new study habits, Continuum’s goal of establishing lifelong learning patterns can be met.

© 2019 American Academy of Neurology.