OCT Biomarkers in neuro-ophthalmic disorders

OCT Biomarkers in neuro-ophthalmic disorders
EOS 2024
Mohamed Ahmed ELShafie
lecturer of ophthalmology
mansoura- kafrelsheikh- portsaid

1. OCT biomarkers in Neuro-ophthalmic Disorders Mohamed Ahmed ELShafie MD, HMS alumni

2. Swelling and elevation of optic nerves due to elevated ICP 1 ST Papilledema

3. 1 2 3 Grading of Papilledema ( Frisen Grading Scale ) 4 5

4. 32 y/o Woman • C/o progressive headaches am > pm • BMI: 41 • BCVA: 20/20 OU

5. 01 02 OCT Analysis of Papilledema ‎ Increased NFL/MRW thickness‎ Elevation of nerve head (>0.8 mm from RPE to apex) 03 04 Maintenance of central cup (until late disease) Inward deflection of RPE/BM (N>T) Subretinal hyporeflective space between photoreceptor layer and RPE (recumbent “lazy V”) 05 06 Peripapillary inner retinal folds (T>N)

6. 40 y/o Woman • C/o chronic daily HAs + synchronous pulsatile tinnitus • BMI = 44 • BCVA: 20/40 OU

7. Champagne cork or dome like sign

8. 32 y/o Woman • c/o progressive, debilitating headaches x 2 mos. • Normal neurologic exam • BCVA: 20/20 OU • BMI: 38

9. F/U x 6 mos • Rx acetazolamide (500 mg BID) • Weight loss (approx. 25 lbs.) • Improvement in headaches F/U x 14 mos • D/C Diamox x 3 months • More weight loss • Headache free Baseline

10. F/U x 14 mos Baseline

11. Pseudopapilledema • An anomalous elevation of one or both optic nerve without optic disc swelling with a small or absent optic cup Optic Disc Drusen • Colloid bodies within substance of optic nerve head Due to Degeneration of NFL axons • NFL may be thickened (< 7 clock hours) or thinned

12. 01 02 OCT Analysis of ODD ‎ Always located above lamina cribrosa Always have hyporeflective core with hyper-reflective margin (most prominent superiorly) 03 04 PHOMS represent bulging axons (should not be considered as ODD) Hyper-reflective horizontal lines (precursor to ODD or artifact) Normal blood vessels (superficial, hyperreflective core, shadow) 05

13. 33 y/o Woman • Normal neurologic exam • Consult for evaluation of ODE OS • BVA: 20/20 OU

14. 29 y/o woman • BCVA: 20/20 OU • History of migraine headaches • No synchronous pulsatile tinnitus, diplopia or transient vision loss • Normal neurologic exam • Consult for evaluation of papilledema

15. Chiasmal compression 2 nd

16. OCT GCC more sensitive than perimetry for detection of early chiasmal compression

17. optic tract lesions 4 TH Retrochiasmal Lesions

18. 01 02 OCT Analysis of Retrochiasmal Lesions ‎ Ipsilateral temporal GCIPL thinning Contralateral nasal GCIPL thinning

19. Pre-geniculate lesion = rapid GCIPL thinning (1 month) Post-geniculate lesion=delayed GCIPL thinning (5-6 months)

20. Multiple sclerosis: RNFL & GCL-IPL thinning 20% - 40% X 3 months Optic Neuritis 5 TH

21. 45 y/o Woman • Recent-onset optic neuritis OS • BCVA: 20/20 OD 20/500 OS

22. July 2022 Sep 2022 Feb 2023 April 2023 The vision getting better…The tissue is progressively thinning

23. 31 y/o Woman • 10-year Hx of MS • Meds: Ocrevus (ocrelizumab) • Prior optic neuritis OD • BVA: 20/20 -1 OD 20/20 OS

24. 30 y/o Woman • 1-year Hx of MS • Meds: Ocrevus (ocrelizumab) Baclofen • No prior history of optic neuritis • BVA: 20/20 OU

25. Thinning of RNFL & GCIPL occurs over time with MS in absence of optic neuritis (thinning of 12%)

26. Reduction in retinal dopamine levels → R NFL thinning Parkinson’s disease 6 TH

27. RNFL thinning Temporal > nasal RNFL thinning in PD associated with visual hallucinations & with PD duration and severity

28. Alzheimer’s disease 7 TH German 1906: PROGREESIVE DECLINE OF COGNETIVE FUNCTION

29. 01 02 OCT Analysis of Alzheimer’s disease ‎ RNFL & paramacular thinning. GCIPL thinning

30. Chronic Traumatic Encephalopathy 8 TH